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2型糖尿病与驾驶安全:机制分析及基于人因设计的改善方法
其他题名Type 2 Diabetes and Driving Safety: Its Mechanism and Ergonomic Improvements
马舒
学位类型博士
导师吴昌旭 ; 孙向红 ; 张警吁 ; 赵国朕
2018-05
学位授予单位中国科学院研究生院
学位授予地点北京
学位专业应用心理学
关键词2型糖尿病 驾驶行为 神经病变 踏板设计
摘要

    近年来,糖尿病患者数量增长迅猛,我国已经成为世界糖尿病患者人数最多的国家。既有研究表明,糖尿病会损害患者的驾驶技能,增加安全隐患。但现有研究主要在欧美国家开展,对于亚洲特别是我国的情况尚未有深入研究;另一方面,现有研究主要关注1型糖尿病患者的驾驶安全情况,对占绝对数目的2型糖尿病患者尚未展开系统研究;特别的,现有研究主要为机制性探讨,鲜有从系统设计的角度出发,提出改善患者驾驶安全的具体方法。为解决以上问题,本研究提出从慢性知觉、认知衰退和糖尿病管理行为的角度出发,探讨影响我国2型糖尿病患者驾驶安全的有关因素;并围绕糖尿病患者中容易被忽视的周围性神经病变这一问题,从人因设计的角度出发,试图找到最适合2型糖尿病患者使用的踏板设计,达到改善驾驶行为的目的。
    研究一(A)采用焦点小组访谈的方法调查糖尿病对驾驶行为的影响。结果发现,受访的2型糖尿病驾驶者中,只有极少数人关注血糖异常与驾驶安全的关系。不同人对血糖水平的觉察敏感性是不同的,血糖异常带来的症状因人而异。受访者倾向于依据症状来决定驾驶行为,主观报告容易焦虑、疲劳、分神、看不清物体、反应变慢、乏力、肢体麻木、失眠多梦、动作迟缓不同程度地影响了驾驶行为。
    研究一(B)采用问卷调查法,收集了2型糖尿病患者疾病相关信息(病程、疗法、糖化血红蛋白、并发症情况、低血糖经历)、认知失误和DPN症状评估,糖尿病知识和自我照护活动,以及驾驶行为相关信息,低血糖经历、糖尿病知识、糖尿病自我照护活动、认知失误以及DPN自评可以不同程度地预测驾驶行为,即在2型糖尿病患者中,那些经常发生低血糖、缺乏糖尿病知识、不注意坚持糖尿病相关自我照护、有更多认知失误以及更频繁的DPN症状的患者将是驾驶的高风险人群。并且发现中年男性驾驶员缺乏糖尿病相关知识并且忽视糖尿病口常自我照护,存在更多的驾驶安全问题,需要予以关注。
    研究二(A)采用模拟器实验探讨2型糖尿病是否影响了驾驶技能。通过比较2型糖尿病驾驶者与健康对照组在曲道变速跟车和紧急避让两项模拟驾驶任务的差别,结果发现,患者组无论在跟车任务还是紧急避让行人的任务中,都有更长的刹车反应时间(BRT),更小的最短碰撞时间(TTC)和距离(DTC),以及更大的道路中心偏移量(CLD)。并且随着曲度的增大,前车更快的减速,患者组的绩效下降得更快。由此初步得出2型糖尿病患者组的驾驶绩效出现衰退。
    研究二(B)进一步探讨引起驾驶绩效衰退的原因。在测量了糖尿病和健康驾驶者在低血糖经历、知觉和认知功能上的差异之后,进一步通过中介效应分析考察这些因素是否能够解释驾驶绩效(刹车反应时间、最短碰撞时间、道路中心偏移量)在组间的差异。结果发现:低血糖经历(前人发现的1型糖尿病患者的主要风险因素),并不能有效的预测2型糖尿病驾驶者的技能衰退;对2型糖尿病患者驾驶技能预测力最强的是视觉搜索任务的正确率、随后依次为注意广度、1-back的正确率以及足底触觉任务的绩效。研究四探讨了如何通过改进刹车踏板减少糖尿病周围神经病变((2型糖尿病的一种常见并发症)对刹车踩踏控制的负面影响。
    研究三(A)考察了健康组与患者组在具有不同距离及大小特征的踏板上刹车反应的差异。本研究采用2(组间:健康组、患者组)X3(刹车一油门水平距离:4. 5cm,  6cm,  7. 5cm) X 3(刹车板宽度:5cm, 7cm, 9cm),因变量是行人-车辆冲突避让任务中的刹车反应时间和最小碰撞距离。结果发现,当踏板距离为4. 5cm时,患者组的刹车反应时间以及最小碰撞距离显著改善,和对照组的差异不再显著,同时并不会带来错踩踏板失误率的显著增加。
    研究三(B)考察了健康组与患者组在具有不同特征的踏板力度调控和保持任务上的表现差异。本研究采用了2(组间:健康组、患者组)X2(力反馈大小:轻、重)X3(力变化幅度:小,中,大)的混合实验设计。结果发现:在提供力度控制视觉反馈的前提下,相对于健康对照组,当力度变化幅度逐渐变小时,患者组的准确性有更大程度的衰退。这一结果可以帮助启发我们在设计适用于周围神经病变的2型糖尿病驾驶者脚踏板时,将踏板力度幅度和效力比率设置为非线性递减关系,辅助其最大程度地提升力度调理准确性。
    综上,本研究初步探讨了影响2型糖尿病驾驶安全的有关因素,发现了一系列具有预测力的认知诊断标准和行为诊断标准,为驾驶风险的早期识别、患者驾驶安全教育和疾病管理建议上提供了理论依据;本研究还从人因设计的角度出发,提出可以通过改进踏板设计的方法,从而改善2型糖尿病患者的驾驶安全。这为进一步改善病患生活质量和安全提供了新的思路和有效的方法。

其他摘要

    The safety of diabetic drivers has become a popular topic very recently, as accumulating evidence in the developed countries has suggested that diabetes is related to increased driving risks. However, the studies were mostly conducted in the developed western nations, and focus on the evaluation of driving safety among type 1 diabetes. The studies of type 2 diabetes which occupied the vast majority in Asia were few. Besides, most of them paid attention to the mechanism of driving with diabetes  during  hypoglycemia.  Driving  during  non-hypoglycemia  attracts  little attention. Last but not the least, no studies put forward the improvement for type 2 diabetes from the aspect of system design. To fill the gaps, we discussed the factors of driving safety for type 2 diabetes, starting from the chronic impairment in cognition and diabetic self-management. Then we went further to find the optimal pedal design specific for drivers with diabetic peripheral nerve lesions.
    The Study One (A) investigate the influence of type 2 diabetes on driving behavior in focus group. The interviews showed that few patients pay attention to the relationship between the abnormal blood glucose (BG) level and driving safety. And the symptoms of abnormal BG varies with the individual. The ability to be aware of abnormal BG is different for everyone. The interviewers tend to make decisions for driving based on the symptoms. They report anxiety, fatigue, distraction, blurred vision, slow reaction, numb, insomnia impaired driving behavior at different levels.
    The Study One (B) conducted surveys among the drivers with type 2 diabetes, and collected disease information (the duration of diabetes, glycosylated hemoglobin, complications, hypoglycemia experiences), cognitive failure, subjective ratings on diabetic peripheral neuropathy (DPN), the brief knowledge about diabetes and the self-care  activities,  as  well  as  the  driving  information.  We  found  that  the hypoglycemia experience, diabetic knowledge, self-care activities, cognitive failure and the subjective ratings on DPN are effective predictors of driving behavior. Those people with diabetes who have more hypoglycemia experiences, be lack of diabetic knowledge, fewer self-care activities, more cognitive failures and higher DPN rating scores are at a higher risk of driving. Also, we should pay attention to the mid-aged male drivers with diabetes, for their lack of knowledge, regardless of self-care activities and more risky driving behavior.
    In Study Two (A), we conducted the experiments by driving simulator to figure out whether developing type 2 diabetes may impair driving skill. We compared the difference of driving performance between patients  and their matched controls through the car-following in curvatures task and the pedestrian-vehicle-conflict tasks.The results showed that the patients' group has a longer brake reaction time, shorter minimum time-to-collision, and larger centerline deviation. Besides, as the road curve become sharper, as well as the leading car triggered a more emergency brake, the driving performance declined faster in patients group. It follows that there are impairments in driving skills of patients with type 2 diabetes.
    In Study Two (B), we discussed the reason for their impairments in driving skills. We recruited patients with type 2 diabetes and their healthy controls to perform a
simulated car-following task and finish behavioral tests of haptic perception, visual search, attention span and working memory abilities during non-hypoglycemia. They also reported their hypoglycemia experience and perceived driving skills. We found that such between-group differences in driving performance could be fully mediated by haptic perception, visual search ability, attention span and working memory capacity but not by hypoglycemia experience. Regarding the effect sizes of the mediation, the visual search ability played the most critical role, and then followed the attention span, working memory, and the haptic perception.
    In Study Three (A) we discussed how to improve the design of brake pedal to reduce the influence of DPN on braking behavior. The Study Four (A) tried reducing the brake reaction time by using pedals with different layout design. Three groups of participants were recruited: the patients with type 2 diabetes and high Semmes-Weinstein monofilaments Examination (SWME) scores (15), the patients with type 2 diabetes and low SWME scores (15), and the healthy controls (29). All participants finished a series of vehicle-pedestrian conflict tasks in a driving simulator using nine different types of pedal layouts. These layouts varied in accelerator-brake lateral distance and brake-pedal width. The results showed that patients with type 2 diabetes and high SWME scores had longer brake reaction time (BRT) and shorter minimum distance-to-collision  (DTC)  as  compared to other two  groups.  Also, under the condition of the shortest accelerator-brake lateral distance (45mm), patients with high SWME scores showed substantially reduced BRT and increased minimum DTC without any increase in pedal errors.
    The Study Three (B) investigated the differences in the performance of force control and force maintain tasks. It is a 2 (groups: healthy controls group and patients group)*2 (force feedback)*3(the amplitude of force)一design. The results showed that:there is a significant interaction effect on the amplitude of force and the groups. The patients' group had worse performance when triggering the small amplitude of force,compared with the healthy controls group. Based on this findings, we suggested that a smaller force transfer rate may benefit the patients' group to get a better pedal control.
    This initial study provides original and first-hand evidence demonstrating that
the   middle-aged  male  drivers  with  type  2  diabetes  have  deteriorated  driving performance, but they are unaware of it. We will also discuss the possible measures to identify people of the highest risk and improve their safety awareness by using the findings of the current study.

语种中文
文献类型学位论文
条目标识符http://ir.psych.ac.cn/handle/311026/26129
专题社会与工程心理学研究室
作者单位中国科学院心理研究所
推荐引用方式
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马舒. 2型糖尿病与驾驶安全:机制分析及基于人因设计的改善方法[D]. 北京. 中国科学院研究生院,2018.
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