A new screening test for idiopathic normal pressure hydrocephalus using bimanual coordination: A preliminary study.

BACKGROUND: The clinical spectrum of idiopathic normal pressure hydrocephalus (iNPH) comprises the triad of gait disturbance, cognitive impairment, and urinary incontinence. However, motor abnormalities involving the upper extremities in iNPH patients have few quantitative studies. OBJECTIVE: The present study was designed to quantitatively assess bimanual tapping tasks in iNPH patients and to compare with the control groups. METHODS: The subjects were divided into three groups: iNPH patients, older healthy group, and younger healthy group. The tasks were three synchronization finger-to-thumb tapping tasks with the auditory stimuli specified at 1 Hz by metronome: unilateral, bimanual simultaneous, and bimanual alternate. Two-way ANOVA was used to compare the outcomes of the three errors (absolute error: AE, variable error: VE, and constant error: CE) for tapping cycles. RESULTS: In the iNPH group, the absolute and variable errors increased in bimanual alternate tapping task with statistical significance (AE: p < 0.05 and VE: p < 0.05). There were no significant differences in errors between the older and young healthy groups (AE: p = 0.62, CE: p = 1.00 and VE: p = 0.31). CONCLUSIONS: We could quantitatively evaluate the bimanual coordination on iNPH patients using the bimanual alternate tapping task, potentially useful for evaluating patients unable to walk.

Effect of educational intervention addressing inaccurate self-assessment of driving performance in older Japanese adults.

To maintain road safety for older drivers as well as other road users, it is important to provide interventions that improve self-awareness and behaviors in older drivers. We developed an intervention that provides feedback on accuracy of self-awareness of driving performance using a workbook, and examined its effectiveness using a prospective design with a follow-up after two months. Japanese drivers aged between 69 and 87 (Mean = 73.96) years were assigned to either the intervention group (n = 26) or the wait-list control group (n = 27). All participants were asked to assess their own driving performance by completing a questionnaire. They also completed an on-road driving assessment that involved driving on a public road while wearing an electronic device that measured their actual driving behaviors, accompanied by a driving instructor who sat in the passenger seat and assessed the participant's driving performance (expert assessment). Thereafter, only the intervention group received the immediate intervention (first wave). One month later, the intervention group completed the booster intervention by post. Two months after the first wave, both groups completed the questionnaire and on-road driving assessment again (second wave). Result revealed that discrepancy between self-assessment and expert assessment reduced in only the intervention group between the two waves. This finding suggests that the intervention was able to improve the accuracy of self-assessment. Furthermore, the expert assessment improved in the intervention group between the two waves, but this change was not observed in the control group. Similar trend was evident for vehicle speed at intersections with a stop sign but the result was not statistically significant. Changes in head rotation at intersections requiring turn in the intervention group did not differ from those in the control group. Improved accuracy of self-assessment as a result of the intervention could have led to improved general driving performance, but did not influence head rotation.

Characteristics of driving self-assessments and factors related to inaccurate self-assessment in Japanese older adults.

Older adults are considered to decide their driving behaviors based their own assessment of their driving performance, and thus it is important that these self-assessments be accurate. Therefore, this study aimed to clarify how older drivers assess their driving performance and examine factors related to the level of inaccuracy in their self-assessments. Japanese drivers aged 70 years or older (N = 181) were asked to assess their own driving performance by questionnaire and then to drive on a public road while wearing an electronic device that measured their actual driving behaviors. They were accompanied by a driving instructor who sat in the passenger seat and assessed their driving performance. The results showed that older drivers' self-assessments were significantly higher than the experts' assessments of their driving performance. This tendency applied to all driving competencies, including overall rating, speed, and scanning. In addition, there were greater discrepancies between self-assessments and expert assessments for drivers who were rated poorly by experts compared with those who were highly rated. Drivers with a greater rating discrepancy were likely to drive faster around an intersection with a stop sign. This discrepancy was also related to a low entropy rate (low randomness in head rotation) around a signalized T-junction. These findings based on on-road driving assessments provide credible evidence of performance overestimation by older drivers. Furthermore, the results suggest that making older drivers recognize the evaluative criteria might be effective for reducing the discrepancy between self-assessments and expert assessments. It was also suggested that improving the accuracy of one's self-assessment had the potential to improve driving behaviors such as choice of speed and scanning behavior.

Effect of visible presence of policing activities on drivers' vigilance and intention to refrain from non-driving activities: A scenario-based survey of general Japanese drivers.

Driver distraction is an important issue for road safety. The visible presence of policing activities alongside roadways seems to be significant in preventing driver distraction and other unsafe driving behaviors. The purpose of this study was to provide evidence of the effectiveness of visible policing presence on drivers' self-reported intention to refrain from non-driving activities and that this effectiveness can be enhanced by manipulating deployment even with limited resources. We conducted a scenario-based survey to compare drivers' self-reported intention to refrain from non-driving activities and their vigilance state across several hypothetical driving situations. The three aims of the study were to examine whether drivers' self-reported vigilance and intention to refrain from non-driving activities were associated with (a) the presence or absence of common forms of roadside policing, (b) the agent (police vs. civilian) and medium (human vs. advertisement) of road safety interventions, and (c) different forms of policing (police officer vs. police car) and their respective levels of conspicuousness. Japanese drivers (N = 367) were randomly assigned to receive one of three booklets that included a scenario-based survey. The three booklets contained different combinations of various hypothetical driving scenarios based on the three experiment designs (a, b, c) described above. Participants were asked to rate their vigilance and their intention to refrain from non-driving activities in hypothetical driving situations that varied by the presence or absence of policing and how conspicuous that presence was. We conducted repeated measures within-subject analysis of variance using the three experimental designs. The results showed that the presence of a single police unit engaged in policing activities was associated with more vigilance and greater intention to refrain from non-driving activities. The results suggested that effectiveness of visible policing could be enhanced by increasing conspicuousness of police officers in order to help drivers more easily recognize the presence of police without having to purchase extra equipment. These findings provide useful insights for traffic police to conduct routine policing practices more efficiently to address non-driving activities. Future research is needed to examine these results in a real-world setting.

Predictors of driving outcomes including both crash involvement and driving cessation in a prospective study of Japanese older drivers.

The first aim of this study was to investigate predictors of future traffic crash involvement, taking into account bias in the handling of data for former drivers. The second aim was to compare characteristics of former drivers and crash-involved drivers in order to gain an understanding of appropriate driving cessation among older drivers. In all, 154 drivers aged 70 years or older participated in the baseline interview and the follow-up survey conducted two years later. In the baseline interview, participants were asked to respond to a questionnaire, take the Useful Field of View test® (UFOV), and complete the Mini-Mental State Examination. In the follow-up survey, participants were asked by mail or telephone whether they had stopped driving. Participants reporting that they still drove were invited to participate in a subsequent interview. Based on the information obtained in the follow-up survey, participants were classified as follows: driving cessation group (n=26); crash-involved group (n=18); and crash-free group (n=110). A multinomial logistic regression was then used to analyse the data. Contrary to the results of previous studies, we found older age to be associated with crash involvement but not with driving cessation. The cessation group had more decreased cognitive processing speed than the crash-involved and crash-free groups. Crash history was also predictive of crash involvement. Participants who were subject to license renewal between baseline and follow-up had a greater tendency to continue driving. Results suggested that age and crash history could potentially identify high-risk older drivers. The predictive power of cognitive processing speed is reduced under certain conditions. License-renewal procedures may induce Japanese older adults to continue driving. Future studies should use a large national sample to confirm the results of the present study.

[Risk factors for mental health problems and complicated grief in bereaved families of motor vehicle accident victims].

This study examined the risk factors for mental health problems and complicated grief in bereaved families using a nationwide sample of 453 Japanese adults who had lost a family member to a motor vehicle accident within three years. The results indicate that 31.0% of participants had K6 scores > 13 and 61.0% had ICG (Inventory of Complicated Grief) scores > 26. A higher K6 score was associated with secondary victimization and support seeking, whereas a higher ICG score was associated with the death of a child. Dispute over the liability for the accident and the resulting anxiety, measured by the Japanese version of ECR (Experiences in Close Relationships), were common predictors of higher K6 and ICG scores. The results suggest that complicated grief is more dependent on the circumstances of the death, whereas mental health problems are more affected by a participant's coping after the death, implying that effective support and interventions are necessary for mental health problems and complicated grief after a violent death.

[Linkage analysis of serial sex crimes].

The purpose of this study was twofold: first, to create an index for a behavioral linkage analysis of serial sex crimes, and second, to construct a predictive model for the analysis. Data on 720 sex crimes (rape, indecent assault) committed by 360 offenders arrested between 1993 and 2005 throughout Japan were collected. The following seven behaviors were examined during a series of analyses aimed at illustrating the effectiveness of crime linkage in serial sex crimes: victim age group, area type, publicness of offense site, weapon, time, contact method, and day of the week. The results indicated that six of the seven behaviors (excluding "day of the week") significantly distinguished between linked and unlinked crime pairs. Under a logistic regression of these six variables, which were dichotomously coded in terms of the concordance or discordance between each pair of incidents, the area under the receiver operating characteristic (ROC) curve was 0.85 (95% CI = 0.82-0.87), indicating a high level of discriminative accuracy in identifying disparate sex crimes committed by the same person.

Typology of driving-under-the-influence (DUI) offenders revisited: Inclusion of DUI-specific attitudes.

OBJECTIVES: Much work remains to improve rehabilitative interventions for driving-under-the-influence (DUI) offenders. There is heterogeneity of patterns of alcohol use, personality, and driving behaviour within DUI offenders, but little is known about how their appraisal of DUI differs. This study investigated within-offender variability in DUI-specific attitudinal variables. METHOD: Convicted male DUI offenders (N=219) living in greater Tokyo were interviewed. Cluster analysis was undertaken using age, psychological distress, personality trait, alcohol use, and attitudes towards DUI. Discriminant function analysis explored the relative explanatory power of the grouping variables. RESULT: Many offenders reported current excessive alcohol consumption. About 26-36% of the participants were potentially alcohol-dependent based on screening instruments/biomarkers. Cluster analysis identified five subgroups. The biggest subgroup considered their DUI a singular mistake and reported strong self-efficacy for avoiding further DUI (clusters 1 and 2). A small subgroup manifested alcohol dependence, psychological distress, higher impulsivity, and lower self-efficacy for avoiding DUI (cluster 3). Another subgroup exhibited a tendency to rationalise DUI, higher likelihood of future DUI, and lower self-efficacy for avoiding DUI (cluster 4). Most participants in another small subgroup abstained from alcohol use temporarily after their convictions (cluster 5). CONCLUSION: The majority of DUI offenders regarded their DUI conviction as an exceptional mishap, while they continued consuming hazardous amounts of alcohol. DUI-specific attitudinal variables, including DUI rationalisation and self-efficacy for avoiding future DUI incidents, constituted a distinct aspect of the problem, suggesting the need to address this issue in addition to the underlying alcohol use problem.

Factors contributing to driver choice after hitting a pedestrian in Japan.

In Japan, where pedestrian deaths account for a third of road traffic fatalities, 7.4% of victims die from hit-and-run accidents. To identify determinants for drivers considering leaving an accident scene after hitting a pedestrian, environment-related, driver-related, and pedestrian-related factors were examined using Japanese national police data. Results generally confirmed the conceptual framework of previous studies, which examined hit-and-run behavior based on a classic economic cost-benefit approach. However, results suggest that effects of road-related factors and harsher legal punishments have limited influence for reducing hit-and-run likelihood after a driver hits a pedestrian. Measures to prevent hit-and-run accidents are presented herein.

Effect of a small dose of alcohol on driving-related behavior of Japanese who self-reported facial flush and nonflushing.

About half of northeastern Asians lack ALDH2 (Acetaldehyde Dehydrogenase 2), an enzyme involved in alcohol metabolism. People with deficient ALDH2 often experience facial flushing after drinking a small dose of alcohol. The present study examined the effect of a small dose of alcohol on driving-related behavior of northeastern Asians (Japanese). Participants were 9 Japanese flushers and 12 Japanese nonflushers. They were evaluated using a driving simulator and self-report of intoxication after ingesting 0.6g/kg or 0.4g/kg of alcohol or a placebo. Facial flushers were more likely to experience subjective feelings of intoxication than were nonflushers. There were no significant differences between facial flushers and nonflushers in blood alcohol concentration and choice reaction time to visual stimuli. Despite having different subjective feelings of intoxication, facial flushers and nonflushers were equally impaired after having ingested equal amounts of alcohol per body weight.

Association of objective measures of trauma exposure from motor vehicle accidents and posttraumatic stress symptoms.

Associations of objective measures of trauma exposure with psychological sequelae following motor vehicle accidents (MVA) were examined in a Japanese population. Impact and injury severity of 93 MVA victims was assessed using on-the-scene in-depth investigations measured by the Injury Severity Score (ISS), barrier equivalent speed (BES), and change in velocity during the impact (Delta-v). Results showed that ISS, BES, and Delta-v were not related to posttraumatic stress symptoms (PTSS) or psychiatric symptoms at 5 and 14 months after the MVA. Subjective measures (e.g., perceived life risk, persistent medical problems) were significantly related to psychological sequelae. These findings suggest that the objective measures of trauma exposure are not associated directly with PTSS or psychiatric symptoms after an MVA.

Application of the behavioral investigative support system for profiling perpetrators of serial sexual assaults.

The authors developed a data-based profiling system in order to support offender profiling. The system stored incident records of prior offenders. Inputting offence details of an unsolved incident, a probability score was assigned to each prior offender in the system; the score represented the behavioral similarity with the unsolved incident. The system then ranked all offenders in the system according to the probability scores, and prioritized the high-ranked offenders as possible suspects. Moreover, the system inferred the characteristics of unknown offenders by accumulating characteristics of the high-ranked offenders. The system achieved promising accuracy, especially for linking crimes to perpetrators. In 45 out of 81 simulation trials, the target offenders were retrieved as a rank score of 1 from among 868 sex offenders.

Successful rehabilitation after hip fracture to a patient with previous above-elbow amputation.

We experienced successful rehabilitation of an elderly man after hip fracture (HF) who had had ipsilateral above-elbow amputation. He was a wounded soldier whose right arm had been amputated more than 60 yrs ago, and he had never used a prosthesis. He had been admitted to our hospital because of exacerbation of chronic obstructive pulmonary disease. During his admission, he had a fall-related hip fracture. We devised a special upper-limb prosthesis so that he could hold an ipsilateral crutch to enable appropriate acute-phase rehabilitation for HF. As a result, effects of disuse were prevented and he gained improvement of lower-limb function. The specialized upper-limb prosthesis also reduced his anxiety regarding walking. It can be considered that the prosthesis contributed to his quality of life with regard to activities of daily living after discharge.

Method to evaluate the effect of safety belt use by rear seat passengers on the injury severity of front seat occupants.

Although the effectiveness of seat belts for reducing injury to rear seat passengers in traffic accidents has been well documented, the ratio of rear-seat passengers restrained by seatbelts remains lower than that of drivers or passengers in front seats. If passengers in rear seats do not wear seat belts, they may sustain unexpected injury to themselves when involved in accidents, and also endanger front occupants (drivers or front seat passengers). This paper focuses on the tendency of front seat occupants to sustain severer injuries due to forward movement of passengers in rear seats at the moment of frontal collisions, and evaluates the effectiveness of rear passengers' wearing seat belts in reducing injuries of front seat occupants. Since the occurrence of occupant injuries depends considerably on the crash severity, we proposed to use pseudo-delta V in regression analysis to represent velocity change during a collision when analyzing statistical accident data. As the crash severity can be estimated from pseudo-delta V, it becomes possible to make appropriate estimations even when the crash severity differs in data. The binary model derived from the ordered response model was used to evaluate the influence on the injury level based on pseudo-delta V, belted or unbelted status, gender and age. Occupants in cars with a hood in the case of car-to-car frontal collisions were extracted from the statistical data on accidents in Japan. Among 81,817 cars, where at least one passenger was present, a total of 6847 cars in which all passengers sustained injuries and which had at least one rear seat passenger aboard were analyzed. The number of killed or seriously injured drivers is estimated to decrease by around 25% if rear seat occupants come to wear seat belts. Also, the number of killed or seriously injured passengers in front seats is estimated to decrease by 28% if unbelted rear seat occupants come to wear seat belts. Thus, wearing of seat belts by previously unbelted rear seat passengers is considered effective in reducing not only injuries to the rear seat passengers themselves but also injuries to front seat occupants.