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PubMed1998

[Continued driving habits of patients diagnosed with excessive daytime sleepiness].

OBJECTIVE: Description of driving behaviour of patients with excessive daytime sleepiness (EDS) and the influence on their driving of diagnosis, therapy, legal guidelines and advices. DESIGN: Inventory based on questionnaires. SETTING: Centre for Sleep and Wake Disorders, The Hague, the Netherlands. METHODS: All patients with EDS who were in a stable condition for at least 6 months after therapy were sent a questionnaire (n = 138). The questions concerned actual driving behaviour, EDS and the effects of diagnosis, therapy and advice given by the Centre. RESULTS: The response was 67% (n = 92). Eighteen patients had never driven a car. Eighteen of the other 74 patients quit driving or drove less. Fifty-six patients did not change their behaviour or drove even more. There was little effect on driving behaviour of diagnosis, therapy and advice to stop driving. CONCLUSION: Patients with EDS often participate as drivers in modern traffic. Legal guidelines and advice given by physicians have only little influence on this behaviour. As general measures seem to be ineffective, approaches tailored to the individual patient may lead to more acceptable results.

Adolescent↗
PubMed1998

[Alcohol, drugs, medication and highway safety in Belgium. Belgian Toxicology and Trauma Study Research Group].

The BTTS study (Belgian Toxicology and Trauma Study) was performed in Belgium between January 15th 1995 and June 15th 1996. The purpose was to investigate how frequently the drivers involved in road accidents were driving under the influence of psychotropic drugs. Two thousand fifty-three blood tests were performed of which 207 in the Liège region. The results obtained at the national level are compared to those obtained at the level of the Liège region. In both cases, the BTTS study allows the conclusion that a considerable proportion of drivers involved in road accidents resulting in significant traumatic consequences were driving under the influence of substances with psychotropic properties.

Accidents, Traffic↗
PubMed2000

Perception of traffic accident risk and decision to drive under light alcohol consumption--a double-blind experimental study.

PURPOSE: Public traffic safety campaigns in Germany have focussed on the changing risk perception of young drivers. While there is some consensus that perceptions of risk affect driving, less is understood about the relationship and interaction of alcohol consumption and risk perception on the decision to drive. We examined the influence of light alcohol consumption on risk perception and decision to drive, and the interaction of alcohol consumption and cognitive feedback on the handicapping effect of alcohol on risk perception and decision to drive. METHOD: In a double-blind block-randomized experimental study of 104 young drivers between 19 and 24 years of age, with two experimentally manipulated independent factors of alcohol consumption (three levels: 0% BAC, 0.015% BAC, 0.03% BAC) and feedback (positive or negative), we assessed three dependent variables: perception of traffic accident risk, subjective judgement about driving-relevant cognitive performance, decision to drive a car. Analyses of variance and covariance were used to analyze differences between levels of experimental factors. RESULTS: We found that persons with 0.015 BAC performed better than persons in both other alcohol conditions on the standardized risk perception task. Perceived handicap of driving was significantly more pronounced for negative feedback compared to positive feedback with no influence of the level of alcohol consumption. No significant influence on decision to drive was found of either level of alcohol consumption, feedback or sex. IMPLICATIONS: Decision to drive in young drivers could not be influenced by feedback or light consumption. Public health approaches have to find better determining factors.

Accidents, Traffic↗
PubMed1992

Evaluation of an educational intervention upon knowledge, attitudes, and behavior concerning drinking/drugged driving.

The Contra Costa County educational program for juveniles found guilty of driving under the influence (DUI) was evaluated. Over 600 juveniles convicted of DUI from 1983 to 1988 formed the study group for this research and of these over 100 participated in the educational program. Assessment of program participants was conducted for knowledge, attitudes and behavior. Participants demonstrated increased knowledge, stronger attitudes against driving under the influence, and less risky alcohol and automobile related behaviors. County juvenile records analyzed by the logit procedure showed that class participants had a significantly lower number of repeat offenses compared to non-program participants that could not be explained by race, offense severity, age or gender.

Accidents, Traffic↗
PubMed1984

Driving and the combined use of drugs and alcohol in The Netherlands.

The extent and nature of the use of medicinal drugs by drivers who had undergone a blood test on suspicion of driving under the influence of alcohol was ascertained by analysing some 40,000 case records in which the suspect had been questioned about the use of drugs. No chemical analyses were performed. 9.7% of the road users indicated that they used drugs in combination with alcohol, and more than 50% of the drugs used must be considered to have a negative impact on driving performance. The influence of the combined use of benzodiazepines and alcohol on behaviour was also investigated. The finding here was that drivers using these drugs should be warned against the consumption of alcohol.

Accidents, Traffic↗
PubMed2001

Alcohol-related motor vehicle crashes: deterrence and intervention.

Impaired driving continues to be a major factor in many injuries and fatalities on our nation's highways. In 1998, alcohol was involved in 38% of all fatal crashes, contributing to 15,935 deaths. The combination of improved public awareness and strong legal sanctions for driving under the influence has been shown to reduce the incidence of impaired driving. A few states have instituted new statutes for mandatory health care reporting of impaired drivers who have been involved in motor vehicle crashes. Current research into establishing emergency department-based effective, efficient, and "user-friendly" methods for screening, intervention, and referral on behalf of the problem drinker offers promise for emergency physicians to become empowered to better manage this individual and public health problem. Emergency physicians may soon need to reassess their role in reducing the occurrence of alcohol-related motor vehicle crashes through widespread screening, intervention, and referral of these patients.

Accident Prevention↗
PubMed2006

Psychiatric disorders in a sample of repeat impaired-driving offenders.

OBJECTIVE: This study was conducted to assess alcohol- and drug-use disorders and other psychiatric disorders in a sample of repeat driving under the influence (DUI) offenders. METHOD: We interviewed offenders to estimate lifetime and 12-month prevalence of psychiatric disorders as designated by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (alcohol and drug abuse and dependence, major depressive or dysthymic disorder, bipolar disorder, post- traumatic stress disorder [PTSD], and obsessive-compulsive disorder). The offenders interviewed (385 men, 74 women) were those who had been adjudicated in the Multnomah County, OR, Driving Under the Influence of Intoxicants Intensive Supervision Program. Psychiatric diagnoses were assessed using the Composite International Diagnostic Interview. RESULTS: The majority of respondents (53.8%) were alcohol dependent. Sixty-five percent of men and 79.7% of women had at least one lifetime disorder comorbid with alcohol abuse or dependence. The most prevalent lifetime non-substance-use disorder was major depressive or dysthymic disorder (30.9%) followed by PTSD (15.3%). Approximately 40% of subjects reported meeting criteria for lifetime nonalcohol drug abuse for at least one drug type, and 30% were drug dependent for at least one drug type; overall, 54% of all offenders had drug abuse or dependence disorders. CONCLUSIONS: Assessment and treatment services for repeat alcohol-impaired driving offenders should be sufficiently comprehensive to provide care for drug-use disorders and other psychiatric problems.

Adult↗
PubMed1999

Blood alcohol concentration among injured drivers in Hualien County.

Vehicle-related injuries are the major cause of death and injuries in Hualien County. Driving under the influence of alcohol plays a major role in such crashes. From December 1997 to May 1998, we determined the blood alcohol concentrations of 750 injured drivers from vehicle crashes, visiting the two emergency rooms of teaching hospitals in Hualien. The objectives of this study were to investigate the incidence of alcohol used in vehicle crashes, to identify the prevalence groups for prevention and to discuss alcohol testing at emergency services. Sixty-four percent were male; 27.5% were aborigines. The mean age was 36.5 +/- 16.5 years. About 54.1% tested positive for blood alcohol concentration (BAC), which ranged from 13 to 611 mg/dL; 38.6% had BAC levels exceeding 50 mg/dL and 21.1% exceeding 200 mg/dL. The mean BAC was 85.9 mg/dL (+/- 118.5). Middle-aged males and aborigines were more likely to drive under the influence of alcohol. We recommend blood alcohol testing to be mandatory at the emergency service and to be used as evidence for prosecution in a court of law. Preventing drunk driving through community programs is imperative, especially in the aboriginal communities.

Adolescent↗
PubMed1995

[Initial experiences with the "0.8 promille regulation in Thüringen].

Blood samples sent in for analysis in 1992 and 1993 showed an increase in the BAC values of offenders in the "driving under the influence" category. At the same time it was found that, proportionally, the number of people whose BAC was below 0.8% had dropped. The same trend could be observed in the "road accident" category. This trend continued throughout 1994. One can therefore assume that the introduction of the "0.8% law" in eastern Germany has brought with it an increase in the level of intoxication of people driving under the influence of alcohol.

Accidents, Traffic↗
PubMed1994

Mexican farmworker women's perspectives on drinking in a migrant community.

Alcohol use in farmworker communities has not been investigated to any extent. The literature on alcohol consumption and farmworkers is virtually nonexistent. This case study provides information on drinking patterns and problems in a Mexican farmworker community in Northern California. The focus is on Mexican farmworker women's perspectives on drinking in a specific social context: A migrant farmworker housing center. Male responses are provided as a basis for comparison and contrast. The study examines issues related to driving under the influence, public versus private space, and the centrality of considerations regarding children/youth in setting acceptable parameters for drinking. Data collection consisted of observations and 29 interviews of men (13) and women (16) farmworkers over a 6-month period in 1991. We found that most of the women in the camp abstain from drinking. They define male drinking as a problem when 1) youth are allowed and encouraged to drink, 2) an increase of individuals driving under the influence in the housing center becomes evident, and 3) when drinkers serve as poor role models for youth.

Adolescent↗
PubMed2003

Forensic cases involving the use of GHB in The Netherlands.

In this study, forensic cases involving the use of Gamma Hydroxy Butyric acid (GHB) from the second half of 1999 through the second half of 2001 in The Netherlands (blood >5mg/l and urine >10mg/l) are described. GHB was analysed by GC-MS after lactone formation and using GHB-d6 as internal standard. The results are divided into three groups: cases of chemical submission, cases of driving under the influence and cases of unknown causes of death.GHB was found in six cases of possible chemical submission. In these cases, relatively low concentrations of GHB were found. The results show that in cases of chemical submission, urine should be analyzed, because GHB is present longer in urine than in blood. The police should collect the samples in containers that do not contain citrate as anticoagulant. Especially at low levels of GHB, the formation of GHB in these tubes hampers an interpretation of the results.GHB was found in 13 cases of driving under the influence. In contrast to the cases of chemical submission, high concentrations of GHB were found, corresponding with observations of extreme sleepiness or temporary loss of consciousness.GHB was found in 16 cases of unexplained death: the measured range of GHB concentrations in blood might correspond to effects such as drowsiness, but not to serious toxicity of GHB. In 4 of these 16 cases, the role of GHB could be excluded. In the remaining cases, the role of GHB remains unclear; more research into "background" concentrations of GHB in post-mortem material is required. The incidence of the use of GHB in The Netherlands cannot be derived from these toxicological data. As GHB is not routinely found during systematical toxicological analyses, these data may seriously underestimate the use of GHB. Therefore, information from the police to the forensic institute is essential.

Automobile Driving↗
PubMed2006

Correlation of Delta9-tetrahydrocannabinol concentrations determined by LC-MS-MS in oral fluid and plasma from impaired drivers and evaluation of the on-site Dräger DrugTest.

Oral fluid (collected with the Intercept((R)) device) and plasma samples were obtained from 139 individuals suspected of driving under the influence of drugs and analyzed for Delta(9)-tetrahydrocannabinol (THC), the major psychoactive constituent of cannabis, using a validated quantitative LC-MS-MS method. The first aim of the study was to investigate the correlation between the analytical data obtained in the plasma and oral fluid samples, to evaluate the use of oral fluid as a 'predictor' of actual cannabis influence. The results of the study indicated a good accuracy when comparing THC detection in oral fluid and plasma (84.9-95.7% depending on the cut-off used for plasma analysis). ROC curve analysis was subsequently used to determine the optimal cut-off value for THC in oral fluid with plasma as reference sample, in order to 'predict' a positive plasma result for THC. When using the LOQ of the method for plasma (0.5 ng/mL), the optimal cut-off was 1.2 ng/mL THC in oral fluid (sensitivity, 94.7%; specificity, 92.0%). When using the legal cut-off in Belgium for driving under the influence in plasma (2 ng/mL), an optimal cut-off value of 5.2 ng/mL THC in oral fluid (sensitivity, 91.6%; specificity, 88.6%) was observed. In the second part of the study, the performance of the on-site Dräger DrugTest for the screening of THC in oral fluid during roadside controls was assessed by comparison with the corresponding LC-MS-MS results in plasma and oral fluid. Since the accuracy was always less than 66%, we do not recommend this Dräger DrugTest system for the on-site screening of THC in oral fluid.

Automobile Driving↗
PubMed2003

Correlation between modes of drinking and modes of driving as reported by students at two American universities.

This paper examines the correlates and predictors of driving under the influence behaviors (DUIBs) during the past month by college students. Measures of heavy episodic drinking, monthly drinking frequency, monthly drinking variance, monthly drinks per occasion and reported marijuana use are compared as predictors net of other predictive factors. A cross-sectional telephone survey was conducted with college students by a university social science research laboratory. Respondents attended two large public universities located in the southwestern part of the US. Participants included 803 randomly selected college students. The interview schedule included items from the Core Alcohol and Drug Survey and the College Alcohol Risk Assessment Guide. Several additional last-drinking-event items were also developed for the interview. Bivariate analyses indicate that marijuana use (past year), heavy episodic drinking, reports of DUIBs (driving under the influence or riding with a driver who is under the influence) in the past year, monthly frequency of drinking, the average number of drinks consumed when drinking and age are correlates of DUIBs during the past month. Multivariate analyses indicate past year DUIBs, monthly frequency of drinking and monthly marijuana use predicted recent DUIB.

Accidents, Traffic↗
PubMed2002

Forebrain renin-angiotensin system has a tonic excitatory influence on renal sympathetic nerve activity.

All elements of the renin-angiotensin system (RAS) are present in the forebrain, particularly in circumventricular organs surrounding the third cerebral ventricle. We tested the hypothesis that forebrain angiotensin-converting enzyme (ACE) has a tonic excitatory influence on sympathetic drive. Neurally intact and sinoaortic-denervated pentobarbital-anesthetized rats were treated with forebrain-directed intracarotid artery (ICA) versus intravenous injections of angiotensin I (ANG I) and of the ACE inhibitor captopril. In intact rats, ICA ANG I elicited a rise in arterial pressure and a concomitant reduction in renal sympathetic nerve activity (RSNA; ICA captopril elicited the opposite responses). In barodenervated rats, ICA ANG I increased and ICA captopril decreased arterial pressure and RSNA in parallel; intravenous ANG I had no effect on RSNA. The findings suggest that the intrinsic forebrain RAS has a tonic excitatory influence on sympathetic drive that is overshadowed in normal rats by baroreflex mechanisms, but may assume a more prominent role in pathophysiological states (e.g., heart failure) in which baroreflex mechanisms are impaired and RAS activity is augmented.

Angiotensin I↗
PubMed2006

The influence of pulmonary receptors on respiratory drive in a rabbit model of pulmonary emphysema.

We have observed that pulmonary rapidly adapting receptor activity is greater in emphysematous rats than in controls. Pulmonary receptor activity, if modified by lung disease, may produce an inappropriate drive to breathe which may be perceived as dyspnoea. To investigate the efferent (drive) component of this hypothesis respiratory drive (phrenic nerve activity) was recorded in a rabbit model of emphysema. Drive was measured as slope and peak height of phrenic nerve activity. Slope and peak height were greater in emphysematous rabbits than controls, by 28% and 34%, respectively. Block of slowly adapting pulmonary stretch receptors by inhaled sulphur dioxide (which left only rapidly adapting and C-fibre receptors active) decreased drive in control (slope: 38.89+/-2.29 to 24.09+/-1.26, P<0.01) but not emphysematous rabbits (slope: 49.92+/-4.11 to 54.51+/-5.28, NS). Subsequent vagotomy decreased drive in emphysematous rabbits (slope: 54.51+/-5.28 to 41.41+/-3.90, P<0.05) but not controls (24.09+/-1.26 to 23.07+/-1.84, NS). Increased rapidly adapting receptor activity may, in part, increase respiratory drive in emphysema. This vagal component is only part of the total increased drive which may be perceived as dyspnoea in man.

Adaptation, Physiological↗
PubMed2003

Nuclear ribosomal DNA monophyly versus mitochondrial DNA polyphyly in two closely related mite species: the influence of life history and molecular drive.

In two very closely related but reproductively isolated mite species, Tetranychus urticae and T. turkestani, we found nucleotide diversity to be extensive for mitochondrial DNA (mtDNA) cytochrome oxidase 1 (COI) (3-4%) but extremely reduced for nuclear ribosomal DNA (rDNA) internal transcribed spacer (ITS2) (less than 0.5%). By contrast, ITS2 was shown to evolve much faster than COI between species of this genus. Furthermore, we found that these two species are polyphyletic for mtDNA but monophyletic for rDNA. Thus it appears that despite its biparental transmission and multiplicity of copies in the genome, nuclear rDNA has a smaller effective population size than mtDNA in these species. The conjunction of efficient concerted evolution and/or gene conversion in the rDNA cluster, the haplodiploidy of these species and their female-biased sex ratio could account for this apparent contradiction.

Animals↗