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PubMed1997

An evaluation of the effectiveness of alcohol treatment, driver license actions and jail terms in reducing drunk driving recidivism in California.

AIM: There has been long-standing interest in determining which sanctions work best to reduce drunk driving. This study examines the effectiveness of alcohol treatment, driver license actions and jail terms in reducing drunk-driving recidivism. DESIGN: This quasi-experimental study examines the relationships between the sanctions that drivers convicted of driving-under-the-influence (DUI) receive and their subsequent reconviction of DUI, while statistically controlling for pre-existing differences among groups receiving different sanctions. Separate analyses were conducted for subjects having 0, 1 or 2 or more prior DUI convictions on their driving record. SETTING: The study analyzes drunk driving reacidivism throughout the state of California. Participants. All drivers holding a California driver license who were convicted of DUI by a California court during 1990 and 1991 were selected for inclusion in the study. MEASUREMENTS: A number of demographic, prior personal driving history and surrogate traffic environment measures were collected and used as covariates in the analyses. Data were also gathered on subsequent DUI reconvictions, and the number of days to first subsequent DUI reconviction, and used as outcome variables in the study. FINDINGS: Results of the analyses showed that for all levels of prior DUI convictions, combining alcohol treatment with either driver license restriction or suspension is associated with the lowest DUI recidivism rates. CONCLUSIONS: Based on this research, and the results of prior studies, it can be persuasively argued that combining license actions with alcohol treatment represents the most effective sanction combination for combating DUI recidivism.

Alcohol Drinking↗
PubMed1989

Intercostal and abdominal muscle afferent influence on caudal medullary expiratory neurons that drive abdominal muscles.

Our objective was to determine if caudal ventral respiratory group (VRG) expiratory (E) neurons that drive abdominal expiratory motoneurons in the lumbar cord respond to intercostal and lumbar nerve afferent stimulation. Results showed that 92% of medullary E-neurons that were antidromically activated from the upper lumbar cord reduced their activity in response to stimulation of external and internal intercostal and lumbar nerve afferents. We conclude that afferent information from intercostal and abdominal muscle tendon organs has an inhibitory effect on caudal VRG E-neurons that drive abdominal expiratory motoneurons.

Abdominal Muscles↗
PubMed1987

Influence of the cycle length of basic drive on induction of sustained ventricular tachycardia associated with coronary artery disease.

The relation between the cycle length of basic drive during programmed ventricular stimulation and the coupling intervals at which sustained monomorphic ventricular tachycardia (VT) was initiated was analyzed in patients with coronary artery disease and documented sustained VT. The study included 28 patients in whom hemodynamically tolerable, monomorphic sustained VT was inducible at different cycle lengths of basic drive during the same electrophysiologic study. The stimulation protocol included single or double premature stimuli during paced ventricular rhythms at different cycle lengths of basic drive. The coupling intervals of premature stimuli for induction of VT (considered the outer margin of the echo zone) during step 1 of the stimulation protocol (basic drive at cycle lengths of 500 or 430 ms) were compared with those during step 2 (basic drive at cycle lengths of 370 or 330 ms). The mean cycle length of induced sustained VT was 370 +/- 79 ms. The mode of induction of VT remained the same in 23 patients (single or double premature stimuli); in 5 patients, fewer premature stimuli were required during step 2 than step 1. By moving from step 1 to step 2, VT could be induced at longer coupling intervals of the premature stimuli in 23 patients (82.1%). The mean increase in the sum of the coupling intervals was 52 +/- 37 ms. In 5 patients, the coupling intervals either did not change from step 1 to step 2 (n = 1) or decreased by an average of -40 +/- 14.1 ms. The results suggest that inducibility of VT is favored by a decrease in the cycle length of basic drive.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

The influence of subclinical epileptiform EEG discharges on driving behaviour.

EEG and driving behaviour were monitored in 6 patients with subclinical focal and generalised epileptiform EEG discharges during 420 km of actual motorway driving in a suitably instrumented vehicle. Evidence of impaired driving performance during subclinical discharges was significant in 3 subjects (P less than 0.025 or less than 0.05) and was suggestive (P less than 0.1) in 1. The two patients with greatest impairment had active epilepsy, whereas the others had been seizure-free for upwards of 4 years. No other features appeared to be predictive of altered driving behaviour during discharges.

Adult↗
PubMed1998

Influences of long- and short-distance driving on alpha waves and natural killer cell activity.

We examined the effective amplitudes of alpha waves (using a mean frequency with a range of +/- 0.5 Hz), and activity of natural killer cells in six subjects, before and after a short-distance (43 km, 1 hr.) drive, and after a midnight (am 0:00-am 7:00 to 8:00) long-distance (550 km on average, for 7 to 8 hr.) drive. Following a long-distance drive, the activity of natural killer cells tended to decrease, and the effective amplitudes of alpha waves in the photic feedback period were greater than those observed during the rest period, showing that photic driving had occurred even under physically and mentally stressful conditions. However, after short-distance driving, no photic driving response occurred and activity of natural killer cells tended to increase, possibly related to mental concentration. Avoiding midnight long-distance driving may help prevent excessive stress and preserve high activity in natural killer cells.

Adult↗
PubMed1982

Fatal snowmobile accidents in northern Sweden.

The number of snowmobiles registered in Sweden has increased rapidly in recent years. At the same time, there has been a proportional increase in the number of snowmobile accidents. In the present study all the 36 fatal accidents reported in northern Sweden in the period 1 July 1973 to 1 July 1981 have been scrutinized. Most of the fatalities were men, two thirds of them between 20 and 40 years of age. Most of the accidents occurred at weekends and during holidays, especially in the spring, when the traffic is heaviest. About two thirds of the fatal accidents occurred at night. Drowning and lacerations of the thorax and the head were the most common causes of death. Twenty-four of the 30 drivers killed were found to have been driving under the influence of alcohol. This suggests that alcohol was a major contributing factor to the accidents. Retrospective analyses of police, social, and medical records revealed that a high proportion of the deceased were habitual excessive drinkers. Preventive measures designed to reduce alcohol consumption while driving snowmobiles seem to be needed.

Accidents↗
PubMed1992

Driver fatalities and DUI offenders in New Jersey.

Comparisons of driving and demographic characteristics were made on 407 driver fatalities (DFs) and 407 motorists convicted of driving under the influence (DUI). Significantly more DUI offenders (DOs) than DFs were men and had previous DUIs, accidents, license suspensions, and weekend "index" events. DFs with a blood or brain alcohol concentration (BAC) of 100 or above mg/dL matched most closely with DOs on negative driving events, "index" event days, and demographics. Conversely, DFs with negative BACs differed significantly with DOs on virtually all characteristics. High-BAC DFs and DOs may well be drawn from the same subpopulation of deviant drivers, whereas DFs with negative BACs seem similar to licensed drivers in general.

Accidents, Traffic↗
PubMedDate not supplied

The sympathetic system in hypertension. State-of-the-art review.

One may postulate a genetic defect in membrane permeability, in the transport of sodium, or in the sodium pump in vascular muscle which could account for increased intracellular sodium and enhanced vascular contractility. If the electrogenic sodium pump is overactive, as in SHR, its inhibition may lead to significant depolarization and greater contraction. Sympathetic innervation may be essential for the development of membrane abnormality as well as for the development of hypertrophic vascular changes, both of which augment contraction and vascular tone. A similar membrane defect at the sensory endings of arterial stretch receptors may account for impaired arterial baroreceptor reflexes seen in very early phases of hypertension or, in some genetic models, before hypertension develops. This defect may be related to the sodium pump or sodium transport in the receptor region and cause a decrease in baroreceptor discharge and in the strain-sensitivity of the baroreceptors, resulting in exaggerated sympathetic drive. Further information is needed on the baroreflex control of various efferents in hypertension. Another membrane defect at the adrenergic nerve terminals may facilitate release of endogenous NE. Excessive salt intake may unmask or exaggerate the membrane defects. In the central nervous system a defect in glutamine, NE, or GABA receptors may contribute to a high central sympathetic drive. Greater receptor affinity to various pressor neuropeptides such as angiotensin and leucine enkephalin or greater release of these peptides may also account for the excessive CNS sympathetic activation or impairment of baroreflexes at a central level. Cardiac receptors may have a variable influence on sympathetic drive in the various stages of hypertension, depending on the degree of cardiac hypertrophy or cardiac size. Finally, increased renal afferent nerve activity may provoke an increase in sympathetic activity and provide a link between natriuretic factors and the sympathetic nervous system in hypertension.

Animals↗
PubMed2006

Cognition and motor control as a function of Delta9-THC concentration in serum and oral fluid: limits of impairment.

Cannabis use has been associated with increased risk of becoming involved in traffic accidents; however, the relation between THC concentration and driver impairment is relatively obscure. The present study was designed to define performance impairment as a function of THC in serum and oral fluid in order to provide a scientific framework to the development of per se limits for driving under the influence of cannabis. Twenty recreational users of cannabis participated in a double-blind, placebo-controlled, three-way cross-over study. Subjects were administered single doses of 0, 250 and 500 microg/kg THC by smoking. Performance tests measuring skills related to driving were conducted at regular intervals between 15 min and 6h post smoking and included measures of perceptual-motor control (Critical tracking task), motor impulsivity (Stop signal task) and cognitive function (Tower of London). Blood and oral fluid were collected throughout testing. Results showed a strong and linear relation between THC in serum and oral fluid. Linear relations between magnitude of performance impairment and THC in oral fluid and serum, however, were low. A more promising way to define threshold levels of impairment was found by comparing the proportion of observations showing impairment or no impairment as a function of THC concentration. The proportion of observations showing impairment progressively increased as a function of serum THC in every task. Binomial tests showed an initial and significant shift toward impairment in the Critical tracking task for serum THC concentrations between 2 and 5 ng/ml. At concentrations between 5 and 10 ng/ml approximately 75-90% of the observations were indicative of significant impairment in every performance test. At THC concentrations >30 ng/ml the proportion of observations indicative of significant impairment increased to a full 100% in every performance tests. It is concluded that serum THC concentrations between 2 and 5 ng/ml establish the lower and upper range of a THC limit for impairment.

Adult↗
PubMed1988

Rearrest following residential treatment for repeat offender drunken drivers.

Multiple offenders are at high risk for continued drunken driving. Massachusetts, therefore, mandated that individuals convicted of a second drunken driving offense either be committed for a minimum of 7 days in a house of correction or enter a 14-day residential alcoholism treatment program for second offenders. A 2-year follow-up study of arrest rates assessed the impact of the two sentencing options on subsequent arrests for driving under the influence of liquor (DUIL). The incarcerated sample (N = 190) was slightly younger, had more prior DUIL charges and exhibited greater criminality than those who entered treatment (N = 199). Offenders admitted to the 14-day program were significantly less likely to be rearrested for drunken driving (10 vs 20%). A summary odds ratio suggested that when adjusted for differences in prior arrests, the risk of rearrest was 1.9 times greater among incarcerated offenders. Although a 2-year follow-up is insufficient to assess the complete impact of the 14-day program, the two-fold difference in the risk of rearrest suggests that mandated short-term residential treatment may provide an effective intervention among repeat offender drunken drivers.

Adult↗
PubMed2000

Influence of longterm CPAP therapy on CO(2) drive in patients with obstructive sleep apnea.

According to recent publications, the values of the hypercapnic ventilatory responses (HCVR) in normocapnic obstructive sleep apnea (OSA) patients are highly variable, but they are usually within the normal range. In our study, CPAP therapy during 1 month did not seem to influence the HCVR [Verbraecken, J., De Backer, W., Willemen, M., De Cock, W., Wittesaele, W., Van de Heyning, P., 1995. Respir. Physiol. 101, 279-287]. It is, however, not well studied whether long term (1 year) CPAP therapy can influence HCVR in normocapnic patients. Therefore, we evaluated the effect of 1 year CPAP therapy on CO(2) drive in 20 OSA patients. The slope of HCVR (SHCVR) changed from 2.35+/-0.21 L min(-1) mmHg(-1) (control) to 1.66+/-0.16 L min(-1) mm Hg(-1) (P=0.04), but the mean within subject coefficient of variation in repeated measurements of SHCVR in treated and untreated OSA patients was not statistically different. Pa(O(2)) increased from 72+/-2 mm Hg to 80+/-2 (1 year) mm Hg. We conclude that CPAP therapy improves daytime gas exchange in normocapnic OSA and may possibly decrease CO(2) drive (slope) after a treatment period of 1 year.

Blood Gas Analysis↗
PubMed1987

Changing perceptions of riskiness in drinking, drugs, and driving: an emergency department-based alcohol and substance abuse prevention program.

For the last three years, the University of New Mexico School of Medicine/Division of Emergency Medicine has sponsored an Alcohol and Substance Abuse Prevention Program (ASAP). The program's objectives were to expose youth to the "real-life" social and medical consequences of alcohol and substance abuse through visits and interviews with patients and their families at the University of New Mexico Emergency Department and Trauma Center. A pretest, post-test, and eight-month follow-up evaluation design was used to assess the program's effects. Questionnaires were administered to randomly selected experimental and control groups of seventh grade students (n = 27). Repeated-measures analysis of variance detected a significant experimental/control condition x time crossover interaction effect for stated perception of riskiness, F (2, 31) = 3.20, P = .049. The data indicated that, over time, the experimental group perceived the riskiness of driving under the influence of drugs or alcohol to be greater, while the control group perceived such behavior to be less risky.

Adolescent↗
PubMed1997

Drugs and alcohol among suspected impaired drivers in Canton de Vaud (Switzerland).

Epidemiological and analytical laboratory records concerning living drivers suspected of driving under the influence of drug (DUID) during the 13 years period ranging from 1982 to 1994 were examined. This study included 641 records. 551 men (86%) and 90 women (14%). The average age of the drivers was 27 +/- 7 years (n = 636, minimum 18 and maximum 74) and the 18-30 interval age range was overrepresented (80%) in this population sample. A traffic accident had occurred in 254 (40%) of the records, 273 (43%) drivers were suspected of DUID during police controls and 95 (15%) drivers were suspected of DUID because of their erratic driving. One or more psychoactive drugs were found in 92.8% of the samples. In these records, cannabinoids were found in 57%, opiates in 36%, ethanol in 36%, benzodiazepines in 15%, cocaine in 11%, methadone in 10% and amphetamines in 4%. The majority (58%) of cases presented two or more drugs in biological samples, thus indicating a high incidence of potential interactions between drugs. This observation was specially relevant for methadone and methaqualone. We conclude that police suspicion about drivers under influence highly correlated with positive results for drug analyses in biological samples.

Adult↗
PubMed1998

Evaluation of the accuracy of on-site multi-analyte drug testing devices in the determination of the prevalence of illicit drugs in drivers.

A principal goal of this research was to conduct a field evaluation of "on-site" multi-analyte drug testing devices to determine the most accurate, efficient, and cost-effective device available for the purpose of rapidly detecting drivers under the influence of drugs. Four on-site kits were selected and evaluated for accuracy and efficiency for the detection of tetrahydrocannabinol (THC), the cocaine metabolites (COC), and opiates (OPI). From 16 December 1995 to 17 March 1996, 303 voluntary urine specimens were collected by law enforcement officers from persons arrested for driving-under-the-influence (DUI). These specimens were tested using the four selected kits and aliquots of the specimens were sent to a DHHS certified lab for "gold standard" comparison testing by immunoassay and Gas Chromatography/Mass Spectrometry. On-site kit sensitivity ranged from 82.9% to 100% for THC, 82.5% to 100% for COC, and all were at 100% for OPI. Specificity, and positive and negative predictive values were also determined. Accuracy ranged from 94.0% to 98.3% for THC, 97.4% to 98.0% for COC, and 99.7% to 100% for OPI. All four kits were in very close agreement on prevalence: 15.5% to 15.8% for THC, all were at 13.2% for COC, and all were at 0.7% for OPI. For law enforcement purposes, sensitivity may be the most important indicator in these kits.

Automobile Driving↗
PubMed1982

A balanced placebo investigation of the effects of alcohol vs. alcohol expectancy on simulated driving behavior.

The present investigation employed a balanced placebo design to examine the effects of alcohol versus the belief that one has consumed alcohol, i.e. alcohol expectancy, on error production while operating a driving simulator. The male subjects employed were social drinkers, having no history of alcohol abuse. The alcoholic beverage consisted of vodka and tonic in the ratio of 1:5, resulting in a mean blood alcohol level of .064%. The placebo beverage consisted of water and tonic, also in the ration 1:5. Principal findings were that alcohol ingestion had a debilitating effect on certain measures of driving behavior (operation of brakes, steering), whereas the belief that one had consumed alcohol had no discernable effects. The results are discussed in relation to other findings using the balanced placebo design. It was concluded that reckless driving under the influence of alcohol, is at least partly a result of the pharmological effects of ethanol.

Adult↗
PubMed1959

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.

Accidents↗
PubMed1996

[Traffic accidents in alcoholic intoxication].

A study of group comprising all road accidents caused by drivers of private cars who were under the influence of alcohol (BAC > = 0.3 g/kg; X = 1.56 +/- 0.62 g/kg) that occurred in a defined area over the span of one calendar year (n = 625) was compared with a randomly selected control group of 718 road accidents in which the drivers had not been under the influence of alcohol. The drivers in the study group were marginally younger than the ones in the control group. However, there was no evidence of an alcohol related increase in the risk of an accident associated with younger age. The sex ratio in the study group corresponded to that, generally found amongst people driving under the influence of alcohol. In the study group there was no evidence of a restricted manner and extent of car use, based on the distances between the sites of the accidents and the offenders' homes. However, the proportion of accidents occurring out of towns was greater in the study group. Alcohol associated accidents occurred more frequently in the evenings and at night, which reflects habitual drinking patterns. Therefore these accidents occurred mainly in darkness and twilight. Surprisingly, unfavorable weather conditions such as rain or ice did not lead to an increase in accidents due to alcohol. In fact, in the study group, proportionally fewer accidents occurred on icy roads. Both injury to persons and damage to property were more severe in the study group. While no relationship between accident severity and blood alcohol concentration could be proven within the study group, the risk of death or severe injury was 3 to 4 times greater in this group than in the control group.

Accidents, Traffic↗