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Bråthen CC, Jørgenrud BM, Bogstrand ST, Gjerde H, Rosseland LA, Kristiansen T. Prevalence of use and impairment from drugs and alcohol among trauma patients: A national prospective observational study. Injury 2023; 54:111160. [PMID: 37944451 DOI: 10.1016/j.injury.2023.111160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Being under the influence of psychoactive substances increases the risk of involvement in and dying from a traumatic event. The study is a prospective population-based observational study that aims to determine the prevalence of use and likely impairment from psychoactive substances among patients with suspected severe traumatic injury. METHOD This study was conducted at 35 of 38 Norwegian trauma hospitals from 1 March 2019 to 29 February 2020. All trauma admissions for patients aged ≥ 16 years admitted via trauma team activation during the study period were eligible for inclusion. Blood samples collected on admission were analysed for alcohol, benzodiazepines, benzodiazepine-like hypnotics (Z-drugs), opioids, stimulants, and cannabis (tetrahydrocannabinol). RESULTS Of the 4878 trauma admissions included, psychoactive substances were detected in 1714 (35 %) and in 771 (45 %) of these, a combination of two or more psychoactive substances was detected. Regarding the level of impairment, 1373 (28 %) admissions revealed a concentration of one or more psychoactive substances indicating likely impairment, and 1052 (22 %) highly impairment. Alcohol was found in 1009 (21 %) admissions, benzodiazepines and Z-drugs in 613 (13 %), opioids in 467 (10 %), cannabis in 352 (7 %), and stimulants in 371 (8 %). Men aged 27-43 years and patients with violence-related trauma had the highest prevalence of psychoactive substance use with respectively 424 (50 %) and 275 (80 %) testing positive for one or more compounds. CONCLUSION The results revealed psychoactive substances in 35 % of trauma admissions, 80 % of which were likely impaired at the time of traumatic injury. A combination of several psychoactive substances was common, and younger males and patients with violence-related injuries were most often impaired. Injury prevention strategies should focus on high-risk groups and involve the prescription of controlled substances. We should consider toxicological screening in trauma admissions and incorporation of toxicological data into trauma registries.
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Affiliation(s)
- Camilla C Bråthen
- Department of Acute Medicine, Division of Elverum-Hamar, Innlandet Hospital Trust, 2381 Brumunddal, Norway; Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway.
| | - Benedicte M Jørgenrud
- Department of Forensic Sciences, Division of Laboratory Medicine, Section of Drug Abuse Research, Oslo University Hospital, 0424 Oslo, Norway
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Division of Laboratory Medicine, Section of Drug Abuse Research, Oslo University Hospital, 0424 Oslo, Norway; Faculty of Health Sciences, Department of Nursing and Health Promotion, Acute and Critical Illness, Oslo Metropolitan University, 0130 Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Hallvard Gjerde
- Department of Forensic Sciences, Division of Laboratory Medicine, Section of Drug Abuse Research, Oslo University Hospital, 0424 Oslo, Norway
| | - Leiv Arne Rosseland
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, 0424 Oslo, Norway
| | - Thomas Kristiansen
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; Department of Anaesthesiology, Division of Emergencies and Critical Care, Radiumhospitalet, Oslo University Hospital, 0424 Oslo, Norway
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Cittadini F, De Giovanni N, Aulino G, Lentini G, Vetrugno G, Strano-Rossi S, Covino M. Blood alcohol concentration and road accidents: Underestimation due to time of the arrival to the emergency department (ED) or delay in blood sampling. A 4-Year Retrospective Study in Rome. MEDICINE, SCIENCE, AND THE LAW 2023; 63:292-297. [PMID: 36740934 DOI: 10.1177/00258024231154219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Alcohol is a significant public health issue, according to the World Health Organization. Our study aims to analyze the correlation between blood alcohol concentrations (BACs) of drivers, their demographic features, and the possible underestimation of BACs due to the time elapsed between hospital admission and blood sampling. Methods: This study includes patients evaluated for BAC levels in the emergency department (ED) of Fondazione Policlinico Universitario A. Gemelli IRCCS from January 2013 to December 2016. BAC levels were compared in patients involved in road crashes according to age group, sex, and time of the accident. The delays in blood sampling and BAC measurement in the ED were recorded for each patient. The time between the accident and access to the hospital in most cases was unknown. Results: A total of 398 patients were included in the analysis, 107 of them had BACs more than 0.05 g/L., and 86 of these individuals had BAC levels more than 0.5 g/L. Road accident patients had higher rates of positive BAC readings at night and on weekends. A significant delay in blood sampling for BAC determination was observed. Discussion: This study demonstrates a critical bias due to the arrival time at the ED and the delay in blood sampling that inevitably influences and underestimates the BAC, resulting in possible false negative results (BAC values below the cutoff). Zero tolerance or a retrospective BAC calculation could mitigate this bias. It is necessary to implement preventive strategies to reduce instances of driving under the influence (DUI) of alcohol.
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Affiliation(s)
- Francesca Cittadini
- Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Nadia De Giovanni
- Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Giovanni Aulino
- Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | | | - Giuseppe Vetrugno
- Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Sabina Strano-Rossi
- Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Marcello Covino
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
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Cardoso AG, Viltres H, Ortega GA, Phung V, Grewal R, Mozaffari H, Ahmed SR, Rajabzadeh AR, Srinivasan S. Electrochemical sensing of analytes in saliva: Challenges, progress, and perspectives. Trends Analyt Chem 2023. [DOI: 10.1016/j.trac.2023.116965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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4
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McGrane IR, Ramsbacher NC, Rook WC, Omar FA. Effects of 3,4-methylenedioxymethamphetamine and methamphetamine on motor vehicle driving performance: A systematic review of experimental and observational studies. J Forensic Sci 2023; 68:22-34. [PMID: 36411495 DOI: 10.1111/1556-4029.15179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/29/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
Methamphetamine (METH) and 3,4-methylenedioxymethamphetamine (MDMA) are common drugs of abuse and driving under their influence may occur in 1 million people yearly in the United States. This systematic review fills the currently unmet need in understanding the effects of METH and MDMA on motor vehicle driving performance (MVP) and provides insight into the forensic community. A PubMed search on September 24, 2020, for experimental and observational studies, which evaluated the impact of METH and MDMA on MVP was performed. After a review of 208 abstracts, 103 were considered potentially interesting and full texts were obtained. After the exclusion of non-English articles, review articles, single case reports, and articles which did not evaluate METH or MDMA on MVP, a total of nine experimental studies, 10 traditional observational studies, and 35 case series were included. The clinical rigor of experimental studies was evaluated using the Jadad scale. Experimental studies often demonstrated no significant MVP safety signals for METH or MDMA use, which was contrary to the overwhelming MVP safety risks found in observational studies. Common driving behaviors while using METH or MDMA include: errors in judgment, traveling at high speeds, failure to stop, merging inappropriately, lane weaving, and crashes. Limitations of experimental studies that led to dissimilar MVP outcomes from observational studies include: the common use of driving simulators, as opposed to actual driving examinations, and doses of METH or MDMA administered may not be representative of blood concentrations seen in observational studies. This systematic review has no funding source and was not registered.
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Affiliation(s)
- Ian R McGrane
- Skaggs School of Pharmacy, College of Health, University of Montana, Missoula, Montana, USA.,Department of Pharmacy, Providence St. Patrick Hospital, Missoula, Montana, USA
| | - Nathan C Ramsbacher
- Department of Pharmacy, Providence St. Patrick Hospital, Missoula, Montana, USA
| | - William C Rook
- Department of Pharmacy, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Faddy A Omar
- Department of Pharmacy, Holy Rosary Healthcare, Miles City, Montana, USA
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Simmons SM, Caird JK, Sterzer F, Asbridge M. The effects of cannabis and alcohol on driving performance and driver behaviour: a systematic review and meta-analysis. Addiction 2022; 117:1843-1856. [PMID: 35083810 DOI: 10.1111/add.15770] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Cannabis and alcohol are frequently detected in fatal and injury motor vehicle crashes. While epidemiological meta-analyses of cannabis and alcohol have found associations with an increase in crash risk, convergent evidence from driving performance measures is insufficiently quantitatively characterized. Our objectives were to quantify the magnitude of the effect of cannabis and alcohol-alone and in combination-on driving performance and behaviour. METHODS Systematic review and meta-analysis. We systematically searched Academic Search Complete, CINAHL, Embase, Scopus, Google Scholar, MEDLINE, PsycINFO, SPORTDiscus and TRID. Of the 616 studies that underwent full-text review, this meta-analysis represents 57 studies and 1725 participants. We extracted data for hazard response time, lateral position variability, lane deviations or excursions, time out of lane, driving speed, driving speed variability, speed violations, time speeding, headway, headway variability and crashes from experimental driving studies (i.e. driving simulator, closed-course, on-road) involving cannabis and/or alcohol administration. We reported meta-analyses of effect sizes using Hedges' g and r. RESULTS Cannabis alone was associated with impaired lateral control [e.g. g = 0.331, 95% confidence interval (CI) = 0.212-0.451 for lateral position variability; g = 0.198, 95% CI = 0.001-0.395 for lane excursions) and decreased driving speed (g = -0.176, 95% CI = -0.298 to -0.053]. The combination of cannabis and alcohol was associated with greater driving performance decrements than either drug in isolation [e.g. g = 0.480, 95% CI = 0.096-0.865 for lateral position variability (combination versus alcohol); g = 0.525, 95% CI = 0.049-1.002 for time out of lane (versus alcohol); g = 0.336, 95% CI = 0.036-0.636 for lateral position variability (combination versus cannabis; g = 0.475, 95% CI = 0.002-0.949 for time out of lane (combination versus cannabis)]. Subgroup analyses indicated that the effects of cannabis on driving performance measures were similar to low blood alcohol concentrations. A scarcity of data and study heterogeneity limited the interpretation of some measures. CONCLUSIONS This meta-analysis indicates that cannabis, like alcohol, impairs driving, and the combination of the two drugs is more detrimental to driving performance than either in isolation.
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Affiliation(s)
- Sarah M Simmons
- Department of Psychology, University of Calgary, Alberta, Canada
| | - Jeff K Caird
- Department of Psychology, University of Calgary, Alberta, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.,O'Brien Institute of Public Health, University of Calgary, Alberta, Canada
| | - Frances Sterzer
- Department of Psychology, University of Calgary, Alberta, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Betz MR, Jones LE. Do opioid prescriptions lead to fatal car crashes? AMERICAN JOURNAL OF HEALTH ECONOMICS 2022; 8:359-386. [PMID: 36910277 PMCID: PMC9997667 DOI: 10.1086/718511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Widespread opioid misuse suggests a potential for increased fatal car crashes. However, opioid use may not necessarily lead to additional crashes if drivers respond to opioid prevalence by substituting away from more inebriating intoxicants like alcohol. Combining data on local opioid prescription rates and car crashes from the Fatality Analysis and Reporting System, we use two-way fixed effects models to test the direction of the association between prescribing intensity and crash fatalities between 2007 and 2016. We estimate that a 10 percent increase in the local prescription rate is associated with a 1 percent increase in the number of driver deaths in motor vehicle accidents. The association is robust to several model specifications, and isolated to drivers most affected by the opioid crisis: males and 25 to 34 year-olds.
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Affiliation(s)
- Michael R Betz
- Department of Human Sciences, The Ohio State University, 171A Campbell Hall, 1787 Neil Ave., Columbus, Ohio, 43201
| | - Lauren E Jones
- Department of Human Sciences and John Glenn College of Public Affairs, The Ohio State University, 115E Campbell Hall, 1787 Neil Ave., Columbus, Ohio, 43201
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Zheng Q, Chan GCK, Wang Z, Connor JP, Ren Y, Thai PK. Assessing alcohol consumption in a Chinese urban population and a university town using high temporal resolution wastewater-based epidemiology. Drug Alcohol Depend 2022; 230:109178. [PMID: 34864567 DOI: 10.1016/j.drugalcdep.2021.109178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcohol consumption is a leading preventable risk factor for morbidity and mortality in China. Understanding drinking patterns provides important data to inform public health policies in alcohol control, especially in specific groups like university students. This study aims to assess the alcohol consumption patterns and level of use in an urban population and a university town in a Chinese city using wastewater-based epidemiology (WBE). METHODS Daily wastewater sample was collected from an urban catchment (n = 270) and every Wednesday's sample from a university town of 10 university campus (n = 43) in 2017-2018. Concentration of alcohol consumption biomarker in wastewater, ethyl sulfate, was measured by direct injection LC-MS/MS analysis. Per capita daily alcohol consumption was then back calculated for assessment purposes. RESULTS Per capita daily alcohol consumption was 1.4 ± 0.6 mL/ person aged 15 + /day (EPD) (range: 0.2-4.9) in the urban catchment and 1.3 ± 0.6 EPD (range: 0.3-2.6) in the university town. Trends of alcohol consumption were stable in both catchments in 2017-2018. Alcohol consumption on weekends (1.5 EPD) and weekdays (1.4 EPD) were at a similar level. Additionally, no difference was observed between holidays (1.5 EPD) and non-holidays (1.4 EPD). CONCLUSION There is a stable weekly drinking level in the studied urban population, which is different compared to studies conducted in Western countries. Our study suggested a similar consumption level between the urban population and university students. Drinking during weekdays could negatively affect China's economic productivity and future public health policies could be adapted to reflect this pattern of drinking.
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Affiliation(s)
- Qiuda Zheng
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102 Brisbane, Australia.
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Zhe Wang
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102 Brisbane, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD 4072, Australia; Discipline of Psychiatry, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Yuan Ren
- School of Environment and Energy, South China University of Technology, Higher Education Mega Center, Panyu District, Guangzhou 510006, PR China.
| | - Phong K Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, 4102 Brisbane, Australia
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Gioldasis C, Christoforou Z, Seidowsky R. Risk-taking behaviors of e-scooter users: A survey in Paris. ACCIDENT; ANALYSIS AND PREVENTION 2021; 163:106427. [PMID: 34628268 DOI: 10.1016/j.aap.2021.106427] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/23/2021] [Accepted: 09/24/2021] [Indexed: 06/13/2023]
Abstract
Risk-taking behavior is often held responsible for increased crash involvement. We designed and undertook a face-to-face road survey (N = 459) in order to explore incident involvement history, driving attitudes and perceived risk among e-scooter users is Paris, France. Three risk factors were specifically explored: (i) riding after having consumed alcohol, (ii) riding after having consumed drugs, and (iii) using the smartphone while riding. The relationship between these factors and user attributes (such as age and gender) and travel behavior (such as frequency of e-scooter usage and trip duration) was examined using logit and mixed logit specifications and a structural equation model. Empirical evidence suggests that it is more likely for young and male riders to develop risky behaviors. Longer trip durations seem to be associated with risk-taking behaviors.
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Affiliation(s)
- Christos Gioldasis
- COSYS-GRETTIA, Univ Gustave Eiffel, IFSTTAR, F-77447 Marne-la-Vallée, France; University of Patras, Department of Civil Engineering, Panepistimioupoli Patron 265 04, Patras, Greece.
| | - Zoi Christoforou
- COSYS-GRETTIA, Univ Gustave Eiffel, IFSTTAR, F-77447 Marne-la-Vallée, France; University of Patras, Department of Civil Engineering, Panepistimioupoli Patron 265 04, Patras, Greece
| | - Régine Seidowsky
- COSYS-GRETTIA, Univ Gustave Eiffel, IFSTTAR, F-77447 Marne-la-Vallée, France
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Maurer J, Vergalito E, Prior AF, Donzé N, Thomas A, Augsburger M. Suspicion of driving under the influence of alcohol or drugs: Cross sectional analysis of drug prevalence in the context of the Swiss legislation. Forensic Sci Int 2021; 329:111081. [PMID: 34741989 DOI: 10.1016/j.forsciint.2021.111081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Abstract
Driving under the influence of alcohol and drugs (DUID) is a major field of study to improve road safety. In Switzerland, during controls whether or not they follow an accident, the police can request toxicological analysis targeted either on alcohol only (ALC cases), or on drugs and alcohol (DUID cases). To evaluate both the drugs consumption on the road and whether or not these requests are well correlated with toxicological results, we built a database recording 4003 offenders (3443 males, 550 females) over a two-year period (2018-2019) in Western Switzerland. ALC case samples were then analyzed to target other substances than ethanol. We found one or more psychoactive drugs in 89% of DUID cases and alcohol alone was found in 56% of ALC cases. In ALC cases, alcohol alone was found in 72% of non-accident cases and in 52% of accident cases. This highlights an influence of accident context, inducing a too high suspicion of alcohol after accidents, and therefore an underestimation of the prevalence of other drugs. The most frequently detected drugs in DUID cases were cannabinoids (58%), ethanol (30%), cocaine (21%), benzodiazepines (11%), amphetamines (7%), opiates (6%), and antidepressants (5%). For the ALC cases, the drugs found were ethanol (84%), cannabinoids (13%), benzodiazepines (9%), antidepressants (6%), opiates (5%), cocaine (4%), methadone (3%), and amphetamines (1%). Prescription drugs, such as benzodiazepines, were common in accidents (22%) but rare in non-accidents DUID cases (5%). Thus, these drugs highly impact driving skills while being hard to suspect. This is of first concern as prescription drugs are largely found in poly-drug consumption, especially in combination with alcohol in accident cases. This emphasizes the emerging issue of prescription drugs and should motivate a strategy of prevention focused on the noxious effect of combining alcohol and prescription drugs on driving skills.
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Affiliation(s)
- Jonathan Maurer
- Laboratory of Catecholamines and Peptides, Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Av. Pierre-Decker 5, 1011 Lausanne, Switzerland; Ecole des Sciences Criminelles/School of Criminal Justice, Faculty of Law, Criminal Justice, and Public Administration, University of Lausanne, 1015 Lausanne, Switzerland; University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne - Geneva University Hospital and University of Geneva, Lausanne Geneva, Switzerland.
| | - Emeline Vergalito
- Institut National de Criminalistique et de Criminologie, Chaussée de Vilvorde 100, 1120 Bruxelles, Belgium
| | - Anne-Flore Prior
- Ecole des Sciences Criminelles/School of Criminal Justice, Faculty of Law, Criminal Justice, and Public Administration, University of Lausanne, 1015 Lausanne, Switzerland
| | - Nicolas Donzé
- Hôpital du Valais - Institut Central, Service de Chimie Clinique et Toxicologie, Avenue du Grand Champsec 86, 1950 Sion, Switzerland
| | - Aurélien Thomas
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne - Geneva University Hospital and University of Geneva, Lausanne Geneva, Switzerland; Faculty Unit of Toxicology, CURML, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marc Augsburger
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne - Geneva University Hospital and University of Geneva, Lausanne Geneva, Switzerland
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Renzi F, Reitano E, Franca D, Chiara O, Cimbanassi S. Trauma, alcohol and drugs misuse in car and motorcycle drivers: a prevalence study in a level one trauma center. Updates Surg 2021; 74:1129-1136. [PMID: 34515980 PMCID: PMC9213368 DOI: 10.1007/s13304-021-01131-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Abstract
Alcohol and drugs misuse represents an important social problem. There is no agreement about influence of ethanol and drugs on trauma severity and clinical course. The aim of this study was to investigate the impact of alcohol and drugs abuse on road related trauma managed to our Level I Trauma Center. Data of 1067 car or motorcycle drivers consecutively admitted in a 5 years period were retrospectively analyzed. The sample was divided into two groups: patients with alcohol and/or drugs misuse and patients without detectable plasmatic levels or not screened because no clinical suspicion of these substance. Demographic data, mechanism of trauma, severity of injury, daily and season time of trauma distribution, alcohol and drugs levels and outcomes were retrieved. Alcohol or drugs misuse were detected in 242 patients. Heavy alcohols levels were the 62.3%. Among drugs cannabis was the most detected substance. These patients were significantly younger than the overall study population (p = 0.011), with a higher ISS (p = 0.012) a lower RTS (p = 0.047), a lower GCS (p = 0.005) and an higher head injuries severity (p = 0.030). Regarding time distribution, Saturday was the day with the highest percentage of trauma associated with substance misuse (21%). Alcohol/drugs misuse plays a very important role in the epidemiology of road related trauma. Despite the higher severity of trauma scores and the higher incidence of severe head injuries in patients with alcohol or drugs consumption, there were no effects of this substances on mortality of injured patients involved in road crashes.
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Affiliation(s)
- Federica Renzi
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3Milano, 20162, Milan, Italy
| | - Elisa Reitano
- Division of General Surgery, Department of Translational Medicine, Maggiore Della Carità Hospital, University of Eastern Piedmont, Corso Giuseppe Mazzini 18, Novara, Italy
| | - Davanzo Franca
- Milan Poison Control Centre, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162, Milan, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, University of Milan, ASST Niguarda, Piazza Ospedale Maggiore 3Milano, 20162, Milan, Italy.
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda, Piazza Ospedale Maggiore 3Milano, 20162, Milan, Italy
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Bourdeau M, Guibert N, Fort E, Boulogne S, Lagarde E, Charbotel B. Medicine consumptions and occupational road risk. ACCIDENT; ANALYSIS AND PREVENTION 2021; 158:106202. [PMID: 34051434 DOI: 10.1016/j.aap.2021.106202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Whereas an increased risk of road traffic crashes has been highlighted as linked to some medicine consumptions, there is no available data on this risk according to the type of journey (private, commuting or mission). Drivers on occupational journey (commuting or mission) are likely to have different coping behaviors related to the use of medicines than drivers on private journey. The aim of our study was to investigate the association between exposure to ten classes of medicines and the risk of being responsible for a road traffic crash according to the type of journey (private, commuting or mission). METHODS The data used came from three French national databases: the national police database of injurious crashes, the police reports and the national health care insurance database. A total of 179,269 drivers aged between 18 and 65 years old involved in an injurious crash in France between July 2005 and December 2015 were included in the analyses. Logistic regression models stratified by journey were used to estimate the Odds Ratios (OR) and 95 % confidence intervals (95 % CI), adjusted for potential confounding factors. RESULTS Medicines exposure levels were generally lower for drivers during occupational journeys, the risk of being responsible for a road traffic crash seems to be higher on commuting or mission journeys than on private journeys for four medicines. Indeed, for antiepileptics the OR was 1.59 [1.01-2.51] for mission journeys, 1.63 [1.24-2.15] for commuting journeys, and 1.47 [1.25-1.73] for private journey. For psycholeptics the OR was 1.02 [0.80-1.28] for mission journey, 1.19 [1.03-1.39] for commuting and 1.17 [1.08-1.26] for private journey. For psychoanaleptics OR was 1.35 [1.02-1.78] for mission journeys, 1.37 [1.17-1.60] for commuting journeys and 1.26 [1.14-1.40] for private journeys. Finally, for other nervous system drugs OR reached 2.04 [1.35-3.07] for mission journeys compared to 1.43 [1.21-1.70] for private journeys. CONCLUSION Our results encourage the implementation of preventive measures about some treatments and diseases in the context of occupational journeys.
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Affiliation(s)
- Manon Bourdeau
- University of Lyon, University of Lyon 1, University of Gustave Eiffel, UMRESTTE, UMR T_9405, F- 69373, Lyon, France
| | - Nicolas Guibert
- University of Lyon, University of Lyon 1, University of Gustave Eiffel, UMRESTTE, UMR T_9405, F- 69373, Lyon, France; Hospices Civils de Lyon, Service de médecine du travail, Hôpital Edouard Herriot, 69003, Lyon, France
| | - Emmanuel Fort
- University of Lyon, University of Lyon 1, University of Gustave Eiffel, UMRESTTE, UMR T_9405, F- 69373, Lyon, France.
| | - Sébastien Boulogne
- Hospices Civils de Lyon, Service des Maladies Professionnelles, Centre Hospitalier Lyon Sud, F-69495 Pierre Bénite, France; Hospices Civils de Lyon, Service neurologie fonctionnelle et épileptologie, Hôpital neurologique, Hospices civils de Lyon, 69577, Bron, France
| | - Emmanuel Lagarde
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team IETO, UMR 1219, F-33000 Bordeaux, France
| | - Barbara Charbotel
- University of Lyon, University of Lyon 1, University of Gustave Eiffel, UMRESTTE, UMR T_9405, F- 69373, Lyon, France; Hospices Civils de Lyon, Service des Maladies Professionnelles, Centre Hospitalier Lyon Sud, F-69495 Pierre Bénite, France
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Beccegato E, Ruggeri A, Montisci M, Terranova C. Driving license regranting in DUI subjects: Road accident variables and predictive factors of substance use disorder. Sci Prog 2021; 104:368504211033702. [PMID: 34289765 PMCID: PMC10364946 DOI: 10.1177/00368504211033702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A comparative case study (2017-2020) was conducted to identify demographic, social, medico-legal, and toxicological variables associated with non-fatal accidents in driving under the influence (DUI) subjects. A second aim was to identify the factors predictive of substance use disorders among subjects. Drivers charged with alcohol DUI (blood alcohol concentration (BAC) > 0.5) and/or psychoactive substance DUI were included; cases included those involved in an accident while intoxicated, and the comparison group included DUI offenders negative for road accident involvement. Significance was determined by chi-square and Mann-Whitney tests. To prevent confounding effects, a multivariate binary logistic regression analysis was performed. Our sample encompassed 882 subjects (381 in the case group and 501 in the comparison group). Parameters such as psychoactive substances and BAC at the time of the road crash/DUI and the day of the week, when subjects were involved in the road accident or found DUI, resulted in significant differences (p < 0.01) between groups. The model's independent variables of BAC > 1.5 g/L (p = 0.013), BAC > 2.5 g/L (p < 0.001), and concurrent alcohol and psychoactive substance use (p < 0.001) were independent risk factors for an accident. Smoking >20 cigarettes/day was an independent risk factor for unfitness to drive (p < 0.01). Unfitness to drive was based primarily on ethyl glucuronide levels >30 pg/mg. Our results suggest a detailed assessment of DUI subjects with variables associated with accidents (BAC > 1.5 g/L and concurrent intake of psychoactive substances). Hair analysis, including ethylglucuronide (EtG) concentration, should be always performed. Based on our results, nicotine use should be investigated in cases of driving license regranting.
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Affiliation(s)
- Elena Beccegato
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Angelo Ruggeri
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimo Montisci
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Claudio Terranova
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Wilson T, Wisborg T, Vindenes V, Jamt RG, Furuhaugen H, Bogstrand ST. Psychoactive substances have major impact on injuries in rural arctic Norway - A prospective observational study. Acta Anaesthesiol Scand 2021; 65:824-833. [PMID: 33638866 DOI: 10.1111/aas.13807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rural areas have increased injury mortality with a high pre-hospital death rate. Knowledge concerning the impact of psychoactive substances on injury occurrence is lacking for rural arctic Norway. These substances are also known to increase pre-, per- and postoperative risk. The aim was by prospective observational design to investigate the prevalence and characteristics of psychoactive substance use among injured patients in Finnmark county. METHODS From January 2015 to August 2016, patients ≥18 years admitted to hospitals in Finnmark due to injury were approached when competent. Blood was analysed for ethanol, sedatives, opioids, hypnotics and illicit substances in consenting patients, who completed a questionnaire gathering demographic factors, self-reported use/behaviour and incident circumstances. RESULTS In 684 injured patients who consented to participation (81% consented), psychoactive substances were detected in 35.7%, alcohol being the most prevalent (23%). Patients in whom substances were detected were more often involved in violent incidents (odds ratio 8.92 95% confidence interval 3.24-24.61), indicated harmful use of alcohol (odds ratio 3.56, 95% confidence interval 2.34-5.43), reported the incident being a fall (odds ratio 2.21, 95% confidence interval 1.47-3.33) and presented with a reduced level of consciousness (odds ratio 3.91, 95% confidence interval 1.58-9.67). Subgroup analysis revealed significant associations between testing positive for a psychoactive substance and being diagnosed with a head injury or traumatic brain injury. CONCLUSION A significant proportion of injured patients had used psychoactive substances prior to admission. Use was associated with violence, falls, at-risk alcohol consumption, decreased level of consciousness on admittance and head injury.
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Affiliation(s)
- Thomas Wilson
- University of TromsøThe Arctic University of Norway Tromsø Norway
- Department of Forensic Sciences Section for Drug Abuse Research Oslo University Hospital Oslo Norway
- Department of Anaesthesia and Intensive Care Hammerfest HospitalFinnmark Hospital Trust Hammerfest Norway
| | - Torben Wisborg
- University of TromsøThe Arctic University of Norway Tromsø Norway
- Department of Anaesthesia and Intensive Care Hammerfest HospitalFinnmark Hospital Trust Hammerfest Norway
- Norwegian National Advisory Unit on Trauma Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
| | - Vigdis Vindenes
- Department of Forensic Sciences Section for Drug Abuse Research Oslo University Hospital Oslo Norway
| | - Ragnhild G. Jamt
- Department of Forensic Sciences Section for Drug Abuse Research Oslo University Hospital Oslo Norway
| | - Håvard Furuhaugen
- Department of Forensic Sciences Section for Drug Abuse Research Oslo University Hospital Oslo Norway
| | - Stig Tore Bogstrand
- Department of Forensic Sciences Section for Drug Abuse Research Oslo University Hospital Oslo Norway
- Institute of Health and Society Faculty of Medicine University of Oslo Oslo Norway
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Evaluating the Effects of Holidays on Road Crash Injuries in the United Kingdom. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010280. [PMID: 33401486 PMCID: PMC7795181 DOI: 10.3390/ijerph18010280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research suggests that drivers tend to engage in risk-taking behaviours on public holidays. Studies that examined the association between holidays (or other special days) and fatal injuries are inconsistent. This study used UK STATS19 data to investigate the associations of nine public holidays on road crash casualties. METHODS This retrospective study assessed UK STATS19 crash data for 1990-2017. All casualties from two vehicle crashes were initially considered; subsequently, casualties with missing data were excluded. Multiple logistic regression was estimated to explore the associations of potential risk factors with the likelihood of killed or seriously injured (KSI) casualties and to calculate adjusted odds ratios (AORs). RESULTS In total, 3,751,998 casualties from traffic accidents in the United Kingdom during 1990-2017 were included in the final data set; among these, 410,299 (10.9%) were KSI casualties, and 3,341,699 (89.1%) were slight injuries. Crashes on public holidays were 16% (AOR = 1.16; 95% confidence interval [CI] = 1.13-1.19) more likely to involve KSI casualties than were crashes on non-holidays. With other factors controlled for, crashes during the Queen's 2002 Golden Jubilee and on New Year's Day were 48% (AOR = 1.48; 95% CI = 1.06-2.07) and 36% (AOR = 1.36; 1.26-1.48) more likely to lead to KSIs, respectively. CONCLUSIONS The proportion of crashes resulting in KSI casualties on public holidays was higher than that on non-holidays. Furthermore, crashes during the Queen's 2002 Golden Jubilee had the highest risk of KSI casualties followed by New Year's Day.
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Høiseth G, Hjelmeland K, Mørland J. A comparison of driving related skills impaired by ethanol and zopiclone. TRAFFIC INJURY PREVENTION 2020; 22:26-31. [PMID: 33320019 DOI: 10.1080/15389588.2020.1849643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023]
Abstract
Objective: Ethanol and zopiclone are both sedating drugs that impair traffic relevant skills, but that show vast differences in epidemiological traffic risk. One explanation for this could be that they impair various kinds of skills differently, but this is less previously studied. The aim of this study was to compare effects of zopiclone and ethanol on a large battery of computerized psychomotor and cognitive tests according to different test classifications. Methods: Ethanol (50 grams), zopiclone 5 mg, zopiclone 10 mg or placebo was administered in a randomized trial with a cross-over design. Blood was sampled nine times after administration and analyzed for zopiclone and ethanol using fully validated methods. The computerized tests Connors Continuous Performance Test (CPT), Stockings of Cambridge (SOC) and choice reaction time (CRT) was performed at baseline and after administration. The three tests yielded fifteen different test components, which were categorized according to the three well-known behavior levels (automative behavior, control behavior and executive planning). Secondly, they were categorized into tests measuring "reaction time", "impulsivity" and "attention/cognition". Results: On all tests belonging to behavior level 1 and on all tests measuring "reaction time", more subjects were impaired by zopiclone than ethanol. On all tests measuring "impulsivity", more subjects were impaired by ethanol than zopiclone. Conclusion: Zopiclone and ethanol both lead to impairment, but have a different profile on what kind of tests and neurocognitive functions they mostly impair. This could be important in the understanding of the differences in traffic risk connected to these two drugs.
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Affiliation(s)
- Gudrun Høiseth
- Department of Forensic Toxicology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Hjelmeland
- Department of Forensic Toxicology, Oslo University Hospital, Oslo, Norway
| | - Jørg Mørland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
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Lasota D, Al-Wathinani A, Krajewski P, Goniewicz K, Pawłowski W. Alcohol and Road Accidents Involving Pedestrians as Unprotected Road Users. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8995. [PMID: 33276696 PMCID: PMC7729452 DOI: 10.3390/ijerph17238995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022]
Abstract
According to the World Health Organization (WHO), more than half of all road fatalities involve vulnerable road users, i.e., pedestrians, cyclists, and motorcyclists. Poland is classified as one of the European Union (EU) countries marked by low road safety, with a higher frequency of accidents involving pedestrians compared to other EU countries (31% of all fatalities). Among unprotected road users, a significant group of victims are pedestrians, who are often under the influence of alcohol. This study aims to analyze the impact of alcohol on the risk of occurrence and consequences of road accidents among pedestrians. The source of data was the medical documentation of the Department of Forensic Medicine of the Medical University of Warsaw. In more than half of pedestrian deaths, the presence of alcohol was found; regardless of the place of the event and the place of death, among the victims under the influence of alcohol, males dominated; the average age of the victims under the influence of alcohol was significantly lower compared to the average age of sober victims, with younger victims being significantly more likely to die at the scene of the accident, especially in rural areas; significantly higher alcohol concentrations were found in males, in victims who died at the scene of the accident, and with victims of accidents in rural areas. Among pedestrian traffic accident fatalities, the most numerous group comprised young men under the influence of alcohol. In rural areas, a higher percentage of pedestrian victims died at the scene as a result of excessive alcohol consumption. These areas should be subject to intensive preventive measures to increase the safety of pedestrians as unprotected road users.
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Affiliation(s)
- Dorota Lasota
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Ahmed Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Paweł Krajewski
- Department of Forensic Medicine, Medical University of Warsaw, 00-001 Warsaw, Poland;
| | - Krzysztof Goniewicz
- Department of Aviation Security, Military University of Aviation, 08-521 Dęblin, Poland;
| | - Witold Pawłowski
- Department of Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland
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Kogani M, Almasi SA, Ansari-Mogaddam A, Dalvand S, Okati-Aliabad H, Tabatabaee SM, Almasi SZ. Relationship between using cell phone and the risk of accident with motor vehicles: An analytical cross-sectional study. Chin J Traumatol 2020; 23:319-323. [PMID: 32893116 PMCID: PMC7718539 DOI: 10.1016/j.cjtee.2020.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Traffic accidents are one of the major health problems in the world, being the first cause of burden of illness and the second leading cause of death in Iran. The Sistan-Baluchestan province is one of the most accidental provinces of Iran with the highest rate of accidents-caused deaths. This study was conducted to determine the risk factors associated with traffic accidents in Zahedan through 2013 to 2016. METHODS This analytical cross-sectional study was carried out on 223 drivers from Zahedan who were traumatized by traffic accident and sent to Zahedan hospitals. The data were obtained through interviews taken by the trained interviewers via refereeing to the medical records and collected in the researcher-made checklist. Census was obtained from the study subjects. For data analysis, independent t-test, one-way ANOVA, Chi-square and logistic regression were used with the Stata software version 11.0. RESULTS In this study, 223 male subjects with the mean age of (32.54 ± 12.95) years, 39.8% single and 60.2% married, entered for investigation. Most accidents (38.8%) occurred between 12:00 to 17:59. While driving, 47.1% of the study subjects were using cell phones, 89.1% had manual use of mobile phones, 21.9% had a habit of sending short message service (SMS) and 23.4% had sent SMS within 10 min before the accident. The one way analysis of variance showed that the mean age of individuals with marital status, driving experience, education and accident with motorcycle were significantly different (p < 0.05). Also, the multivariate logistic regression test indicated a significant relationship of smoking, ethnicity, insurance and SMS typing while driving with motorcycle accident (p < 0.05). CONCLUSION In this study, SMS and smoking while driving had the highest risk among the variables studied in the motorcycle accidents. Therefore, effective education attempting to enhance people's awareness about the consequences of using cell phone and smoking during driving to reduce traffic accidents seems necessary.
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Affiliation(s)
- Mohammad Kogani
- Department of Epidemiology and Biostatistics, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Almasi
- Department of Civil Engineering, Imam Khomeini International University, Qazvin, Iran
| | | | - Sahar Dalvand
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Okati-Aliabad
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Seyedeh Zeinab Almasi
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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Chihuri S, Li G. Direct and indirect effects of marijuana use on the risk of fatal 2-vehicle crash initiation. Inj Epidemiol 2020; 7:49. [PMID: 32921302 PMCID: PMC7488993 DOI: 10.1186/s40621-020-00276-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Marijuana and alcohol each play a significant role in fatal crash initiation. We decomposed the total effect of marijuana use in the presence or absence of alcohol on fatal crash initiation into direct and indirect effects. METHODS Pair-matched data on 5856 culpable drivers (initiators) and 5856 nonculpable drivers (noninitiators) involved in the same fatal 2-vehicle crashes recorded in the Fatality Analysis Reporting System between 2011 and 2016 were analyzed using the conditional logistic regression model and the unified mediation and interaction analysis framework. RESULTS Crash initiators were more likely than noninitiators to test positive for marijuana (16.1% vs. 9.2%, P < 0.001), alcohol (28.6% vs. 9.7%, P < 0.001) and both substances (6.3% vs. 1.6%, P < .0001). Adjusted odds ratios of fatal 2-vehicle crash initiation revealed a positive interaction on the additive scale between marijuana and alcohol. Of the total effect of marijuana use on fatal 2-vehicle crash initiation, 68.8% was attributable to the direct effect (51.5% to controlled direct effect and 17.3% to reference interaction effect with alcohol) and 31.2% to the indirect effect (7.8% to mediated interaction effect and 23.4% to pure indirect effect through alcohol). CONCLUSION Our results indicate that the increased odds of fatal 2-vehicle crash initiation associated with marijuana use is due mainly to the direct effect.
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Affiliation(s)
- Stanford Chihuri
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th St, PH5-505, New York, NY 10032 USA
| | - Guohua Li
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th St, PH5-505, New York, NY 10032 USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 622 West 168th St, PH5-505, New York, NY 10032 USA
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Lu L, Contrand B, Gadegbeku B, Salmi LR, Lagarde E. Road traffic crash characteristics of drivers who take prescription medicines that carry a risk to driving. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102929. [PMID: 32919299 DOI: 10.1016/j.drugpo.2020.102929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The specific features of crashes involving an alcohol-intoxicated driver have been extensively characterized, but no such data are available for crashes involving a driver who has used a prescription medicine, which could help to plan and target prevention and control initiatives. This study aimed to describe the characteristics of crashes involving drivers under the influence of prescription medicines. METHODS We took advantage of CESIR, a French record linkage study for which data were extracted and matched from three French national databases: police reports, the national police database of injurious crashes and the national health care insurance database (HCI database). The drivers included in the study were those involved in an injurious road crash in France from July 1, 2005 to December 31, 2015, whose national identity number, date of birth and sex allowed matching. Prescription medicines considered were those with the two highest levels of warning. RESULTS Similar crash profiles were found when drivers used alcohol or medicines, particularly with respect to injury severity, type of vehicle, type of collision, type of road and cross-track profile. Alcohol-related crashes were over-represented during weekends and in low-density areas and medicine-related crashes were over-represented during weekdays and in cities of fewer than 300 000 inhabitants. While a much higher strength of association with responsibility was found for alcohol than for medicines, the proportion of crashes with drivers using medicines was twice as high as crashes with drivers using alcohol. CONCLUSION The lower risk carried by medicines is therefore in part compensated by a higher prevalence of use, making medicines one of the hidden factors of road risk. Characterizing these crashes will therefore be useful to better focus road safety intervention on the prevention of driving under the influence of psychotropic medicines.
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Affiliation(s)
- Li Lu
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Benjamin Contrand
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Blandine Gadegbeku
- Université de Lyon, Université Gustave Eiffel, IFSTTAR, UMRESTTE UMR_T9405, F-69675 Lyon, France
| | - Louis-Rachid Salmi
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France; Service d'Information Médicale, Pôle de Santé Publique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Emmanuel Lagarde
- Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, Bordeaux, France; Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France.
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20
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Höiseth G, Nilsson GH, Lundberg R, Forsman M, Kronstrand C, Nyström I, Oscarsson C, Ericsson E, Cherma MD, Ahlner J, Kugelberg FC, Kronstrand R. Evaluating the hip-flask defence using analytical data from ethanol and ethyl glucuronide. A comparison of two models. Forensic Sci Int 2020; 316:110409. [PMID: 32871451 DOI: 10.1016/j.forsciint.2020.110409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/19/2022]
Abstract
AIM Claimed intake of alcohol after a traffic incident, called the hip-flask defence, can be objectively assessed by different methods. One of them is the use of two consecutive ethanol concentrations in urine and the ratio between ethanol concentrations in urine and blood. Another one is the concentrations of ethyl glucuronide (EtG) and ethyl sulphate (EtS) in blood and their ratio to ethanol. The experimental basis for both these models is from single dose studies only. The aim of this study was therefore to describe the kinetics of ethanol, EtG and EtS after ingestion of two repeated doses of ethanol and to investigate the usefulness of the different models for the assessment of the hip-flask defence. METHODS Thirty-five subjects ingested a first dose of 0.51 g of ethanol per kilo body weight, and two hours later a second dose (the hip-flask drink) of 0.25, 0.51 or 0.85 g of ethanol per kilo body weight. Ten urine and 17 blood samples were collected and analysed for ethanol, EtG and EtS using fully validated methods. It was investigated if all subjects fulfilled the criteria for recent drinking, according to the two different models, when using the samples collected 180-240 minutes after start of first dose drinking. According to the first model, increase in urinary ethanol concentrations and a ratio UAC/BAC below 1.3 indicated recent drinking. According to the second model, increase in blood EtG concentrations and a ratio ethanol (g/kg)/EtG (mg/L) above 1 indicated recent drinking. RESULTS All subjects in the high dose group fulfilled all criteria for recent drinking. One subject in the medium dose group and nine subjects in the low dose group failed to show increasing UAC and/or a UAC/BAC ratio below 1.3. One subject in the low dose group failed to show increasing concentrations of blood EtG, but all subjects showed a ratio ethanol/EtG above 1. CONCLUSIONS The present study showed, by the use of experimental data, that both two models used to investigate the hip-flask defence can be used, but only when the hip-flask dose is sufficiently high.
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Affiliation(s)
- G Höiseth
- Oslo University Hospital, Department of Forensic Sciences, Oslo, Norway; Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway; University of Oslo, Institute of Clinical Medicine, Oslo, Norway.
| | - G H Nilsson
- National Board of Forensic Medicine, Department of Forensic Genetics and Forensic Toxicology, Linköping, Sweden
| | - R Lundberg
- National Board of Forensic Medicine, Department of Forensic Genetics and Forensic Toxicology, Linköping, Sweden
| | - M Forsman
- National Board of Forensic Medicine, Department of Forensic Genetics and Forensic Toxicology, Linköping, Sweden
| | - C Kronstrand
- Linköping University, Faculty of Health Sciences, Linköping, Sweden
| | - I Nyström
- National Board of Forensic Medicine, Department of Forensic Genetics and Forensic Toxicology, Linköping, Sweden
| | - C Oscarsson
- National Board of Forensic Medicine, Department of Forensic Genetics and Forensic Toxicology, Linköping, Sweden
| | - E Ericsson
- National Board of Forensic Medicine, Department of Forensic Genetics and Forensic Toxicology, Linköping, Sweden
| | - M D Cherma
- National Board of Forensic Medicine, Department of Forensic Genetics and Forensic Toxicology, Linköping, Sweden
| | - J Ahlner
- National Board of Forensic Medicine, Department of Forensic Genetics and Forensic Toxicology, Linköping, Sweden; Linköping University, Department of Biomedical and Clinical Sciences, Division of Drug Research, Linköping, Sweden
| | - F C Kugelberg
- National Board of Forensic Medicine, Department of Forensic Genetics and Forensic Toxicology, Linköping, Sweden; Linköping University, Department of Biomedical and Clinical Sciences, Division of Drug Research, Linköping, Sweden
| | - R Kronstrand
- National Board of Forensic Medicine, Department of Forensic Genetics and Forensic Toxicology, Linköping, Sweden; Linköping University, Department of Biomedical and Clinical Sciences, Division of Drug Research, Linköping, Sweden
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Wiratama BS, Chen PL, Ma ST, Chen YH, Saleh W, Lin HA, Pai CW. Evaluating the combined effect of alcohol-involved and un-helmeted riding on motorcyclist fatalities in Taiwan. ACCIDENT; ANALYSIS AND PREVENTION 2020; 143:105594. [PMID: 32474168 DOI: 10.1016/j.aap.2020.105594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/22/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Alcohol-involved riders tend to engage in other risk-taking behaviours such as un-helmeted riding which could further increases injury severity. The combined effect of alcohol-involved and un-helmeted riding on fatal injuries is rarely investigated. This study investigated the interaction effect between blood alcohol concentration and helmet use on fatal injuries. METHODS This study used the National Taiwan Traffic Crash Dataset for the period from 2011 to 2015. Data on road crashes involving a motorcycle and an automobile were extracted and analysed. Multiple logistic regression models were used to calculate the adjusted odds ratio (AOR). We calculated an interaction effect for blood alcohol concentration and helmet use based on STROBE guidelines. RESULTS There were a total of 669,292 motorcyclist casualties; among these casualties, 3459 (0.5 %) motorcyclists sustained fatal injuries. Alcohol-involved riders were 9.47 times (AOR = 9.47; 95 % CI = 8.75-10.25) more likely than sober ones to sustain fatal injuries. Alcohol-involved and un-helmeted riders were approximately 18 times (AOR = 18.1; CI: 15.9-20.4) more likely to sustain fatal injuries than sober and helmeted riders. Riders involved in head-on crashes and approach-turn motorcycle crashes had an increased probability of sustaining fatal injuries by 240 % (AOR = 3.4; 95 % CI = 2.91-4.09) and 132 % (AOR = 2.3; 95 % CI = 2.016-2.67), respectively. CONCLUSIONS This study found that alcohol-involved riding acts synergistically with un-helmeted riding to increase motorcyclist injury severity.
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Affiliation(s)
- Bayu Satria Wiratama
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Epidemiology, Biostatistics and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, Indonesia.
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.
| | - Shiao-Tzu Ma
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.
| | - Yi-Hua Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Emergency Medicine, New Taipei City Hospital, New Taipei City, Taiwan.
| | - Wafaa Saleh
- Transport Research Institute, Edinburgh Napier University, Scotland, United Kingdom; Department of Engineering, Princess Nora bint Abdul Rahman University Riyadh, Saudi Arabia.
| | - Hui-An Lin
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Emergency Medicine, Taipei Medical University Hospital, Taipei City, Taiwan.
| | - Chih-Wei Pai
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.
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Kelty E, Hulse G, Joyce D, Preen DB. Impact of Pharmacological Treatments for Opioid Use Disorder on Mortality. CNS Drugs 2020; 34:629-642. [PMID: 32215842 DOI: 10.1007/s40263-020-00719-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The use of pharmacological treatments for opioid use disorders, including methadone, buprenorphine and naltrexone has been associated with a reduction in mortality compared with illicit opioid use. However, these treatments can also contribute significantly to the risk of death. The opioid agonists methadone and buprenorphine achieve clinical efficacy in patients with an opioid use disorder through suppressing craving and diminishing the effectiveness of illicit opioid doses, while the antagonist naltrexone blocks the action of opioids. Pharmacological differences between opioid pharmacotherapies then create different temporal patterns of protection and mortality risk, different risks of relapse to illicit opioid use, and variations in direct and indirect toxicity, which are revealed in clinical and epidemiological studies. Induction onto methadone and the cessation of oral naltrexone treatment are associated with an elevated risk of opioid poisoning, which is not apparent in patients treated with buprenorphine or sustained-release naltrexone. Beyond drug-related mortality, these pharmacotherapies can impact a participant's risk of death. Buprenorphine may also have some advantages over methadone in patients with depressive disorders or cardiovascular abnormalities. Naltrexone, which is also commonly prescribed to manage problem alcohol use, may reduce deaths in chronic co-alcohol users. Understanding these pharmacologically driven patterns then guides the judicious choice of drug and dosing schedule and the proactive risk management that is crucial to minimising the risk of death in treatment.
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Affiliation(s)
- Erin Kelty
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.
| | - Gary Hulse
- Division of Psychiatry, Medical School, The University of Western Australia, Perth, WA, Australia.,Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - David Joyce
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia
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Gonçalves REM, de Carvalho Ponce J, Leyton V. Alcohol Consumption and Violent Deaths in the City of Sao Paulo in 2015. Subst Use Misuse 2020; 55:1875-1880. [PMID: 32460601 DOI: 10.1080/10826084.2020.1771596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Excessive alcohol consumption is a serious public health issue, because drunkenness affects critical judgment and self-control, making people more vulnerable to violence and accidents, with thus a potential association between alcohol consumption and violent deaths. Objective: To assess the association between alcohol consumption and violent deaths in the city of Sao Paulo, Brazil, in 2015, and its relationship with gender, age, cause of death and blood alcohol concentration (BAC) of victims. Methods: A cross-sectional retrospective study was conducted by collection of data from 2,882 victims of violent deaths subjected to examination of BAC from the archives of the Institute of Legal Medicine of the State of Sao Paulo, Brazil. Results: Alcohol was detected in blood samples of 27.06% of the victims and mean BAC levels were 1.92 ± 1.24 g/L. The mean age of the victims was 33.49 ± 15.19 years. The majority of the victims were male (84.14%) and the prevalence of positive BAC was higher amongst men (28.74%) than women (18.16%). Homicide was the most prevalent cause of death in the sample (36.57%), but there were a higher proportion of traffic accidents victims with positive BAC (32.01%), as well as higher BAC levels in these victims (46.77% in the range of 1.6-2.5 g/L). Conclusions: The results obtained in this study support a potential association between alcohol consumption and violent deaths in the city of Sao Paulo, mainly in traffic accidents victims.
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Affiliation(s)
| | - Júlio de Carvalho Ponce
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Vilma Leyton
- Department of Legal Medicine, Ethics and Occupational Health, University of Sao Paulo Medical School, Sao Paulo, Brazil
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24
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Validity and Reliability of the Attitudes toward Traffic Safety Scale in Argentina. SPANISH JOURNAL OF PSYCHOLOGY 2019; 22:E51. [PMID: 31787124 DOI: 10.1017/sjp.2019.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The main objective of this research was to investigate the psychometric properties of a Spanish-language version of the Attitudes toward Traffic Safety Scale (ATTS) for the assessment of risky driving attitudes among Spanish-speaking populations. Five hundred and fifty-eight drivers from Argentina participated in the study. Confirmatory factor analysis supported the ATTS three-factor structure: Attitude towards violations and speeding, attitude towards the careless driving of others and attitude towards drinking and driving, χ2(87) = 205.91, p < .001; χ2/df = 2.36; GFI = .94; CFI = .93; TLI = .91; RMSEA = .05; 90% CI [.04, .06]. A model with one higher-order factor (overall attitude toward risky driving) also fits the data. Reliability estimates were acceptable for the total scale (α = .81) and for all subscales (with α values ranging from .74 to .84), and concurrent validity was supported by theoretically expected correlations with self-reported risky driving behavior (r ranging from .27 to .45, ps < .01). Subsequent comparison between zero-order correlation and partial correlation (controlling for Driver Impression Management) between ATTS subscales and self-reported risky driving behavior revealed minor or no effects of social desirability bias. Implications for road safety intervention are discussed.
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Siya A, Ssentongo B, Abila DB, Kato AM, Onyuth H, Mutekanga D, Ongom I, Aryampika E, Lukwa AT. Perceived factors associated with boda-boda (motorcycle) accidents in Kampala, Uganda. TRAFFIC INJURY PREVENTION 2019; 20:S133-S136. [PMID: 31577452 DOI: 10.1080/15389588.2019.1658084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
Objective: According to the United Nations, nearly 1.25 million people are killed and up to 50 million people are injured on the world's roads every year. Uganda loses about 10 people daily to road accidents, costing about US$1.2 billion annually, which represents about 5% of the gross domestic product (GDP). The objective of this study was to identify causal factors that can be associated with boda-boda accidents in Uganda.Method: A cross sectional study assessed 200 boda-boda riders in the urban areas of Kampala, Uganda. Interviews using semistructured questionnaires were administered to all participants. Data were entered in Excel and imported to STATA for analysis. Multivariate and bivariate analyses were conducted to determine factors that influenced accident risk perception. All variables that were significant at a bivariate level and thought to be theoretically important in influencing the outcome variable were included in a logistic regression model. All tests were performed at a significance of P < .05.Results: Competition for passengers with other public transport operators (83%), negligence of road safety rules (78%), and inadequate helmet usage (62%) were the main factors perceived to be associated with boda-boda accidents. Other factors identified by the respondents include age of the boda-boda rider (58%) and drug use (56%; P < .05). At multivariate analysis, competition for passengers (adjusted odds ratio [AOR] = 17; 95% confidence interval CI, 1.34-26.5) and being in between 18 and 25 years old (AOR = 19; 95% CI, 1.42-27.1) remained statistically significant.Conclusions: This study revealed behavioral factors by all public transport users as the main factors associated with boda-boda accidents in urban Kampala. This demonstrates the need for holistic interventions to address such boda-boda accidents in Uganda. Such interventions can be through digitization of transport system for clients to engage remotely with the transport operators, routine refresher trainings of all transport operators, and construction of lanes for boda-boda riders.
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Affiliation(s)
- Aggrey Siya
- Department of Biosecurity, Ecosystems and Veterinary Public Health, Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | - Benard Ssentongo
- Department of Environmental Management, Makerere University College of Agricultural and Environmental Sciences, Kampala, Uganda
| | - Derrick Bary Abila
- Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Arthur M Kato
- Department of Environmental Management, Makerere University College of Agricultural and Environmental Sciences, Kampala, Uganda
| | - Howard Onyuth
- Department of Biosecurity, Ecosystems and Veterinary Public Health, Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | - Denis Mutekanga
- Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Isaac Ongom
- Department of Biosecurity, Ecosystems and Veterinary Public Health, Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity, Kampala, Uganda
| | - Edmand Aryampika
- Department of Environmental Management, Makerere University College of Agricultural and Environmental Sciences, Kampala, Uganda
| | - Akim Tafadzwa Lukwa
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Lantos T, Nyári TA, McNally RJQ. Seasonal variation of mortality from external causes in Hungary between 1995 and 2014. PLoS One 2019; 14:e0217979. [PMID: 31170243 PMCID: PMC6553771 DOI: 10.1371/journal.pone.0217979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 05/22/2019] [Indexed: 11/23/2022] Open
Abstract
Objective To analyze trends in external mortality in Hungary between 1995 and 2014 by sex. Methods Data on the numbers of deaths due to external causes were obtained from the published nationwide population register. Negative binomial regression was applied to investigate the yearly trends in external-cause mortality rates. Cyclic trends were investigated using the Walter-Elwood method. Results Suicide and accidents accounted for approximately 84% of the all-external-cause of deaths in Hungary. Annual suicide, unintentional falls and traffic accidents mortality declined significantly (p-value for annual trend: p < 0.001) from 30.5 (95% CI: 29.5–31.5) to 15.8 (15.1–16.5), from 31.2 (30.2–32.2) to 12.2 (11.7–12.8) and from 17.2 (16.4–18) to 5.4 (5–5.8) per 100 000 persons per year, respectively, during the study period. A significant declining trend in annual mortality was also found for assault, cold/heating-related accidents and accidents caused by electric current. However, the declining trend for drowning-related accidents was significant only for males. Significant winter-peak seasonality was found in the mortality rates from accidental falls, cold/heat-related accidents, other accidents caused by submersion/obstruction and other causes. Seasonal trends with a peak from June to July were observed in death rates from suicide/self-harm, accidental drowning/submersion and accidents caused by electric current. A significant seasonal variation with a peak in September was revealed in the mortality due to traffic accidents. Conclusions This Hungarian study suggests that there was a significant seasonal effect on almost all kinds of deaths from external causes between 1995 and 2014. Environmental effects are involved in the aetiology of suicide and accidents.
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Affiliation(s)
- Tamás Lantos
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Tibor András Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- * E-mail:
| | - Richard J. Q. McNally
- Institute of Health & Society, Newcastle University, Royal Victoria Infirmary, Newcastle, England, United Kingdom
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Park JY, Wu LT. Trends and correlates of driving under the influence of alcohol among different types of adult substance users in the United States: a national survey study. BMC Public Health 2019; 19:509. [PMID: 31054563 PMCID: PMC6500580 DOI: 10.1186/s12889-019-6889-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 04/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background Despite a decrease in driving under the influence of alcohol (DUIA) prevalence over the past decades, DUIA prevalence still remains high in the United States. To date, there is limited research examining whether different types of substance users have different trends in DUIA. This study sought to assess trends and variables associated with DUIA by substance use type. Methods National Survey on Drug Use and Health (NSDUH) is a cross-sectional, nationally representative population-based survey. By using the NSDUH 2008–2014, we performed the Joinpoint analysis to identify time trends of DUIA in each group of substance users (aged ≥18 years). Logistic regression analysis was used to explore association between substance use type and DUIA and to identify variables associated with DUIA. Results Adults who reported alcohol or drug use in the past year were classified into different groups based on past-year substance use status: alcohol use only (n = 141,521) and drug use regardless alcohol use. Drug users included prescription opioids only (n = 5337), marijuana only (n = 32,206), other single drug (n = 3789), prescription opioids-marijuana (n = 3921), multiple prescription drugs (n = 1267), and other multiple drugs (n = 18,432). The Joinpoint analysis showed that DUIA prevalence decreased significantly from 2008 to 2014 among alcohol only users (Average Annual Percent Change [AAPC] = − 2.8), prescription opioids only users (AAPC = -5.4), marijuana only users (AAPC = -5.0), prescription opioids-marijuana users (AAPC = -6.5), multiple prescription drug users (AAPC = -7.4), and other multiple drug users (AAPC = -3.2). Although the estimate was not statistically significant, other single drug users showed a decreasing trend (AAPC = -0.9). Substance use type was significantly associated with DUIA in the adjusted logistic regression. All drug use groups, relative to the alcohol only group, had elevated odds of DUIA, and the odds were especially elevated for the multiple drug use groups (prescription opioids-marijuana, adjusted odds ratio [AOR] = 2.71; multiple prescription drugs, AOR = 2.83; and other multiple drugs, AOR = 3.68). Additionally, younger age, male sex, being white, higher income, and alcohol abuse/dependence were positively associated with DUIA. Conclusions DUIA prevalence decreased over time and the magnitude of this reduction differed by substance use type. DUIA interventions need to be tailored to substance use type and individual characteristics.
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Affiliation(s)
- Ji-Yeun Park
- Department of Psychiatry and Behavioral Sciences, BOX 3903, Duke University School of Medicine, Durham, NC, USA.
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, BOX 3903, Duke University School of Medicine, Durham, NC, USA. .,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA. .,Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA. .,Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
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Pawłowski W, Lasota D, Goniewicz M, Rzońca P, Goniewicz K, Krajewski P. The Effect of Ethyl Alcohol upon Pedestrian Trauma Sustained in Traffic Crashes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081471. [PMID: 31027255 PMCID: PMC6517985 DOI: 10.3390/ijerph16081471] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/28/2019] [Accepted: 04/23/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Every year more than 1.2 million people worldwide die due to trauma sustained in road crashes, with an additional number of people injured exceeding 50 million. To a large extent, this applies to so called "unprotected road users", including pedestrians. The risk involved in a traffic crash for pedestrians can result from many factors, one of which is participation in road traffic when under the influence of alcohol. The aim of this study was to analyze the impact of alcohol use among pedestrians as unprotected road traffic participants, and the consequences of them being struck by motor vehicles. MATERIAL AND METHODS The source of data was the medical documentation of the Department of Forensic Medicine at the Medical University of Warsaw. The sample for this research consisted of 313 pedestrians who were victims of fatal road crashes resulting from a collision with a mechanical vehicle. The obtained results were subjected to statistical analysis using the STATISTICA version 12.5 program (StatSoft Polska, Cracow, Poland). RESULTS Male fatalities constituted the majority of the study sample. Nearly half of the fatal pedestrian victims were found to be under the influence of alcohol. The statistical analysis demonstrated a significant relationship between the gender and age of the victims, as well as between the place of the event, the place of death, the mechanism of the event, and the presence of alcohol in pedestrians. CONCLUSIONS Among pedestrians, victims of road crashes who were under the influence of alcohol were predominantly drunk young males. Victims under the influence of alcohol were more likely to become fatalities in crashes where the mechanism of the incident was being struck by a passenger car, and when the place of the incident was a rural area, in these cases the rates of death directly at the scene were much more frequent. The eradication of alcohol consumption by all road users should be the overriding objective of all measures aimed at reducing the number of road crashes.
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Affiliation(s)
- Witold Pawłowski
- Department of Disaster Medicine, Medical University of Warsaw, 02-091 Warszawa, Poland.
| | - Dorota Lasota
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-091 Warszawa, Poland.
| | - Mariusz Goniewicz
- Department of Emergency Medicine, Medical University of Lublin, 20-059 Lublin, Poland.
| | - Patryk Rzońca
- Department of Emergency Medicine, Medical University of Lublin, 20-059 Lublin, Poland.
| | - Krzysztof Goniewicz
- Department of Security Studies, Polish Air Force Academy, 08-521 Dęblin, Poland.
| | - Paweł Krajewski
- Department of Forensic Medicine, Medical University of Warsaw, 02-091 Warszawa, Poland.
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Jamt REG, Gjerde H, Romeo G, Bogstrand ST. Association between alcohol and drug use and arrest for driving under the influence after crash involvement in a rural area of Norway: a case-control study. BMJ Open 2019; 9:e023563. [PMID: 30610022 PMCID: PMC6326312 DOI: 10.1136/bmjopen-2018-023563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The rate of deaths caused by road traffic crashes is particularly high in rural areas. It has been hypothesised that one factor that may contribute is differences in patterns of alcohol use. The aim was to compare the prevalence of psychoactive substances among crash-involved drivers arrested for suspicion of driving under the influence (DUI) who are tested for alcohol and drugs and recent random drivers in a rural area. Furthermore, we investigated the association between traffic crashes and driving after using alcohol, illicit or medicinal drugs either alone or in combination. METHODS A case-control study was carried out in which the case group consisted of crash-involved drivers arrested for suspicion of DUI from 2000 to 2015. This group was compared with a control group of randomly selected drivers recruited to a roadside survey in normal traffic from 2014 to 2015. The case group consisted of 612 individuals (542 men and 70 women) and the control group of 3027 individuals (2099 men and 927 women). Drug and alcohol screening was performed on blood samples from the cases and samples of oral fluid from the controls. RESULTS The proportion of psychoactive substances was 81.7% among cases and 1.6% among the controls. The prevalence of combinations of psychoactive substances was 18% among the cases and 0.3% among the controls. The multivariate regression model analysis identified significant drug interactions. CONCLUSION The prevalence of alcohol and drugs was high among the crash-involved drivers arrested for suspicion of DUI by the police. In contrast to earlier published research combinations of different psychoactive substances did not increase the OR for traffic crash involvement more than the single drug with highest OR. The statistical methodology presented in this study should be allied in future studies with greater statistical power to confirm these findings.
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Affiliation(s)
- Ragnhild Elén Gjulem Jamt
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Giovanni Romeo
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
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Davila VR, Stahl DL, Bhandary SP, Papadimos TJ. What's New in Critical Illness and Injury Science? The association between initial blood alcohol concentration and polysubstance use may be indicative of a gateway drug effect. Int J Crit Illn Inj Sci 2018; 8:181-183. [PMID: 30662862 PMCID: PMC6311969 DOI: 10.4103/ijciis.ijciis_80_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Victor R. Davila
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David L. Stahl
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sujatha P. Bhandary
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas J. Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Gjerde H, Romeo G, Mørland J. Challenges and common weaknesses in case-control studies on drug use and road traffic injury based on drug testing of biological samples. Ann Epidemiol 2018; 28:812-820. [PMID: 30217677 DOI: 10.1016/j.annepidem.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/01/2018] [Accepted: 08/19/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine and discuss common weaknesses and errors in case-control studies on the association between drug use and road traffic crash injury among drivers and recommend improvements for future studies. METHODS A search for case-control studies published between 2000 and 2016 was performed using PubMed and other databases in addition to manual search. The used methodologies were compared with requirements and recommendations for case-control studies as well as current knowledge on the interpretation of drug concentrations in biological samples. RESULTS Seventeen studies were identified. The major difficulties in the studies were related to likely selection bias, information bias, and confounding. In some studies, the definition of drug exposure was different for controls than for cases, generating potentially serious errors in the odds ratio estimations. Other weaknesses include lacking explanation of the assessment of drug exposure, missing covariates, lacking description of statistical methods, and lack of discussion of bias and confounding. CONCLUSIONS Many of the observed challenges and weaknesses can be overcome or reduced. Recommendations for future studies are presented.
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Affiliation(s)
- Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.
| | - Giovanni Romeo
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jørg Mørland
- Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Simonsen KW, Linnet K, Rasmussen BS. Driving under the influence of alcohol and drugs in the eastern part of Denmark in 2015 and 2016: Abuse patterns and trends. TRAFFIC INJURY PREVENTION 2018; 19:468-475. [PMID: 29370543 DOI: 10.1080/15389588.2018.1428743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/11/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The objective of this study was to examine the frequency of psychoactive drugs and alcohol in drivers under suspicion of driving under the influence of drugs and alcohol in 2015 and 2016 in the eastern part of Denmark. The trends in the number of traffic cases sent for drug analysis since 2000 and alcohol analysis since 2011 are also discussed. METHODS Blood samples from drivers suspected of being under the influence of alcohol and/or medication and/or illicit drugs in 2015 and 2016 were investigated as requested by the police. The blood samples were screened for alcohol and/or tetrahydrocannabinol (THC) alone, for other drugs (covering all drugs, except THC, listed in the Danish list of narcotic drugs), or for THC and other drugs. Age and gender were also recorded. The number of drug traffic cases since 2000 and the number of alcohol cases since 2011 were extracted from our Laboratory Information Management System (LIMS). RESULTS In total, 11,493 traffic cases were investigated. Alcohol and/or drugs exceeded the legal limit in 9,657 (84%) cases. Men constituted 95% of the drivers investigated for drugs and 88% of the alcohol cases. The drivers investigated for drugs consisted primarily of young men, whereas drivers investigated for alcohol were older. The frequency was higher for positive alcohol cases above the legal limit (87%) than for drug cases (76%) above the fixed concentration limit. THC (67-69%) was the most frequently detected drug above the legal limit, followed by cocaine (27-28.5%), amphetamine (17%), and clonazepam (6-7%) in both years. Morphine (5.4%), included among the 5 most frequent drugs in 2015, was replaced by methadone (4.6%) in 2016. Few new psychoactive drugs (NPS) were detected. The number of traffic cases sent for drug analysis has increased more than 30-fold since 2000-2006, and the number of traffic cases submitted in 2016 for drug analysis was higher than the number for alcohol analysis; the latter has decreased since 2011. CONCLUSION Overall, alcohol was the most frequent compound detected above the legal limit in both years, followed by the well-known illicit drugs THC, cocaine, and amphetamine. NPS were seldom seen. One consequence of the increased focus on drugs in traffic has been an immense increase in drug traffic cases sent for analysis since 2006 in the eastern part of Denmark. Although this survey revealed only minimal changes compared to earlier investigations, surveys like this are invaluable for monitoring abuse patterns and trends in drugged and drunken driving.
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Affiliation(s)
- Kirsten Wiese Simonsen
- a Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Kristian Linnet
- a Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Brian Schou Rasmussen
- a Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark
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Hostiuc S, Moldoveanu A, Negoi I, Drima E. Corrigendum: The Association of Unfavorable Traffic Events and Cannabis Usage: A Meta-Analysis. Front Pharmacol 2018; 9:564. [PMID: 29882551 PMCID: PMC5989488 DOI: 10.3389/fphar.2018.00564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/11/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alin Moldoveanu
- Faculty of Automatic Control and Computers, Polytechnic University of Bucharest, Bucharest, Romania
| | - Ionuţ Negoi
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Eduard Drima
- Clinical-Medical Department, Faculty of Medicine and Pharmacy, University Dunǎrea de Jos, Galați,, Romania.,Galati, Psychiatry Hospital, Galați,, Romania
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Elvik R. Interpreting interaction effects in estimates of the risk of traffic injury associated with the use of illicit drugs. ACCIDENT; ANALYSIS AND PREVENTION 2018; 113:224-235. [PMID: 29428641 DOI: 10.1016/j.aap.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/05/2018] [Accepted: 02/03/2018] [Indexed: 06/08/2023]
Abstract
Interactions characterise the relationship between use of amphetamines, cannabis and opiates as a driver and the risk of traffic injury associated with the use of these drugs. Inverse risk curves have been found for these drugs, meaning that the higher the proportion of drivers in normal traffic testing positive for the drugs, the lower is the increase in risk associated with them. The inverse risk curves can arise in many ways. The paper discusses ten different interpretations of the curves; seven of these are methodological and claim that the risk curves are statistical artefacts. Some support for these interpretations is found; however, this does not rule out that substantive interpretations, proposing causal mechanisms underlying the curves may also be correct. Unfortunately, there is insufficient evidence to assess the support for the substantive interpretations. There is, accordingly, a large element of uncertainty about how the inverse risk curves arise and whether they can be modified.
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Affiliation(s)
- Rune Elvik
- Institute of Transport Economics, Gaustadalleen 21, Oslo NO-0349, Norway.
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Damsere-Derry J, Palk G, King M. Prevalence of alcohol among nonfatally injured road accident casualties in two level III trauma centers in northern Ghana. TRAFFIC INJURY PREVENTION 2018; 19:118-124. [PMID: 28829627 DOI: 10.1080/15389588.2017.1369533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Alcohol use is pervasive among motorists on the road in Ghana; however, we do not know the extent to which this behavior is implicated in road accidents in this country. OBJECTIVES The main objective of this research was to establish the prevalence of alcohol in the blood of nonfatally injured casualties in the emergency departments (EDs) in northern Ghana. METHOD Participants were injured road traffic crash victims, namely, pedestrians, cyclists, motorcyclists, and drivers seeking treatment at an ED. The study sites were 2 level III trauma centers located in Wa and Bolgatanga. Participants were screened for alcohol followed by breath tests for positive participants using breathalyzers. RESULTS Two hundred and sixty-two accident victims visited EDs, 58% of whom were in Wa. Among the victims, 41% were hospitalized and 57% experienced slight injuries. The vast majority (76%) of the casualties were motorcyclists, 13% were pedestrians, 8% were cyclists, and 2% were drivers. Casualties who had detectable alcohol in their blood were predominantly vulnerable road users. In all, 34% of participants had detectable blood alcohol concentrations (BACs) and the mean BAC for all casualties who tested positive and could give definitive BACs was 0.2265 (226 mg/dl). The prevalence of alcohol use was 53% among cyclists, 34% among motorcyclists, 21% among pedestrians, and 17% among drivers. Male casualties were more likely to test positive for alcohol than females. In addition, the prevalence of alcohol was significantly higher among injured casualties in Bolgatanga compared to Wa. CONCLUSION There was a high prevalence of alcohol use among nonfatally injured casualties in northern Ghana and injury severity increased with BAC. AUDIT screening in the hospital, alcohol consumption guideline, road safety education with an emphasis on minimizing or eliminating alcohol consumption, and enhanced enforcement of the BAC limit among motorists are recommended.
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Affiliation(s)
- James Damsere-Derry
- a Queensland University of Technology (QUT) , Centre for Accident Research & Road Safety-Queensland (CARRS-Q) , Brisbane , Australia
- b CSIR-Building & Road Research Institute , Kumasi , Ghana
| | - Gavan Palk
- a Queensland University of Technology (QUT) , Centre for Accident Research & Road Safety-Queensland (CARRS-Q) , Brisbane , Australia
| | - Mark King
- a Queensland University of Technology (QUT) , Centre for Accident Research & Road Safety-Queensland (CARRS-Q) , Brisbane , Australia
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Hostiuc S, Moldoveanu A, Negoi I, Drima E. The Association of Unfavorable Traffic Events and Cannabis Usage: A Meta-Analysis. Front Pharmacol 2018; 9:99. [PMID: 29487531 PMCID: PMC5816577 DOI: 10.3389/fphar.2018.00099] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/29/2018] [Indexed: 01/07/2023] Open
Abstract
Background: In the last years were published many epidemiological articles aiming to link driving under the influence of cannabis (DUIC) with the risk of various unfavorable traffic events (UTEs), with sometimes contradictory results. Aim: The primary objective of this study was to analyze whether there is a significant association between DUIC and UTEs. Materials and Methods: We used two meta-analytical methods to assess the statistical significance of the effect size: random-effects model and inverse variance heterogeneity model. Results: Twenty-four studies were included in the meta-analysis. We obtained significant increases in the effect size for DUIC tested through blood analysis, with an odds ratio (OR) of 1.97 and a confidence interval (CI) between 1.35 and 2.87; death as an outcome, with an OR of 1.56 and a CI between 1.16 and 2.09; and case–control as the type of study, with an OR of 1.99 and a CI between 1.05 and 3.80. Publication bias was very high. Conclusion: Our analysis suggests that the overall effect size for DUIC on UTEs is not statistically significant, but there are significant differences obtained through subgroup analysis. This result might be caused by either methodological flaws (which are often encountered in articles on this topic), the indiscriminate employment of the term “cannabis use,” or an actual absence of an adverse effect. When a driver is found, in traffic, with a positive reaction suggesting cannabis use, the result should be corroborated by either objective data regarding marijuana usage (like blood analyses, with clear cut-off values), or a clinical assessment of the impairment, before establishing his/her fitness to drive.
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Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alin Moldoveanu
- Faculty of Automatic Control and Computers, Polytechnic University of Bucharest, Bucharest, Romania
| | - Ionuţ Negoi
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Eduard Drima
- Clinical-Medical Department, Faculty of Medicine and Pharmacy, University Dunǎrea de Jos, Galaţi, Romania.,Galai Psychiatry Hospital, Galaţi, Romania
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Alcohol and illicit drugs in drivers involved in road traffic crashes in the Milan area. A comparison with normal traffic reveals the possible inadequacy of current cut-off limits. Forensic Sci Int 2018; 282:127-132. [DOI: 10.1016/j.forsciint.2017.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/02/2017] [Accepted: 11/04/2017] [Indexed: 01/24/2023]
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Chihuri S, Li G. Use of prescription opioids and motor vehicle crashes: A meta analysis. ACCIDENT; ANALYSIS AND PREVENTION 2017; 109:123-131. [PMID: 29059534 DOI: 10.1016/j.aap.2017.10.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/17/2017] [Accepted: 10/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Opioid analgesics are a major driver of the ongoing opioid epidemic in the United Sates, accounting for about two thirds of drug overdose fatalities. There are conflicting reports regarding the effects of prescription opioids on driving safety. A meta-analysis was performed to assess the epidemiologic evidence for the association between use of prescription opioids and the risk of motor vehicle crashes. METHODS Studies examining the association between driver prescription opioid use and motor vehicle crash involvement or crash culpability and published in English were identified through a comprehensive search of 15 bibliographic databases. Eligible articles were fully reviewed and summarized. Study quality was assessed using the Newcastle-Ottawa Scale. Overall summary odds ratios (ORs) and 95% confidence intervals (CIs) were estimated through random effects models. RESULTS Overall, 15 studies were included in the meta-analysis; of them, 10 assessed the association of prescription opioid use with the risk of crash involvement and 5 assessed the association of prescription opioid use with the risk of crash culpability. Reported crude ORs associated with prescription opioid use ranged from 1.15 to 8.19 for the risk of crash involvement and from 0.75 to 2.78 for the risk of crash culpability. Summary ORs based on pooled data were 2.29 (95% CI: 1.51, 3.48) for crash risk and 1.47 (95% CI: 1.01, 2.13) for crash culpability. CONCLUSIONS The existent epidemiologic evidence indicates that use of prescription opioids by drivers is associated with significantly increased risks of crash involvement and crash culpability. Further research is needed to understand the epidemiologic patterns of prescription opioid use in the driver population and the interaction effects between opioids and alcohol on driving safety.
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Affiliation(s)
- Stanford Chihuri
- Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY, United States; Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Guohua Li
- Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY, United States; Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.
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Abstract
Introduction This research aims to estimate the relative risks of responsibility for a fatal accident linked to driving under the influence of cannabis or alcohol, the prevalence of these influences among drivers and the corresponding attributable risk ratios. A secondary goal is to estimate the same items for three other groups of illicit drugs (amphetamines, cocaine and opiates), and to compare the results to a similar study carried out in France between 2001 and 2003. Methodology Police procedures for fatal accidents in Metropolitan France during 2011 were analyzed and 300 characteristics encoded to provide a database of 4,059 drivers. Information on alcohol and four groups of illicit drugs derived from tests for positivity and potential confirmation through blood analysis. The study compares drivers responsible for causing the accident, that is to say having directly contributed to its occurrence, to drivers involved in an accident for which they were not responsible, and who can be assimilated to drivers in general. Results The proportion of persons driving under the influence of alcohol is estimated at 2.1% (95% CI: 1.4–2.8) and under the influence of cannabis at 3.4% (2.9%-3.9%). Drivers under the influence of alcohol are 17.8 times (12.1–26.1) more likely to be responsible for a fatal accident, and the proportion of fatal accidents which would be prevented if no drivers ever exceeded the legal limit for alcohol is estimated at 27.7% (26.0%-29.4%). Drivers under the influence of cannabis multiply their risk of being responsible for causing a fatal accident by 1.65 (1.16–2.34), and the proportion of fatal accidents which would be prevented if no drivers ever drove under the influence of cannabis is estimated at 4.2% (3.7%-4.8%). An increased risk linked to opiate use has also been found to be significant, but with low prevalence, requiring caution in interpreting this finding. Other groups of narcotics have even lower prevalence, and the associated extra risks cannot be assessed. Conclusion Almost a decade separates the present study from a similar one previously conducted in France, and there have been numerous developments in the intervening years. Even so, the prevalence of drivers responsible for causing fatal accidents under the influence of alcohol or narcotics has stayed remarkably stable, as have the proportion of fatal accidents which could in theory be prevented if no drivers ever exceeded the legal limits. The overall number of deaths from traffic accidents has dropped sharply during this period, and the number of victims attributable to alcohol and/or cannabis declined proportionally. Alcohol remains the main problem in France. It is just as important to note that one in two drivers considered to be under the influence of cannabis was also under the influence of alcohol. With risks cumulating between the two, it is particularly important to point out the danger of consuming them together.
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Behnood A, Mannering FL. The effects of drug and alcohol consumption on driver injury severities in single-vehicle crashes. TRAFFIC INJURY PREVENTION 2017; 18:456-462. [PMID: 27893281 DOI: 10.1080/15389588.2016.1262540] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE It is well known that alcohol and drugs influence driving behavior by affecting the central nervous system, awareness, vision, and perception/reaction times, but the resulting effect on driver injuries in car crashes is not fully understood. The purpose of this study was to identify factors affecting the injury severities of unimpaired, alcohol-impaired, and drug-impaired drivers. METHOD The current article applies a random parameters logit model to study the differences in injury severities among unimpaired, alcohol-impaired, and drug-impaired drivers. Using data from single-vehicle crashes in Cook County, Illinois, over a 9-year period from January 1, 2004, to December 31, 2012, separate models for unimpaired, alcohol-impaired, and drug-impaired drivers were estimated. A wide range of variables potentially affecting driver injury severity was considered, including roadway and environmental conditions, driver attributes, time and location of the crash, and crash-specific factors. RESULTS The estimation results show significant differences in the determinants of driver injury severities across groups of unimpaired, alcohol-impaired, and drug-impaired drivers. The findings also show that unimpaired drivers are understandably more responsive to variations in lighting, adverse weather, and road conditions, but these drivers also tend to have much more heterogeneity in their behavioral responses to these conditions, relative to impaired drivers. In addition, age and gender were found to be important determinants of injury severity, but the effects varied significantly across all drivers, particularly among alcohol-impaired drivers. CONCLUSIONS The model estimation results show that statistically significant differences exist in driver injury severities among the unimpaired, alcohol-impaired, and drug-impaired driver groups considered. Specifically, we find that unimpaired drivers tend to have more heterogeneity in their injury outcomes in the presence potentially adverse weather and road surface conditions. This makes sense because one would expect unimpaired drivers to apply their full knowledge/judgment range to deal with these conditions, and the variability of this range across the driver population (with different driving experiences, etc.) should be great. In contrast, we find, for the most part, that alcohol-impaired and drug-impaired drivers have far less heterogeneity in the factors that affect injury severity, suggesting an equalizing effect resulting from the decision-impairing substance.
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Affiliation(s)
- Ali Behnood
- a Lyles School of Civil Engineering, Purdue University , West Lafayette , Indiana
| | - Fred L Mannering
- b Department of Civil and Environmental Engineering , University of South Florida , Tampa , Florida
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Toxicological findings in driver and motorcyclist fatalities in Scotland 2012–2015. Forensic Sci Int 2017; 274:22-26. [DOI: 10.1016/j.forsciint.2016.12.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 11/20/2022]
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Høiseth G, Austdal LE, Wiik E, Bogstrand ST, Mørland J. Prevalence and concentrations of drugs in older suspected drugged drivers. TRAFFIC INJURY PREVENTION 2017; 18:231-236. [PMID: 27740861 DOI: 10.1080/15389588.2016.1247209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Older drivers are somewhat more likely to be involved in car crashes than middle-aged drivers but less likely to be involved than younger drivers. This study aimed to assess the extent of drug use in older suspected drunk and drugged drivers, with respect to which drugs were detected and at which concentrations. METHODS Blood samples from older suspected drunk and drugged drivers taken between February 1, 2012, and May 22, 2013, were identified from the database at the Norwegian Institute of Public Health and were retrospectively analyzed for a broad repertoire of drugs relevant for impairment. The prevalence of different drugs among the suspected drunk and drugged drivers was studied. Regarding drug concentrations, the findings in older drivers (>65 years) were compared to a reference group of apprehended drivers aged 20-40 years. RESULTS Four hundred and ten older suspected drunk and drugged drivers were included. Any drug (including ethanol) was detected in 92% of blood samples, and ethanol was detected in 81%. Benzodiazepines were found in 15% of the older drivers and z-hypnotics (zopiclone or zolpidem) were detected in 13%. The most frequent single legal drugs found in blood samples taken from older impaired drivers were zopiclone (9.8%) and diazepam (9.3%). Regarding drug combinations, older drivers used a mean number of 1.4 drugs, and 20% of ethanol-positive cases showed at least one other drug. High drug concentrations of clonazepam and diazepam were more frequently seen in the younger group. CONCLUSIONS This study showed that drugs were detected in the vast majority of older drivers suspected for drunk or drugged driving. Ethanol was the most frequent drug detected, followed by zopiclone and diazepam. Older drivers combine drugs to a lesser degree than younger drivers, but their combination of ethanol and other drugs represents a considerable traffic risk. Lower concentrations of benzodiazepines are seen in older compared to younger drivers.
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Affiliation(s)
- Gudrun Høiseth
- a Norwegian Institute of Public Health, Division of Forensic Sciences , Oslo , Norway
- b Diakonhjemmet Hospital , Center for Psychopharmacology , Oslo , Norway
| | - Linn Engeset Austdal
- a Norwegian Institute of Public Health, Division of Forensic Sciences , Oslo , Norway
| | - Elisabeth Wiik
- a Norwegian Institute of Public Health, Division of Forensic Sciences , Oslo , Norway
| | - Stig Tore Bogstrand
- a Norwegian Institute of Public Health, Division of Forensic Sciences , Oslo , Norway
- c Lovisenberg University College , Oslo , Norway
| | - Jørg Mørland
- a Norwegian Institute of Public Health, Division of Forensic Sciences , Oslo , Norway
- d Institute of Clinical Medicine, University of Oslo , Oslo , Norway
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Nevriana A, Möller J, Laflamme L, Monárrez-Espino J. New, Occasional, and Frequent Use of Zolpidem or Zopiclone (Alone and in Combination) and the Risk of Injurious Road Traffic Crashes in Older Adult Drivers: A Population-Based Case-Control and Case-Crossover Study. CNS Drugs 2017; 31:711-722. [PMID: 28669021 PMCID: PMC5533809 DOI: 10.1007/s40263-017-0445-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous studies on the effect of zolpidem or zopiclone use on the risk of road traffic crashes (RTCs) have shown mixed results. OBJECTIVE Our objective was to determine the association between zolpidem or zopiclone use (as separate drugs or combined) and the occurrence of injurious RTCs among older adult drivers. METHODS This was a population-based matched case-control and case-crossover study based on secondary data linked together from Swedish national registers. Cases were drivers aged 50-80 years involved in a vehicle crash resulting in injuries between January 2006 and December 2009 for the case-control study (n = 27,096) and from February 2006 to December 2009 for the case-crossover study (n = 26,586). For the first design, four controls were matched to each case by sex, age, and residential area, and exposure was categorized into new, occasional, and frequent use of zolpidem only, zopiclone only, and combined zolpidem and zopiclone. For the case-crossover study, newly dispensed zolpidem or zopiclone users were assessed during the 28 days prior to the crash and compared with an equally long control period using a 12-week washout period. Matched adjusted odds ratios (OR) were computed using conditional logistic regression. RESULTS Increased ORs for all users were observed. In the case-control study, the highest odds were seen among newly initiated zolpidem-only users involved in single-vehicle crashes (adjusted OR 2.27; 95% confidence interval [CI] 1.21-4.24), followed by frequent combined zolpidem and zopiclone users [adjusted OR 2.20; CI 1.21-4.00]. In the case-crossover, newly initiated treatment with zolpidem or zopiclone showed an increased risk that was highest in the 2 weeks after the start of the treatment (OR 2.66; 95% CI 1.04-6.81). CONCLUSIONS These results provide more compelling evidence for the role of zolpidem or zopiclone in the occurrence of RTCs among older adults, not only in frequent users, but also at the beginning of treatment.
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Affiliation(s)
- Alicia Nevriana
- Department of Public Health Sciences, Widerströmska huset, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden
| | - Jette Möller
- Department of Public Health Sciences, Widerströmska huset, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden
| | - Lucie Laflamme
- Department of Public Health Sciences, Widerströmska huset, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden
| | - Joel Monárrez-Espino
- Department of Public Health Sciences, Widerströmska huset, Karolinska Institutet, Tomtebodavägen 18A, 17177, Stockholm, Sweden.
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Swortwood MJ, Newmeyer MN, Abulseoud OA, Andersson M, Barnes AJ, Scheidweiler KB, Huestis MA. On-site oral fluid Δ9-tetrahydrocannabinol (THC) screening after controlled smoked, vaporized, and oral cannabis administration. Forensic Toxicol 2016. [DOI: 10.1007/s11419-016-0348-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Rudisill TM, Zhu M, Kelley GA, Pilkerton C, Rudisill BR. Medication use and the risk of motor vehicle collisions among licensed drivers: A systematic review. ACCIDENT; ANALYSIS AND PREVENTION 2016; 96:255-270. [PMID: 27569655 PMCID: PMC5045819 DOI: 10.1016/j.aap.2016.08.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 06/17/2016] [Accepted: 08/02/2016] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Driving under the influence of prescription and over-the-counter medication is a growing public health concern. A systematic review of the literature was performed to investigate which specific medications were associated with increased risk of motor vehicle collision (MVC). METHODS The a priori inclusion criteria were: (1) studies published from English-language sources on or after January 1, 1960, (2) licensed drivers 15 years of age and older, (3) peer-reviewed publications, master's theses, doctoral dissertations, and conference papers, (4) studies limited to randomized control trials, cohort studies, case-control studies, or case-control type studies (5) outcome measure reported for at least one specific medication, (6) outcome measure reported as the odds or risk of a motor vehicle collision. Fourteen databases were examined along with hand-searching. Independent, dual selection of studies and data abstraction was performed. RESULTS Fifty-three medications were investigated by 27 studies included in the review. Fifteen (28.3%) were associated with an increased risk of MVC. These included Buprenorphine, Codeine, Dihydrocodeine, Methadone, Tramadol, Levocitirizine, Diazepam, Flunitrazepam, Flurazepam, Lorazepam, Temazepam, Triazolam, Carisoprodol, Zolpidem, and Zopiclone. CONCLUSIONS Several medications were associated with an increased risk of MVC and decreased driving ability. The associations between specific medication use and the increased risk of MVC and/or affected driving ability are complex. Future research opportunities are plentiful and worthy of such investigation.
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Affiliation(s)
- Toni M Rudisill
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA; Injury Control Research Center, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - Motao Zhu
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Injury Control Research Center, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - George A Kelley
- Department of Biostatistics, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
| | - Courtney Pilkerton
- Department of Epidemiology, West Virginia University, PO BOX 9151, Morgantown, WV, 26506, USA.
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Pelição FS, Peres MD, Pissinate JF, de Paula DML, de Faria MDGC, Nakamura-Palacios EM, De Martinis BS. Predominance of alcohol and illicit drugs among traffic accidents fatalities in an urban area of Brazil. TRAFFIC INJURY PREVENTION 2016; 17:663-667. [PMID: 26891425 DOI: 10.1080/15389588.2016.1146824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence of alcohol and illicit drug use among victims of fatal traffic accidents in the Metropolitan Region of Vitória, Brazil, during the period 2011-2012. METHODS Blood samples were collected and analyzed for the presence of drugs from 391 deceased victims of traffic crashes that occurred in the Metropolitan Region of Vitória, Brazil. The victims included drivers, passengers, and pedestrians. Sociodemographic variables such as age, gender, day of the week, and period of the year in which the accidents occurred were recorded. The analyses were performed by a gas chromatography-flame ionization method for alcohol and by a gas chromatography-mass spectrometry for amphetamines, cocaine, and cannabis. RESULTS The results showed that 44.8% (n = 175) of all cases were positive for alcohol and/or illicit drugs. The detection of alcohol and/or drugs was more frequent in young males, aged 17 to 34, whose samples were positive in 46.8% of cases. Small differences among drivers, passengers, and pedestrians were observed (drivers = 45.9%, passengers = 46.4%, and pedestrians = 45.6%). In general, the most prevalent drug was alcohol, with 141 positive cases (36.1%), followed by cocaine, with 47 positive cases (12%). Amphetamines and cannabis had positivity rates of 4.1 and 4.3%, with 16 and 17 positive cases, respectively. The combined use of alcohol and other drugs was found in 36 cases (9.2%). Crack cocaine use was observed in 27.7% of the positive cases for cocaine. CONCLUSIONS For the effective reduction of traffic accidents related to driving under influence of drugs (DUID), we suggest the intensification of enforcement actions against the use of alcohol by drivers, the definition of which illicit drugs should be surveyed, as well the cutoff values, the promotion of changing legislation to oblige drivers to provide samples for toxicological testing, and the establishment of public information programs and specific actions aimed at young drivers to promote behavioral changes.
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Affiliation(s)
- Fabrício Souza Pelição
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
- b Departamento de Análises Clínicas , Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
| | - Mariana Dadalto Peres
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
- b Departamento de Análises Clínicas , Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
| | - Jauber Fornaciari Pissinate
- a Departamento Médico Legal, Serviço de Laboratório Médico Legal , Polícia Civil do Espírito Santo , Vitória , Brazil
| | | | | | - Ester Miyuki Nakamura-Palacios
- c Departamento de Ciências Fisiológicas , Centro de Ciências da Saúde, Universidade Federal do Espírito Santo , Vitória , Brazil
| | - Bruno Spinosa De Martinis
- d Departamento de Química , Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo , Ribeirão Preto , Brazil
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Kim JH, Mooney SJ. The epidemiologic principles underlying traffic safety study designs. Int J Epidemiol 2016; 45:1668-1675. [PMID: 27524819 DOI: 10.1093/ije/dyw172] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/12/2022] Open
Abstract
This article describes the epidemiological principles underlying four observational study designs commonly used to assess traffic safety: the case-control, case-crossover, culpability and quasi-induced exposure designs. We focus in particular on the specific challenges for preventing bias using each design. Whereas recruiting controls representative of the source population poses a special challenge in case-control traffic safety studies, case-crossover designs are prone to recall bias, and culpability and quasi-induced exposure studies can be undermined by difficulties assigning crash responsibility. Using causal diagrams and worked examples, we provide a simple way to teach traffic safety designs to epidemiologists and to encourage proper application of epidemiological principles among researchers designing traffic safety studies.
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Affiliation(s)
- June H Kim
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Stephen J Mooney
- Department of Epidemiology, Columbia University, New York, NY, USA
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48
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Bakke E, Bogstrand ST, Normann PT, Ekeberg Ø, Bachs L. Influence of alcohol and other substances of abuse at the time of injury among patients in a Norwegian emergency department. BMC Emerg Med 2016; 16:20. [PMID: 27277762 PMCID: PMC4898304 DOI: 10.1186/s12873-016-0085-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The presence of alcohol or other substances of abuse in blood or urine from injured patients is often used as a proxy for substance influence at the time of injury. The aim of this study was to obtain an estimate of substance influence at the time of injury based on blood concentrations of alcohol and other substances of abuse, and to explore the relationship between the substance prevalence at the time of admittance to the hospital and the actual influence at the time of the injury. METHODS The study included all adult patients admitted to the emergency department of a university hospital during 1 year (n = 996). Quantification in blood was done by an enzymatic method for alcohol, and by liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry for 28 other substances of abuse. Concentrations of alcohol and other substances in blood at the time of injury were calculated. The degree of influence was assessed on the basis of the calculated blood concentrations, with a threshold of influence set at a blood alcohol concentration (BAC) of 0.05 %, or a substance concentration leading to an influence similar to that of a BAC of 0.05 %. RESULTS A total of 324 patients (32.5 %) were determined to be under the influence at the time of injury. In comparison, 394 patients (39.6 %) had one or more substances above the cut-off limit in blood at the time of admittance to the hospital. Alcohol was the most prevalent substance causing influence at 25.9 %. Among patients with violence-related injuries, almost 75 % were under the influence of alcohol and/or substances. Patients under the influence were younger, and men were more often under the influence than women. More patients were under the influence at nighttime and during weekends than at daytime and on weekdays. CONCLUSIONS About one third of the injured patients were determined to be under the influence at the time of injury, with alcohol being the most prevalent substance causing influence. Approximately 98 % of the patients with alcohol detected in blood at the time of admittance to the hospital were under the influence of alcohol at the time of injury.
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Affiliation(s)
- Eirin Bakke
- Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
| | - Stig Tore Bogstrand
- Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
| | - Per Trygve Normann
- Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
| | - Øivind Ekeberg
- Department of Acute Medicine, Oslo University Hospital, 0407, Oslo, Norway
| | - Liliana Bachs
- Division of Forensic Sciences, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway
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49
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Amphetamine-type stimulant use and the risk of injury or death as a result of a road-traffic accident: A systematic review of observational studies. Eur Neuropsychopharmacol 2016; 26:901-22. [PMID: 27006144 DOI: 10.1016/j.euroneuro.2016.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/12/2016] [Accepted: 02/20/2016] [Indexed: 11/23/2022]
Abstract
Amphetamine-type substances are frequently detected among drivers injured or killed due to road-trauma. However, the role of this substance in crash causation remains equivocal. We performed a systematic review to evaluate existing evidence regarding the association between amphetamine use and the risk of injury or death due to road traffic accidents. A bibliographical search of PubMed, SafetyLit, Scopus, and Science Direct literature databases from 01 January 1980 until May 2015 was performed. The quality of included studies was assessed using the Newcastle-Ottowa Scale (NOS) (cut-off of ≥7 indicated high quality). Inter-rater reliability between three independent reviewers for the NOS was calculated using Cohens kappa (κ) statistic, and best-evidence synthesis was performed. A total of 182 articles were found. Nine studies met eligibility criteria for inclusion for review, and seven studies were included for best-evidence synthesis. Best-evidence synthesis demonstrated a conflicting level of evidence for associations between the use of-amphetamine-type substances and the risk of sustaining an injury, and a moderate level of evidence between amphetamine use and the risk of death due to road trauma. This is the first review to synthesise evidence regarding the association between amphetamine-type substance use and the risk of injury or death due to a road traffic accident. More conclusive evidence of death due to road trauma among amphetamine users may reflect significant and global deficits in functioning associated with effective vehicular control under the influence of this substance. Additional high quality, sufficiently powered studies are required to elucidate the magnitude of these associations.
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50
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Heydari ST, Vossoughi M, Akbarzadeh A, Lankarani KB, Sarikhani Y, Javanmardi K, Akbary A, Akbari M, Mahmoodi M, Shirazi MK, Tabrizi R. Prevalence and risk factors of alcohol and substance abuse among motorcycle drivers in Fars province, Iran. Chin J Traumatol 2016; 19:79-84. [PMID: 27140214 PMCID: PMC4897829 DOI: 10.1016/j.cjtee.2015.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of this present study is to investigate the prevalence of alcohol and substance abuse (ASA) and its relationship with other risky driving behaviors among motorcycle drivers. METHODS This is a cross sectional study which is performed at Shiraz city of Iran. Data from motorcycle drivers were collected using a standard questionnaire in eight major streets at different times of the day. The data includes consumption of alcohol and other substances two hours before driving and some of the risky behaviors during driving. RESULTS A total of 414 drivers with a mean ± SD age of (27.0 ± 9.3) years participated in the study. Alcohol or substance consumptions two hours before driving was significantly associated with risky driving behaviors such as using mobile phone during driving, poor maneuvering, and driving over the speed limit (both p < 0.001). It was also associated with carelessness about safety such as driving with technical defects (p < 0.001) and not wearing a crash helmet (p=0.008). CONCLUSION Screening for alcohol and substance consumption among motorcycle drivers is an efficient way to identify drivers that are at a greater risk for road traffic accidents.
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Affiliation(s)
- Seyed Taghi Heydari
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Vossoughi
- Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Akbarzadeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran B. Lankarani
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yaser Sarikhani
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Kazem Javanmardi
- Fars Province Police Headquarter Applied Research & Studies Office, Shiraz, Iran
| | - Ali Akbary
- Department of Psychiatry, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Maryam Akbari
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author. Tel.: +98 711 2309615.
| | - Mojtaba Mahmoodi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Tabrizi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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