Consenso de Buenos Aires sobre alcohol y drogas en áreas relacionadas con el transporte de pasajeros / Consensus about alcohol and drugs in areas related to passenger transportation

Obligatoriedad de investigar el uso de alcohol y drogas en todo el personal de áreas vinculadas al transporte de pasajeros, sea cual fuere el medio de transporte. El resultado obligatorio requerido debe ser cero alcohol y test de drogas negativos. Luego de la existencia del consentimiento informado y explicitación de la política en la materia, el personal con una toma positiva de alcohol o drogas será retirado definitivamente de su función. (AU)

Mandatory requirement to investigate the use of alcohol and drugs in all personnel working in areas related to all passenger transportation. The mandatory required result should be "0" alcohol and negative drugs tests. After having confirmed consent of the given information as well as a proper explanation of the policy related to this matter, in case of drug or alcohol positive result, the personnel will be ceased in their function. (AU)

The influence of an injury prevention program on young road users: a German experience.

PURPOSE: Trauma remains a leading cause of mortality and morbidity in youth. The Prevent Alcohol and Risk Related Trauma in Youth (P.A.R.T.Y.) program is an injury prevention program. The aim of the study was to analyze the influence on risk-taking behaviors and risk awareness on young road users by a pre-post-questionnaire. METHODS: A pre-post intervention study was performed using a standardized questionnaire. The questionnaire contained three sections with different items (in total 22) to identify differences regarding students' risk behavior and risk awareness. Data were analyzed using the Wilcoxon signed-rank test with significance defined as p < 0.05. RESULTS: The study sample contains 193 students (age 14-17, 44% male). We found significant differences for asking if a student "fastens his/her helmet's chinstrap when driving a motorbike" (p = 0.001) and for the question "Do you wear a helmet when you go rollerblading" (p = 0.008). After attending the program, participants would decrease the use of a mobile phone while driving (p = 0.038) and the understanding of the risk "speeding" and "cycling without a helmet" significantly increased. CONCLUSIONS: The P.A.R.T.Y. program focuses on items like "use of helmet and mobile phones" and "alcohol/drug abuse". Evaluating the program helps to uncover vulnerabilities and to enhance important effects. Some of these items are addressed by the program, whereas some are not. It will be important to improve the program according to address topics that have not shown significant improvements, so that students learn more about the dangers and the right behavior in road traffic.

Differences in alcohol cognitions, consumption, and consequences among first-time DUI offenders who co-use alcohol and marijuana.

BACKGROUND: A significant portion of alcohol-related DUI offenders engage in co-use of alcohol and marijuana (AM). Given expanding marijuana legalization and the impaired driving risks associated with co-use, it is of increased importance to understand how characteristics of AM co-users compare to those who use alcohol only (AO) in order to inform DUI interventions and prevent recidivism. METHODS: Participants were 277 first-time DUI offenders enrolled in a first-time DUI offender program across three locations. Using well-established measures, we evaluated differences in alcohol-related cognitions (positive expectancies and self-efficacy), frequency and quantity of alcohol consumption, and alcohol-related consequences between AO users and AM co-users by running a series of multivariate generalized linear models. RESULTS: Compared to AO users, AM co-users reported lower self-efficacy to achieve abstinence and avoid DUI. Differences in abstinence self-efficacy largely explain higher relative rates of average and peak drinking quantity and higher odds of binge drinking among AM co-user. Despite lower self-efficacy and higher drinking quantity, there were no significant differences between AM and AO-users on alcohol-related consequences and past month reports of drinking and driving. CONCLUSIONS: Our results provide preliminary evidence that DUI offenders who co-use alcohol and marijuana have higher alcohol use and lower self-efficacy than AO-users, and long-term consequences for this group should be monitored in future research. DUI programs may screen and identify co-users and consider tailoring their interventions to build self-efficacy to address the risks associated with AM co-use uniquely.

A systematic review of the effectiveness of interventions to reduce motor vehicle crashes and their injuries among the general and working populations / Revisión sistemática de la efectividad de las intervenciones para reducir las colisiones de vehículos de motor y lesiones Asociados Resultantes en la población general y la población económicamente activa / Revisão sistemática da efetividade de intervenções para reduzir os acidentes de trânsito e ferimentos na população geral e na população ativa

ABSTRACT Objective To summarize the best available international scientific evidence on the effectiveness of interventions to reduce motor vehicle collisions and their consequences among the working and general populations. Methods A broad and systematic review was conducted of the literature available in biomedical databases and grey literature. At least two investigators working in parallel performed data extraction, synthesis, and risk of bias analysis. Results Forty-one studies with low to moderate risk of bias were included. Of these, 18 had an ecological design (time series), 10 were quasi-experimental, one was a population survey, one was a randomized clinical trial, and 11 were systematic reviews. Conclusions The interventions that most consistently show a positive effect on incidence, morbidity, and mortality due to motor vehicle collisions are national policies or programs that: regulate, enforce, and penalize driving under the influence of alcohol; improve driving safety and driver conditions; improve road infrastructure with the purpose of preventing collisions; and educate and penalize drivers with a history of road violations.

RESUMEN Objetivo Resumir la mejor evidencia disponible a nivel internacional sobre la efectividad de las intervenciones para reducir el número de colisiones de vehículos de motor y sus consecuencias en la población general y la población económicamente activa. Métodos Revisión amplia y sistemática de la bibliografía contenida en las bases de datos biomédicas y la literatura gris. Al menos dos investigadores trabajando en paralelo realizaron la extracción de datos, la síntesis y el análisis del riesgo de sesgo. Resultados Se incluyeron 41 estudios con un riesgo de sesgo bajo o moderado. De ellos, 18 tenían un diseño ecológico (series de tiempo), 10 eran cuasiexperimentales, 1 era una encuesta poblacional, 1 era un ensayo clínico aleatorizado y 11 eran revisiones sistemáticas. Conclusiones Las intervenciones que muestran más sistemáticamente un efecto positivo sobre la incidencia, la morbilidad y la mortalidad por colisiones de vehículos de motor son las políticas o programas nacionales que reglamentan, hacen cumplir los reglamentos y sancionan a quienes conducen bajo los efectos del alcohol; mejoran la seguridad al conducir y con respecto a los conductores; mejoran la infraestructura vial a fin de prevenir las colisiones; y educan y sancionan a los conductores con antecedentes de infracciones de las leyes de tránsito.

RESUMO Objetivo Sintetizar as melhores evidências científicas internacionais disponíveis sobre a efetividade das intervenções para reduzir os acidentes de trânsito e suas consequências na população geral e na população ativa. Métodos Foi realizada uma ampla revisão sistemática da literatura em bases de dados biomédicas e da literatura cinzenta. A extração e a síntese dos dados e a análise de risco de viés foram conduzidas em paralelo por, pelo menos, dois pesquisadores. Resultados Foram selecionados para análise 41 estudos com risco de viés baixo a moderado. Destes, 18 possuíam design ecológico (série temporal), 10 eram estudos quase-experimentais, um estudo era um levantamento populacional, um era um estudo clínico randomizado e 11 eram revisões sistemáticas. Conclusões As intervenções que sistematicamente demonstraram um efeito positivo na incidência, morbidade e mortalidade de acidentes de trânsito são as políticas ou programas nacionais para regulamentar, cumprir as leis e aplicar sanções aos condutores que dirigem sob influência de álcool, melhorar a segurança e condições para condução de veículos, melhorar a infraestrutura viária visando evitar acidentes e educar e multar os condutores com histórico de infrações.

International approaches to driving under the influence of cannabis: A review of evidence on impact.

BACKGROUND: There are knowledge gaps regarding the effectiveness of different approaches designed to prevent and deter driving under the influence of cannabis (DUIC). Policymakers are increasingly interested in evidence-based responses to DUIC as numerous jurisdictions worldwide have legally regulated cannabis or are debating such regulation. We contribute a comprehensive review of international literature on countermeasures that address DUIC, and identify where and how such measures have been evaluated. METHODS: The following databases were systematically searched from 1995 to present: Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts, and Criminal Justice Abstracts. Hand searching of relevant documents, internet searches for grey literature, and review of ongoing email alerts were conducted to capture any emerging literature and relevant trends. RESULTS: Numerous international jurisdictions have introduced a variety of measures designed to deter DUIC. Much interest has been generated regarding non-zero per se laws that set fixed legal limits for tetrahydrocannabinol and/or its metabolites detected in drivers. Other approaches include behavioural impairment laws, zero-tolerance per se laws, roadside drug testing, graduated licensing system restrictions, and remedial programs. However, very few evaluations have appeared in the literature. CONCLUSIONS: Although some promising results have been reported (e.g., roadside testing), it is premature to draw firm conclusions regarding the broader impacts of general deterrent approaches to DUIC. This review points to the need for a long-term commitment to rigorously evaluate, using multiple methods, the impact of general and specific deterrent DUIC countermeasures.

Underage drinking, brief interventions, and trauma patients: Are they really special?

BACKGROUND: While the relationship between underage drinking and injury has been well established, few studies have examined whether presenting for an acute injury moderates the efficacy of a brief intervention (BI) on alcohol misuse. METHODS: Patients (aged 14-20 years) in the emergency department screening positive for risky drinking (Alcohol Use Disorders Identification Test-Consumption score) completed a baseline assessment, were randomized to conditions (a standalone computer-delivered BI [n = 277], a therapist-delivered BI [n = 278], or a control condition [n = 281]), and completed a 3-month follow-up. This secondary analysis of Project U-Connect examined regression models (controlling for baseline values) to examine the main effects of injury and the interaction effects of injury by BI condition on alcohol consumption and consequences. RESULTS: Among 836 youth enrolled in the randomized controlled trial (mean age, 18.6 years; 51.6% were male; 79.4% were white), 303 (36.2%) had a primary complaint of intentional or unintentional injury. At baseline, injured patients were more likely to be male (p < 0.001) and have higher alcohol consumption (p < 0.01), but were less likely to misuse prescription drugs (p = 0.02) than those presenting for medical reasons. Regression models (controlling for baseline values) demonstrated that injury presentation predicted greater alcohol consumption prior to a BI. The computer BI was more effective at reducing alcohol consequences among those presenting with injury than those presenting for other reasons. Injury did not affect the efficacy of the computer BI on alcohol consumption, and injury did not affect the efficacy of the therapist BI on alcohol outcomes. CONCLUSIONS: A therapist or computer BI reduced alcohol consumption and consequences among risky drinkers regardless of reason for emergency department presentation highlighting the opportunity to reach a broad array of youth. Although the therapist BI was not moderated by injury presentation, the computer BI was particularly effective at reducing alcohol consequences among those presenting with injury at 3-month follow-up. LEVEL OF EVIDENCE: Therapeutic/care management study, level III.

Can a criminal justice alcohol abstention programme with swift, certain, and modest sanctions (24/7 Sobriety) reduce population mortality? A retrospective observational study.

BACKGROUND: In the UK and USA, various jurisdictions have launched new approaches for managing alcohol-involved offenders that might have public health implications. These programmes require participants to abstain from alcohol and submit to frequent alcohol testing with swift, certain, and modest sanctions for violations, with the aim to reduce crime and keep alcohol-involved offenders in the community. In this study we examine whether the 24/7 Sobriety programme in South Dakota, USA-the largest such programme to date-is associated with reductions in mortality. METHODS: With a differences-in-differences design, we used variation in the timing of 24/7 Sobriety implementation across South Dakota counties between 2005 and 2011 to estimate the association between programme introduction and county-level mortality. We used monthly, county-level, aggregate counts for mortality from January, 2000, to June, 2011. We assessed total deaths, and deaths due to external injuries, circulatory disorders, digestive disorders, and cancer (as a potential placebo). FINDINGS: Between January, 2005, and June, 2011, 16 932 people (about 3% of the adult population) participated in the 24/7 Sobriety programme. The analysis was based on a sample size of 9 108 county-month observations (ie, 66 counties × 12 months × 11·5 years). Implementation of 24/7 Sobriety was associated with a 4·2% (95% CI 1·5-6·9) reduction in all-cause adult mortality, with the largest associations among women (8·0%, 95% CI 3·9-11·8) and individuals older than 40 years (4·3%, 95% CI 1·4-7·0). Associations were most evident among circulatory disorders. INTERPRETATION: 24/7 Sobriety might have public health benefits, which could extend beyond individuals directly enrolled in the programme. However, further research, including randomised controlled trials and analyses of individual-level data, is needed to corroborate the finding, reassess the size of these associations, and gain insight into causal mechanisms. Should a negative association be replicated, it might represent a substantial advance in our understanding of how criminal justice interventions could help shape public health. FUNDING: National Institute on Alcohol Abuse and Alcoholism, US National Institutes of Health.

Teste do bafômetro: resultados e recusas de motoristas interceptados pela Operação Lei Seca no Rio de Janeiro / Breathalyzer test: results and refusals to take the test of drivers intercepted under the DUI Spot-Check Campaign in Rio de Janeiro

Resumo Estudo transversal que avaliou os resultados e as recusas ao teste do bafômetro entre motoristas interceptados pela Operação Lei Seca na capital do Rio de Janeiro e Baixada Fluminense. Realizado com base em dados cedidos pelo Governo do Estado que foram coletados durante atendimento de motoristas interceptados entre dezembro de 2013 e janeiro de 2014. Procederam-se análises descritivas da amostra e de associação entre as variáveis sexo, faixa etária e local de abordagem com as recusas e os resultados do teste do bafômetro através de um modelo de regressão logística. Dos 4756 (100%) condutores interceptados, 59 (1,2%) apresentaram resultado positivo no teste do bafômetro e 229 (4,8%) recusaram-no. Apenas a variável local de abordagem apresentou significância estatística com maiores chances de resultados positivos (OR = 4,01) e recusas ao teste (OR = 5,14) entre os condutores interceptados na Baixada Fluminense. As ações sistemáticas de fiscalização efetuadas pela Operação Lei Seca que ocorrem há mais tempo na capital parecem influenciar positivamente o comportamento de beber e dirigir dos motoristas.

Abstract Abstract This paper involved a cross-sectional study that evaluated the results and refusals to take the breathalyzer test among drivers intercepted by the Driving Under the Influence (DUI) Spot-Check Campaign (Operação Lei Seca) in the capital of Rio de Janeiro and Baixada Fluminense. It was conducted using data provided by the State Government which were collected from drivers intercepted in the months of December 2013 and January 2014. Descriptive analysis was conducted of the sample and of the association between gender, age and location variables with the result of the breathalyzer test and refusal to take the test using a logistic regression model. Of the 4756 (100%) drivers intercepted, 59 (1.2%) failed the breathalyzer test and 229 (4.8%) refused to take it. Only the location of interception variable was statistically significant with greater chances of failing (OR = 4.01) and refusal to take the test (OR = 5.14) among drivers intercepted in the Baixada Fluminense. Systematic monitoring actions taken by the DUI Spot-Check Campaign that have occurred for longer in the capital appear to have a positive impact on the drinking and driving behavior of drivers.