Alcohol, drugs, and road traffic crashes in India: a systematic review

Challenges for setting up psychiatric services in a trauma centre in India

Psychiatric sequelae may occur following traumatic injury irrespective of whether an insult has been caused to the brain. A range of psychiatric illnesses have been either causative of or associated with road traffic accidents and traumatic injuries, including depression, anxiety, post-traumatic stress disorder, substance use disorder and attention-deficit hyperactivity disorder. Despite literature on such associations, psychiatric intervention in the treatment of patients following traumatic injury is limited. The authors share their experience of challenges in addressing mental health problems in a tertiary care trauma centre located in North India. Steps in overcoming those challenges included: developing a semi-structured form to be completed for referrals and consultations, a psychiatrist attending weekly rounds with the surgeons, and initiating a psychiatry out-patient clinic for patients discharged from the trauma centre. It may be worthwhile in the future to set up a trauma psychiatry unit at the centre, involving a clinical psychologist, a psychiatric social worker and an occupational therapist for the comprehensive care of patients.

Use of psychoactive substances by goods carriage drivers associated with Kerala, India

OBJECTIVE

This study aimed to measure the prevalence of drugs of abuse (DOA) among the goods carriage drivers associated with the southern State of India, Kerala.

METHODS

Point-of-collection testing (POCT) of oral fluid collected from the participants (n = 249) was done using the Evidence MultiSTAT DOA Oral Fluid II Assay kits and the Evidence MultiSTAT analyzer.

RESULTS

Out of the total samples, 53 (21.29%) were positive for one or more DOA. A high prevalence of tetrahydrocannabinol (THC) (10.04%) and synthetic cannabinoids were detected in the samples. The use of ketamine, alpha-PVP, LSD, methamphetamine, opiate, 6-MAM, benzodiazepines I, methadone, PCP, tramadol, and amphetamine was also detected and their frequency of use ranged between 4.02 and 0.80%. An association between drug abuse and distance of travel was found in drivers in this study, χ2 (5, N = 249) = 123.5, p < 0.001. Confirmatory analysis using ultra-high performance liquid chromatography-tandem mass spectrometry showed excellent agreement with the results of the screening test.

CONCLUSIONS

This was the first study conducted among drivers in India for the detection of DOA. Tetrahydrocannabinol (THC) was used more by the goods carriage drivers associated with Kerala State, India. The use of psychoactive substances significantly increased with the distance of travel. Point-of-collection testing (POCT) by the biochip array technology is an efficient method for the detection of these substances.

Electrochemical Nanosensors for Sensitization of Sweat Metabolites: From Concept Mapping to Personalized Health Monitoring

Sweat contains a broad range of important biomarkers, which may be beneficial for acquiring non-invasive biochemical information on human health status. Therefore, highly selective and sensitive electrochemical nanosensors for the non-invasive detection of sweat metabolites have turned into a flourishing contender in the frontier of disease diagnosis. A large surface area, excellent electrocatalytic behavior and conductive properties make nanomaterials promising sensor materials for target-specific detection. Carbon-based nanomaterials (e.g., CNT, carbon quantum dots, and graphene), noble metals (e.g., Au and Pt), and metal oxide nanomaterials (e.g., ZnO, MnO2, and NiO) are widely used for modifying the working electrodes of electrochemical sensors, which may then be further functionalized with requisite enzymes for targeted detection. In the present review, recent developments (2018-2022) of electrochemical nanosensors by both enzymatic as well as non-enzymatic sensors for the effectual detection of sweat metabolites (e.g., glucose, ascorbic acid, lactate, urea/uric acid, ethanol and drug metabolites) have been comprehensively reviewed. Along with this, electrochemical sensing principles, including potentiometry, amperometry, CV, DPV, SWV and EIS have been briefly presented in the present review for a conceptual understanding of the sensing mechanisms. The detection thresholds (in the range of mM-nM), sensitivities, linear dynamic ranges and sensing modalities have also been properly addressed for a systematic understanding of the judicious design of more effective sensors. One step ahead, in the present review, current trends of flexible wearable electrochemical sensors in the form of eyeglasses, tattoos, gloves, patches, headbands, wrist bands, etc., have also been briefly summarized, which are beneficial for on-body in situ measurement of the targeted sweat metabolites. On-body monitoring of sweat metabolites via wireless data transmission has also been addressed. Finally, the gaps in the ongoing research endeavors, unmet challenges, outlooks and future prospects have also been discussed for the development of advanced non-invasive self-health-care-monitoring devices in the near future.

The Association among Alcohol Consumption Patterns, Drink-Driving Behaviors, and the Harm from Alcohol-Related Road Traffic Injuries Due to the Drinking of Others in Thailand

Thailand has one of the highest rates of traffic-related fatalities and alcohol-related road traffic injuries globally. Previous studies focused on alcohol consumption and road traffic injuries. However, no existing studies investigate the association between drink-driving behaviors and road traffic injuries due to the drinking of others. This study aims to explore any potential associations among alcohol drinking patterns, drink-driving behaviors, and the harm from alcohol-related road traffic injuries due to the drinking of others. The Thai Tobacco and Alcohol Use Household National Survey data in 2017 (n = 80,797) were analyzed using multiple logistic regression. This study found that current drinkers and binge drinkers were more likely to suffer from road traffic injuries due to others' drink-driving behavior, i.e., 1.50 times (95% CI: 1.49-1.51) and 2.31 times (95% CI: 2.30-2.33), respectively, compared with non-drinkers. In addition, we found that drink-driving behavior was associated with harm from road traffic injuries due to others' drink-driving behavior by 2.12 times (95% CI: 2.10-2.14) compared with the non-drinker group. This study calls for effective measures to reduce drink-driving behaviors to prevent road traffic injuries due to the drinking of others.

The burden of transport injury and risk factors in India from 1990 to 2019: evidence from the global burden of disease study

BACKGROUND

India is one of the fastest-growing developing economies associated with many socio-demographic challenges that include a high density of population, growing urbanization, and poor road infrastructure. These challenges might lead to the cause of injury, especially transport related. Therefore, we aim to analyze the burden of Transport Injury (TI) and associated risk factors in India using the required data from 1990 to 2019.

METHODS

This study has used the latest Global Burden of Disease Study (GBD) 2019 data set and estimated TI-related incidence rate, mortality (death) rate, and Disability-Adjusted Life Years (DALYs) lost for India over the period from 1990 to 2019. The latest round of GBD survey-2019 provides information about 369 diseases and injuries and 87 risk factors across age groups and gender.

RESULTS

Around 25% of the death rate of all ages was caused due to TI in 2019, significantly higher than in 1990 (20%). However, between 1990 and 2019, the DALYs rate per 100,000 people due to TI decreased slightly by 1.6% for all ages and both gender while more reduction has been observed in under 5- and 5-14-years age groups. On the contrary, the incidence rate and DALYs rate had increased substantially in the age group above 50 years which could be a serious issue for the safety of aging people. By analyzing the sub-cause of TI, we found that motorcyclist road injuries and pedestrian road injuries have been major causes of deaths in India during the last three decades. Further, we have found four risk factors associated with environmental change, occupational hazard, behavioral risk, and metabolic risk that cause TI injuries.

CONCLUSIONS

TI-related disease burden has not been reduced over the years in India despite improvements in road infrastructure and digital technology. Improvement in transport policies; awareness about traffic rules and laws among citizens, and improvement in governance in the road & transport sector could change the behavioral risk factors of TI and reduce population unwanted death and suffering.

Traumatic brain injury during COVID-19 pandemic-time-series analysis of a natural experiment

OBJECTIVES

This study aims to find if the incidence and pattern of traumatic brain injury (TBI) changed during the COVID-19pandemic. We also aim to build an explanatory model for change in TBI incidence using Google community mobility and alcohol sales data.

DESIGN

A retrospective time-series analysis.

SETTING

Emergency department of a tertiary level hospital located in a metropolitan city of southern India. This centre is dedicated to neurological, neurosurgical and psychiatric care.

PARTICIPANTS

Daily counts of TBI patients seen between 1 December 2019 and 3 January 2021 (400 days); n=8893. To compare the profile of TBI cases seen before and during the pandemic, a subset of these cases seen between 1 December 2019 and 31 July 2020 (244 days), n=5259, are studied in detail.

RESULTS

An optimal changepoint is detected on 20 March 2020 following which the mean number of TBI cases seen every day has decreased and variance has increased (mean 1=29.4, variance 1=50.1; mean 2=19.5, variance 2=59.7, loglikelihood ratio test: χ2=130, df=1, p<0.001). Two principal components of community mobility, alcohol sales and weekday explain the change in the number of TBI cases (pseudo R2=58.1). A significant decrease in traffic accidents, falls, mild/moderate injuries and, an increase in assault and severe injuries is seen during the pandemic period.

CONCLUSIONS

Decongestion of roads and regulation of alcohol sales can decrease TBI occurrence substantially. An increase in violent trauma during lockdown needs further research in the light of domestic violence. Acute care facilities for TBI should be maintained even during a strict lockdown as the proportion of severe TBI requiring admission increases.

Epidemiology, Hot Spots, and Sociodemographic Risk Factors of Alcohol Consumption in Indian Men and Women: Analysis of National Family Health Survey-4 (2015-16), a Nationally Representative Cross-Sectional Study

Objectives: To map the alcohol hot spots and understand the Sociodemographic Indices (SDI) affecting alcohol consumption in Indian men and women.

Methods: Data from National Family Health Survey-4 carried out from 2015 to 2016 with a sample size of 103,411 men and 699,686 women were used for Geographic Information System mapping, and hot spot identification by spatial statistics (Getis-Ord Gi^*). Bivariate analyses and multiple logistic regressions were used to analyze SDI.

Results: India has three major alcohol hot spots: (1) North-East (NE) states, (2) Eastern Peninsular states formed by Chhattisgarh, Odisha, Jharkhand, and Telangana, and (3) Southern states of Tamil Nadu and Kerala. Hot spot analysis strongly correlated with region-wise analysis of SDI. Respondents who consumed tobacco have higher odds (men adjusted odds ratio [aOR]: 5.42; women aOR: 4.30) of consuming alcohol. Except for religion and social category, other socioeconomic factors have a low to moderate effect on alcohol consumption.

Conclusions: Hot spots and high-risk districts of alcohol consumption identified in this study can guide public health policies for targeted intervention. Alcohol use is at the discretion of individual states and union territories, and stringent anti-alcohol policies strictly enforced across India are the keys to control alcohol use.

Changing pattern of trauma during the COVID-19 Pandemic

Background

The COVID-19 pandemic compelled the Indian government to enforce a complete nationwide lockdown on 24th March 2020.

Methods

This retrospective study was done to analyse the profile of trauma patients presenting to the emergency department (ED) from January to August 2020. Data from 69 days of lockdown and 83 days of pre-lockdown periods were used to calculate the 30-day incidence rates.

Results

During the 7-month study period, 5220 patients presented to our ED with trauma; 2296 in the prelockdown phase (83 days), 1205 during the lockdown phase (69 days), and 1719 during the postlockdown phase (92 days). There was a significant decrease (36.7%) in the 30-day incidence rate of trauma victims presenting to the ED during the lockdown phase (525) compared with the prelockdown phase (830). The 30-day incidence of road traffic accidents (RTA), fall from height, fall on level ground and other trauma decreased by 53.2%, 26%, 23.2% and 12.9%, respectively, while assault cases increased by 8.3% during the lockdown period as compared with the prelockdown period. During the lockdown period, the 30-day incidence of trauma victims with a positive blood alcohol content decreased by 39.6% with a significant drop in the strict lockdown month of April 2020.

Conclusions

A significant reduction in the incidence rate of trauma victims, especially RTA and geriatric trauma was seen during the gruelling lockdown period of the COVID 19 pandemic.

Legal, Social, and Occupational Problems in Persons with Alcohol Use Disorder: An Exploratory Study

BACKGROUND

Very few studies have examined the extent and nature of legal, social, and occupational problems among persons who have SUDs. This study was aimed at studying the prevalence and patterns of the aforementioned problems among individuals with alcohol use disorders (AUDs) and their relationship with the quantity of alcohol consumed and other variables.

METHODS

We conducted a cross-sectional study of adult patients with a diagnosis of AUDs admitted to the deaddiction unit of a tertiary care facility in India, using a semistructured questionnaire prepared for this study.

RESULTS

The mean age (SD) of the 91 subjects (95.6% males) was 40.3 years (8.5). Majority of them (92.3%) had started alcohol consumption before the age of 25 years. Common problems reported were work absenteeism (83.5%), a major altercation with spouse (69.3%), assaulting someone while intoxicated (53.8%), and driving under the influence of alcohol (59.3%). Significant association was found between being unemployed and having a police complaint lodged against them (chi-square = 5.7, P = 0.01). Quantity of alcohol consumed per day was significantly more among those who had a history of work absenteeism (Z = 2.27, P = 0.01), major altercation with spouse (Z = 2.25, P = 0.02) and assaulted someone under intoxication (Z = 2.33, P = 0.02).

CONCLUSION

The quantity of alcohol consumed is significantly more in those who had several legal, social, and occupational problems when compared to those who did not have, highlighting the need for routine assessment of the aforementioned problems among patients of AUDs. Treatment of AUDs should be multidisciplinary, with targeted interventions tailored to the aforementioned problems. Doing so will go a long way in reducing the harm to patients and the community at large.

Tocilizumab: An Effective Therapy for Severely and Critically Ill COVID-19 Patients

Background: Tocilizumab (TCZ), a monoclonal antibody against the most prevalent cytokine interleukin-6 (IL-6), is an emerging therapeutic option for COVID-19 infections. The present study was undertaken to assess the therapeutic response of TCZ therapy in severely or critically ill COVID-19 patients and its role as an effective modality of management. Methods: The present retrospective observational study included 30 admitted severely or critically ill COVID-19 patients, treated with TCZ therapy on behalf of raised IL-6 levels. The patients' data concerning medical history, clinical manifestation, arterial blood gas analysis, mode of oxygenation, radiological imaging, and outcome were extracted from their medical records and compared pre- and post-TCZ infusion. Results: All patients of the study group had symptomatic presentations with a mean PaO2/FiO2 (P/F) ratio of 205.41 before TCZ infusion. All patients had a raised IL-6 level (mean value 206.56 pg/mL) that was extremely elevated in 90% of patients. Infusion of TCZ dramatically reduced mean body temperature (100.78-99.32°F) and the requirement for supplemental oxygen (68-48%) and improved mean SpO2 (86-89%) and mean P/F ratio (208-240) within 24 hours. Three patients on noninvasive ventilation were weaned off after TCZ infusion. Serum levels of IL-6 were raised initially but declined within 3-5 days of post-TCZ infusion. Conclusion: TCZ appears to be an effective therapeutic option in severely or critically ill COVID-19 patients with raised IL-6 levels. TCZ immediately improves the clinical status of patients by a probable mechanism of inhibition of cytokine storm and reduces COVID-19-related mortalities. How to cite this article: Bhandari S, Rankawat G, Singh A. Tocilizumab: An Effective Therapy for Severely and Critically Ill COVID-19 Patients. Indian J Crit Care Med 2021;25(3):260-266.

Evaluation of Clinical Outcome in Traumatic Facial Nerve Paralysis

Introduction  The facial nerve is the most commonly paralyzed nerve in the human body, resulting in far-reaching functional, aesthetic and emotional concerns to the patient.

Objective  Evaluation of the clinical outcome of 47 patients with traumatic facial nerve paralyses, with respect to clinical recovery and audiological sequelae.

Methods  A descriptive longitudinal study was conducted over 24 months between January 2017 and December 2018 at a tertiary center with detailed clinical, topodiagnostic, audiometric and radiological evaluation and regular follow-up after discharge.

Results  Road traffic accidents constituted 82.98% of the trauma cases, out of which 76.60% were found to be under the influence of alcohol.

Delayed facial paralysis was observed in 76.60% cases. Temporal bone fracture was reported in 89.36%, with otic capsule (OC) sparing fractures forming 91.49% of the cases. Topologically, the injury was mostly at the suprachordal region around the second genu. The majority of the patients (65%) attained full recovery of facial nerve function with conservative medical management. Audiometrically, 77.27% of the patients had hearing loss at the time of presentation, of which 64.71% were conductive in nature; 51.22% attained normal hearing at follow-up visits.

Conclusion  Early initiation of steroid therapy, concurrent eye care and physiotherapy are the cornerstones in the management of traumatic facial nerve paralysis.

A copula-based approach for jointly modeling crash severity and number of vehicles involved in express bus crashes on expressways considering temporal stability of data

The consequences of crashes, including injury, loss of lives, and damage to properties, are further worsened when buses plying expressways are involved in the crash. Previous studies have separately analyzed crash severity in terms of monetary cost, injuries and loss of lives, and the size of crashes in terms of the number of vehicles involved. However, as both outcome variables are correlated, it is imperative to perform a combined analysis using an appropriate econometric model to achieve a better model fit. This study contributes to the literature by jointly exploring the factors influencing the severity and size of express bus-involved crashes that occur on expressways and characterizes the dependence between both outcome variables by employing a more plausible copula regression framework. Likelihood ratio tests were also conducted to investigate the temporal stability of the factors that affect both crash severity and size. Based on the goodness-of-fit statistics, the Frank copula model proved superior to the independent ordered probit model. The estimate of the underlying dependence between the outcome variables provided a better comprehension of the correlation between them. Temporal instability was detected for the individual parameters in the models and is attributed to the changing driving behavior due to the heightened road safety campaigns. The results suggest that traffic exposure measures are significantly associated with a higher propensity of observing increased bus crash severity and size. Insights into the factors influencing the size and severity of express bus crashes are discussed, and appropriate engineering, enforcement, and education-related countermeasures are proposed.

Injury severity analysis of familiar drivers and unfamiliar drivers in single-vehicle crashes on the mountainous highways

Mountainous highways suffer from high crash rates and fatality rates in many countries, and single-vehicle crashes are overrepresented along mountainous highways. Route familiarity has been found greatly associated with driver behaviour and traffic safety. This study aimed to investigate and compare the contributory factors that significantly influence the injury severities of the familiar drivers and unfamiliar drivers involved in mountainous highway single-vehicle crashes. Based on 3037 cases of mountainous highway single-vehicle crashes from 2015 to 2017, the characteristics related to crash, environment, vehicle and driver are included. Random-effects generalized ordered probit (REGOP) models were applied to model injury severities of familiar drivers and unfamiliar drivers that are involved in the single-vehicle crashes on the mountainous highways, given that the single-vehicle crashes had occurred. The results of REGOP models showed that 8 of the studied factors are found to be significantly associated with the injury severities of the familiar drivers, and 10 of the studied factors are found to significantly influence the injury severities of unfamiliar drivers. These research results suggest that there is a large difference of significant factors contributing to the injury severities between familiar drivers and unfamiliar drivers. The results shed light on both the similar and different causes of high injury severities for familiar and unfamiliar drivers involved in mountainous highway single-vehicle crashes. These research results can help develop effective countermeasures and proper policies for familiar drivers and unfamiliar drivers targetedly on the mountainous highways and alleviate injury severities of mountainous highway single-vehicle crashes to some extent. Based on the results of this study, some potential countermeasures can be proposed to minimize the risk of single-vehicle crashes on different mountainous highways, including tourism highways with a large number of unfamiliar drivers and other normal mountainous highways with more familiar drivers.

RETRACTED ARTICLE: Psychological predictors behind the intention to drink and drive among female drivers: Application of extended theory of planned behavior

We, the Editor and Publisher of Traffic Injury Prevention, have retracted the following article:Ankit Kumar Yadav. Psychological predictors behind the intention to drink and drive among female drivers: Application of extended theory of planned behavior. Traffic Injury Prevention. 2020. https://doi.org/10.1080/15389588.2019.1703961.The author has requested the retraction of his article due to an error in one of the collected psychological measures. During data extraction, the responses for 'attitude' and 'intention' measures were switched and may have influenced the findings from the developed regression model and its results. As a result, the Editor and Publisher have agreed to retract the article in full.We have investigated and have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions.The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as "Retracted".

Blood alcohol levels in road traffic accidents: Factors associated and the relationship between history of alcohol consumption and blood alcohol level detection

Introduction:

Alcohol consumption contributes to a significant number of road traffic accidents (RTAs), and data regarding the reliability of history and blood alcohol content (BAC) in RTA victims are scant.

Methodology:

This retrospective study was conducted in the emergency departments (EDs) over 6 weeks. All adult RTAs presenting within 12 h of the incident were included for analysis.

Results:

The study cohort included 369 RTA patients, with the mean interval before presentation being 3 h (standard deviation: 2.22). Two-wheeler accidents (77.2%) were the predominant mode of injury. Usage of a helmet and seat belt was documented in a meager (6.4% [17/267] and 8.8% [3/34], respectively). A positive history of alcohol consumption was reported by 19.5% of cases (72/369). However, BAC was detectable in 30.1% of cases (111/369), with an alarming 19.78% (73/369) being above the legal limit for driving. Nearly 77.5% (86/111) of those who tested positive for alcohol consumption were driving the vehicle involved. Positive BAC levels showed a significant association with young age (18–39 years), male gender, two-wheeler usage, and between 5 PM and 12 AM.

Conclusion:

A history of alcohol consumption leading to an RTA is not reliable in the ED. Hence, measuring BAC levels in all RTA patients provides an objective and reliable form of documentation for medico-legal purposes.

Acute Kidney Injury in Severe Trauma Patients; a Record-Based Retrospective Study

Introduction:

Acute kidney injury (AKI) is a common and devastating clinical issue in the community associated with high rates of morbidity and mortality.

Objective:

We aimed at estimating the frequency and levels of severity of AKI in trauma patients requiring hospital admission using the RIFLE criteria and assess their outcome.

Method:

Our retrospective record based study enrolled data of 80 participants aged 18–59 years who presented to the emergency department of KIMS hospital following an acute traumatic event. Participants with pre-existing renal dysfunction, chronic heart failure and chronic liver disease were excluded. Tests of significance were Chi square and independent sample t test, a p<0.05 was considered statistically significant.

Results:

Participants with AKI had significantly lower age (p=0.02) and lower revised trauma score (RTS) (p=0.01). Significant association of AKI with hypotension (p=0.01) and Glasgow coma scale (GCS) (p=0.008) was observed. No association of AKI with gender was observed (p=0.6). None of the AKI patients required renal replacement therapy and all participants attained normal renal function at discharge. Significantly longer mean duration of hospital stay (14.4 days) was observed among AKI patients (p=0.02). Totally, 6.3 % mortality was observed among both participants with and without AKI.

Conclusion:

Forty percent of acute trauma patients had AKI (in risk and injury category); but none were in failure, loss or end stage renal disease. No association of AKI and mortality was observed. AKI was associated with age, RTS, hypotension and GCS.

Factors affecting the injury severity of out-of-control single-vehicle crashes in Singapore

Single-vehicle (SV) crashes are of major concerns because of their high fatality rates. To understand the proneness of high injury severity for vehicle operators brought about by SV crashes without the confounding influence of other road users, this study focuses on those SV crashes without colliding with pedestrians, which are defined as out-of-control SV crashes given the general consequence of involved vehicles. Moreover, to compare the influence of contributory factors (including driver-vehicle/rider-vehicle, roadway, and environmental characteristics) by vehicle types, the injury severity for riders of motorized two-wheelers and drivers of other motorized vehicles are investigated separately using two disaggregated ordered probit models. The results show that for both riders and drivers, variables such as age (65 and above), drink driving, error type of failing to have proper control, driving maneuvers of left and right turns as well as driving after midnight are associated with more severe injuries whereas factors such as wet, oily or sandy surfaces are related to less severe injury. Four other variables, i.e., foreign vehicle registration, probation or expired license, high speed-limit roads, and type of median lane, have different influences on riders and drivers on injury severity. Additionally, factors such as road traffic type and nationality are only found to significantly influence only riders and drivers respectively. The results shed light on both the similar and different causes of high injury severity for riders and drivers involved in out-of-control SV crashes. Based on the findings, targeted countermeasures may be introduced from multiple perspectives such as driver education and policy development to improve non-traffic-interactive safety.

Prevalence and Correlates of Current Alcohol Use among Bhutanese Adults: A Nationally Representative Survey Data Analysis

BACKGROUND

Alcohol-related ailments are among the 10 leading causes of morbidity and mortality in Bhutan. The objectives of this article were to determine the prevalence and explore the correlates of current alcohol use among Bhutanese adults.

MATERIALS AND METHODS

This is a retrospective study of secondary data from the National Health Survey 2012 of Bhutan. The outcome variable of interest was current alcohol use. The questionnaire was developed following the World Health Organization (WHO) STEPwise approach to Surveillance (STEPS) of noncommunicable diseases. Univariate and multivariate logistic regression was performed to identify the correlates of current alcohol use. The prevalence of current alcohol use was 30.9%. The correlates of current alcohol use were male sex [adjusted odds ratio (AOR) = 1.85; 95% confidence interval (CI) 1.47-2.36], widowhood (AOR = 2.92, 95% CI, 1.22-6.99), and chewing betel quid >20 times per week (AOR = 2.07, 95% CI, 1.08-4.03). Primary (AOR = 0.67, 95% CI, 0.50-0.91), high (AOR = 0.52, 95% CI, 0.38-0.71), and university (AOR = 0.46, 95% CI, 0.29-0.73) educated participants were less likely to be current alcohol users when compared with those who had no education. Compared with unskilled workers, services and sales workers were less likely to use alcohol regularly (AOR = 0.64, 95% CI, 0.49-0.82). Homemade alcohol Ara was the most common drink.

CONCLUSION

The national prevalence of current alcohol use in Bhutan is higher than the national average in the WHO South-East Asia Region. Prevention should target the correlates and limit the availability of locally home-brewed Ara.

Substance abuse at early age as a potential risk factor for driving under the influence of substance in Jeddah, Saudi Arabia: A cross-sectional study

OBJECTIVE

Worldwide, trauma is a major health problem, and road traffic accidents (RTAs) are the primary cause of death among young men in Saudi Arabia. The aim of our study was to estimate the extent of driving under the influence of an abused substance in Saudi Arabia and to explore the associated factors.

METHODS

This is a cross-sectional survey conducted between May and September 2016 at Al-Amal Hospital in Jeddah, Saudi Arabia, a referral center for addiction. We included all patients who were admitted for additional education and rehabilitation and had no psychotic symptoms. We used a standardized and pretested questionnaire to collect data regarding sociodemographic and socioeconomic characteristics, history of and current substance abuse, driving under the influence of an abused substance, injuries, imprisonment, and fatalities under the influence of an abused substance. Whenever possible, we compared self-reported data with medical records and resolved any conflict by discussion with the patient.

RESULTS

A total of 101 out of 112 invited patients participated in our study (90.2%). The mean age of the participants was 33.28 years (SD = 9.46 years). Of the total, 93.1% (n = 94) drove under the influence of an abused substance. Amphetamines and alcohol were the first substance abused (56.4% [n = 57] and 25.7% [n = 26] of patients, respectively). As currently abused substances, amphetamines and cannabis were reported in 38.6% (n = 39) and 24.8% (n = 25) of participants, respectively. The mean age at the time of the first substance abuse was 18.76 years (SD = 4.99 years). In the univariate regression (odds ratio [OR] = 0.86; 95% confidence interval [CI], 0.75-0.99; P = .046) but not the multivariate regression (OR =0.87; 95% CI, 0.75-1.00; P = .056), a younger age at the time of the first substance abuse was associated with a higher probability of driving under the influence of an abused substance.

CONCLUSIONS

Our study showed that among individuals hospitalized due to substance abuse problems, driving under the influence of drugs and alcohol was common. Preventive measures to reduce driving under the influence should be introduced in addition to specialized hospitals. Further research is required to investigate the factors associated with driving under the influence of abused substances in Saudi Arabia.

Epidemiological and Clinical Profile of Fatality in Vulnerable Road Users at a High Volume Trauma Center

Background:

Motorized two-wheelers, pedestrians, and cyclists are termed vulnerable road users (VRUs).Globally up to 50% of road deaths involve VRU and up to 80% in developing and rapidly motorizing economies.

Objective:

The objective of this study is to study the prehospital and clinical profile of fatally injured VRU. This would help in informed decision-making regarding prevention and trauma care infrastructure.

Materials and Methods:

A hospital-based study was performed at a Trauma Centre in Puducherry from January 2013 to June 2014 (18 months). Puducherry is a union territory of India in the state of Tamil Nadu. A total of 193 deaths due to Road traffic accident were included in this study. The demographics, prehospital findings, and the clinical progress of fatally injured VRU are described.

Results:

More than 80% of road traffic collision/crash deaths involved VRU of which the elderly comprised a significant proportion. Alcohol was a serious issue even in the elderly pedestrian. This study revealed specific injury patterns and severity. Head injury was the most common cause of death. Early deaths, that is within 24 h of injury was common at 50%.

Conclusion:

The majority of deaths were in the early phase of trauma hence mandating a strong call for prevention, along with strengthening of trauma care.

Cross-sectional study of road accidents and related law enforcement efficiency for 10 countries: A gap coherence analysis

OBJECTIVE

Road crashes are considered as the eighth leading causes of death. There is a wide disparity in crash severity and law enforcement efficiency among low-, medium-, and high-income countries. It would be helpful to review the crash severity trends in these countries, identify the vulnerable road users, and understand the law enforcement effectiveness in devising efficient road safety improvement strategies.

METHOD

The crash severity, fatality rate among various age groups, and law enforcement strategies of 10 countries representing low-income (i.e., India and Morocco), medium-income (i.e. Argentina, South Korea, and Greece), and high-income (i.e., Australia, Canada, France, the UK, and the United States) are studied and compared for a period of 5 years (i.e., 2008 to 2012). The critical parameters affecting road safety are identified and correlated with education, culture, and basic compliance with traffic safety laws. In the process, possible road safety improvement strategies are identified for low-income countries.

RESULTS

The number of registered vehicles shows an increasing trend for low-income countries as do the crash rate and crash severity. Compliance related to seat belt and helmet laws is high in high-income countries. In addition, recent seat belt- and helmet-related safety programs in middle-income countries helped to curb fatalities. Noncompliance with safety laws in low-income countries is attributed to education, culture, and inefficient law enforcement.

CONCLUSION

Efficient law enforcement and effective safety education taking into account cultural diversity are the key aspects to reduce traffic-related injuries and fatalities in low-income countries like India.

Predominance of alcohol and illicit drugs among traffic accidents fatalities in an urban area of Brazil

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.

Factors Impacting Mortality in the Pre-Hospital Period After Road Traffic Accidents in Urban India

Background

India currently has the dubious distinction of experiencing the highest number of road traffic accidents in the world.

Objectives

We believe that this study on road traffic accidents may help to identify factors in the pre-hospital setting that may influence mortality rates.

Patients and Methods

A prospective observational study was carried out in a metro area in India over a period of one year. The study included consecutive patients admitted to the trauma service after road traffic accidents. Demographic information, time and place of accident, and details regarding the vehicle and the events leading up to the hospital admission were recorded. Injury severity, management in the hospital, and final outcomes in terms of mortality were noted. The data were analyzed with SPSS software.

Results

A total of 773 patients were enrolled. Of these, there were 197 deaths and 576 survivors. The majority of patients were aged 15 - 40 years (67%) and were male (87.84%). More accidents occurred at night (58.2%) than during the day (41.8%). Mortality was not significantly associated with age, sex, or time of accident. City roads (38.9%) saw more accidents than highways (26.13%), but highway accidents were more likely to be fatal. Two-wheeler riders (37.65%) and pedestrians (35.75%) formed the majority of our study population. Mortality was significantly associated with crossing the road on foot (P = 0.004). Pillion riders on two-wheeler vehicles were more likely to experience poor outcomes (relative risk [RR] = 1.9, P = 0.001). Front-seat occupants in four-wheeler vehicles were at an increased risk of not surviving the accident (61.98%; RR=2.56, P = 0.01). Lack of safety gear, such as helmets, seat belts, and airbags, was significantly associated with mortality (P = 0.05). Delays in transfers of patients to the hospital and a lack of pre-hospital emergency services was significantly associated with increased mortality (P = 0.000).

Conclusions

A lack of respect for the law, weak legislation and law enforcement, disregard for personal safety, and driving vehicles under adverse conditions are some of the leading causes of road traffic accidents. There should be an emphasis on emergency trauma care in the pre-hospital setting.

Characteristics associated with alcohol consumption among emergency department patients presenting with road traffic injuries in Hyderabad, India

INTRODUCTION

Each year in India, road traffic crashes lead to more than 200,000 deaths and the country has seen an unprecedented rate of roadway fatalities in recent years. At the same time, alcohol consumption per capita among Indians is rising. Despite these increasing trends of road traffic injuries (RTIs) and alcohol use, alcohol is not routinely assessed as a risk factor for RTIs. This study aims to examine the involvement of alcohol among emergency department patients presenting with RTIs in the Indian city of Hyderabad.

PATIENTS AND METHODS

As part of a prospective study, data were collected from 3366 patients (88.0% male) presenting with RTIs at an emergency department in Hyderabad, India, from September 2013 to February 2014. Logistic regression models were used to assess individual-level and road traffic crash characteristics associated with suspected or reported alcohol consumption six hours prior to the RTI.

RESULTS

Alcohol was suspected or reported among 17.9% of the patients with RTIs. Adjusting for confounders, males experienced 9.8 times greater odds of alcohol-related RTIs than females. Compared to 15-24 year-olds, the odds of alcohol consumption was 1.4 times greater among 25-34 year-olds and 1.7 times greater among 35-44 year-olds, adjusting for confounding factors. Patients who were passengers in vehicles other than motorized two-wheelers had 90% reduced odds of an alcohol-related RTI than motorized two-wheeler drivers. Drivers of non-two-wheelers, passengers on two-wheelers, and pedestrians did not have significantly different odds of an alcohol-related RTI compared to two-wheeler drivers. Nighttime crashes were associated with nearly a threefold increase in the odds of alcohol consumption.

CONCLUSIONS

Given that alcohol was suspected or reported in more than one in six injured ED patients with RTIs, it is clear that alcohol is a serious risk factor for RTIs; this evidence can guide prevention efforts. These findings suggest that evidence-based interventions to reduce drink-driving, such as random breath testing (where law enforcement officials stop drivers on the road to test them for alcohol use), could be more widespread in India. Future studies should assess the effectiveness of greater implementation and enforcement of policies to decrease alcohol's availability to reduce RTIs.

Multinational Alcohol Market Development and Public Health: Diageo in India

Alcohol is a risk factor for communicable and noncommunicable diseases, and alcohol consumption is rising steadily in India. The growth of multinational alcohol corporations, such as Diageo, contributes to India's changing alcohol environment. We provide a brief history of India's alcohol regulation for context and examine Diageo's strategies for expansion in India in 2013 and 2014. Diageo is attracted to India's younger generation, women, and emerging middle class for growth opportunities. Components of Diageo's responsibility strategy conflict with evidence-based public health recommendations for reducing harmful alcohol consumption. Diageo's strategies for achieving market dominance in India are at odds with public health evidence. We conclude with recommendations for protecting public health in emerging markets.

Development of Screening Questionnaire for Detection of Alcohol Dependence

INTRODUCTION

Alcohol dependence (AD) is a major reason for morbidity and visits to emergency medical settings. However, the detection of AD is often difficult or overlooked. This study aimed to develop a brief screening questionnaire in Hindi language for detection of AD in an emergency medical setting.

MATERIALS AND METHODS

The authors in consultation devised a set of questions related to AD in the Hindi language requiring binary yes/no type of response. These questions were guided by clinical experience, nosological criteria and previously published screening questionnaires. After initial piloting, these questions were administered by the treating doctors to 100 consenting adult patients presenting with possible AD in the emergency medical services of a tertiary care hospital in North India. A diagnosis of AD was arrived at by administering Mini-International Neuropsychiatric Interview separately. Identification of the most discriminant combinations of items for the detection of AD were based on the chi-square test and binary logistic regression analyses. The final version of the questionnaire was then externally validated on another cohort of patients.

RESULTS

Based on the analyses, we retained 5 items in the final version of the questionnaire. Sensitivity and specificity values for cut-off scores were calculated. Subsequent external validation revealed satisfactory psychometric properties of the questionnaire.

CONCLUSION

The questionnaire represents a simple and brief clinician-administered instrument for screening of AD in an emergency medical setting.

Harms to Adults from Others' Heavy Drinking in Five Indian States

AIMS

The aims of this study were to assess a wide range of alcohol-related harms from known heavy drinkers in Indian respondents' lives, and to assess respondents' characteristics and drinking patterns associated with reporting these harms.

METHODS

Household interviews were administered in five Indian states from October 2011 to May 2012. For the secondary data analyses in this study, participants were Indians, ages 15-70, who self-reported having a heavy drinker in their lives (n = 5,375). We assessed the proportion of respondents reporting seventeen types of alcohol-related harms from a heavy drinker.

RESULTS

Approximately 83% of respondents reported at least one alcohol-related harm from a heavy drinker in their lives. Twenty-five percent of respondents reported physical harm, 6% reported sexual harm and 50% reported emotional harm or neglect. Controlling for other factors, being in the upper income quartiles was associated with reporting ≥5 harm types. Among females, being age 25-39 and married/cohabitating predicted reporting ≥5 harm types, while among males, being age 25-39 or age 40-70 and living in a rural area increased the odds. Among females, binge drinkers had 46% lower odds of reporting ≥5 harm types than abstainers; among males, binge drinkers had 54% greater odds.

CONCLUSION

Regardless of respondents' own drinking pattern, a substantial proportion of respondents reported experiencing a range of harms from a known heavy drinker; interventions are needed to reduce these harms.

Burden, pattern and outcomes of road traffic injuries in a rural district of India

Road traffic injuries (RTIs) are a leading public health problem and the understanding of RTIs in rural India is limited. The present report documents the burden, pattern, characteristics and outcomes of RTIs in a rural district of India using combined data sources: police and hospital. RTIs contributed for 38% of fatal and 39% of non-fatal injuries with an annual mortality rate of 18.1/100,000 population/year. Young males were affected most and two-wheeler users and pedestrians were involved in 45% and 20% of fatal crashes, respectively. Nearly half (51%) of fatal RTIs occurred on national highways of the district; 46% died immediately at the site. Among those hospitalised, 20% were under the influence of alcohol while use of helmets and seat belts was <5%. Trauma care was deficient in the district leading to greater number of referrals. Road safety should be given high importance in rural India with a focus on safe roads, safe vehicles and safe people along with trauma care.