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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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Choo EK, Trent SA, Nishijima DK, Eichelberger A, Kazmierczak S, Ye Y, Brasel KJ, Audett A, Cherpitel CJ. Risk of motor vehicle collision associated with cannabis and alcohol use among patients presenting for emergency care. ACCIDENT; ANALYSIS AND PREVENTION 2024; 198:107459. [PMID: 38277855 DOI: 10.1016/j.aap.2024.107459] [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: 01/20/2023] [Revised: 09/26/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND The objective of this study was to examine the relationship between cannabis and alcohol use and occurrence of motor vehicle collision (MVC) among patients in the emergency department (ED). METHODS This was a cross-sectional study of visits to EDs in Denver, CO, Portland, OR, and Sacramento, CA by drivers who were involved in MVCs and presented with injuries (cases) and non-injured drivers (controls) who presented for medical care. We obtained blood samples and measured delta-9-THC and its metabolites. Alcohol levels were determined by breathalyzer or samples taken in the course of clinical care. Participants completed a research-assistant-administered interview consisting of questions about drug and alcohol use prior to their visit, context of use, and past-year drug and alcohol use. Multiple logistic regression was used to estimate the association between MVC and cannabis/alcohol use, adjusted for demographic characteristics. We then stratified participants based on levels of cannabis use and calculated the odds of MVC across these levels, first using self-report and then using blood levels for delta-9-THC in separate models. We conducted a case-crossover analysis, using 7-day look-back data to allow each participant to serve as their own control. Sensitivity analyses examined the influence of usual use patterns and driving in a closed (car, truck, van) versus open (motorcycle, motorbike, all-terrain vehicle) vehicle. RESULTS Cannabis alone was not associated with higher odds of MVC, while acute alcohol use alone, and combined use of alcohol and cannabis were both independently associated with higher odds of MVC. Stratifying by level of self-reported or measured cannabis use, higher levels were not associated with higher odds for MVC, with or without co-use of alcohol; in fact, high self-reported acute cannabis use was associated with lower odds of MVC (odds ratio [OR] 0.18, 95% confidence interval [CI] 0.05-0.65). In the case-crossover analysis, alcohol use alone or in combination with cannabis was associated with higher odds of MVC, while cannabis use alone was again associated with decreased odds of MVC. CONCLUSIONS Alcohol use alone or in conjunction with cannabis was consistently associated with higer odds for MVC. However, the relationship between measured levels of cannabis and MVC was not as clear. Emphasis on actual driving behaviors and clinical signs of intoxication to determine driving under the influence has the strongest rationale.
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Affiliation(s)
- Esther K Choo
- Center for Policy & Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States.
| | - Stacy A Trent
- Department of Emergency Medicine, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, United States
| | - Daniel K Nishijima
- Department of Emergency Medicine, University of California Davis, Sacramento, CA, United States
| | | | | | - Yu Ye
- Alcohol Research Group, Emeryville, CA, United States
| | - Karen J Brasel
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Ariane Audett
- Portland State University, Portland, OR, United States
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Borges G, Orozco R, Pérez-Núñez R, Pechansky F. Substance use and type of Road Traffic Injury in Mexico City. JOURNAL OF PREVENTION (2022) 2024; 45:323-337. [PMID: 38353804 DOI: 10.1007/s10935-024-00769-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 04/02/2024]
Abstract
Limited data are available in Mexico on the prevalence of alcohol and drug use and the possible differences in their effects on types of road traffic injury (RTI), such as those involving pedestrians, drivers or passengers of motorcycles or other motor vehicles, and the association between substance use and driving behaviors, for preventive purposes. The sample comprised 433 adult RTI patients, admitted to the emergency department (ED) of a public hospital in Mexico City (January to April 2022). Breath Alcohol Concentration (BAC) was measured using a breath tester, and six types of drugs (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, and methamphetamine) were assessed using a saliva screen test. RTI patients also self-reported their alcohol and drug use in the six hours prior to the accident. Approximately 62% of respondents had been involved in a motorcycle crash. One in three patients self-reported or had traces of a substance in their saliva or breath. The most common substance was alcohol (23.6%), followed by cannabis and stimulants (10.9%). One in five patients reported having used a cell phone ten minutes before the injury. One in three had not been using any safety device, the only behavior exacerbated by substance use. We found a high prevalence of substance use in the sample of RTI patients admitted to the ED, regardless of the type of the RTI, together with high cell phone rates. Motorcycle passengers under the influence were particularly likely not to have been wearing a helmet.
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Affiliation(s)
- Guilherme Borges
- Instituto Nacional de Psiquiatría, Calzada México Xochimilco 101. Col. San Lorenzo Huipulco C.P., Tlalpan, 14370, CDMX, México.
| | - Ricardo Orozco
- Instituto Nacional de Psiquiatría, Calzada México Xochimilco 101. Col. San Lorenzo Huipulco C.P., Tlalpan, 14370, CDMX, México
| | | | - Flavio Pechansky
- Universidade Federal do Rio Grande do Sul / Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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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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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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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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Brands B, Di Ciano P, Mann RE. Cannabis, Impaired Driving, and Road Safety: An Overview of Key Questions and Issues. Front Psychiatry 2021; 12:641549. [PMID: 34489746 PMCID: PMC8416748 DOI: 10.3389/fpsyt.2021.641549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/01/2021] [Indexed: 12/19/2022] Open
Abstract
The road safety impact of cannabis has been a topic of much discussion and debate over the years. These discussions have been revitalized in recent years by initiatives in several jurisdictions to legalize non-medical cannabis. Canada became the second country to legalize non-medical cannabis use in October, 2018, preceded by Uruguay in December 2013. Road safety concerns were key issues in the Canadian government's deliberations on the issue. In this paper, we identify several key questions related to the impact of cannabis on road safety, and provide a consideration of the relevant literature on these questions. These questions cover several perspectives. From an epidemiological perspective, perhaps the central question is whether cannabis use contributes to the chances of being involved in a collision. The answer to this question has evolved in recent years as the ability to conduct the relevant studies has evolved. A related question is the extent to which cannabis plays an important role in road safety, and recent research has made progress in estimating the collisions, injuries, and deaths that may be attributed to cannabis use. Several questions relate to the behavioral and pharmacological effects of cannabis. One central question is whether cannabis affects driving skills in ways that can increase the chances of being involved in a collision. Another important question is whether the effects of the drug on the driving behavior of medical users is similar to, or different from, the effects on non-medical users and whether there are sex differences in the pharmacological and behavioral effects of cannabis. Other important questions are the impact of tolerance to the effects of cannabis on road safety as well as different routes of administration (e.g., edibles, vaped). It remains unclear if there is a dose-response relationship of cannabis to changes in driving. These and other key questions and issues are identified and discussed in this paper.
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Affiliation(s)
- Bruna Brands
- Health Canada, Ottawa, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Patricia Di Ciano
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Dalla Lana School of Public Health, Toronto, ON, Canada
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