Incidence of fatalities of road traffic accidents associated with alcohol consumption and the use of psychoactive drugs: A 7-year survey (2011-2017)

Prevalence of alcohol-impaired driving: a systematic review with a gender-driven approach and meta-analysis of gender differences

BACKGROUND

A growing number of studies investigated the factors that contribute to driving under the influence (DUI) of alcohol in relation to gender. However, a gendered approach of the scientific evidence is missing in the literature. To fill this gap, a gender-driven systematic review on real case studies of the last two decades was performed. In addition to the gender of the drivers involved, major independent variables such as the period of recruitment, the type of drivers recruited, and the geographical area where the study was conducted, were examined. Afterwards, a meta-analysis was performed comparing alcohol-positive rates (APR) between male and female drivers in three subgroups of drivers: those involved in road traffic accidents, those randomly tested on the road, and volunteers.

METHODS

Three databases were searched for eligible studies in October 2023. Real-case studies reporting APR in man and women convicted for DUI of alcohol worldwide were included. Univariate analysis by ANOVA with post-hoc tests identified the independent variables with a significant impact on the dependent variable APR, according to a relationship subsequently investigated by standard multiple linear regression. The meta-analysis of random effects estimates was performed to investigate the change in overall effect size (measured by Cohen's d standardized mean difference test) and 95% confidence interval (CI).

RESULTS

Among papers addressing driver gender, univariate analysis of independent variables revealed a higher Alcohol Positive Rate (APR) in men, particularly in drivers involved in crashes, with a noticeable decrease over time. Analyzing the gender of drivers involved in crashes, the meta-analysis showed that men had a significantly higher APR (30.7%; 95%CI 26.8-35.0) compared to women (13.2%; 95%CI 10.7-16.1). However, in drivers randomly tested, there was no significant difference in APR between genders (2.1% for men and 1.4% for women), while in volunteers, there was a statistically significant difference in APR with 3.4% (95%CI 1.5-7.6) for men and 1.1% (95%CI 0.5-2.7) for women.

CONCLUSION

Despite a progressive decrease in the epidemiological prevalence of alcohol-related DUI over time, this phenomenon remains at worryingly high levels among drivers involved in road traffic accidents in both genders, with a higher prevalence in men. It's important for policymakers, professionals, and scientists to consider gender when planning research, analysis, interventions, and policies related to psychoactive substances, such as alcohol or other licit drugs. Forensic sciences can play a vital role in this regard, enabling a thorough analysis of gender gaps in different populations.

The role of alcohol and patterns of alcohol-related deaths in Republic of North Macedonia within the period 2007-2020

Excessive alcohol consumption is one of the most important factors in a substantial number of violent deaths. The aim of our study was to investigate alcohol-related deaths in the Republic of North Macedonia in the period from 2007 to 2020, in order to study the influence of elevated blood alcohol levels in violent deaths. Five hundred sixty-four post-mortem blood samples from alcohol-related death cases-natural deaths and violent deaths (suicides, accidents, and homicides)-were analyzed, and the results were evaluated according to sex, age, and cause of death. Among 564 cases, traffic accidents were the leading cause of violent death (54.3% of the cases) followed by suicides (19.9% of the cases). In the examined post-mortem samples, BAC values ranged from 0.15-6.20 g/L. The average age was 45 ± 16 years for the male and 49 ± 19 years for the female group. The biggest proportion of high BAC values was found in the group of accidents specifically road traffic accidents and accidental intoxication as well as in the group of bolus deaths. The analysis of BAC in the cases of violent deaths in the Republic of North Macedonia confirmed that consumption of alcohol is strongly related to violent deaths. The data obtained from this study could raise caution and give aid in a national strategy for the prevention of alcohol-related violent deaths.

Visual Functions, Seatbelt Usage, Speed, and Alcohol Consumption Standards for Driving and Their Impact on Road Traffic Accidents

Purpose

 The incidence of road traffic accidents (RTAs) is dramatically increasing worldwide. Consequently, driving and licensing authorities have instituted strict rules and regulations, such as vision standards, restrictions on drunk driving, seat belt usage, and speeding, for driving safety. This study aimed to summarize the global visual standards for driving license issuing and renewal and investigate the effect of driving safety laws on RTA-related death rates in different countries.

Methods

 The study gathered data on visual standards for driving licenses from reliable sources and extracted enforcement scores (drunk driving, seat belt usage, and speeding) and RTA-related death rates from the World Health Organization status report on road safety. The Wilcoxon test explored the association between visual standards and RTA-related death rates, while the Kruskal-Wallis test analyzed the relationship between visual functions and death rates, as well as driving safety enforcement scores and RTA-related death rates.

Results

 The analysis was conducted on 71 countries and 50 states within the United States out of the 193 countries listed by the United Nations. It was found that 116 countries and states required a minimum VA range of 6/6-6/18, while 91 countries and states mandated a similar range for one-eyed drivers. VF testing for driving licenses was necessary in 77 countries and states. No significant association was observed between VA or VF testing and RTA-related death rates. However, countries that conducted more visual function tests demonstrated lower rates of RTA-related fatalities. Furthermore, RTA-related death rates were significantly associated with speeding, drunk driving, and seat belt laws.

Conclusion

Implementing clear policies regarding vision requirements, maintaining strict rules, and promoting law enforcement on speeding, drunk driving, and seat belt usage are crucial for improving road safety. These measures should be prioritized by driving and licensing authorities worldwide to mitigate the escalating incidence of RTAs.

Prevalence of Substance Abuse Among Trauma Patients in Rural West Virginia

BACKGROUND

 Substance abuse poses considerable clinical, economic, and social challenges. West Virginia is hailed as the epicenter of the substance abuse in the United States, the prevalence and pattern of different trauma mechanisms in a rural context or in patients with different forms of substance abuse remain unclear.

OBJECTIVE

 We performed the following analysis to understand the prevalence of substance abuse in patients with different trauma mechanisms in the rural setting with high substance abuse in the West Virginia.

METHODS

 We performed a cross-sectional retrospective analysis of adult trauma patients (motor vehicle, fall, assault, firearm suicide, brawl/rape and machinery) hospitalized in two tertiary care hospitals in West Virginia between 2006 and 2016. We identified all patients who had a urine drug screen (UDS) test and extracted the data related to the substance and trauma.

RESULTS

 Among 8734 patients screened using UDS, 5940 (68.1%) patients were tested positive for the substance. Opiates, alcohol, benzodiazepines, and cannabis were the four most common substances identified in trauma victims. In all instances, the prescribed drug was less than 20%. Fatal outcome was observed in 366 patients in the sample, with 44% (n=162) testing positive for UDS, 12% (n=45) testing positive for only alcohol, and 15% (n=56) testing positive for both alcohol and UDS. Regarding the trauma mechanism, the motor vehicle accident (MVA) was the most prominent with a clear association of substance abuse with fatal outcome.

CONCLUSION

 The most prevalent trauma mechanism was a MVA, with a strong link between drug usage and mortality. Due to the high incidence of positive substance abuse screens, UDS tests may need to be more widely implemented in trauma in the West Virginia region. The findings of this study might help in establishing regional or national policies to reduce acute substance abuse.

The Prevalence of Several Risky Driving Behaviors and Associated Crash Risk in Adolescent: A Population-Based Study of Tuscany Region

Objectives: To evaluate the prevalence of numerous risky driving behaviors (RDBs) and the associated risk of road traffic accidents (RTA) in a population-based sample of adolescent drivers (14–19 years) of Tuscany, Italy.

Methods: The frequency of participation -by age and sex- often RDBs were investigated: Multivariable analyses were performed to evaluate the association between RDBs and the risk of RTA and severe RTA.

Results: 2,737 adolescents were included in the study. Talking to passenger(s), listening to loud music, speeding, and texting showed the highest weekly participation rates. For all the considered RDBs, the frequency of participation significantly increased with age. Males reported a significantly higher participation in speeding, DUI of alcohol or drugs; while females reported listening to loud music and talking to passenger(s) more frequently. All the considered RDBs were significantly associated with the risk of RTA and severe RTA.

Conclusion: The prevalence of RDBs and the associated risk of RTA largely varied in adolescents. Findings provide evidence for tailoring prevention interventions and suggest the need to include common- but traditionally overlooked- RDBs in road safety campaigns.

A qualitative exploration of the role of NGOs in the recovery support for persons with substance use disorders in a low-income African setting

BACKGROUND

In sub-Saharan Africa, most government mental health facilities are under-resourced to cater for the mental health needs of the population, including the provision of treatment and recovery support services for persons with substance use disorders (SUDs). However, in other settings, non-governmental organizations (NGOs) play significant roles by complementing governments' efforts in the provision of care for vulnerable groups. Presently, no study exists that examines the contributions of NGOs in the recovery support of individuals with SUDs in the Ghanaian context. This study sets out to explore the role of NGOs in the recovery of persons with SUDs in Ghana.

METHOD

Using a descriptive qualitative design, eight staff (directors and senior recovery practitioners) from eight NGOs in southern Ghana were purposively selected and interviewed face-to-face using semi-structured interview guide. The interviews were audio-taped, transcribed verbatim, and analyzed using the thematic analysis within an inductive approach.

RESULTS

The results showed that NGOs provide three main services: treatment of drug addiction (through psychotherapy and recovery capital), re-integration of recovered individuals into society, and advocacy and awareness creation in schools and communities. These efforts are thwarted by limited qualified professionals and inadequate government support.

CONCLUSION

Our results underscore the need for government agencies to collaborate with NGOs involved in the recovery management of persons with SUDs and other mental disorders to complement their efforts in strategizing, designing, and implementing context-appropriate substance misuse prevention and intervention programs and policies in Ghana.

A meta-analysis study of worldwide prevalence of mortality in cocaine-consuming motorcyclists

For this meta-analysis, the aim is to estimate the prevalence and to determine the factors associated with changes in this prevalence in the world. A systematic review of PubMed/Medline, ISI Web of Knowledge, Scopus, and Science Direct, SID, and Google Scholar from 2011 to April 2020 was performed. Point prevalence was analyzed with a 95% confidence interval. The variances of each study were calculated using a two-sentence distribution formula, and the heterogeneity between the studies was assessed by the Q-Cochran test with a significance level of less than 0.1. Also, the index of changes attributed to I² was examined. Due to the heterogeneity between the studies, the random-effects model was used to combine the results of the studies. All statistical analyses were performed by the STATA software version 11 using Meta-Analysis commands. The significance level of the tests was considered to be P < 0.05. The prevalence of mortality in motorcyclists in six studies was reported to be 12% (0.05-0.18 = 95% CI). We stratified this study by participant geographical region and age group. In this study, the highest prevalence of mortality was in the under-30 age group. Furthermore, planning educational campaigns and advertisements by state authorities that are pointing out the harmful effects of motorcyclists' cocaine and/or other substances consumption is necessary.

Profiles of Risky Driving Behaviors in Adolescent Drivers: A Cluster Analysis of a Representative Sample from Tuscany Region (Italy)

(1) Background: Research on patterns of risky driving behaviors (RDBs) in adolescents is scarce. This study aims to identify distinctive patterns of RDBs and to explore their characteristics in a representative sample of adolescents. (2) Methods: this is a cross-sectional study of a representative sample of Tuscany Region students aged 14–19 years (n = 2162). The prevalence of 11 RDBs was assessed and a cluster analysis was conducted to identify patterns of RDBs. ANOVA, post hoc pairwise comparisons and multivariate logistic regression models were used to characterize cluster membership. (3) Results: four distinct clusters of drivers were identified based on patterns of RDBs; in particular, two clusters—the Reckless Drivers (11.2%) and the Careless Drivers (21.5%)—showed high-risk patterns of engagement in RDBs. These high-risk clusters exhibited the weakest social bonds, the highest psychological distress, the most frequent participation in health compromising and risky behaviors, and the highest risk of a road traffic accident. (4) Conclusion: findings suggest that it is possible to identify typical profiles of RDBs in adolescents and that risky driving profiles are positively interrelated with other risky behaviors. This clustering suggests the need to develop multicomponent prevention strategies rather than addressing specific RDBs in isolation.

Health Care Resources and 24,910 Deaths Due to Traffic Accidents: An Ecological Mortality Study in Poland

Background: Deaths due to traffic accidents are preventable and the access to health care is an important determinant of traffic accident case fatality. This study aimed to assess the relation between mortality due to traffic accidents and health care resources (HCR), at the population level, in 66 sub-regions of Poland. Methods: An area-based HCR index was delivered from the rates of physicians, nurses, and hospital beds. Associations between mortality from traffic accidents and the HCR index were tested using multivariate Poisson regression models. Results: In the sub-regions studied, the average mortality from traffic accidents was 11.7 in 2010 and 9.3/100.000 in 2015. After adjusting for sex, age and over time trends in mortality, out-of-hospital deaths were more frequently compared to hospitalized fatal cases (incidence rate ratio (IRR) = 1.68, 95% CI 1.45–1.93). Compared to sub-regions with high HCR, mortality from traffic accidents was higher in sub-regions with low and moderate HCR (IRR = 1.25, 95% CI 1.11–1.42 and IRR = 1.19, 95% CI 1.02–1.38, respectively), which reflected the differences in out-of-hospital mortality most pronounced in car accidents. Conclusions: Poor HCR is an important factor that explains the territorial differentiation of mortality due to traffic accidents in Poland. The high percentage of out-of-hospital deaths indicates the importance of preventive measures and the need for improvement in access to health care to reduce mortality due to traffic accidents.

Alcohol-Induced Blood-Brain Barrier Impairment: An In Vitro Study

In recent years, alcohol abuse has dramatically grown with deleterious consequence for people's health and, in turn, for health care costs. It has been demonstrated, in humans and animals, that alcohol intoxication induces neuroinflammation and neurodegeneration thus leading to brain impairments. Furthermore, it has been shown that alcohol consumption is able to impair the blood-brain barrier (BBB), but the molecular mechanisms underlining this detrimental effect have not been fully elucidated. For this reason, in this study we investigated the effects of alcohol exposure on a rat brain endothelial (RBE4) cell line, as an in vitro-validated model of brain microvascular endothelial cells. To assess whether alcohol caused a concentration-related response, the cells were treated at different times with increasing concentrations (10-1713 mM) of ethyl alcohol (EtOH). Microscopic and molecular techniques, such as cell viability assay, immunofluorescence and Western blotting, were used to examine the mechanisms involved in alcohol-induced brain endothelial cell alterations including tight junction distribution, apoptosis, and reactive oxygen species production. Our findings clearly demonstrate that alcohol causes the formation of gaps between cells by tight junction disassembly, triggered by the endoplasmic reticulum and oxidative stress, highlighted by GRP78 chaperone upregulation and increase in reactive oxygen species production, respectively. The results from this study shed light on the mechanisms underlying alcohol-induced blood-brain barrier dysfunction and a better understanding of these processes will allow us to take advantage of developing new therapeutic strategies in order to prevent the deleterious effects of alcohol.

Prevalence and Pattern of Road Traffic Accidents among Commercial Motorcyclists in the Central Tongu District, Ghana

Background

The World Health Organisation estimates that 1.35 million people die as a result of road traffic crashes. Motorcycles as a means of transport are increasingly becoming the preferred and easiest means of transportation for most people in developing countries despite the associated risk. This study determined the prevalence and pattern of motorcycle crashes in Adidome among commercial motorcyclists.

Methods

A descriptive, cross-sectional study design was used as 114 commercial motorcyclists were recruited to respond to a pretested research questionnaire in the Adidome district of the Volta Region. Data were analyzed using SPSS, version 22.0. Data were presented as simple descriptive statistics. A chi-square relationship was determined using the demographic variables, and the history of accident at a 95% confidence interval with 0.05 was considered as statistically significant.

Results

The prevalence of road traffic crashes at Adidome was 64.0%. Motorcyclists (74.0%) were reported to have been involved in crashes in the past one year prior to the study. Motorcyclists attributed the last accident to excessive speeding (31.5%) and bad roads (23.3%), this accident as a result of colliding with another motorcycle (50.7%), and slippery surfaces (24.7%). The majority (63.0%) of the respondents had an accident once. The consumption of alcohol was associated with the occurrence of an accident as 34.2% occurred among cyclists who drank alcohol, compared with 29.8% who did not (p < 0.05).

Conclusion

There should be strict implementation of current road traffic regulations of Ghana by the MTTD of the Ghana Police Service, and penalties should be awarded against anybody caught riding a motorcycle under the influence of alcohol. Helmet and other protective devices must be made compulsory for motorcycle riders to prevent injuries, especially head injuries, if an accident occurs.