Alcohol and Road Traffic Injuries in Latin America and the Caribbean: A Case-Crossover Study

Sober up: Time from last drink to a road traffic injury

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.

Unsafe Practices of Motorcycle Riders in El Petén, Guatemala: A Community Observational Study and a Retrospective Institutional Review

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.

Syncope and Traffic Crash: A Population-Based Case-Crossover Analysis

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.

Reducing the incidence and mortality of traumatic brain injury in Latin America

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.

Global burden and trends of three common road injuries from 1990 to 2019 and the implications for prevention and intervention

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.

Alcohol, drugs, and road traffic injuries in an emergency department in Mexico City

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.

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

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.

Alcohol and cannabis use in traffic-related injuries in Mexico City

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.

Road traffic injury risk from alcohol and cannabis use among emergency department patients in Argentina

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.

Road traffic injuries and substance use in Latin America: A systematic review

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.

Use of alcohol and illicit drugs by trauma patients in Sao Paulo, Brazil

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.

Global estimates of the attributable risk of alcohol consumption on road injuries

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.

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

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.

The association between the time of alcohol drinking and injury risk in Thailand: a cross-sectional emergency department study

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.

Road traffic injuries and substance use among emergency department patients in the Dominican Republic and Peru

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.

Prevalence and incidence of epilepsy in Latin America and the Caribbean: A systematic review and meta-analysis of population-based studies

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.

Identify the key characteristics of pedestrian collisions through in-depth interviews: a pilot study

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.

Predictors and geographic analysis of road traffic accidents in Leon, Nicaragua

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.

Ethnopharmacological Applications Targeting Alcohol Abuse: Overview and Outlook

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.

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

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.

Neurologic injuries following road traffic accidents in the Dominican Republic: Examining causes and potential solutions

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.

Physical and cognitive functions affecting road traffic injuries among senior drivers

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.

Estimating the drink driving attributable fraction of road traffic deaths in Mexico

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.