The absence of data on driving under the influence of alcohol in road traffic studies: a scoping review of non-randomized studies with vote counting based on the direction of effects of alcohol policies.

BACKGROUND: Data on driving under the influence of alcohol (DUIA) are not always available, accurate, or reliable, making it difficult to study the effects of alcohol policies on road traffic outcomes. The objectives of our study were twofold: 1) to describe how road traffic outcomes of alcohol policies are assessed when DUIA data are missing, and 2) to explore the effects of alcohol policies when DUIA data are missing. METHODS: We conducted a scoping review of non-randomized studies that assessed the road traffic outcomes of alcohol policies when DUIA data are missing. Until November 2021, we searched studies published between 2000 and 2021, in English or French, via MEDLINE, APA PsycInfo, CINAHL, and SocINDEX. We assessed the risk of bias in the included studies with the Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. The selection process, data extraction, and the risk of bias assessment were conducted independently and in duplicate. We used vote counting based on the direction of the effects of alcohol policies as a synthesis method. The protocol for this review was published in PROSPERO under record number CRD42021266744. RESULTS: Twenty-four eligible studies were included. Regarding objective 1, most studies used uncontrolled interrupted time series designs to assess road traffic fatalities resulting from night-time crashes. The reasons for missing DUIA data were generally not reported. Regarding objective 2, we found evidence for an association between alcohol policies and decreased road traffic fatalities. Subgroup analyses found no evidence for an association between methodological modifiers and positive effect directions for road traffic fatalities. CONCLUSION: Caution is needed when interpreting road traffic outcomes associated with alcohol policies when DUIA data are missing. Greater efforts should be made to improve the reporting of outcomes assessments. Future studies must address several methodological issues (e.g., more granular data, well-defined intervention and implementation, and controlled designs). Our results should be compared to those from others reviews where DUIA data were available to confirm or recalibrate the associations found in studies where DUIA data were missing.

A new alcohol-related traffic law, a further reduction in traffic fatalities? Analyzing the case of Turkey.

BACKGROUND: In June 2013, an alcohol-related traffic law took effect in Turkey. The law 6487 introduced administrative fines for not respecting blood alcohol concentration limits, health warning messages on alcohol containers (bottles, cans), and prohibited the sale of alcohol beverages in retail facilities between 10 p.m. and 6 a.m.. This article examines how this law is associated with traffic fatality variation. METHODS: Data from the Turkish Statistical Institute for the 2008-2019 period were analyzed. Outcomes were traffic fatality rates per 100,000 population and 10,000 motor vehicles. Exposure variable was the presence of law 6487. Alcohol, tobacco, and related beverages' household expenditure, unemployment rate, number of health professionals, number of crashes, and lags of the outcomes represented control variables. A time-series cross-regional fixed effect model was applied. RESULTS: Empirical estimates suggest that the law 6487 was associated with a reduction of 15% (Incidence Rate Ratio (IRR) 0.85, 95% Confidence Interval (CI): 082, 0.94) in the traffic fatality per population rate and with a reduction of 14% (IRR: 0.86 (95% CI: 0.78, 0.92) in the traffic fatality per motor-vehicle rate. After 6 years of its implementation, this intervention was associated with an absolute reduction of 1519 (95% reduction interval: 1177, 1810) traffic fatalities. CONCLUSIONS: Our research emphasizes that legislation with direct and indirect measures targeting driving under the influence of alcohol (DUIA) may be related to traffic fatalities reduction. PRACTICAL APPLICATIONS: This finding has important implications for policy and future research in contexts in which alcohol consumption is low such is in Turkey. Future research should seek to identify mechanisms that explain how laws are ultimately associated with DUIA variation.

Integrating hypertension services at an HIV clinic in Port-au-Prince, Haiti: A report from the field.

HIV-positive adults with hypertension have increased risk of mortality but HIV clinics often do not provide hypertension care. The authors integrated hypertension management into existing HIV services at a large clinic in Haiti. Of 1729 documented HIV-positive adults presenting for care at the GHESKIO HIV clinic between March and July 2016, 551 screened positive for hypertension, with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. A convenience sample of 100 patients from this group received integrated hypertension and HIV care for 6 months. At time of identification, patients were screened for proteinuria and initiated on antihypertensive medication. Hypertension and HIV visits coincided; medications were free. Outcomes were retention in care and change in blood pressure over 6 months. Average blood pressure over 6 months was described using linear mixed-effects model. Of 100 HIV-positive adults with hypertension referred for integrated care, three were ineligible due to comorbidities. Among 97 participants, 82% (N = 80) remained in care at 6 months from time of positive hypertension identification. 96% (N = 93) were on antiretroviral therapy with median CD4+ count of 442 cells/µL (IQR 257-640). Estimated average blood pressure over 6 months decreased from systolic 160 mmHg (CI 156, 165) to 146 mmHg (CI 141, 150), P-value <0.0001, and diastolic 105 mmHg (CI 102, 108) to 93 mmHg (CI 89, 96), P-value <0.0001. HIV and hypertension management were successfully integrated at a HIV clinic in Haiti. Integrated management is essential to combat the growing burden of cardiovascular disease among HIV-positive adults.