Impact of a New Law to Reduce the Legal Blood Alcohol Concentration Limit - A Poisson Regression Analysis and Descriptive Approach

BACKGROUND

In Chile, a new law introduced in March 2012 lowered the blood alcohol concentration (BAC) limit for impaired drivers from 0.1% to 0.08% and the BAC limit for driving under the influence of alcohol from 0.05% to 0.03%, but its effectiveness remains uncertain. The goal of this investigation was to evaluate the effects of this enactment on road traffic injuries and fatalities in Chile.

STUDY DESIGN

A retrospective cohort study.

METHODS

Data were analyzed using a descriptive and a Generalized Linear Models approach, type of Poisson regression, to analyze deaths and injuries in a series of additive Log-Linear Models accounting for the effects of law implementation, month influence, a linear time trend and population exposure. A review of national databases in Chile was conducted from 2003 to 2014 to evaluate the monthly rates of traffic fatalities and injuries associated to alcohol and in total.

RESULTS

It was observed a decrease by 28.1 percent in the monthly rate of traffic fatalities related to alcohol as compared to before the law (P<0.001). Adding a linear time trend as a predictor, the decrease was by 20.9 percent (P<0.001).There was a reduction in the monthly rate of traffic injuries related to alcohol by 10.5 percent as compared to before the law (P<0.001). Adding a linear time trend as a predictor, the decrease was by 24.8 percent (P<0.001).

CONCLUSIONS

Positive results followed from this new 'zero-tolerance' law implemented in 2012 in Chile. Chile experienced a significant reduction in alcohol-related traffic fatalities and injuries, being a successful public health intervention.

The effects and risks associated to mephedrone and methylone in humans: A review of the preliminary evidences

New psychoactive substances have drastically modified the world drug scene. An increasingly popular class comprises synthetic or substituted cathinones (legal highs, research chemicals, bath salts). Among the most common psychoactive constituents of bath salts are mephedrone and methylone. Recent reports on the abuse of novel synthetic cathinone derivatives call attention to the serious physical and psychological risks resulting from their consumption, thereby emphasizing the growing use of these drugs might constitute an important public health issue. In this paper, we will review the available data regarding the use and effects of mephedrone and methylone in humans in order to highlight their impact on public health. To reach this objective, a literature search was performed on two representative databases (Pubmed, Google Scholar), the Erowid Center website (a US non-profit educational organization that provides information about psychoactive plants and chemicals), and various governmental websites. The terms used for the database search were "mephedrone", "methylone", "new psychoactive substances", "synthetic cathinones", "substituted cathinones", "substance abuse", "substance use disorder", "adverse effects", "fatalities". The literature search was limited to years 2005-2015 and led to the identification of 71 potentially relevant articles. To date, the actual prevalence rates of their use remains difficult to estimate. Important health-related issues have emerged in relation to the somatic, psychiatric, and addictive consequences of their use. The potential chronic health effects of their prolonged use remain to date unknown (e.g., reproductive toxicity, genotoxicity and carcinogenic potential). Treatment for patients with prolonged exposure to synthetic cathinones should ideally include a drug management plan coupled with psychotherapy taking place in a structured program of care.

Modelling of fire count data: fire disaster risk in Ghana

Stochastic dynamics involved in ecological count data require distribution fitting procedures to model and make informed judgments. The study provides empirical research, focused on the provision of an early warning system and a spatial graph that can detect societal fire risks. It offers an opportunity for communities, organizations, risk managers, actuaries and governments to be aware of, and understand fire risks, so that they will increase the direct tackling of the threats posed by fire. Statistical distribution fitting method that best helps identify the stochastic dynamics of fire count data is used. The aim is to provide a fire-prediction model and fire spatial graph for observed fire count data. An empirical probability distribution model is fitted to the fire count data and compared to the theoretical probability distribution of the stochastic process of fire count data. The distribution fitted to the fire frequency count data helps identify the class of models that are exhibited by the fire and provides time leading decisions. The research suggests that fire frequency and loss (fire fatalities) count data in Ghana are best modelled with a Negative Binomial Distribution. The spatial map of observed fire frequency and fatality measured over 5 years (2007–2011) offers in this study a first regional assessment of fire frequency and fire fatality in Ghana.

Determinant of Road Traffic Crash Fatalities in Iran: A Longitudinal Econometric Analysis

BACKGROUND

Injuries and deaths from road traffic crashes are one of the main public health problems throughout the world. This study aimed to identify determinants of fatality traffic accident in Iran for the twenty-span year from 1991 to 2011.

METHODS

A time series analysis (1991-2011) was used to examine the effects of some of the key explanatory factors (GDP per capita, number of doctors per 10,000 populations, degree of urbanization, unemployment rate and motorization rate) on deaths from road traffic in Iran. In order to examine long- and short-run effects of variables, we employed autoregressive distributed lag (ARDL) approach and error correction method (ECM). The data for the study was obtained from the Central Bank of Iran (CBI), Iranian Statistical Center (ISC) and Legal medical organizations (LMO).

RESULTS

GDP per capita, doctor per 10,000 populations, degree of urbanization and motorization rate had a significant impact on fatality from road traffic in Iran. We did not observe any short- and long-term effects of the unemployment rate on fatality from road traffic.

CONCLUSION

GDP per capita, doctor per 10,000 populations, degree of urbanization and motorization rate were identified as main determinant of fatality from road traffic accidents in Iran. We hope the results of the current study enable health policy-makers to understand better the factors affecting deaths from road traffic accidents in the country.

A collection of evidence for the impact of the economic recession on road fatalities in Great Britain

There was a considerable reduction in the number of fatalities on British roads between 2007 and 2010. This substantial change led to debate as to the cause of the reduction. Multiple sources of information and evidence have been collated including STATS19 road accident data, population data, socio-demographic data, economic patterns, weather trends and traffic and vehicle data. Summary analyses of these data sources show a reduction in overall traffic, a large reduction in HGV traffic, a reduction in young male drivers, a reduction in speeding, and a reduction in drink driving during the recession period. All of these reductions can be associated with a reduction in fatal accidents and have led to the conclusion that the economic recession changed behaviours in such a way that fewer people were killed on the roads in Britain during this period.

Injury patterns and features of cycling fatalities in South Australia

There has been an increase in cycling in Australia. This means that more cyclists are at risk of injuries, which account for a proportion of transport-related fatalities. In this study, all cyclist fatalities from 2002 to 2013 in South Australia where post-mortem examinations were performed were investigated. There were 42 deaths representing 3% of the total road fatalities over the same time. Of this total number of cases, 13 deaths (31%) involved collapse (mostly natural causes from an underlying medical condition) and 29 (69%) resulted from trauma. There were no cases of hyperthermia. Of the decedents 95% were male, and the mean age at death was 47 years. Fatal incidents were more likely to occur during April and November, and on a Monday. However, statistical analysis was not possible due to the small number of cases. Fatalities (traumatic and collapse) predominantly occurred whilst the cyclist was riding (86%). The majority of riding fatalities were as a result of collision with vehicles (81%). Drugs (including alcohol) were detected in two (15%) of the 13 cases of the collapses, and in seven (26%) of the 27 trauma cases tested. In trauma cases, death was most often due to multiple injuries. The most frequent area for injury was the head (found in 90% of traumatic deaths). Despite the increasing numbers of cyclists on South Australian roads over the last decade, death rates have trended downwards suggesting that road safety campaigns and the provision of more dedicated bicycle lanes have had a positive outcome.

Recreational use, analysis and toxicity of tryptamines

The definition New psychoactive substances (NPS) refers to emerging drugs whose chemical structures are similar to other psychoactive compounds but not identical, representing a "legal" alternative to internationally controlled drugs. There are many categories of NPS, such as synthetic cannabinoids, synthetic cathinones, phenylethylamines, piperazines, ketamine derivatives and tryptamines. Tryptamines are naturally occurring compounds, which can derive from the amino acid tryptophan by several biosynthetic pathways: their structure is a combination of a benzene ring and a pyrrole ring, with the addition of a 2-carbon side chain. Tryptamines include serotonin and melatonin as well as other compounds known for their hallucinogenic properties, such as psilocybin in 'Magic mushrooms' and dimethyltryptamine (DMT) in Ayahuasca brews.

AIM

To review the scientific literature regarding tryptamines and their derivatives, providing a summary of all the available information about the structure of these compounds, their effects in relationship with the routes of administration, their pharmacology and toxicity, including articles reporting cases of death related to intake of these substances.

METHODS

A comprehensive review of the published scientific literature was performed, using also non peer-reviewed information sources, such as books, government publications and drug user web fora.

CONCLUSIONS

Information from Internet and from published scientific literature, organized in the way we proposed in this review, provides an effective tool for specialists facing the emerging NPS threat to public health and public security, including the personnel working in Emergency Department.

Jurisdictional spillover effects of sprawl on injuries and fatalities

There is a considerable literature on the relationship between sprawl and accidents. However, these studies do not account for the spatially correlated effects of sprawl on accidents. In our analysis of 122 jurisdictions in Southeast Michigan, we use a Bayesian spatial autoregressive model to estimate how injuries and fatalities in one jurisdiction are associated with sprawl in that jurisdiction and sprawl in neighboring jurisdictions; we also correct for heteroskedasticity in the data. Using principal component analysis, we create a sprawl index from five underlying land use characteristics. Our results show that the number of injuries and fatalities in a jurisdiction increases with the magnitude of sprawl in neighboring jurisdictions. We believe that this is because more drivers per capita in sprawled jurisdictions traverse similarly sprawled neighboring jurisdictions for daily activities. Furthermore, driving habits attuned to less defensive driving in sprawled jurisdiction are transferred to similarly designed neighboring jurisdictions, contributing to accidents in the latter.

Road traffic fatalities - a neglected epidemic in rural northern Ghana: evidence from the navrongo demographic surveillance system

Background

Globally, road traffic fatalities have been on the increase, particularly in low-and-middle income countries. Much of this is attributed to increases in the acquisition, and use of motorized vehicles. However, there is very little empirical research to understand the causes and determinants of this threat. This paper investigates time trends and determinants of road traffic accidents in the Kassena-Nankana district of northern Ghana.

Methods

First, we utilized causes of death data gathered by the Health and Demographic Surveillance System in Navrongo, to examine trends in deaths due to injury, particularly those related to road traffic crashes. Subsequently, we employed multivariate logistic regression to examine factors associated with deaths due to all injuries and road traffic crashes among adults 15–59 years of age.

Results

Results show a three-fold increase in mortality (from less than 6% in 1995 to about 18% in 2010) due to injuries in the Kassena-Nankana district in about a decade. Fatalities resulting from road traffic crashes constitute the greatest share of the burden of mortality resulting from injuries. Increases in road traffic fatalities have coincided with recent increases in motor and vehicular traffic in the region. Several factors are associated with the increased risk of deaths from road traffic accidents, principal among which include urban residence (OR = 1.74 95% CI 1.09-2.78), being male and in the prime adult ages of between 20–29 years old (OR = 4.85 95% CI 2.65-8.89), as well as people with higher levels of education (OR = 3.21 95% CI 1.75-5.87) and those in higher socioeconomic status categories (OR = 2.43 95% CI 1.21-4.88).

Conclusions

Results suggest that road traffic fatalities have become a major cause of morbidity and mortality and brings into focus the need for measures to curb this looming crisis. There is need for strategic interventions to be adopted to avert what is sure to become one of the leading causes of death in this impoverished locality.

On-road all-terrain vehicle (ATV) fatalities in the United States

BACKGROUND

The study was designed to describe the characteristics of all-terrain vehicle (ATV) rider fatalities and fatal crashes involving ATVs that occur on public roads.

METHODS

Information on fatal crashes occurring on public roads during the years 2007-2011 was obtained from the Fatality Analysis Reporting System (FARS).

RESULTS

There were 1,701 ATV rider deaths during the 5-year study period, including 1,482 drivers, 210 passengers, and 9 with unknown rider status. An additional 19 non-ATV occupants, primarily motorcyclists, died in crashes with ATVs. About half of the ATV passenger deaths were teenagers or younger, and the majority of passenger deaths were female. Ninety percent of the fatally injured drivers were 16 or older, and 90% were male. The crashes were most likely to occur in relatively rural states, and in rural areas within states. Only 13% of drivers and 6% of passengers killed wore helmets. Forty-three percent of the fatally injured drivers had blood alcohol concentrations (BACs) of 0.08% or greater. Seventy-five percent of the fatal crashes involved single ATVs; 5% involved multiple ATVs but no non-ATV vehicles, and 20% involved ATVs and non-ATVs, usually passenger vehicles. Speeding was reported by police as a contributing factor in the crash for 42% of ATV drivers in single-vehicle crashes and 19% of ATV drivers in multiple-vehicle crashes.

PRACTICAL APPLICATIONS

Although ATVs are designed exclusively for off-road use, many ATV occupant deaths occur on roads, despite most states having laws prohibiting many types of on-road use. Attention needs to be given to ways to reduce these deaths.

A 3-year review of new psychoactive substances in casework

Following the initial popularity of mephedrone (4-methylmethcathinone) there has been a stream of new "recreational drugs" entering the global market. The lack of clinical studies on the effects and toxicity of these drugs has made interpretation of toxicological findings difficult. In an attempt to assist in a better understanding of the extent of their use and the fatalities that have been linked to these compounds we present our collated findings in post-mortem and criminal casework where these have been detected and/or implicated. Between January 2010 and December 2012 we have detected new psychoactive substances (NPS) in 203 cases, with 120 cases in 2012 alone. The drugs detected in in life or post-mortem blood and urine are, in order of decreasing frequency; mephedrone, 4-methylethcathinone, BZP, MDPV, TFMPP, methoxetamine, 4-fluoromethcathinone, 4-methylamphetamine, PMA, methylone, PMMA, naphyrone, alpha-methyltryptamine, butylone, MDAI, desoxypipradrol, D2PM, MPA, synthetic cannabinoids, 2-AI, 5-IAI, 5-MeODALT, MDPBP, 5/6-APB, pentedrone and pentylone. Other drugs or alcohol were detected in 84% of the cases including other NPS and in fatalities it should be noted that alternative causes of death (including mechanical suicide, accidental death and non-psychoactive drug overdose) accounted for the majority. Related to this was that of all fatalities involving cathinones, 41% of these were hangings or other mechanical suicides, this was a higher proportion than seen with other drugs found in such cases. The presence of multiple NPS and/or other stimulants was a particular feature in various cases, however, of the drug deaths only 7% solely involved NPS. Across all case types and including some cases investigated in 2013, NPS concentrations showed a wide range but these and selected cases are presented to assist toxicological interpretation in future cases.

Adverse medical complications: an under-reported contributory cause of death in New York City

OBJECTIVES

The current death certification system in the USA fails to accurately track deaths due to adverse medical events. The aim of this study was to demonstrate the under-reporting of deaths due to adverse medical events due to limitations in the current death certification/reporting system, and the benefits of using the term 'therapeutic complication' as the manner of death.

STUDY DESIGN

Retrospective review and comparison of death certificates and vital statistical coding.

METHODS

The manner of death is certified as a therapeutic complication when death is caused by predictable complications of appropriate therapy, and would not have occurred but for the medical intervention. Based on medical examiner records, complications that caused or contributed to deaths over a five-year period were examined retrospectively. These fatalities were compared with deaths coded as medical and surgical complications by the New York City Bureau of Vital Statistics.

RESULTS

The Medical Examiner's Office certified 2471 deaths as therapeutic complications and 312 deaths as accidents occurring in healthcare facilities. In contrast, the New York City Bureau of Vital Statistics reported 188 deaths due to complications of medical and surgical care.

CONCLUSIONS

Use of the term 'therapeutic complication' as the manner of death identified nearly 14 times more deaths than were reported by the New York City Bureau of Vital Statistics. If these therapeutic complications and medical accidents were considered as a 'disease', they would rank as the 10th leading cause of death in New York City, surpassing homicides and suicides in some years. Nationwide policy shifts that use the term 'therapeutic complication' would improve the capture and reporting of these deaths, thus allowing better identification of fatal adverse medical events in order to focus on and assess preventative strategies.

Road traffic fatalities in oman from 1995 to 2009: evidence from police reports

BACKGROUND

Fatalities from road traffic crashes (RTCs) are a public health challenge for low- and middle-income countries, especially those experiencing epidemiological transition. This paper aims to describe demographics and trend analysis of fatalities of RTCs in Oman from 1995 to 2009.

METHODS

The RTC data from 1995 to 2009 were obtained from the published reports of the Royal Oman Police (ROP). Data were extracted on the distribution of deaths by age, sex, nationality, mode of travel (driver, passenger, pedestrians), and type of vehicle (four- vs. two-wheelers). Trend analyses were carried out using the Chi-square for the percentages of deaths and linear regression for rates.

RESULTS

A total of 9,616 deaths from RTCs were reported from 1995 to 2009. Of 9,616 fatalities, 4,666 (48.5%) were aged 26-50 years, 7,927 (82.4%) were males, 7,215 (75.0%) were Omanis, and 2,278 (23.8%) were pedestrians. Overall, mortality increased by around 50% from 479 deaths during 1995 to 953 deaths during 2009. There was a significant increase in the proportion of deaths (P < 0.05) and death rates (P < 0.05) among individuals aged 26-50 years, males, Omani nationals, and drivers. The number and rate of RTC fatalities due to overspeeding was also increased (P < 0.05).

CONCLUSIONS

Fatalities due to RTCs in Oman are increasing, especially among those aged 26-50 years, males, drivers, and Omani nationals with overspeeding as a major cause of road traffic fatalities. There is a need for more research in understanding the risk-taking behaviors of young drivers, and sociocultural factors, especially among Omani nationals to target interventions.