Contribution of alcohol to deaths in road traffic accidents in Tayside 1982-6

In Britain the precise number and relative proportions of deaths among drivers, passengers, and pedestrians in road traffic accidents related to alcohol are not known. These data were obtained in Tayside by cross matching police accident records with blood alcohol concentrations at necropsy. Of 71 alcohol-related deaths 30 were the drivers (or motorcyclists) themselves, nine were their passengers, 23 were pedestrians with raised blood alcohol concentrations, and nine were innocent victims.The high blood alcohol concentrations of the intoxicated drivers, passengers, and pedestrians, which may point to alcoholism, suggest that publicity campaigns will be of little value in reducing the number of deaths in road traffic accidents related to alcohol. The time at which these accidents occurred was related to licensing hours, and this should be taken into account when considering changes in licensing laws.     

Survey of impaired drivers,fatally injured or surviving,who caused fatal highway accidents in Alberta in 1970-72.

In 1970-72, 456 (53.4%) of 854 drivers responsible for a motor vehicle accident in which either they or other persons were killed had been drinking beforehand. Of surviving culpable drivers tested for blood alcohol concentration 81.7% were found to be legally impaired; however, only 24.8% of these drivers were tested. Because surviving culpable drivers pose a possible future hazard to highway safety it is important that data on this group be collected and analysed.     

Role of drugs in traffic accidents.

Serum samples from 201 drivers who presented at emergency departments within six hours after being injured in a road accident and 325 control drivers selected randomly at petrol stations were screened for drugs by combined thin-layer and gas chromatography. Blood alcohol concentrations were also measured, and a questionnaire on the subjects'' state of health and use of drugs administered. At interview 30 patients (15%) and 44 controls (13%) said that they had taken drugs in the previous 24 hours. Four patients (2%) and six controls (2%) said that they had taken psychotropic drugs, but serum analysis detected psychotropic drugs in 10 patients (5%) and eight controls (2.5%). Diazepam was found in 16 of the 18 subjects in whom psychotropic drugs were detected. Alcohol was detected in 30 patients (15%) and three controls (1%). Drug use appeared to be somewhat lower in Finland than in other Western countries, and illness to be a more important traffic hazard than drugs in general. Interview was not a reliable method of establishing whether drivers had taken psychotropic drugs. Taking diazepam may increase the risk of being involved in a traffic accident, but alcohol was the most powerful risk factor.     

Immediate fatal outcome vs. fatal outcome within the first 48 hours following a severe traffic trauma--analysis of the possible effect of alcohol intoxication on the outcome

This paper is a retrospective analysis of data on 278 persons with fatal outcomes in traffic accidents in Osjecko--baranjska County, Croatia, during a five-year period. The observed sample of casualties was divided according to the time of fatal outcome into three groups: immediately deceased (139 or 50.0%), deceased within the first 48 hours (84 or 30.2%) and deceased after 48 hours (55 or 19.8%). A comparison of data was made for the first two groups of casualties, based on the level of alcohol intoxication, and an analysis of the possible influence of alcohol intoxication on an early outcome of severe trauma, which was defined as immediate fatal outcome and fatal outcome within the first 48 hours following the trauma. Casualties from the group of immediately deceased had a significantly higher average blood alcohol level than casualties from the group of persons deceased within the first 48 hours (shown through arithmetic mean of 0.81 g/kg vs. 0.33 g/kg, p =0.000). A binary logistic regression analysis showed that every increase in blood alcohol level by 1 g/kg also increased the odds of an immediate fatal outcome by 1.92 times (p=0.004). CONCLUSION: Beside increased risks of traffic accidents, the collected data showed that alcohol intoxication of accident participants also increases their chances of an immediate fatal outcome.     

Seasonal variation of falling asleep while driving: An examination of fatal road accidents

Road accidents related to sleep show a clear time-of-day pattern. Following the previous finding that such accidents in Finland happen more often (absolutely and relatively) during the summer months, especially during the afternoon, the main aim of this study was to reveal the factors behind such seasonality. The data included the computerized database of the Finnish fatal road accident investigation system restricted to nonprofessional, nonintoxicated car drivers (N=1464) and sample of the original folders (N=101). The results of the analysis on the sample of the original folders showed that investigation teams adequately documented and explained their decisions concerning falling-asleep accidents and that the observed seasonality is a real phenomenon, not a result of bias of the teams. With the exception of 26-35-year-olds, men of all of the other age groups had a notable absolute and relative increase of sleep-related accidents in the summer. Young male drivers (≤25 yrs), followed by the oldest group (≥66 yrs) had the highest increase in the absolute number of sleep-related accidents between the summer and winter months, while the relative change was the highest for ages 56-65. Women showed similar trends. A detailed analysis of 44 cases of summer afternoon falling-asleep accidents revealed that many drivers were engaged in unusual activities the day or night before the accident. The findings are discussed in relation to different driving and lifestyle habits between seasons, including sleep quality.     

Seasonal Variation of Falling Asleep while Driving: An Examination of Fatal Road Accidents

Road accidents related to sleep show a clear time‐of‐day pattern. Following the previous finding that such accidents in Finland happen more often (absolutely and relatively) during the summer months, especially during the afternoon, the main aim of this study was to reveal the factors behind such seasonality. The data included the computerized database of the Finnish fatal road accident investigation system restricted to nonprofessional, nonintoxicated car drivers (N=1464) and sample of the original folders (N=101). The results of the analysis on the sample of the original folders showed that investigation teams adequately documented and explained their decisions concerning falling‐asleep accidents and that the observed seasonality is a real phenomenon, not a result of bias of the teams. With the exception of 26–35‐year‐olds, men of all of the other age groups had a notable absolute and relative increase of sleep‐related accidents in the summer. Young male drivers (≤25 yrs), followed by the oldest group (≥66 yrs) had the highest increase in the absolute number of sleep‐related accidents between the summer and winter months, while the relative change was the highest for ages 56–65. Women showed similar trends. A detailed analysis of 44 cases of summer afternoon falling‐asleep accidents revealed that many drivers were engaged in unusual activities the day or night before the accident. The findings are discussed in relation to different driving and lifestyle habits between seasons, including sleep quality.     

ALCOHOL AND DRIVING—Application of a Definition in a Way to Deter Offenders

Increasing speed and congestion of vehicular traffic have made the effect of alcohol on the drivers of motor vehicles a matter of growing concern. It is not possible, using the definition of drunken driving that is now prevalent in California, to establish a rule, based on a stipulated minimum concentration of blood alcohol, that will serve to indict most of the guilty yet free all the innocent. If, instead of comparing the suspected driver with the hypothetical “ordinarily prudent and cautious person” as is now done in California, we accept the more widely prevalent definition of driving under the influence which defines the offense as any appreciable diminution in skill ascribable to alcohol, then a blood alcohol concentration of 150 mg. per 100 cc. or even 100 mg. per 100 cc., could suffice for conviction.For the rule as to alcohol content of the blood to be an effective deterrent of drunken driving, all drivers—not just those involved in accidents or observed to drive erratically—would have to be subject to testing.     

Traffic accidents-chronic medical conditions as a cause

From comparatively scanty information, an increased traffic accident risk appears to be associated with several chronic medical conditions including alcoholism, cardiovascular disease, epilepsy, diabetes and mental illness. Further study probably will show that medical handicaps other than alcoholism are a factor in from 5 to 10 per cent of traffic accidents. However, in about half of the accidents caused by heart attacks, the individual has no previous knowledge of his illness, and prevention of the accident would not be possible. A selective program for identifying high risk drivers with medical conditions is feasible and warranted, but a program of mass medical examinations for all drivers is not.A very strong relationship has been shown between drunk driving and traffic accidents, and 50 to 75 per cent of all severe and fatal traffic accidents involve the use of alcohol. However, studies have shown that drivers with alcoholism rather than social drinkers represent the preponderance, but not the entirety, of those who get into trouble. A major reduction in the traffic accident toll may thus depend on the early identification and treatment of alcoholism.     

Traffic Accidents—Chronic Medical Conditions as a Cause

From comparatively scanty information, an increased traffic accident risk appears to be associated with several chronic medical conditions including alcoholism, cardiovascular disease, epilepsy, diabetes and mental illness. Further study probably will show that medical handicaps other than alcoholism are a factor in from 5 to 10 per cent of traffic accidents. However, in about half of the accidents caused by heart attacks, the individual has no previous knowledge of his illness, and prevention of the accident would not be possible. A selective program for identifying high risk drivers with medical conditions is feasible and warranted, but a program of mass medical examinations for all drivers is not.A very strong relationship has been shown between drunk driving and traffic accidents, and 50 to 75 per cent of all severe and fatal traffic accidents involve the use of alcohol. However, studies have shown that drivers with alcoholism rather than social drinkers represent the preponderance, but not the entirety, of those who get into trouble. A major reduction in the traffic accident toll may thus depend on the early identification and treatment of alcoholism.     

Negativity Bias in Dangerous Drivers

The behavioral and cognitive characteristics of dangerous drivers differ significantly from those of safe drivers. However, differences in emotional information processing have seldom been investigated. Previous studies have revealed that drivers with higher anger/anxiety trait scores are more likely to be involved in crashes and that individuals with higher anger traits exhibit stronger negativity biases when processing emotions compared with control groups. However, researchers have not explored the relationship between emotional information processing and driving behavior. In this study, we examined the emotional information processing differences between dangerous drivers and safe drivers. Thirty-eight non-professional drivers were divided into two groups according to the penalty points that they had accrued for traffic violations: 15 drivers with 6 or more points were included in the dangerous driver group, and 23 drivers with 3 or fewer points were included in the safe driver group. The emotional Stroop task was used to measure negativity biases, and both behavioral and electroencephalograph data were recorded. The behavioral results revealed stronger negativity biases in the dangerous drivers than in the safe drivers. The bias score was correlated with self-reported dangerous driving behavior. Drivers with strong negativity biases reported having been involved in mores crashes compared with the less-biased drivers. The event-related potentials (ERPs) revealed that the dangerous drivers exhibited reduced P3 components when responding to negative stimuli, suggesting decreased inhibitory control of information that is task-irrelevant but emotionally salient. The influence of negativity bias provides one possible explanation of the effects of individual differences on dangerous driving behavior and traffic crashes.     

Motor vehicle driving among diabetics taking insulin and non-diabetics.

OBJECTIVE--To determine whether rates of road traffic accidents were higher in diabetics treated with insulin than in non-diabetic subjects. DESIGN--Controlled, five year retrospective survey. SETTING--Diabetic, dermatology, and gastroenterology outpatient clinics. PATIENTS--596 Diabetics treated with insulin (354 drivers) aged 18-65 attending two clinics and 476 non-diabetic outpatients (302 drivers). MAIN OUTCOME MEASURES--Rates of accidents in diabetic and non-diabetic subjects. RESULTS--A self completed questionnaire was used to record age, sex, driving state, and rates of accidents and convictions for motoring offences among diabetic and non-diabetic volunteers. For the diabetic volunteers further information was obtained on treatment, experience of hypoglycaemia, and declaration of disability to the Driving and Vehicle Licensing Centre and their insurance company. Accident rates were similar (81 (23%) diabetic and 76 (25%) non-diabetic drivers had had accidents in the previous five years). A total of 103 diabetic drivers had recognised hypoglycaemic symptoms while driving during the previous year. Only 12 reported that hypoglycaemia had ever caused an accident. Overall, 249 had declared their diabetes to an insurance company. Of these, 107 had been required to pay an increased premium, but there was no excess of accidents in this group. CONCLUSIONS--Diabetic drivers treated with insulin and attending clinics have no more accidents than non-diabetic subjects and may be penalised unfairly by insurance companies.     

High risk for obstructive sleep apnea in truck drivers estimated by the Berlin questionnaire: prevalence and associated factors

The health issues that attract our attention when analyzing the truck driver population are the high prevalence of sedentary habits, inadequate diet, obesity, and proportion of hypertensive. All these are either considered risk factors for or a consequence of Obstructive Sleep Apnea (OSA). The objective of this study was to investigate the risk for OSA among 10,101 truck drivers and to correlate it with potentially related factors, such as serum glucose and cholesterol levels, smoking habits, alcohol and drug consumption, and self-reported physical activity. The drivers were invited to participate in the campaign "Saúde na Boléia" (Health Behind the Wheel) promoted by a Brazilian company responsible for the maintenance of approximately 360km of roads in the country. Drivers who spontaneously stopped at the campaign booths placed along the roads were invited to answer a questionnaire covering sociodemographic data such as age, alcohol, and drug consumption. All participants completed a Berlin Questionnaire and were classified as low- or high-risk subjects for OSA based on questions about snoring, tiredness during the day, and the presence of hypertension or obesity. Blood collection was accomplished at the same site by nurses and/or nursing students collaborating with the campaign for subsequent laboratory studies. Approximately 26% of the truck drivers were found to be at high-risk group for OSA. An adjusted multiple logistic model found the independent risk factors of smoking (OR=1.16; p=0.014) and drug use (OR= 1.32; p < 0.0001) were associated with high risk for OSA. The presence of self-reported occasional (OR=0.62; p<0.0001) and regular (OR=0.53; p < 0.0001) physical activity was found to be an independent factor protective of OSA. Educational programs, including ones aimed at improving one's health habits, such as engagement in physical exercise, should be considered in the development of initiatives to reduce the risk for OSA among the truck driver population.     

Alcoholic drinkers and road safety in the Republic of Slovenia

In this study we were therefore interested in the percentage of road traffic offenses (RTO) and road traffic accidents (RTA) involving inebriated drivers one year before and one year after the passing of the new Law on Road Traffic Safety (LRTS) as well as measures (referrals, punishments and final decisions on the revoking of driver's licenses due to drunk driving). One year before the passing of the new LRTS, there were 40,702 RTA-s in the Republic of Slovenia (12.2% caused by drunk drivers). The average alcohol concentration in exhaled air for those analysed was 1.19 g/kg. One year after the passing of this law there were 36,479 RTA-s (8.6% caused by drunk drivers). The average alcohol concentration in exhaled air for those analysed was 1.32 g/kg (the differences were statistically significant). In 13.8% cases the reason for performing a measurement of the alcohol concentration in exhaled aier was an RTA with an average alcohol concentration in exhaled air of 1.22 g/kg and in 86.2% of cases an RTO with an average alcohol concentration in exhaled air of 1.25 g/kg (the differences were statistically significant). We found it interesting that the number of events minvolving lower concentrations decreased, but the percentage involving higher alcohol concentrations even increased. The results of this study indicate without a doubt that the law was not successful enough with its repressive and preventative measures in the field of drunk drivers. Experts on alcohol believe that punishment cannot make alcoholics and other drivers abandon their behavioural patterns and stop driving under the influence of alcohol. This can be achieved only by treatment, and the present practice (police--misdenveanour counts--repeat general medical check-up) has been ineffective as prevention among alcoholic drivers. We therefore believe that supplements to the LRTS should be adopted urgently, that would contribute, through better medical selection, to a reduction in the number of drunk drivers behind the wheel, both those who are alcohol dependent (and should be referred to treatment).     

Comorbidities and Crash Involvement among Younger and Older Drivers

Previous studies identified comorbidities as predictors of older driver performance and driving pattern, while the direct impact of comorbidities on road crash risk in elderly drivers is still unknown. The present study is a cross-sectional aimed at investigating the association between levels of comorbidity and crash involvement in adult and elderly drivers. 327 drivers were stratified according to age range in two groups: elderly drivers (age ≥70 years old, referred as older) and adult drivers (age <70 years old, referred as younger). Driving information was obtained through a driving questionnaire. Distance traveled was categorized into low, medium and high on the basis of kilometers driven in a year. CIRS-illness severity (IS) and CIRS-comorbidity indices (CI) in all populations were calculated. Older drivers had a significantly higher crash involvements rate (p = .045) compared with the younger group based on the number of licensed drivers. Dividing comorbidity indices into tertiles among all licensed subjects, the number of current drivers significantly decreased (p<.0001) with increasing level of comorbidity. The number of current drivers among older subjects significantly decreased with increasing comorbidity level (p = .026) while no difference among younger group was found (p = .462). Among younger drivers with increasing comorbidity level, the number of road accidents significantly increased (p = .048) and the logistic regression analysis showed that comorbidity level significantly associated with crash involvement independent of gender and driving exposure. Older subjects with high level of comorbidity are able to self-regulate driving while comorbidity burden represents a significant risk factor for crash involvements among younger drivers.     

A case-control study estimating accident risk for alcohol, medicines and illegal drugs

Background

The aim of the present study was to assess the risk of having a traffic accident after using alcohol, single drugs, or a combination, and to determine the concentrations at which this risk is significantly increased.

Methods

A population-based case-control study was carried out, collecting whole blood samples of both cases and controls, in which a number of drugs were detected. The risk of having an accident when under the influence of drugs was estimated using logistic regression adjusting for gender, age and time period of accident (cases)/sampling (controls). The main outcome measures were odds ratio (OR) for accident risk associated with single and multiple drug use. In total, 337 cases (negative: 176; positive: 161) and 2726 controls (negative: 2425; positive: 301) were included in the study.

Results

Main findings were that 1) alcohol in general (all the concentrations together) caused an elevated crash risk; 2) cannabis in general also caused an increase in accident risk; at a cut-off of 2 ng/mL THC the risk of having an accident was four times the risk associated with the lowest THC concentrations; 3) when ranking the adjusted OR from lowest to highest risk, alcohol alone or in combination with other drugs was related to a very elevated crash risk, with the highest risk for stimulants combined with sedatives.

Conclusion

The study demonstrated a concentration-dependent crash risk for THC positive drivers. Alcohol and alcohol-drug combinations are by far the most prevalent substances in drivers and subsequently pose the largest risk in traffic, both in terms of risk and scope.     

Methods for retrospective assessment of an unusual behavior of a person with diabetes: ebrietas alcoholica and/or hypoglycaemia?

Drunkenness and/or hypoglycaemia are possible causes of unusual behavior in a person with diabetes. The aim of this study was to demonstrate different methods which were used in two contradictory reviews of experts for retrospective assessment of a patient's condition in the course of a car crash: An insulin-treated driver caused a car accident resulting in injuries to two men. He was accused of the crime of damage to health as well as of driving under the influence of an addictive drug. One expert, having seen the police and medical reports, concluded the driver was influenced by alcohol at the time of the accident. The contradictory argument of another expert, based on his own thorough investigation including self monitoring and completed by a model experiment, resulted in the conclusion that the driver was probably influenced by hypoglycaemia. Thus, the methods of the second expert seem to be useful reasonable tools to assess the unusual behavior of a person with diabetes.     

Traits of winner and loser species indicate drivers of herb layer changes over two decades in forests of NW Germany

Questions: What are the most likely environmental drivers for compositional herb layer changes as indicated by trait differences between winner and loser species? Location: Weser‐Elbe region (NW Germany). Methods: We resurveyed the herb layer communities of ancient forest patches on base‐rich sites of 175 semi‐permanent plots. Species traits were tested for their ability to discriminate between winner and loser species using logistic regression analyses and deviance partitioning. Results: Of 115 species tested, 31 were identified as winner species and 30 as loser species. Winner species had higher seed longevity, flowered later in the season and more often had an oceanic distribution compared to loser species. Loser species tended to have a higher specific leaf area, were more susceptible to deer browsing and had a performance optimum at higher soil pH compared to winner species. The loser species also represented several ancient forest and threatened species. Deviance partitioning indicated that local drivers (i.e. disturbance due to forest management) were primarily responsible for the species shifts, while regional drivers (i.e. browsing pressure and acidification from atmospheric deposition) and global drivers (i.e. climate warming) had moderate effects. There was no evidence that canopy closure, drainage or eutrophication contributed to herb layer changes. Conclusions: The relative importance of the different drivers as indicated by the winner and loser species differs from that found in previous long‐term studies. Relating species traits to species performance is a valuable tool that provides insight into the environmental drivers that are most likely responsible for herb layer changes.     

Phosphorus in agricultural soils: drivers of its distribution at the global scale

Phosphorus (P) availability in soils limits crop yields in many regions of the World, while excess of soil P triggers aquatic eutrophication in other regions. Numerous processes drive the global spatial distribution of P in agricultural soils, but their relative roles remain unclear. Here, we combined several global data sets describing these drivers with a soil P dynamics model to simulate the distribution of P in agricultural soils and to assess the contributions of the different drivers at the global scale. We analysed both the labile inorganic P (P_ILAB), a proxy of the pool involved in plant nutrition and the total soil P (P_TOT). We found that the soil biogeochemical background corresponding to P inherited from natural soils at the conversion to agriculture (BIOG) and farming practices (FARM) were the main drivers of the spatial variability in cropland soil P content but that their contribution varied between P_TOT vs. P_ILAB. When the spatial variability was computed between grid cells at half‐degree resolution, we found that almost all of the P_TOT spatial variability could be explained by BIOG, while BIOG and FARM explained 38% and 63% of P_ILAB spatial variability, respectively. Our work also showed that the driver contribution was sensitive to the spatial scale characterizing the variability (grid cell vs. continent) and to the region of interest (global vs. tropics for instance). In particular, the heterogeneity of farming practices between continents was large enough to make FARM contribute to the variability in P_TOT at that scale. We thus demonstrated how the different drivers were combined to explain the global distribution of agricultural soil P. Our study is also a promising approach to investigate the potential effect of P as a limiting factor for agroecosystems at the global scale.     

Taking alcohol by deception II: Paraga (alcoholic herbal mixture) use among commercial motor drivers in a south-western Nigerian city

ABSTRACT: BACKGROUND: Paraga, an alcoholic herbal preparation that comes in different varieties had been shown to be commonly available to commercial drivers in southern Nigeria. This study aims to determine the prevalence and pattern of paraga use, and to evaluate the level of awareness of the risks entailed in taking paraga among intercity commercial drivers operating out of motor parks in Osogbo, southwest Nigeria. We administered a locally validated version of the WHO drug and alcohol survey questionnaire to 350 commercial drivers. RESULTS: Of the 350 questionnaires administered, 332 were used for the data analysis; the remaining 18 were rejected because they had too many missing data. The prevalence rate in the past one year was 53.6% and 43.2% for the past one month (current). Three-quarters were moderate to heavy users, and many take the drug while working. A total of 25.6% had been involved in road crashes after taking paraga and 36.7% had actually seen people getting drunk from taking paraga. Only 40% of the drivers thought paraga use was harmful to their health, the others believing it to have therapeutic values (25%) or undecided (35.0%). Only 43.8% of the drivers would be willing to stop taking paraga. CONCLUSIONS: Paraga use is popular among commercial drivers. Because of its alcoholic nature, drivers' access to the concoction should be controlled and appropriate enforcement put in place.     

High Risk for Obstructive Sleep Apnea in Truck Drivers Estimated by the Berlin Questionnaire: Prevalence and Associated Factors

The health issues that attract our attention when analyzing the truck driver population are the high prevalence of sedentary habits, inadequate diet, obesity, and proportion of hypertensive. All these are either considered risk factors for or a consequence of Obstructive Sleep Apnea (OSA). The objective of this study was to investigate the risk for OSA among 10,101 truck drivers and to correlate it with potentially related factors, such as serum glucose and cholesterol levels, smoking habits, alcohol and drug consumption, and self-reported physical activity. The drivers were invited to participate in the campaign “Saúde na Boléia” (Health Behind the Wheel) promoted by a Brazilian company responsible for the maintenance of approximately 360 km of roads in the country. Drivers who spontaneously stopped at the campaign booths placed along the roads were invited to answer a questionnaire covering sociodemographic data such as age, alcohol, and drug consumption. All participants completed a Berlin Questionnaire and were classified as low- or high-risk subjects for OSA based on questions about snoring, tiredness during the day, and the presence of hypertension or obesity. Blood collection was accomplished at the same site by nurses and/or nursing students collaborating with the campaign for subsequent laboratory studies. Approximately 26% of the truck drivers were found to be at high-risk group for OSA. An adjusted multiple logistic model found the independent risk factors of smoking (OR = 1.16; p = 0.014) and drug use (OR = 1.32; p < 0.0001) were associated with high risk for OSA. The presence of self-reported occasional (OR = 0.62; p < 0.0001) and regular (OR = 0.53; p < 0.0001) physical activity was found to be an independent factor protective of OSA. Educational programs, including ones aimed at improving one's health habits, such as engagement in physical exercise, should be considered in the development of initiatives to reduce the risk for OSA among the truck driver population.