YOUR LICENSE AND THE LAW

Rare is the individual respondent in a hearing before the California Board of Medical Examiners who has read the compilation of laws relating to the practice of medicine and surgery before he became involved with the law. Many physicians do not realize that the conviction of either a felony or any offense, misdemeanor or felony involving moral turpitude constitutes unprofessional conduct and that, after being penalized by the civil courts, they then are subject to action by the Board which may revoke the license to practice. During 1960, forty-two hearings on charges of unprofessional conduct were held. Many of these could have been avoided had the doctors involved not been ignorant of the law.     

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).     

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.     

Eveningness is associated with higher risk-taking in dangerous driving situations

Inclination toward eveningness is often associated with risky behavior. But the existing studies are scarce, inconsistent and usually limited to self-reported measures. We sought to investigate in young adults whether morningness-eveningness is associated with risky behavior in dangerous driving situations, with self-reported drunk driving and with alcohol consumption. Results show that, indeed, inclination toward eveningness is associated with these risky behaviors. We also demonstrate a link between morningness-eveningness and sensation seeking. Therefore, young adults with a tendency toward eveningness might be more at risk to face negative consequences of alcohol abuse or to be involved in a road accident.     

Reaching the hard-to-reach: a probability sampling method for assessing prevalence of driving under the influence after drinking in alcohol outlets

Drinking alcoholic beverages in places such as bars and clubs may be associated with harmful consequences such as violence and impaired driving. However, methods for obtaining probabilistic samples of drivers who drink at these places remain a challenge--since there is no a priori information on this mobile population--and must be continually improved. This paper describes the procedures adopted in the selection of a population-based sample of drivers who drank at alcohol selling outlets in Porto Alegre, Brazil, which we used to estimate the prevalence of intention to drive under the influence of alcohol. The sampling strategy comprises a stratified three-stage cluster sampling: 1) census enumeration areas (CEA) were stratified by alcohol outlets (AO) density and sampled with probability proportional to the number of AOs in each CEA; 2) combinations of outlets and shifts (COS) were stratified by prevalence of alcohol-related traffic crashes and sampled with probability proportional to their squared duration in hours; and, 3) drivers who drank at the selected COS were stratified by their intention to drive and sampled using inverse sampling. Sample weights were calibrated using a post-stratification estimator. 3,118 individuals were approached and 683 drivers interviewed, leading to an estimate that 56.3% (SE = 3,5%) of the drivers intended to drive after drinking in less than one hour after the interview. Prevalence was also estimated by sex and broad age groups. The combined use of stratification and inverse sampling enabled a good trade-off between resource and time allocation, while preserving the ability to generalize the findings. The current strategy can be viewed as a step forward in the efforts to improve surveys and estimation for hard-to-reach, mobile populations.     

Physicians' attitudes toward the legalization of marijuana use.

We asked 303 practicing physicians in general internal medicine, family medicine, gastroenterology, or psychiatry to indicate whether possessing or using marijuana should be considered a felony, a misdemeanor, warrant the issuance of a citation, or be legalized. The position physicians advocated was unrelated to their specialty, experience diagnosing or treating substance abuse problems, their attitudes toward the efficacy of the treatment of drug abuse, or any other work role or habit we measured. Legalization or citation as compared with harsher penalties, however, was more likely favored by physicians who were younger, less religious, politically more liberal, and those less likely to perceive a serious drug problem in society. Legalization was also more likely favored by physicians who themselves had used marijuana, cocaine, and amphetamines but was unrelated to the use of alcohol, cigarettes, or tranquilizers. Although physician opinion should be sought as society deals with the drug problem, this study suggests how physicians'' characteristics may influence the opinions that are rendered.     

Driving Performance on the Descending Limb of Blood Alcohol Concentration (BAC) in Undergraduate Students: A Pilot Study

Young drivers are overrepresented in collisions resulting in fatalities. It is not uncommon for young drivers to socially binge drink and decide to drive a vehicle a few hours after consumption. To better understand the risks that may be associated with this behaviour, the present study has examined the effects of a social drinking bout followed by a simulated drive in undergraduate students on the descending limb of their BAC (blood alcohol concentration) curve. Two groups of eight undergraduate students (n = 16) took part in this study. Participants in the alcohol group were assessed before drinking, then at moderate and low BAC as well as 24 hours post-acute consumption. This group consumed an average of 5.3 ± 1.4 (mean ± SD) drinks in an hour in a social context and were then submitted to a driving and a predicted crash risk assessment. The control group was assessed at the same time points without alcohol intake or social context.; at 8 a.m., noon, 3 p.m. and 8 a.m. the next morning. These multiple time points were used to measure any potential learning effects from the assessment tools (i.e. driving simulator and useful field of view test (UFOV)). Diminished driving performance at moderate BAC was observed with no increases in predicted crash risk. Moderate correlations between driving variables were observed. No association exists between driving variables and UFOV variables. The control group improved measures of selective attention after the third asessement. No learning effect was observed from multiple sessions with the driving simulator. Our results show that a moderate BAC, although legal, increases the risky behaviour. Effects of alcohol expectancy could have been displayed by the experimental group. UFOV measures and predicted crash risk categories were not sentitive enough to predict crash risk for young drivers, even when intoxicated.     

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.     

Reduced Dopamine Transporter Availability and Neurocognitive Deficits in Male Patients with Alcohol Dependence

Dopamine plays an important role in the development of alcohol dependence, cognitive dysfunction, and is regulated via dopamine transporter activity. Although dopamine transporter activity is critically involved in alcohol dependence, studies observing this relationship are limited. Thus the current study examined whether dopamine transporter availability is associated with developing of alcohol dependence and cognitive dysfunction. Brain imaging with ^99mTc-TRODAT-1 as a ligand was used to measure dopamine transporter availability among 26 male patients with pure alcohol dependence and 22 age- and sex- matched healthy volunteers. The Wisconsin Card Sorting Test (WCST) and Tridimensional Personality Questionnaire (TPQ) were administered to assess neurocognitive functioning and personality traits, respectively. Compared to healthy controls, patients with alcohol dependence showed a significant reduction in dopamine transporter availability (p < 0.001), as well as diminished performance on the WCST (p < 0.001). Dopamine transporter availability was negatively correlated with both total and perseverative WCST errors among healthy controls, but only patients with alcohol dependence showed a positive correlation between dopamine transporter availability and a harm avoidance personality profile. Thus, reductions in dopamine transporter availability may play a pathophysiological role in the development of pure alcohol dependence, given its association with neurocognitive deficits. Moreover, personality may influence the development of pure alcohol dependence; however, additional clinical subgroups should be examined to confirm this possibility.     

Limited Supermarket Availability Is Not Associated With Obesity Risk Among Participants in the Kansas WIC Program

Socioecological theory and a growing body of research suggests that geographic, racial, ethnic, and socioeconomic disparities in the prevalence of obesity are linked to disparities in the availability of food retail outlets that provide healthy food options. We examined the availability of food stores for low‐income women in Kansas and tested whether food store availability was associated with obesity using cross‐sectional, geocoded data from women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n = 21,166) in Kansas. The availability and density of food stores within a 1, 3, and 5 mile radius of residence was determined, and multivariate logistic regression was used to examine the association of food store availability with obesity. The availability of convenience, grocery stores, and supermarkets varied across the urban–rural continuum, but the majority of WIC recipients lived within a 1 mile radius of a small grocery store. WIC participants in micropolitan areas had the greatest availability of food stores within a 1 mile radius of residence. Availability and density of food stores was not associated with obesity in metropolitan and rural areas, but availability and density of any type of food store was associated with an increased risk of obesity among WIC recipients in micropolitan areas. These results suggest that limited spatial availability of grocery stores and supermarkets does not contribute to obesity risk among low‐income WIC recipients in Kansas, and that urban influence moderates the contribution of food environments to obesity.     

The Relationship between Alcohol Outlets,HIV Risk Behavior,and HSV-2 Infection among South African Young Women: A Cross-Sectional Study

BackgroundAlcohol consumption has a disinhibiting effect that may make sexual risk behaviors and disease transmission more likely. The characteristics of alcohol-serving outlets (e.g. music, dim lights, lack of condoms) may further encourage risky sexual activity. We hypothesize that frequenting alcohol outlets will be associated with HIV risk.MethodsIn a sample of 2,533 school-attending young women in rural South Africa, we performed a cross-sectional analysis to examine the association between frequency of alcohol outlet visits in the last six months and four outcomes related to HIV risk: number of sex partners in the last three months, unprotected sex acts in the last three months, transactional sex with most recent partner, and HSV-2 infection. We also tested for interaction by alcohol consumption.ResultsVisiting alcohol outlets was associated with having more sex partners [adjusted odds ratio (aOR), one versus zero partners (95% confidence interval (CI)): 1.51 (1.21, 1.88)], more unprotected sex acts [aOR, one versus zero acts (95% CI): 2.28 (1.52, 3.42)], higher levels of transactional sex [aOR (95% CI): 1.63 (1.03, 2.59)], and HSV-2 infection [aOR (95% CI): 1.30 (0.88, 1.91)]. In combination with exposure to alcohol consumption, visits to alcohol outlets were more strongly associated with all four outcomes than with either risk factor alone. Statistical evidence of interaction between alcohol outlet visits and alcohol consumption was observed for all outcomes except transactional sex.ConclusionsFrequenting alcohol outlets was associated with increased sexual risk in rural South African young women, especially when they consumed alcohol. Sexual health interventions targeted at alcohol outlets may effectively reach adolescents at high risk for sexually transmitted infections like HIV and HSV-2.

Trial Registration

HIV Prevention Trials Network HPTN 068     

粗毛纤孔菌子实体与菌丝体粗多糖改善小鼠急性酒精肝损伤的比较研究

粗毛纤孔菌是一种常见的药用真菌,具有医疗保健价值,多糖作为其主要活性成分之一,在生物活性中发挥着重要的作用。本文从粗毛纤孔菌子实体和菌丝体中提取了多糖成分,探讨了子实体多糖（IHFPS）和菌丝体多糖（IHMPS）对小鼠急性酒精肝损伤的保护作用。采用灌胃的方式给予C57BL-6小鼠多糖,连续灌胃3周,最后一次给药4h后,给予乙醇造成小鼠急性酒精肝损伤,通过记录小鼠醉酒、醒酒的时间,测定血清和肝脏相关生理生化指标以及病理切片来评价子实体和菌丝体多糖对急性酒精肝损伤小鼠的作用效果。结果表明,子实体与菌丝体多糖均能够显著延长小鼠的醉酒时间和缩短醒酒时间（P<0.05）,并降低了由酒精引起的肝指数、谷丙转氨酶（ALT）、谷草转氨酶（AST）和丙二醛（MDA）的升高,提高了乙醇脱氢酶（ADH）、过氧化氢酶（CAT）和超氧化物歧化酶（SOD）的活性,病理切片结果进一步证实了子实体多糖与菌丝体多糖可以减轻由酒精引起的细胞损伤,总体来说,子实体多糖比菌丝体多糖对急性酒精损伤小鼠的保护作用更强。该研究表明了粗毛纤孔菌子实体与菌丝体多糖对急性酒精肝损伤小鼠具有一定的保护作用,研究结果丰富了粗毛纤孔菌多糖的药理药效,为其功能食品的开发提供了新思路。     

Le binge drinking chez les jeunes

Binge drinking refers to an alcohol intake of at least 5 drinks on a single occasion and in a limited period of time (less than two hours). Most of the time, binge drinking occurs during weekend evenings. The only goal of the binge drinker is to get drunk, whatever quantity of alcohol is needed. This behavior usually begins around 12–13 years of age, and dramatically increases after high school, in the context of parties. The 18–25 age range represents almost half of binge drinking prevalence. Maintenance of this behavior after 25 could be a predictive factor of future alcohol dependence; about 50% of binge drinkers become dependent. Health care professionals have an important role to play, not only during routine visits, but particularly after an accident or suicide attempt. Adolescents should be routinely asked about their alcohol drinking behavior, in order to give them the opportunity to talk freely about their problems. Once problems are recognized, they should be referred to the appropriate forums. Parents should be involved in the therapeutic process whenever possible. Recent public awareness of the binge drinking problem has led to government action, together with prevention activities oriented towards the youth.     

Factors Associated with Self-Reported Repeat HIV Testing after a Negative Result in Durban,South Africa

Background

Routine screening for HIV infection leads to early detection and treatment. We examined patient characteristics associated with repeated screening in a high prevalence country.

Methods

We analyzed data from a cohort of 5,229 adults presenting for rapid HIV testing in the outpatient departments of 2 South African hospitals from November 2006 to August 2010. Patients were eligible if they were ≥18 years, reported no previous diagnosis with HIV infection, and not pregnant. Before testing, participants completed a questionnaire including gender, age, HIV testing history, health status, and knowledge about HIV and acquaintances with HIV. Enrollment HIV test results and CD4 counts were abstracted from the medical record. We present prevalence of HIV infection and median CD4 counts by HIV testing history (first-time vs. repeat). We estimated adjusted relative risks (ARR’s) for repeat testing by demographics, health status, and knowledge of HIV and others with HIV in a generalized linear model.

Results

Of 4,877 participants with HIV test results available, 26% (N = 1258) were repeat testers. Repeat testers were less likely than first-time testers to be HIV-infected (34% vs. 54%, p<0.001). Median CD4 count was higher among repeat than first-time testers (201/uL vs. 147/uL, p<0.001). Among those HIV negative at enrollment (N = 2,499), repeat testing was more common among those with family or friends living with HIV (ARR 1.50, 95% CI: 1.33–1.68), women (ARR: 1.24, 95% CI: 1.11–1.40), and those self-reporting very good health (ARR: 1.28, 95% CI: 1.12–1.45).

Conclusions

In this high prevalence setting, repeat testing was common among those undergoing HIV screening, and was associated with female sex, lower prevalence of HIV infection, and higher CD4 counts at diagnosis.     

Alcohol Use and Transactional Sex among Women in South Africa: Results from a Nationally Representative Survey

Background

Transactional sex is a risk factor for HIV infection. Alcohol use may increase the risk of transactional sex. No nationally-representative studies have examined the relationship between multiple dimensions of alcohol use and transactional sex in women in South Africa. The aim of the study was to examine the relationship between alcohol dependence, binge drinking and frequency of drinking in the past month and transactional sex in adult women in South Africa.

Methods

A cross-sectional study using multi-stage, cluster sampling collected data from a nationally representative sample of 5,969 women aged 16–55 years in 2012. The analysis conducted for this paper was restricted to women reporting sexual activity in the past 12 months (n = 3,594). Transactional sex was defined as having received money/gifts in exchange for sex with any sex partner in the past year. Alcohol use measures included: alcohol dependence (≥2 positive responses to the CAGE questionnaire); binge drinking (≥4 drinks for women on one occasion); and drinking frequency in the previous month. Logistic regression models were built to test the hypotheses that each dimension of alcohol use was associated with transactional sex.

Results

About 6.3% (n = 225) of sexually active women reported transactional sex. Almost a third (30.6%) of sexually active women had ever drunk alcohol, and 19.2% were current (past month) drinkers. Among lifetime drinkers, 28.0% were alcohol dependent and 56.6% were binge drinkers. Alcohol dependent women were twice as likely to report transactional sex (AOR 2.0, 95% CI 1.1–4.3, p<0.05) than those not alcohol dependent. Binge drinkers were 3.1 times more likely to have had transactional sex (95% CI 1.5–6.6, p<0.01) than non-binge drinkers. There was no significant relationship between frequency of drinking in the past month and transactional sex.

Conclusion

Alcohol dependency and binge drinking are significantly associated with transactional sex in South African women. HIV prevention programmes need to target these women, and address both their alcohol use, as well as the HIV risks associated with transactional sex.     

Mortality in relation to consumption of alcohol: 13 years' observations on male British doctors.

OBJECTIVE--To assess the risk of death associated with various patterns of alcohol consumption. DESIGN--Prospective study of mortality in relation to alcohol drinking habits in 1978, with causes of death sought over the next 13 years (to 1991). SUBJECTS--12,321 British male doctors born between 1900 and 1930 (mean 1916) who replied to a postal questionnaire in 1978. Those written to in 1978 were the survivors of a long running prospective study of the effects of smoking that had begun in 1951 and was still continuing. RESULTS--Men were divided on the basis of their response to the 1978 questionnaire into two groups according to whether or not they had ever had any type of vascular disease, diabetes, or "life threatening disease" and into seven groups according to the amount of alcohol they drank. By 1991 almost a third had died. All statistical analyses of mortality were standardised for age, calendar year, and smoking habit. There was a U shaped relation between all cause mortality and the average amount of alcohol reportedly drunk; those who reported drinking 8-14 units of alcohol a week (corresponding to an average of one to two units a day) had the lowest risks. The causes of death were grouped into three main categories: "alcohol augmented" causes (6% of all deaths: cirrhosis, liver cancer, upper aerodigestive (mouth, oesophagus, larynx, and pharynx) cancer, alcoholism, poisoning, or injury), ischaemic heart disease (33% of all deaths), and other causes. The few deaths from alcohol augmented causes showed, at least among regular drinkers, a progressive trend, with the risk increasing with dose. In contrast, the many deaths from ischaemic heart disease showed no significant trend among regular drinkers, but there were significantly lower rates in regular drinkers than in non-drinkers. The aggregate of all other causes showed a U shaped dose-response relation similar to that for all cause mortality. Similar differences persisted irrespective of a history of previous disease, age (under 75 or 75 and older), and period of follow up (first five and last eight years). Some, but apparently not much, of the excess mortality in non-drinkers could be attributed to the inclusion among them of a small proportion of former drinkers. CONCLUSION--The consumption of alcohol appeared to reduce the risk of ischaemic heart disease, largely irrespective of amount. Among regular drinkers mortality from all causes combined increased progressively with amount drunk above 21 units a week. Among British men in middle or older age the consumption of an average of one or two units of alcohol a day is associated with significantly lower all cause mortality than is the consumption of no alcohol, or the consumption of substantial amounts. Above about three units (two American units) of alcohol a day, progressively greater levels of consumption are associated with progressively higher all cause mortality.     

Sensation seeking and hormones in men and women: exploring the link.

Risky behaviors (e.g., binge drinking, drunk driving, risky sex) are increasing among U.S. college students, and the personality trait of sensation seeking provides a potential link between such norm-breaking behaviors and biological processes. We examined the relationship between sensation-seeking behaviors and two hormones, testosterone and cortisol, in male and female college students. Hormone levels were hypothesized to contribute to the variability of individual scores on Zuckerman's Sensation-Seeking Scale. As expected, males scored higher on the scale than females, but the data failed to support the generally accepted positive relationship between testosterone and sensation seeking for either sex. Instead, our results support the existence of a significant inverse relationship between cortisol and sensation seeking in men, but not in women, even after adjustment for testosterone levels and age. Our study contributes to the current literature by (a) supporting the association between risky behavior and a hormone other than testosterone, (b) being the first to examine the association between cortisol and sensation seeking in women, and (c) identifying a possible effect of gender on the association between hormones and sensation-seeking behaviors. Gendered social norms and expectations are likely to be partly responsible for this effect. Theory-guided interdisciplinary research is needed to improve understanding of the biological influences on human behavior, and special attention must be paid to social context, women's perceptions of their expected behavior, and gendered socialization regarding norm-breaking or risky behaviors, which may obscure biological links to female behavior.