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Flores M, Reyna T, Quiñonez E, Mendoza JA, Corzo VF, Ortiz C, Huerta S. Unsafe Practices of Motorcycle Riders in El Petén, Guatemala: A Community Observational Study and a Retrospective Institutional Review. J Surg Res 2024; 301:103-109. [PMID: 38917573 DOI: 10.1016/j.jss.2024.04.084] [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: 01/16/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Outcomes from trauma at the major referral hospital [Hospital Nacional de San Benito (HNSB)] in El Petén, Guatemala, have not been analyzed. Empirical evidence demonstrated a high number of motorcycle accidents (MAs). We hypothesized a large incidence of head trauma with poor outcomes in MAs compared to all other forms of blunt trauma. METHODS Our hypothesis was tested by performing a community observational study and a retrospective chart review in El Petén, Guatemala. An independent observer catalogued 100 motorcycle riders on the streets of El Petén for riding practices as well as helmet utilization. HNSB does not have electronic medical records. For this study, we performed a retrospective chart review of randomly selected nonconsecutive trauma admission at HNSB between March 2018 and June 2023. Blunt trauma was compared between MAs versus all others. Variables were examined by parametric and nonparametric tests as well as contingency table analyses. RESULTS Most motorcycles riders involved multiple individuals (2.61 ± 0.79/motorcycle). Seventy riders included children (median = 1.0 [Q1-Q3 range = 1.0-3.0]/motorcycle). Overall, only three riders were wearing helmets. Forty-one were women. Of patients presenting to HNSB with trauma, 91 charts were reviewed (33.0 [20.0-37.0] y old; male 89%), 76.7% were blunt, and 23.3% were penetrating trauma. Within blunt trauma, 57.1% were MAs versus 42.9% all others; P = 0.13. MAs were younger (29.5 [20.0-37.0] versus 34.0 [21.8-45.8] y old; P < 0.05) and of similar gender (male 82.5% versus 96.6%; P = 0.1). More MAs had a computed tomography (70.0% versus 30.0%; P < 0.01) and they were more likely to present with head trauma (72.5% versus 46.7%; P = 0.04) but similar Glasgow Coma Scale (15.0 [13.5-15.0] versus 15.0 [12.5-15.0]; P = 0.7). MAs were less likely to require surgical intervention (37.5% versus 56.7%; P = 0.05) but had similar hospital length of stay (4.0 [2-6] versus 4.0 [2-10.5] d; P = 0.5). CONCLUSIONS Unsafe motorcycle practices in El Petén are staggering. Most trauma at HNSB is blunt, and likely from MAs. More patients with MAs presented with head trauma. However, severe trauma might be transferred to higher level hospitals or mortality might occur on scene, which will need further investigations. Assessment of mortality from trauma admissions is ongoing. These findings should lead to enforcement of safe motorcycle practices in El Petén, Guatemala.
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Affiliation(s)
- Miranda Flores
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tanya Reyna
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Eugenia Quiñonez
- Hospital Nacional de San Benito, El Peten Guatemala, Dallas, Texas
| | - Juan A Mendoza
- Hospital Nacional de San Benito, El Peten Guatemala, Dallas, Texas
| | - Victor F Corzo
- Hospital Nacional de San Benito, El Peten Guatemala, Dallas, Texas
| | - Cesar Ortiz
- Hospital Nacional de San Benito, El Peten Guatemala, Dallas, Texas
| | - Sergio Huerta
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Hospital Nacional de San Benito, El Peten Guatemala, Dallas, Texas; Department of Surgery, VA North Texas Health Care System, Dallas, Texas.
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Borges G, Orozco R. Sober up: Time from last drink to a road traffic injury. Alcohol 2024; 118:57-63. [PMID: 38040203 DOI: 10.1016/j.alcohol.2023.11.008] [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: 06/26/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE There is no intervention that quickly reduces a person's blood alcohol content (BAC). "Sober up before you drive" may prevent road traffic injury (RTI) caused by alcohol consumption. The aim of this study was to analyze the risk of RTI on an hourly basis (1-6 h) after the last drink and the determinants of this risk. METHODS This was a case-crossover study of alcohol consumption among 430 patients who suffered an RTI and arrived at an emergency department in a large hospital in Mexico City from January to April 2022. RESULTS Of the 430 patients studied, 46 reported drinking within 1 h before the RTI, for a risk ratio (RR) of 7.7 (95% CI [5.6, 10.4]). This RR decreased to 2.2 (95% CI [1.3, 3.7]) for the 12 patients drinking in the second hour before the RTI and was null for those drinking earlier (p ≤ 0.001 for the trend). The induction time was 3 h among those with higher BAC and intoxication levels. The RR for an RTI decreases 71% from the first to second hour from the last drink and 32% from the second to third hour. This decrease was similar among those intoxicated and those with increased BACs. In multiple regression models, higher levels of intoxication and higher BACs remained associated with higher RRs. DISCUSSION People should avoid driving after drinking. Waiting to drive, walking, or riding after drinking reduces the risk of an RTI, especially for people with higher BAC and intoxication levels.
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Affiliation(s)
- Guilherme Borges
- Instituto Nacional de Psiquiatría, Calzada México Xochimilco 101, Col. San Lorenzo Huipulco, C.P. 14370, Mexico City, Mexico.
| | - Ricardo Orozco
- Instituto Nacional de Psiquiatría, Calzada México Xochimilco 101, Col. San Lorenzo Huipulco, C.P. 14370, Mexico City, Mexico
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Quistberg DA, Perez-Ferrer C, Bilal U, Rodriguez Hernandez JL, Ramírez-Toscano Y, Cardenas Cardenas LM, Junquera-Badilla I, Yamada G, Barrientos-Gutierrez T, Diez Roux AV. Impact of an enhanced sobriety checkpoints programme and publicity campaign on motor vehicle collisions, injuries and deaths in Leon, MX: a synthetic control study. Inj Prev 2024:ip-2023-045019. [PMID: 39038940 DOI: 10.1136/ip-2023-045019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVE Drunk driving is a major cause of road traffic injuries and deaths in Latin America. We evaluated the impact of a drunk driving intervention in Leon, Mexico on road traffic safety. METHODS The intervention included increased drunk driving penalties, enhanced sobriety checkpoints and a young adult-focused mass media campaign, beginning 19 December 2018. We created a synthetic control Leon from 12 Mexican municipalities from a pool of 87 based on similarity to Leon using key predictors from 2015 to 2019. We assessed the effect of the intervention on road traffic collisions overall and collisions with injuries, deaths and involving alcohol, using data from police, insurance claims and vital registration. RESULTS As compared with the synthetic control, Leon experienced significant postintervention lower police-reported total collision rate (17%) and injury collisions (33%). Alcohol-involved collisions were 38% lower than the synthetic control. Fatal collisions reported by police were 28% lower while vital registration road traffic deaths were 12% lower, though these declines were not statistically significant. We found no impact on insurance collision claims. There was heterogeneity in these changes over the evaluation year, with stronger initial effects and weaker effects by the end of the year. CONCLUSIONS Drunk driving policies in Leon led to fewer traffic collisions and injuries during the first year of implementation, with a weakening of this effect over time, similar to interventions in high-income settings and other Latin American countries. Supporting the expansion of similar policies to other cities in the region could improve road safety.
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Affiliation(s)
- D Alex Quistberg
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Environmental & Occupational Health, Dornsife School of Public Health, drexel University, Philadelphia, Pennsylvania, USA
| | - Carolina Perez-Ferrer
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Yenisei Ramírez-Toscano
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico
| | - Luz Mery Cardenas Cardenas
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico
| | - Isabel Junquera-Badilla
- Consejo Nacional de Ciencia y Tecnología, Instituto Nacional de Salud Publica, Mexico City, Distrito Federal, Mexico
| | - Goro Yamada
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Holguín-Carvajal JP, Otzen T, Sanhueza A, Castillo Á, Manterola C, Muñoz G, García-Aguilera F, Salgado-Castillo F. Trends in traffic accident mortality and social inequalities in Ecuador from 2011 to 2022. BMC Public Health 2024; 24:1951. [PMID: 39034408 PMCID: PMC11264957 DOI: 10.1186/s12889-024-19494-7] [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: 04/11/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Traffic accidents (TA) remain a significant global public health concern, impacting low-and middle-income countries. This study aimed to describe the trend in TA mortality and inequalities in Ecuador for 2011-2022, distributed by year, gender, age group, geographical location, type of accident, and social inequalities. METHODS An ecological study was conducted using INEC national-level data on TA fatalities in Ecuador. Mortality rates were calculated per 100,000 population and analyzed by year, gender, age group, geographic region, and accident type. Annual percentage variation (APV) was determined using linear regression models. Inequality analyses examined associations between TA mortality and socioeconomic factors like per capita income and literacy rates. Complex measures such as the Slope Inequality Index (SII) were calculated to assess the magnitude of inequalities. RESULTS There were 38,355 TA fatalities in Ecuador from 2011 to 2022, with an overall mortality rate of 19.4 per 100,000 inhabitants. The rate showed a non-significant decreasing trend (APV - 0.4%, p = 0.280). Males had significantly higher mortality rates than females (31.99 vs. 7.19 per 100,000), with the gender gap widening over time (APV 0.85%, p = 0.003). The Amazon region had the highest rate (24.4 per 100,000), followed by the Coast (20.4 per 100,000). Adults aged ≥ 60 years had the highest mortality (31.0 per 100,000), followed by those aged 25-40 years (28.6 per 100,000). The ≥ 60 age group showed the most significant rate decrease over time (APV - 2.25%, p < 0.001). Pedestrians were the most affected group after excluding unspecified accidents, with a notable decreasing trend (APV - 5.68%, p < 0.001). Motorcyclist fatalities showed an increasing trend, ranking third in TA-related deaths. Lower literacy rates and per capita income were associated with higher TA mortality risks. Inequality in TA mortality between provinces with the highest and lowest per capita income increased by 247.7% from 2011 to 2019, as measured by the SII. CONCLUSION While overall TA mortality slightly decreased in Ecuador, significant disparities persist across demographic groups and geographic regions. Older adults, males, pedestrians, and economically disadvantaged populations face disproportionately higher risks. The increasing trend in motorcycle-related fatalities and widening socioeconomic inequalities are particularly concerning.
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Affiliation(s)
- Juan Pablo Holguín-Carvajal
- Programa de Doctorado en Ciencias Médicas, Universidad de La Frontera, Temuco, Chile
- Facultad de Medicina, Universidad del Azuay, Cuenca, Ecuador
- Núcleo Milenio de Sociomedicina, Santiago, Chile
| | - Tamara Otzen
- Programa de Doctorado en Ciencias Médicas, Universidad de La Frontera, Temuco, Chile.
- Núcleo Milenio de Sociomedicina, Santiago, Chile.
- Departamento de Especialidades Médicas, Universidad de La Frontera, Temuco, Chile.
| | | | - Álvaro Castillo
- Núcleo Milenio de Sociomedicina, Santiago, Chile
- Department of Public Health, Facultad de Medicina y Ciencia, Universidad San Sebastián, Concepción, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago, Chile
| | - Carlos Manterola
- Programa de Doctorado en Ciencias Médicas, Universidad de La Frontera, Temuco, Chile
- Núcleo Milenio de Sociomedicina, Santiago, Chile
| | - Georgina Muñoz
- Programa de Doctorado en Ciencias Médicas, Universidad de La Frontera, Temuco, Chile
- Facultad de Medicina, Universidad del Azuay, Cuenca, Ecuador
- Núcleo Milenio de Sociomedicina, Santiago, Chile
| | - Fernanda García-Aguilera
- Programa de Doctorado en Ciencias Médicas, Universidad de La Frontera, Temuco, Chile
- Núcleo Milenio de Sociomedicina, Santiago, Chile
- Universidad Central del Ecuador, Quito, Ecuador
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Staples JA, Erdelyi S, Merchant K, Yip C, Khan M, Maclure KM, Redelmeier DA, Chan H, Brubacher JR. Syncope and Traffic Crash: A Population-Based Case-Crossover Analysis. Can J Cardiol 2024; 40:554-561. [PMID: 37290537 DOI: 10.1016/j.cjca.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Among individuals with recent syncope, recurrence of syncope while driving might incapacitate a driver and cause a motor vehicle crash. Current driving restrictions assume that some forms of syncope transiently increase crash risk. We evaluated whether syncope is associated with a transient increase in crash risk. METHODS We performed a case-crossover analysis of linked administrative health and driving data from British Columbia, Canada (2010 to 2015). We included licensed drivers who visited an emergency department with "syncope and collapse" and who were involved as a driver in an eligible motor vehicle crash, both within the study interval. Using conditional logistic regression, we compared the rate of emergency visits for syncope in the 28 days before crash (the "pre-crash interval") with the rate of emergency visits for syncope in 3 self-matched 28-day control intervals (ending 6, 12, and 18 months before the crash). RESULTS Among eligible crash-involved drivers, 47 of 3026 pre-crash intervals and 112 of 9078 control intervals had emergency visits for syncope, indicating syncope was not significantly associated with subsequent crash (1.6% vs 1.2%; adjusted odds ratio [OR], 1.27; 95% confidence interval [CI], 0.90-1.79; P = 0.18). There was no significant association between syncope and crash in subgroups at higher risk for adverse outcomes after syncope (eg, age > 65 years, cardiovascular disease, cardiac syncope). CONCLUSIONS In the context of prevailing modifications of driving behaviour after syncope, an emergency department visit for syncope did not transiently increase the risk of subsequent traffic collision. Overall crash risks after syncope appear to be adequately addressed by current driving restrictions.
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Affiliation(s)
- John A Staples
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada.
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ketki Merchant
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Candace Yip
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayesha Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - K Malcolm Maclure
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donald A Redelmeier
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Rivera-Lara L, Videtta W, Calvillo E, Mejia-Mantilla J, March K, Ortega-Gutierrez S, Obrego GC, Paranhos JE, Suarez JI. Reducing the incidence and mortality of traumatic brain injury in Latin America. Eur J Trauma Emerg Surg 2023; 49:2381-2388. [PMID: 36637481 DOI: 10.1007/s00068-022-02214-4] [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: 03/25/2021] [Accepted: 12/26/2022] [Indexed: 01/14/2023]
Abstract
Traumatic brain injury (TBI) represents a considerable portion of the global injury burden. The incidence of TBI will continue to increase in view of an increase in population density, an aging population, and the increased use of motor vehicles, motorcycles, and bicycles. The most common causes of TBI are falls and road traffic injuries. Deaths related to road traffic injury are three times higher in low-and middle-income countries (LMIC) than in high-income countries (HIC). The Latin American Caribbean region has the highest incidence of TBI worldwide, primarily caused by road traffic injuries. Data from HIC indicates that road traffic injuries can be successfully prevented through concerted efforts at the national level, with coordinated and multisector responses to the problem. Such actions require implementation of proven measures to address the safety of road users and the vehicles themselves, road infrastructure, and post-crash care. In this review, we focus on the epidemiology of TBI in Latin America and the implementation of solutions and preventive measures to decrease mortality and long-term disability.
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Affiliation(s)
- Lucia Rivera-Lara
- Department of Neurology, School of Medicine, Center for Academic Medicine, Stanford University, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Walter Videtta
- Department of National Hospital, Alejandro Posadas, Buenos Aires, Argentina
| | - Eusebia Calvillo
- Departments of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
| | | | - Karen March
- Clinical Development at Integra Life Sciences, Seattle, WA, USA
| | | | | | - Jorge E Paranhos
- Santa Casa da Misericordia de São João del Rey, Minas Gerais, Brazil
| | - Jose I Suarez
- Departments of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
- Departments of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA
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Ou Z, Wu K, Ruan Y, Zhang Y, Zhu S, Cui J, Gao Y, Jiang D, Tang S, Su Y, Ren Y, Duan D, Zhang J, Wang Z. Global burden and trends of three common road injuries from 1990 to 2019 and the implications for prevention and intervention. ACCIDENT; ANALYSIS AND PREVENTION 2023; 193:107266. [PMID: 37801816 DOI: 10.1016/j.aap.2023.107266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/09/2023] [Accepted: 08/14/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Analysis on the burden of specific types of road injuries (RIs) in the previous Global burden of disease (GBD) studies is lacking. The present work aimed to analyze the burden of three common RIs using the updated data of the GBD 2019, which would inform policy-making. METHODS Data on cyclist road injuries (CRIs), motorcyclist road injuries (MRIs), and motor vehicle road injuries (MVRIs) were extracted from the GBD 2019. Trends of age-standardized rate (ASR) were predicted using estimated annual percentage change (EAPC) from 1990 to 2019. RESULTS Over the past three decades, the global incident ASRs of CRIs and MRIs presented increasing trends, but that of MVRIs declined slightly. However, trends of death and disability adjusted life years (DALYs) caused by three common RIs decreased in most regions and countries. Particularly, trends in ASRs of years of life lost (YLLs) cuased by RIs decreased more pronouncedly than that of years of life lived with disability (YLDs). The burden of three common RIs showed significant social and demographic characteristics. Low-middle and middle socio-demographic index (SDI) areas had a heavy burden of RIs, particularly CRIs and MRIs. However, the high SDI area undertook a relatively low burden, and presented more pronounced downward trends in death and DALYs. CONCLUSIONS The burden and changing trends of three common RIs were geographically heterogeneous. The findings highlighted that increasing incident trends of RIs needed more cost-effective measures of prevention and intervention.
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Affiliation(s)
- Zejin Ou
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Kangyong Wu
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Yanmei Ruan
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Yuxia Zhang
- School of Basic Medicine and Public Health, Jinan University, Guangzhou, China
| | - Shaofang Zhu
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Jiaxin Cui
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yunxia Gao
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Diwei Jiang
- School of Basic Medicine and Public Health, Jinan University, Guangzhou, China
| | - Shihao Tang
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Yiwei Su
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Yixian Ren
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Danping Duan
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Jinwei Zhang
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China
| | - Zhi Wang
- Key Laboratory of Occupational Environment and Health, Guangzhou Twelfth People's Hospital, Guangzhou, China.
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Alcohol, drugs, and road traffic injuries in an emergency department in Mexico City. Injury 2023; 54:481-489. [PMID: 36588032 DOI: 10.1016/j.injury.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
There have been no studies reporting on the use of biological specimens in Mexico to analyze the prevalence of alcohol and drug use among Emergency Department (ED) patients with a road traffic injury (RTI). We report here on a sample of 304 adult patients, admitted to the ED of a public hospital in Mexico City from January to April 2022, after being involved in an RTI. Patients gave informed consent for a breath test measuring breath alcohol concentration (BAC) and a saliva screening test for six classes of drugs (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, and methamphetamine). We found that at least one in every four patients (27.6%) had traces of alcohol or drugs in their body upon arrival in the ED. The breath test found a positive BAC in 16.1% of the sample; the most common substances detected in saliva were amphetamines or methamphetamine (8.6%), followed by cocaine (7.0%) and cannabis (6.9%). Only a few variables differentiated those with positive BAC from those with negative BAC (male, arriving on a weekend day or night, and arriving by ambulance), and even fewer variables differentiated those testing positives for drugs than those testing negative (less than 13 years of education and drivers of cars, bicycles, or other vehicles). While alcohol continues to be the single most used substance, our findings indicate that stimulants are of great concern. Since those testing positives for alcohol or drugs are so similar in their demographic pattern to those testing negative, the introduction of biological testing as a routine practice in the ED is highly recommended. Routine testing makes it possible to provide the patient with the best treatment and is also the best way to assess substance use.
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O’Donnell A, Anderson P, Schmidt C, Braddick F, Lopez-Pelayo H, Mejía-Trujillo J, Natera G, Arroyo M, Bautista N, Piazza M, Bustamante IV, Kokole D, Jackson K, Jane-Llopis E, Gual A, Schulte B. Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America. Glob Health Action 2022; 15:2080344. [PMID: 35867541 PMCID: PMC9310809 DOI: 10.1080/16549716.2022.2080344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru. OBJECTIVE To describe the process of development and cultural adaptation of the clinical intervention and training package. METHODS We drew on Barrero and Castro's four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement's Going to Scale Framework. RESULTS In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway. CONCLUSION Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.
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Affiliation(s)
- Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Anderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Christiane Schmidt
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fleur Braddick
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
| | - Hugo Lopez-Pelayo
- Addictions Unit, Psychiatry Department, Hospital Clínic, Barcelona, Spain
- Red de Trastornos Adictivos, Instituto Carlos III. Sinesio Delgado, Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | | | - Guillermina Natera
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Natalia Bautista
- Instituto Nacional de Psiquiatría Ram´on de la Fuente, Ciudad de México, Mexico
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Ines V. Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eva Jane-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Univ. Ramon Llull, ESADE, Barcelona, Spain
| | - Antoni Gual
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS); Rosselló, Barcelona, Spain
| | - Bernd Schulte
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Borges G, Orozco R. Alcohol and cannabis use in traffic-related injuries in Mexico City. Inj Prev 2022; 29:207-212. [PMID: 36600617 DOI: 10.1136/ip-2022-044782] [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: 09/28/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022]
Abstract
BACTERKGROUND There is debate on whether cannabis affects road traffic injuries (RTIs) separately from the effects of alcohol. Our goals are to report the possible increase in risk of an RTI among alcohol and cannabis users by type of exposure (biological, self-reported and combined) and the possible interaction of alcohol and cannabis in patients with an RTI in an emergency department in Mexico City. METHODS A case-crossover study with 433 cases of RTI (as a pedestrian, driver or passenger) during the period January-April 2022. A breath sample, an oral sample for cannabis detection and self-reported alcohol and cannabis use 6 hours prior to the RTI and in two control periods were used. We report ORs and 95% CIs from conditional logistic regressions for the case-crossover estimates. RESULTS Alcohol alone increased the risk of an RTI (OR=6.02, 95% CI 3.29 to 10.99) for most RTIs, regardless of whether we used information from self-reports or a breath sample in the hazard period. Conversely, cannabis only increased the RTI when we added information in the hazard period from self-reports or oral samples. Nevertheless, this increase in risk disappeared (OR=2.06, 95% CI 0.90 to 4.70) among those who only used cannabis. We also found no evidence of interaction between alcohol and cannabis in the risk of an RTI. CONCLUSIONS Alcohol is the most commonly used substance in Mexico and a high-risk factor for RTI in Mexico City. Although cannabis alone was not associated with an RTI, continuous monitoring of its effects is required.
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Affiliation(s)
- Guilherme Borges
- Center of Global Mental Health, National Institute for Psychiatry Ramon de la Fuente Muniz, Ciudad de Mexico, Mexico
| | - Ricardo Orozco
- Center of Global Mental Health, National Institute for Psychiatry Ramon de la Fuente Muniz, Ciudad de Mexico, Mexico
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11
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Conde K, Peltzer RI, Gimenez PV, Salomón T, Suarez G, Monteiro M, Cherpitel CJ, Cremonte M. Road traffic injury risk from alcohol and cannabis use among emergency department patients in Argentina. Rev Panam Salud Publica 2022; 46:e116. [PMID: 36060199 PMCID: PMC9426949 DOI: 10.26633/rpsp.2022.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/07/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To report the risk from alcohol, cannabis, and their combined use for non-fatal road traffic injuries for drivers, passengers, and pedestrians. Methods Risk was estimated using the case-crossover method. Participants (N= 306) were injured patients from an emergency department in Mar del Plata, Argentina. Results Alcohol use (OR= 6.78, CI 95% 3.75-12.25) as well as combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.73) significantly increased the risk of a road traffic injuries. Alcohol use increased the risk in both, women (OR= 8.87, CI 95% 2.69-29.21) and men (OR= 6.16, CI 95% 3.10-12.23); in those >30 years old (OR= 6.01, CI 95% 2.09-17.24) and those <30 years old (OR= 7.15, CI 95% 3.49-14.65). This last group also had an increased risk after combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.75). Both drivers (OR= 6.40, CI 95% 3.23-12.69) and passengers (OR= 13.83, CI 95% 2.87-66.42) had an increased risk after alcohol consumption. Conclusions To our knowledge, these are the first estimates of the risk of having a road traffic injury after alcohol and cannabis consumption in one of the countries of the Southern Cone (Argentina, Chile, and Uruguay). These results highlight the urgent need to implement and enforce comprehensive alcohol control measures. Furthermore, given the global trend towards legalizing cannabis for recreational use, our results could also inform policymakers to enact or amend impaired driving laws.
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Affiliation(s)
- Karina Conde
- Universidad Nacional de Mar del PlataMar del PlataArgentinaUniversidad Nacional de Mar del Plata, Mar del Plata, Argentina.
| | - Raquel Inés Peltzer
- Universidad Nacional de Mar del PlataMar del PlataArgentinaUniversidad Nacional de Mar del Plata, Mar del Plata, Argentina.
| | - Paula Victoria Gimenez
- Universidad Nacional de Mar del PlataMar del PlataArgentinaUniversidad Nacional de Mar del Plata, Mar del Plata, Argentina.
| | - Tomás Salomón
- Universidad Nacional de Mar del PlataMar del PlataArgentinaUniversidad Nacional de Mar del Plata, Mar del Plata, Argentina.
| | - Gabriel Suarez
- Hospital Interzonal General de Agudos “Dr. Oscar Alende”Mar del PlataArgentinaHospital Interzonal General de Agudos “Dr. Oscar Alende”, Mar del Plata, Argentina
| | - Maristela Monteiro
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Cheryl J Cherpitel
- Public Health InstituteEmeryvilleUnited States of AmericaPublic Health Institute, Emeryville, United States of America
| | - Mariana Cremonte
- Universidad Nacional de Mar del PlataMar del PlataArgentinaUniversidad Nacional de Mar del Plata, Mar del Plata, Argentina.
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12
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Borges G, Orozco R, Becerril Z, Ortega BE, Flores J. Injury, alcohol, and drug use in an emergency department in Mexico City. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2098844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Guilherme Borges
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Ricardo Orozco
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Zaide Becerril
- Nursing Department, Hospital General Regional No. 2 “Guillermo Fajardo Ortiz,” Mexican Institute of Social Security, Mexico City, Mexico
- Doctorate Program in Medical, Odontology and Health Sciences of the National Autonomous University of Mexico, Mexico City, Mexico
| | - Brenda E. Ortega
- Doctorate Program in Psychology of the National Autonomous University of Mexico, Mexico City, Mexico
| | - Julio Flores
- Master Program in Addictive Behaviours of the National Autonomous University of Mexico, Mexico City, Mexico
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13
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Hernández-Becerril Z, Orozco R, Borges G. Road traffic injuries and substance use in Latin America: A systematic review. TRAFFIC INJURY PREVENTION 2022; 23:209-214. [PMID: 35333682 DOI: 10.1080/15389588.2022.2051018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 02/19/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of the study is to identify and report the epidemiological patterns of substance use on fatal and non-fatal road traffic injuries (RTIs) in Latin America. METHODS A systematic review identified all published studies from January 2010 through October 2020. Twenty-eight studies were included from PubMed and SciELO databases. The Newcastle-Ottawa scale was used to assess the methodological quality of the studies. RESULTS The prevalence of alcohol consumption in fatal RTIs in studies where 100% of the target population were tested varies from 15.3% up to 55% in Brazil; with respect to non-fatal RTIs, it varies from 9.1% in car drivers in Brazil to 24.1% in emergency patients in Argentina. The most studied drug other than alcohol was cannabis, present in 6.5% up to 20.8% of non-fatal RTIs cases, but lower rates of testing for drugs was reported. Few studies reported epidemiological association measures. CONCLUSIONS This article shows that scientific production on substance use and RTIs in the region is limited and reports the prevalence of substance use, with few estimates of the relative risk of drug use and RTIs.
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Affiliation(s)
- Zaide Hernández-Becerril
- Nursing Department, Hospital General Regional No. 2 "Mexican Institute of Social Security", Mexico City, Mexico
- Doctorate Program in Medical, Odontology and Health Sciences of the National Autonomous, University of Mexico, Mexico City, Mexico
| | - Ricardo Orozco
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Guilherme Borges
- Directorate of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, Mexico
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14
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Bombana HS, Bogstrand ST, Gjerde H, Jamt REG, Carvalho HBD, Andreuccetti G, Bernini CDO, Muñoz DR, Leyton V, Greve JMD. Use of alcohol and illicit drugs by trauma patients in Sao Paulo, Brazil. Injury 2022; 53:30-36. [PMID: 34749908 DOI: 10.1016/j.injury.2021.10.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/07/2021] [Accepted: 10/28/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Alcohol and illicit drugs impair cognitive and psychomotor skills and may thereby increase the risk of involvement in a road traffic crash and other types of injuries. However, the knowledge on the use of psychoactive substances among injured patients presenting to emergency departments in low and middle-income countries remains limited. AIMS To estimate the prevalence of alcohol and illicit drug use among patients with traumatic injuries admitted to an emergency department in Sao Paulo, Brazil. METHODS Blood samples from injured patients requiring hospitalization for more than 24 h due to road traffic crashes, falls, or violence, were collected from July 2018 to June 2019. The samples were analyzed for alcohol and illicit drugs. RESULTS A total of 376 patients were included in this study; the median age was 36 years and 80% of patients were male. The majority (56%) of injuries resulted from road traffic crashes, with approximately half of them being motorcyclists. Alcohol, drugs, or both were detected in 32% of samples. The proportion that tested positive was highest for males (35%), for the age group 18-39 years (41%), for singles (43%), and for patients injured at nighttime (44%). Patients injured due to violence had the highest prevalence of alcohol or drugs in their blood samples (44%). Alcohol was most prevalent (23%), followed by cocaine (12%) and cannabis (5%). CONCLUSION The use of alcohol and illicit drugs was common among injured patients in Sao Paulo; it was likely a contributing factor in a third of the injurious accidents. Alcohol was the most prevalent substance followed by cocaine and cannabis.
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Affiliation(s)
- Henrique Silva Bombana
- Department of Legal Medicine, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo SP 01246-903, Brazil.
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Oslo University Hospital, Oslo, P.O. Box 4950 Nydalen, NO-0424, Norway
| | - Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, P.O. Box 4950 Nydalen, NO-0424, Norway
| | - Ragnhild Elén Gjulem Jamt
- Department of Forensic Sciences, Oslo University Hospital, Oslo, P.O. Box 4950 Nydalen, NO-0424, Norway
| | - Heráclito Barbosa de Carvalho
- Department of Preventive Medicine, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo SP 01246-903, Brazil
| | - Gabriel Andreuccetti
- Department of Legal Medicine, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo SP 01246-903, Brazil
| | - Celso de Oliveira Bernini
- Department of Surgery, Clinical Hospital of the University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255 - Cerqueira César, São Paulo SP 05403-000, Brazil
| | - Daniel Romero Muñoz
- Department of Legal Medicine, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo SP 01246-903, Brazil
| | - Vilma Leyton
- Department of Legal Medicine, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo SP 01246-903, Brazil
| | - Julia Maria D'Andréa Greve
- Department of Traumatology and Orthopedics, Clinical Hospital of the University of Sao Paulo Medical School, R. Dr. Ovídio Pires de Campos, 333 - Cerqueira César, São Paulo SP 05403-010, Brazil
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15
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Borges G, García-Pacheco JÁ, Familiar-Lopez I. Global estimates of the attributable risk of alcohol consumption on road injuries. Alcohol Clin Exp Res 2021; 45:2080-2089. [PMID: 34748239 DOI: 10.1111/acer.14689] [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: 03/25/2021] [Revised: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Alcohol consumption is one of the main risk factors for death by road injuries, but little is known about the global distribution of the population-attributable risk (PAR) of alcohol use for death by road injuries. METHODS We used publicly available data from the 2019 Global Burden of Disease Study (GBD) to estimate the PAR of alcohol use for 5 types of road injury, globally and individually for available countries, by socio-demographic index (SDI), and by age, sex, and year from 1990 to 2019. RESULTS 6.6% of all road injuries in 2019 were attributable to alcohol consumption, with large variations worldwide; the highest burden was in Europe and among countries classified in the high-middle SDI. PAR was higher in men than in women, and among younger individuals. Important variations in PAR of alcohol were also observed by road injury type, with motorcyclist road injuries having the highest PAR. Overall, PAR showed a small increase during 1990-2019; younger (<39 years old) men showed an increasing trend during this period, while older women had a decreasing trend in PAR. CONCLUSIONS PAR for alcohol and road injuries is not homogenous. Large PAR for alcohol and road deaths was found in Europe, among men, young adults, and motorcyclists. These results could help public health agencies, law enforcement, and the public guide efforts to reduce these deaths.
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Affiliation(s)
- Guilherme Borges
- Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Ciudad de México, Mexico
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16
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Nazif-Munoz JI, Martínez P, Williams A, Spengler J. The risks of warm nights and wet days in the context of climate change: assessing road safety outcomes in Boston, USA and Santo Domingo, Dominican Republic. Inj Epidemiol 2021; 8:47. [PMID: 34281624 PMCID: PMC8287725 DOI: 10.1186/s40621-021-00342-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background There remains a dearth of cross-city comparisons on the impact of climate change through extreme temperature and precipitation events on road safety. We examined trends in traffic fatalities, injuries and property damage associated with high temperatures and heavy rains in Boston (USA) and Santo Domingo (Dominican Republic). Methods Official publicly available data on daily traffic outcomes and weather conditions during the warm season (May to September) were used for Boston (2002–2015) and Santo Domingo (2013–2017). Daily maximum temperatures and mean precipitations for each city were considered for classifying hot days, warm days, and warm nights, and wet, very wet, and extremely wet days. Time-series analyses were used to assess the relationship between temperature and precipitation and daily traffic outcomes, using a quasi-Poisson regression. Results In Santo Domingo, the presence of a warm night increased traffic fatalities with a rate ratio (RR) of 1.31 (95% CI [confidence interval]: 1.00,1.71). In Boston, precipitation factors (particularly, extremely wet days) were associated with increments in traffic injuries (RR 1.25, 95% CI: 1.18, 1.32) and property damages (RR 1.42, 95% CI: 1.33, 1.51). Conclusion During the warm season, mixed associations between weather conditions and traffic outcomes were found across Santo Domingo and Boston. In Boston, increases in heavy precipitation events were associated with higher traffic injuries and property damage. As climate change-related heavy precipitation events are projected to increase in the USA, the associations found in this study should be of interest for road safety planning in a rapidly changing environment. Supplementary Information The online version contains supplementary material available at 10.1186/s40621-021-00342-w.
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Affiliation(s)
- José Ignacio Nazif-Munoz
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada. .,Centre de recherche Charles-Le Moyne - Saguenay - Lac-Saint-Jean, 150, place Charles‑Le Moyne, C. P. 200, Longueuil, Canadá. .,Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, 4th Floor West, 404N, Boston, MA, 02215, USA.
| | - Pablo Martínez
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 150, place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada.,Centre de recherche Charles-Le Moyne - Saguenay - Lac-Saint-Jean, 150, place Charles‑Le Moyne, C. P. 200, Longueuil, Canadá
| | - Augusta Williams
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, 4th Floor West, 404N, Boston, MA, 02215, USA
| | - John Spengler
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Drive, 4th Floor West, 404N, Boston, MA, 02215, USA
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17
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Sornpaisarn B, Sornpaisarn S, Rehm J. The association between the time of alcohol drinking and injury risk in Thailand: a cross-sectional emergency department study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:28. [PMID: 33785034 PMCID: PMC8011167 DOI: 10.1186/s13011-021-00365-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although the relationship between acute alcohol consumption and injuries is well recognized, studies exploring how the time of day the drinking commences affects alcohol-related injuries have been scarce. This contribution examines the associations between the time at which the drinking began and the duration of the drinking, the volume of alcohol consumed, the injury type, and the blood alcohol concentration (BAC) level. METHOD This study employed a cross-sectional survey, which was conducted in two hospital emergency departments (ED) in Chiangmai Province, Thailand. The sample was composed of 519 injured patients aged 18 years and older. Outcome measures included the BAC and type of injury. Exposures included the quantity of alcohol consumed, the time the drinking commenced, and the pattern of drinking involved. RESULTS The injured patients who drank alcohol within six hours prior to sustaining their injury were more likely to get injured and present themselves at the ED at night (20:00-04:00) compared to those who sustained an injury but did not drink in the hours prior. However, this relationship was only true for unintentional injuries, not intentional ones. The majority of participants consumed their first drink between 16:00 and 20:00. On average, among the 104 patients who drank prior to sustaining an injury, the total amount of alcohol consumed was 6.9 drinks, the duration of drinking was 2.6 h, the rate of drinking was 6.0 drinks/hour, and the BAC was 0.119 gm%. Every drink increased the BAC by 0.012 gm% and each year of increasing age increased the BAC by 0.003 gm%. People who were older, less educated, and drank more frequently tended to have their first drink earlier than other drinkers. An earlier start to their drinking resulted in a faster pace of drinking and a higher BAC. CONCLUSIONS BAC increased with the total amount of alcohol consumed and the age of the drinker. Different groups of people had their first drink at different times of the day, resulting in differences in the rate of drinking, the BAC, the time of injury, and the time they presented to the ED after injury.
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Affiliation(s)
- Bundit Sornpaisarn
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Ontario, M5S 2S1, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, M5T 3M7, Toronto, Ontario, Canada. .,Faculty of Public Health, Mahidol University, 420/1 Ratchawithi Road, Thung Phaya Thai, Ratchathewi, 10400, Bangkok, Thailand.
| | - Sarnti Sornpaisarn
- Faculty of Health Science, McMaster University, 1280 Main Street West, L8S 4L8, Hamilton, Ontario, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Ontario, M5S 2S1, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, M5T 3M7, Toronto, Ontario, Canada.,World Health Organization / Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, M5S 2S1, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, M5S 2S1, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, M5T 1R8, Toronto, Ontario, Canada.,Centre for Interdisciplinary Addiction Research, University of Hamburg, Martinstraße 52, 20246, Hamburg, Germany.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, 119992, Moscow, Russian Federation
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18
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Cherpitel CJ, Witbrodt J, Ye Y, Monteiro MG, Málaga H, Báez J, Valdés MPDL. Road traffic injuries and substance use among emergency department patients in the Dominican Republic and Peru. Rev Panam Salud Publica 2021; 45:e31. [PMID: 33790955 PMCID: PMC7993299 DOI: 10.26633/rpsp.2021.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022] Open
Abstract
Objective. To report demographic and substance use characteristics and risk of road traffic injury (RTI) from alcohol use, cannabis use, and combined use in a sample of emergency department patients from two countries in Latin America and the Caribbean. Methods. A cross-sectional study in which patients 18 years and older admitted within six hours of suffering an RTI to one emergency department in Santa Domingo, Dominican Republic (n = 501) and in Lima, Peru (n = 431) were interviewed. Case-crossover analysis, based on self-reported use prior to the RTI, was used to analyze risk from alcohol, cannabis, and co-use. Results. Overall, 15.3% reported alcohol use prior to the event and 2.5% cannabis use. Drivers using alcohol only were over twice as likely to have an RTI (OR = 2.46, p < 0.001), and nearly eight times more likely if using both alcohol and cannabis (OR = 6.89, p < 0.01), but risk was not elevated for cannabis alone. Significant differences were not found for passengers or pedestrians. Conclusions. Risk of RTI for drivers in these two samples is significantly elevated from alcohol use, and more so for co-use with cannabis. Differences between the two countries underscore the need for similar data from the region to determine risk of RTI from substance use, including risk for passengers and pedestrians. Data suggest that alcohol contributes significantly to the burden of RTI, which calls for more stringent enforcement of alcohol control policy related to drink driving in the region.
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Affiliation(s)
- Cheryl J Cherpitel
- Alcohol Research Group EmeryvilleCalif. United States of America Alcohol Research Group, Emeryville, Calif., United States of America
| | - Jane Witbrodt
- Alcohol Research Group EmeryvilleCalif. United States of America Alcohol Research Group, Emeryville, Calif., United States of America
| | - Yu Ye
- Alcohol Research Group EmeryvilleCalif. United States of America Alcohol Research Group, Emeryville, Calif., United States of America
| | - Maristela G Monteiro
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Hernán Málaga
- Ricardo Palma University Lima Peru Ricardo Palma University, Lima, Peru
| | - Jeannette Báez
- National Center of Investigations in Maternal Child Health Santo Domingo Dominican Republic National Center of Investigations in Maternal Child Health, Santo Domingo, Dominican Republic
| | - Marisela Ponce de León Valdés
- Inter-American Development Bank Washington, D.C. United States of America Inter-American Development Bank, Washington, D.C., United States of America
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19
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Alva-Díaz C, Navarro-Flores A, Rivera-Torrejon O, Huerta-Rosario A, Molina RA, Velásquez-Rimachi V, Morán-Mariños C, Farroñay C, Pacheco-Mendoza J, Metcalf T, Burneo JG, Pacheco-Barrios K. Prevalence and incidence of epilepsy in Latin America and the Caribbean: A systematic review and meta-analysis of population-based studies. Epilepsia 2021; 62:984-996. [PMID: 33651439 DOI: 10.1111/epi.16850] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study was undertaken to perform an updated systematic review and meta-analysis to estimate the pooled prevalence and incidence of epilepsy in Latin America and the Caribbean (LAC), describing trends over time, and exploring potential clinical and epidemiological factors explaining the heterogeneity in the region. METHODS Observational studies assessing the incidence or prevalence of epilepsy in LAC countries up to March 2020 were systematically reviewed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses and cumulative analyses were performed using random-effects models. We assessed between-study heterogeneity with sensitivity, subgroup, and meta-regression analyses. Moreover, the quality of the included studies and the certainty of evidence were evaluated using the GRADE (grading of recommendation, assessment, development, and evaluation) approach. RESULTS Overall, 40 studies (from 42 records) were included, 37 for prevalence analyses and six for incidence (312 387 inhabitants; 410 178 person-years). The lifetime prevalence was 14.09 per 1000 inhabitants (95% confidence interval [CI] = 11.72-16.67), for active epilepsy prevalence was 9.06 per 1000 individuals (95% CI = 6.94-11.44), and the incidence rate was 1.11 per 1000 person-years (95% CI = .65-1.70). These high estimates have been constant in the region since 1990. However, substantial statistical heterogeneity between studies and publication bias were found. The overall certainty of evidence was low. Methodological aspects (sample size) and countries' epidemiological characteristics such as access to sanitation services and child and adult mortality rates explained the high heterogeneity. Finally, the prevalence of epilepsy associated with neurocysticercosis (NCC) in the general population was high, and the proportion of NCC diagnosis among people living with epilepsy was 17.37%. SIGNIFICANCE The epilepsy prevalence and incidence in LAC are higher than worldwide estimates, being constant since 1990 and strongly influenced by NCC. We identified high between-study heterogeneity and significant methodological limitations (e.g., heterogeneous definitions, lack of longitudinal studies). The region needs upgraded research using standardized definitions and diagnostic methods, and urgent action against preventable causes.
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Affiliation(s)
- Carlos Alva-Díaz
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru
| | - Alba Navarro-Flores
- Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Oscar Rivera-Torrejon
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru
| | - Andrely Huerta-Rosario
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Roberto A Molina
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru.,School of Medicine, Universidad Nacional Federico Villarreal, Lima, Peru
| | - Victor Velásquez-Rimachi
- Neurosciences, Clinical Effectiveness and Public Health Research Group, Universidad Cientifica del Sur, Lima, Peru.,Clinical and Health Efficacy Network, REDECS, Lima, Peru
| | - Cristian Morán-Mariños
- Clinical and Health Efficacy Network, REDECS, Lima, Peru.,San Ignacio de Loyola University, Lima, Peru
| | | | | | - Tatiana Metcalf
- Neurology Department, Department of Medicine and Office for Teaching Support and Research, Daniel Alcides Carrion Hospital, Callao, Peru
| | - Jorge G Burneo
- Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine, Western University, London, Canada
| | - Kevin Pacheco-Barrios
- Research Unit for the Generation and Synthesis of Evidence in Health, San Ignacio de Loyola University, Lima, Peru.,SYNAPSIS Mental Health and Neurology, Lima, Peru.,Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
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20
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Perkins M, Casalaz S, Mitra B, Gabbe B, Brown J, Oxley J, Cameron P, Beck B. Identify the key characteristics of pedestrian collisions through in-depth interviews: a pilot study. Int J Inj Contr Saf Promot 2021; 28:135-140. [PMID: 33517835 DOI: 10.1080/17457300.2021.1876736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study aimed to assess the feasibility of recruiting injured pedestrians from the emergency department of a major trauma centre, using an in-depth interview shortly post collision. Convenience sampling was used to prospectively recruit injured pedestrians from the Alfred Hospital Emergency and Trauma Centre. Of the 102 injured pedestrians, 39 met eligibility criteria and of these, 30 (77%) consented and completed the questionnaire. Over half of the collisions occurred at an intersection (57%), and of these the most common pre-impact vehicle manoeuvre was a vehicle turning into the street the pedestrian was crossing. In-depth interview during the early post-crash period was a feasible and effective method of collecting detailed data in an accessible sample. However, only 38% of patients met eligibility criteria. To enhance representativeness, supplementing interview data with police-reported crash data, recruiting from hospital wards and crash location assessment is recommended.
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Affiliation(s)
- Monica Perkins
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sam Casalaz
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,The Alfred Hospital, Melbourne, VIC, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Julie Brown
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Jennifer Oxley
- Monash University Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,The Alfred Hospital, Melbourne, VIC, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Faculty of Medicine, Laval University, Quebec City, QC, Canada
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21
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Toval-Ruiz C, Rojas-Roque C, Hernández-Vásquez A. Predictors and geographic analysis of road traffic accidents in Leon, Nicaragua. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 24:e210003. [PMID: 33331412 DOI: 10.1590/1980-549720210003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/04/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify environmental factors present in areas with high density of road traffic accidents (RTA) in Leon, Nicaragua. METHODS The analysis included all accidents recorded by the Police Department in León City, from January to June 2017. All crashes were georeferenced, and data were collected from the environment elements within a perimeter of 20 meters from the site in which accidents occurred with a pre-tested data collection instrument. We specified a Poisson regression model to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) to determine environmental factors associated with the event incidence. For the identification areas with high, medium, and low occurrences of crashes, kernel density around points in which RTA occurred were estimated. RESULTS Out of 667 recorded crashes, 90% involved men aged 15-40, and motorcycle accidents represented 60% of injuries or deaths. Environmental factors that were positively associated with RTA included good road conditions (adjusted IRR = 1.36, 95%CI 1.13 - 1.63) and the existence of bicycle lanes (adjusted IRR = 1.64, 95%CI 1.29 - 2.10). Environmental characteristics associated with higher speeds and heavier accidents can increase their incidence. CONCLUSION We found that high-foot-traffic commercial or touristic centers are three areas with high density of crashes. Local authorities can use these findings to promote road safety measures in high-incidence areas in León City.
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Affiliation(s)
- Christian Toval-Ruiz
- Centro de Investigación en Demografía y Salud, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Nicaragua - León, Nicaragua
| | - Carlos Rojas-Roque
- Centro de Investigación en Demografía y Salud, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Nicaragua - León, Nicaragua
| | - Akram Hernández-Vásquez
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud - Lima, Peru
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22
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Singh L, Joshi T, Tewari D, Echeverría J, Mocan A, Sah AN, Parvanov E, Tzvetkov NT, Ma ZF, Lee YY, Poznański P, Huminiecki L, Sacharczuk M, Jóźwik A, Horbańczuk JO, Feder-Kubis J, Atanasov AG. Ethnopharmacological Applications Targeting Alcohol Abuse: Overview and Outlook. Front Pharmacol 2020; 10:1593. [PMID: 32116660 PMCID: PMC7034411 DOI: 10.3389/fphar.2019.01593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022] Open
Abstract
Excessive alcohol consumption is the cause of several diseases and thus is of a major concern for society. Worldwide alcohol consumption has increased by many folds over the past decades. This urgently calls for intervention and relapse counteract measures. Modern pharmacological solutions induce complete alcohol self-restraint and prevent relapse, but they have many side effects. Natural products are most promising as they cause fewer adverse effects. Here we discuss in detail the medicinal plants used in various traditional/folklore medicine systems for targeting alcohol abuse. We also comprehensively describe preclinical and clinical studies done on some of these plants along with the possible mechanisms of action.
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Affiliation(s)
- Laxman Singh
- Centre for Biodiversity Conservation & Management, G.B. Pant National Institute of Himalayan Environment & Sustainable Development, Almora, India
| | - Tanuj Joshi
- Department of Pharmaceutical Sciences, Faculty of Technology, Kumaun University Bhimtal Campus, Nainital, India
| | - Devesh Tewari
- Department of Pharmacognosy, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, Poland
| | - Javier Echeverría
- Department of Environmental Sciences, Faculty of Chemistry and Biology, Universidad de Santiago de Chile, Santiago, Chile
| | - Andrei Mocan
- Department of Pharmaceutical Botany, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Archana N. Sah
- Department of Pharmaceutical Sciences, Faculty of Technology, Kumaun University Bhimtal Campus, Nainital, India
| | - Emil Parvanov
- Institute of Molecular Genetics, Academy of Sciences of the Czech Republic, Division BIOCEV, Prague, Czechia
| | - Nikolay T. Tzvetkov
- Institute of Molecular Biology “Roumen Tsanev”, Department of Biochemical Pharmacology and Drug Design, Bulgarian Academy of Sciences, Sofia, Bulgaria
- Department Global R&D, NTZ Lab Ltd., Sofia, Bulgaria
| | - Zheng Feei Ma
- Department of Public Health, Xi’an Jiaotong-Liverpool University, Suzhou, China
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Piotr Poznański
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, Poland
| | - Lukasz Huminiecki
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, Poland
| | - Mariusz Sacharczuk
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, Poland
| | - Artur Jóźwik
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, Poland
| | - Jarosław O. Horbańczuk
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, Poland
| | - Joanna Feder-Kubis
- Faculty of Chemistry, Wrocław University of Science and Technology, Wybrzeże Wyspiańskiego, Wrocław, Poland
| | - Atanas G. Atanasov
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, Poland
- Department of Pharmacognosy, University of Vienna, Vienna, Austria
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
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23
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Randle R, Bazargan-Hejazi S, Pen D, Diab S, Shaheen M. Racial and ethnic differences in patients involved in alcohol-impaired motor vehicle crashes and its related clinical outcomes among various age groups in the U.S. TRAFFIC INJURY PREVENTION 2020; 21:115-121. [PMID: 32023129 DOI: 10.1080/15389588.2019.1688312] [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: 05/20/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
Objective(s): 1) to determine whether the proportion of alcohol-impaired patients involved in motor vehicle crashes (MVCs) varies by race/ethnicity within different age groups; 2) to explore the relationship between alcohol impairment, race/ethnicity and clinical outcomes among patients involved in MVCs across age groups.Methods: The 2012 National Trauma Data Bank (NTDB) queried for patients aged 16-55 involved in MVCs who received a blood ethanol test on admission.Results: Of the 44,216 patients involved in MVC, 68% were White, 14% Black, and 13% were Hispanic. About 36% were 16-25 years old, and 19% were 46-55 years old. Alcohol-impaired patients constituted 34% of the patients. The multiple logistic regression analysis of HLOS ≥ 2 days revealed that, when controlling for age, gender, race/ethnicity, insurance status, and the interaction between alcohol impairment and age as well as alcohol impairment and race/ethnicity, alcohol impairment positivity carried a 15% increase in probability of HLOS ≥ 2 days (OR 1.15, p < 0.0001). Additionally, using the 16-25 age group as reference, each of the older age groupings showed an increased probability of HLOS ≥ 2 days with ORs of 1.15, 1.32, and 1.51 for ages 26-35, 36-45, and 46-55, respectively (p-values < 0.0001). Blacks, Hispanics, and Asians/others were less likely than Whites to have HLOS ≥ 2 days with OR of 0.88, 0.89, and 0.88, respectively (p < 0.05). There was no statistically significant difference in the clinical outcome of mortality between races/ethnicities and alcohol-impaired driving.Conclusions: This study demonstrates that the proportions of alcohol-impaired driving and the associated clinical outcomes vary among race/ethnic groups in different age groups. More research is needed to determine the reasons for the observed differences in these vulnerable sub-groups.
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Affiliation(s)
- Ryan Randle
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- David Geffen School of Medicine, UCLA, Los Angeles, California
- Medical Education Program, Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Shahrzad Bazargan-Hejazi
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Deyu Pen
- Preventive and Social Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Sara Diab
- Department of Public Health, University of California, Irvine, California
| | - Magda Shaheen
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- David Geffen School of Medicine, UCLA, Los Angeles, California
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24
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Reddy SP, Walsh MS, Paulino-Ramirez R, Florenzán J, Fernández J, Nwariaku FE, Abdelnaby A. Neurologic injuries following road traffic accidents in the Dominican Republic: Examining causes and potential solutions. TRAFFIC INJURY PREVENTION 2019; 20:690-695. [PMID: 31381379 DOI: 10.1080/15389588.2019.1643016] [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: 01/07/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
Objective: Road traffic accidents (RTAs) are the number one cause of traumatic brain injuries (TBIs) worldwide. This study examines RTA-related TBIs in the Dominican Republic, a country in the Caribbean with the highest RTA fatality rate in the Western Hemisphere. Methods: We interviewed 117 adult patients or medical guardians of patients admitted to Hospital Traumatológico Dr. Ney Arias Lora in Santo Domingo following an RTA. Information regarding the type of accident, patient demographics, and injuries sustained was collected for each patient. Results: Most study participants were males (79.5%), and the most common method of transportation was motorized 2-wheeled vehicle (MTW; 74.4%). Of the 69 patients who suffered a TBI, 66.7% were classified as moderate-severe TBIs and 30.3% were classified as mild TBIs. The most common types of intracranial hemorrhage were subdural hemorrhage (12%) and subarachnoid hemorrhage (9.4%). Helmet use among admitted MTW riders was reported at 22.4%, and none of the 9 MTW riders who died in the hospital were wearing a helmet. Only 58.1% of patients lived in an area that offered 911 emergency response services at the time of the study. At 66.2%, the majority of people living within the 911 service area utilized emergency response services following an RTA. Multiple logistic regression determined that the utilization of 911 emergency response services was associated with a decrease in the likelihood of presenting with a moderate/severe TBI by a factor of 0.78 (adjusted odds ratio [OR]; P < .008; 95% confidence interval [CI], 0.65, 0.93). Nonuse of a helmet was associated with a 1.22 times increased risk of presenting with a moderate/severe TBI (adjusted OR; P < .04; 95% CI, 1.01, 1.61). Age and gender were not statistically significant in this model. Conclusions: The results of this study support 2 important avenues for reducing the burden of RTA-associated neurologic disease in the Dominican Republic. As with many other middle-income countries, MTWs represent an economical and efficient mode of transportation. Therefore, increasing helmet use may be the most effective way to reduce RTA-associated TBIs. In addition, continuing the expansion of postcrash emergency response services may mitigate the severity of RTA-associated neurologic disease.
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Affiliation(s)
- Sumanth P Reddy
- Office of Global Health, University of Texas Southwestern Medical School , Dallas , Texas
| | - Maura S Walsh
- Office of Global Health, University of Texas Southwestern Medical School , Dallas , Texas
| | - Robert Paulino-Ramirez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE) , Santo Domingo , Dominican Republic
| | - Jomar Florenzán
- School of Medicine, Universidad Iberoamericana (UNIBE) , Santo Domingo , Dominican Republic
| | - Jaime Fernández
- School of Medicine, Universidad Iberoamericana (UNIBE) , Santo Domingo , Dominican Republic
- Department of Surgery, Hospital Traumatológico Dr. Ney Arias Lora , Santo Domingo , Dominican Republic
| | - Fiemu E Nwariaku
- Department of Surgery, University of Texas Southwestern Medical Center , Dallas , Texas
| | - Abier Abdelnaby
- Department of Surgery, University of Texas Southwestern Medical Center , Dallas , Texas
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25
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Physical and cognitive functions affecting road traffic injuries among senior drivers. Arch Gerontol Geriatr 2018; 78:160-164. [PMID: 29981493 DOI: 10.1016/j.archger.2018.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The size of elderly populations is growing in most areas of the world. The Thai Eleventh National Economic and Social Development Plan revealed an increase in the elderly, while numbers of younger, working-age adults decreased. Thailand has become an aging society since 2015, which is significant in that senior adults have a higher risk of involvement in motor vehicle accidents and are more susceptible to injuries and fatalities. This study investigated the role of physical and cognitive function with regard to road traffic injury in senior drivers. METHODS A community survey was carried out among people aged 60 years and older in the villages representing four regions of Thailand. Face-to-face interviews and anthropometric measurements were used to gather data including individual characteristics, medical history, risk behaviors, cognitive function and traffic injury within the last 12 months. Associations between risk factors and injury were assessed by the chi-square tests, and comparison of the cognitive function score between the injury and non-injury groups was identified using the independent t-test. RESULTS A total of 314 completed questionnaires were used for analysis. Ten percent of respondents had experienced a road traffic injury in the last 12 months. Analysis revealed that level of cognitive function, smoking behavior and been diagnosed with arthritis were associated with road traffic injury incidence in senior drivers (p-value < 0.05). CONCLUSION Results revealed the potential need for strategies to increase road traffic safety in senior drivers. Special protection should be prioritized for the elderly with physical and cognitive impairment.
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26
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Santoyo-Castillo D, Pérez-Núñez R, Borges G, Híjar M. Estimating the drink driving attributable fraction of road traffic deaths in Mexico. Addiction 2018; 113:828-835. [PMID: 29274185 DOI: 10.1111/add.14153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/15/2017] [Accepted: 12/15/2017] [Indexed: 11/27/2022]
Abstract
AIM To estimate the Drink Driving Attributable Fraction (DDAF) of road traffic injury mortality in car occupants in Mexico during 2010-13. DESIGN A case-control study was conducted to examine the presence of alcohol in analysed body fluids of car occupants killed in fatal crashes (cases) compared with car drivers tested in alcohol-testing checkpoints who were not involved in a fatal collision (controls). Two data sets were used for the period 2010-13: the forensic module of the Epidemiological Surveillance System on Addictions that included car occupants killed in a collision (cases) and a data set from alcohol-testing at police checkpoints available for matching municipalities (controls). SETTING Mexico. PARTICIPANTS The analysed study sample included 1718 car occupants killed in a traffic collision and 80 656 drivers tested at alcohol police checkpoints, all from 10 municipalities. MEASUREMENTS Unadjusted and adjusted odds ratios (OR) of presence of alcohol in body fluids were obtained stratified by sex and age groups and the interaction with these two variables were assessed. The ORs were used to calculate the DDAF. FINDINGS It was estimated that 19.5% of car occupants' deaths due to road traffic injuries were attributable to alcohol consumption [95% confidence interval (CI) = 19.1-19.9]. The adjusted OR of presence of alcohol was 6.84 (95% CI = 6.06-7.71) overall. For males it was 7.21 (95% CI = 6.35-8.18) and for females it was 4.45 (95% CI = 3.01-6.60). The ORs were similar across younger age bands (10-19 years: 9.61, 95% CI = 6.72-13.73; 20-29 years: 7.70, 95% CI = 6.28-9.4; and 30-49 years: 7.21, 95% CI = 5.98-8.70); and lower but still elevated among older people (50+ years: 3.19, 95% CI = 2.19-4.65). CONCLUSIONS An estimated 19.5% of car occupant deaths in Mexico may have been caused by alcohol in 2010-13.
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Affiliation(s)
- Dzoara Santoyo-Castillo
- Secretariado Técnico del Consejo Nacional para la Prevención de Accidentes (ST CONAPRA), Cuauhtémoc, Ciudad de México, Mexico
| | - Ricardo Pérez-Núñez
- Secretariado Técnico del Consejo Nacional para la Prevención de Accidentes (ST CONAPRA), Cuauhtémoc, Ciudad de México, Mexico
| | - Guilherme Borges
- Instituto Nacional de Psiquiatría 'Ramón de la Fuente Muñiz', Tlalpan, Ciudad de México, Mexico
| | - Martha Híjar
- Secretariado Técnico del Consejo Nacional para la Prevención de Accidentes (ST CONAPRA), Cuauhtémoc, Ciudad de México, Mexico
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