CORRELATION BETWEEN THE SEVERITY AND BLOOD ALCOHOL LEVEL OF TRAFFIC ACCIDENTS VICTIMS.

Objective: To evaluate the correlation between blood alcohol levels and the severity of injuries assessed by the Injury Severity Score (ISS) in patients who were victims of traffic accidents admitted to the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP). Methods: Cross-sectional study carried out between July 2018 and June 2019, at the Central Emergency Room of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (PSC-HCFMUSP). A total of 172 hospitalized patients victims of traffic accidents were included in this study. Blood samples were analyzed by the FMUSP Toxicology Laboratory. Results: 36 patients (20.9%) had positive BAC (≥ 0.2 g/L) with a mean of 1.21 g/L. Overall, patients had a mean age of 37.2 years old, and 136 (79.1%) were men. The ISS of the total casuistry was 15.6; regarding the external cause, the motorcycle was ranked first with 100 cases (58.1%), and drivers were the majority with 57.4% of the sample. Conclusion: There was no correlation between the severity of the injuries and the blood alcohol levels of traffic accident victims admitted to a reference hospital. Level of Evidence II, Cross-Sectional Study.

Objetivo: Avaliar a correlação entre a alcoolemia e a gravidade das lesões avaliadas pelo Índice de Gravidade da Lesão ( Injury Severity Score* ­ ISS) em vítimas de acidentes de trânsito internadas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Método: Estudo transversal realizado entre julho de 2018 e junho de 2019, no Pronto Socorro Central do HC-FMUSP. Foram incluídas 172 vítimas de acidentes de trânsito. Amostras de sangue foram analisadas pelo Laboratório de Toxicologia da FMUSP. Resultados: 36 pacientes (20,9%) apresentaram alcoolemia positiva (≥ 0,2 g/L), com valor médio de 1,21 g/L. No geral, os pacientes tinham uma idade média de 37,2 anos, e 136 (79,1%) eram homens. O ISS da casuística total foi 15,6; quanto à causa externa, a motocicleta ficou em primeiro lugar com 100 casos (58,1%); e os condutores foram prevalentes entre as vítimas (57,4%). Conclusão: Não houve correlação entre a gravidade das lesões e a alcoolemia das vítimas de acidente de trânsito internadas em um hospital de referência. Nível de Evidência II, Estudo de Corte Transversal.

Correlation between the severity and blood alcohol level of traffic accidents victims / Correlação entre gravidade e alcoolemia de vítimas de acidentes de trânsito

ABSTRACT Objective: To evaluate the correlation between blood alcohol levels and the severity of injuries assessed by the Injury Severity Score (ISS) in patients who were victims of traffic accidents admitted to the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP). Methods: Cross-sectional study carried out between July 2018 and June 2019, at the Central Emergency Room of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (PSC-HCFMUSP). A total of 172 hospitalized patients victims of traffic accidents were included in this study. Blood samples were analyzed by the FMUSP Toxicology Laboratory. Results: 36 patients (20.9%) had positive BAC (≥ 0.2 g/L) with a mean of 1.21 g/L. Overall, patients had a mean age of 37.2 years old, and 136 (79.1%) were men. The ISS of the total casuistry was 15.6; regarding the external cause, the motorcycle was ranked first with 100 cases (58.1%), and drivers were the majority with 57.4% of the sample. Conclusion: There was no correlation between the severity of the injuries and the blood alcohol levels of traffic accident victims admitted to a reference hospital. Level of Evidence II, Cross-Sectional Study.

RESUMO Objetivo: Avaliar a correlação entre a alcoolemia e a gravidade das lesões avaliadas pelo Índice de Gravidade da Lesão ( Injury Severity Score* - ISS) em vítimas de acidentes de trânsito internadas no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP).* Método: Estudo transversal realizado entre julho de 2018 e junho de 2019, no Pronto Socorro Central do HC-FMUSP. Foram incluídas 172 vítimas de acidentes de trânsito. Amostras de sangue foram analisadas pelo Laboratório de Toxicologia da FMUSP. Resultados: 36 pacientes (20,9%) apresentaram alcoolemia positiva (≥ 0,2 g/L), com valor médio de 1,21 g/L. No geral, os pacientes tinham uma idade média de 37,2 anos, e 136 (79,1%) eram homens. O ISS da casuística total foi 15,6; quanto à causa externa, a motocicleta ficou em primeiro lugar com 100 casos (58,1%); e os condutores foram prevalentes entre as vítimas (57,4%). Conclusão: Não houve correlação entre a gravidade das lesões e a alcoolemia das vítimas de acidente de trânsito internadas em um hospital de referência. Nível de Evidência II, Estudo de Corte Transversal.

Public Health Measures and Prevention of Alcohol-Associated Liver Disease.

Hazardous alcohol consumption causes approximately 4% of deaths globally, constituting one of the leading risk factors for the burden of the disease worldwide. Alcohol has several health consequences, such as alcohol-associated liver disease, hepatocellular carcinoma, nonliver neoplasms, physical injury, cardiac disease, and psychiatric disorders. Alcohol misuse significantly affects workforce productivity, with elevated direct and indirect economic costs. Due to the high impact of alcohol consumption on the population, public health has led to the development of a range of strategies to reduce its harmful effects. Regulatory public health policies (PHP) for alcohol can exist at the global, regional, international, national, or subnational levels. Effective strategies incorporate a multilevel, multicomponent approach, targeting multiple determinants of drinking and alcohol-related harms. The World Health Organization categorizes the PHP into eight categories: national plan to fight the harmful consequences of alcohol, national license and production and selling control, taxes control and pricing policies, limiting drinking age, restrictions on alcohol access, driving-related alcohol policies, control over advertising and promotion, and government monitoring systems. These policies are supported by evidence from different populations, demonstrating that determinants of alcohol use depend on several factors such as socioeconomic level, age, sex, ethnicity, production, availability, marketing, and others. Although most policies have a significant individual effect, a higher number of PHP are associated with a lower burden of disease due to alcohol. The excessive consequences of alcohol constitute a call for action, and clinicians should advocate for developing and implementing a new PHP on alcohol consumption.

Compliance with a law to reduce alcoholic beverage sales and service in Zacatecas, Mexico.

BACKGROUND: Research on the effects of restricting bar opening hours and alcohol sales in middle-income countries is very limited. We assessed compliance with and possible effects of a law enacted in Zacatecas, Mexico on December 30, 2017 and implemented in 2018 and 2019 that established a 2 AM bar closing time and 10 PM cut-off for alcohol sales by off-premises stores. METHODS: Monthly observations of bars and off-premises stores and alcohol mystery shopping visits from 2018 to early 2020 were conducted to assess compliance with the law. Breath tests were conducted in 2018 and 2019 with samples of pedestrians in the nighttime entertainment districts of Zacatecas and a comparison city (Aguascalientes). Surveys of bar owners/managers and staff, emergency medical personnel (EMP), and police officers were conducted in Zacatecas in 2018 and 2019 to assess awareness and support of the law and possible effects of the law on alcohol-related problems such as violence and injuries. RESULTS: Monthly observations indicated that a substantial percentage of bars and off-premises package stores did not comply with the law. Pedestrian breath tests in 2018 and 2019 indicated significant reductions in blood alcohol concentration and heavy drinking among pedestrians in Zacatecas from 11 PM to 2 AM compared to Aguascalientes, but not after 2 AM. Surveys of bar owners/managers indicated that most were aware and supportive of the law. EMP surveys indicated reductions in incidents of physical fighting and drunk or injured customers during the annual September fair in Zacatecas. CONCLUSIONS: This study suggests that restricting bar opening hours and alcohol sales may not result in full compliance by bars and off-premises stores, but may help to reduce excessive alcohol use and related harms in a middle-income country. A more rigorous evaluation with pre-intervention data is needed, however, to fully address this latter question.

Associated factors to abusive alcoholic beverage consumption in suicide victims.

BACKGROUND: Suicide is a worldwide phenomenon, as well as a challenge for public health, and alcoholic beverage abuse is one of the most important risk factors. However, the association between possible factors related to alcoholic beverage consumption in suicide victims has rarely been investigated. OBJECTIVE: To evaluate the factors associated with abusive alcoholic beverage consumption among people who died from suicide in the Brazilian Federal District (BFD). METHOD: A population-based and cross-sectional study with suicide victims in the BFD between 2016 and 2017. Information was collected about sociodemographic characteristics, autopsy appraisal, and drug use. A trained team evaluated all cases to define factors associated with abusive alcoholic beverage consumption. This outcome was measured using the Blood Alcohol Concentration. Poisson regression analysis was applied to calculate the Prevalence Ratios and respective populational confidence intervals. RESULTS: The findings of the present study were collected from a database containing information related to 278 suicide victims. Being male and having cocaine identified in the toxicological test were the factors that showed a strong association with abusive alcohol beverage consumption in suicide victims. Other factors showed a slight association (PR < 1.5): having an education level with greater than 8 years of study, being black, having a professional occupation or being retired or pensioner, and having the presence of cannabis in the toxicological test. CONCLUSION: Socioeconomic-demographic and behavioral factors proved to be positively associated with abusive alcoholic beverage consumption among suicide victims, suggesting the need for effective public health policy measures to combat this health problem.

Assessment of the impact of implementation of a zero blood alcohol concentration law in Uruguay on moderate/severe injury and fatal crashes: a quasi-experimental study.

BACKGROUND AND AIMS: Debates regarding lowering the blood alcohol concentration (BAC) limit for drivers are intensifying in the United States and other countries, and the World Health Organization recommends that the limit for adults should be 0.05%. In January 2016, Uruguay implemented a law setting a zero BAC limit for all drivers. This study aimed to assess the effect of this policy on the frequency of moderate/severe injury and fatal traffic crashes. DESIGN: A quasi-experimental study in which a synthetic control model was used with controls consisting of local areas in Chile as the counterfactual for outcomes in Uruguay, matched across population counts and pre-intervention period outcomes. Sensitivity analyses were also conducted. SETTING: Uruguay and Chile. CASES: Panel data with crash counts by outcome per locality-month (2013-2017). INTERVENTION AND COMPARATOR: A zero blood alcohol concentration law implemented on 9 January 2016 in Uruguay, alongside a continued 0.03 g/dl BAC threshold in Chile. MEASUREMENTS: Per-capita moderate/severe injury (i.e. moderate or severe), severe injury and fatal crashes (2013-2017). FINDINGS: Our base synthetic control model results suggested a reduction in fatal crashes at 12 months [20.9%; P-value = 0.018, 95% confidence interval (CI) = -0.340, -0.061]. Moderate/severe injury crashes did not decrease significantly (10.2%, P = 0.312, 95% CI = -0.282, 0.075). The estimated effect at 24 months was smaller and with larger confidence intervals for fatal crashes (14%; P = 0.048, 95% CI = -0.246, -0.026) and largely unchanged for moderate/severe injury crashes (-9.4%, P = 0.302, 95% CI = -0.248, 0.058). Difference-in-differences analyses yielded similar results. As a sensitivity test, a synthetic control model relying on an inferior treatment-control match pre-intervention (measured by mean squared error) yielded similar-sized differences that were not statistically significant. CONCLUSIONS: Implementation of a law setting a zero blood alcohol concentration threshold for all drivers in Uruguay appears to have resulted in a reduction in fatal crashes during the following 12 and 24 months.

Alcohol Consumption and Violent Deaths in the City of Sao Paulo in 2015.

Background: Excessive alcohol consumption is a serious public health issue, because drunkenness affects critical judgment and self-control, making people more vulnerable to violence and accidents, with thus a potential association between alcohol consumption and violent deaths. Objective: To assess the association between alcohol consumption and violent deaths in the city of Sao Paulo, Brazil, in 2015, and its relationship with gender, age, cause of death and blood alcohol concentration (BAC) of victims. Methods: A cross-sectional retrospective study was conducted by collection of data from 2,882 victims of violent deaths subjected to examination of BAC from the archives of the Institute of Legal Medicine of the State of Sao Paulo, Brazil. Results: Alcohol was detected in blood samples of 27.06% of the victims and mean BAC levels were 1.92 ± 1.24 g/L. The mean age of the victims was 33.49 ± 15.19 years. The majority of the victims were male (84.14%) and the prevalence of positive BAC was higher amongst men (28.74%) than women (18.16%). Homicide was the most prevalent cause of death in the sample (36.57%), but there were a higher proportion of traffic accidents victims with positive BAC (32.01%), as well as higher BAC levels in these victims (46.77% in the range of 1.6-2.5 g/L). Conclusions: The results obtained in this study support a potential association between alcohol consumption and violent deaths in the city of Sao Paulo, mainly in traffic accidents victims.

Alcohol use by suicide victims in the city of Sao Paulo, Brazil, 2011-2015.

Excessive alcohol consumption is a serious public health issue, because drunkenness affects critical judgment and self-control which could trigger violent and self-harm behavior, with thus a potential association between alcohol consumption and suicide deaths. The objective of the present study was to assess the association between alcohol consumption and suicide deaths in the city of Sao Paulo, Brazil, from 2011 to 2015, and its relationship with socio-demographic characteristics of the victims and the circumstances of the suicide. A cross-sectional retrospective study was conducted by collection of data from 1,700 suicide victims subjected to examination of blood alcohol concentration (BAC) from toxicology reports from the Institute of Legal Medicine of the State of Sao Paulo, Brazil. Alcohol was detected in blood samples of 30.2% of the victims and mean BAC levels were 1.73 ± 0.08 g/L. The mean age of the victims was 39.90 ± 0.75 years. The majority of the victims were male (74.6%) and the prevalence of positive BAC was higher amongst men (34.7%) than women (17.1%), p<0.05. The majority of the victims were white skinned (64.7%), but there was a higher proportion of victims with positive BAC among mulatto and black individuals, p<0.05. Hanging was the most prevalent suicide method in the sample (48.7%) and amongst men (55.4%), but amongst women it was jumping from a height (35%), p < 0.05.

Segmented regression analysis of interrupted time series data to assess outcomes of a South American road traffic alcohol policy change.

BACKGROUND: In Chile, a new law introduced in March 2012 decreased the legal blood alcohol concentration (BAC) limit for driving while impaired from 1 to 0.8 g/l and the legal BAC limit for driving under the influence of alcohol from 0.5 to 0.3 g/l. The goal is to assess the impact of this new law on mortality and morbidity outcomes in Chile. METHODS: A review of national databases in Chile was conducted from January 2003 to December 2014. Segmented regression analysis of interrupted time series was used for analyzing the data. In a series of multivariable linear regression models, the change in intercept and slope in the monthly incidence rate of traffic deaths and injuries and association with alcohol per 100,000 inhabitants was estimated from pre-intervention to postintervention, while controlling for secular changes. In nested regression models, potential confounding seasonal effects were accounted for. All analyses were performed at a two-sided significance level of 0.05. RESULTS: Immediate level drops in all the monthly rates were observed after the law from the end of the prelaw period in the majority of models and in all the de-seasonalized models, although statistical significance was reached only in the model for injures related to alcohol. After the law, the estimated monthly rate dropped abruptly by -0.869 for injuries related to alcohol and by -0.859 adjusting for seasonality (P < 0.001). Regarding the postlaw long-term trends, it was evidenced a steeper decreasing trend after the law in the models for deaths related to alcohol, although these differences were not statistically significant. CONCLUSIONS: A strong evidence of a reduction in traffic injuries related to alcohol was found following the law in Chile. Although insufficient evidence was found of a statistically significant effect for the beneficial effects seen on deaths and overall injuries, potential clinically important effects cannot be ruled out.

Impact of a New Law to Reduce the Legal Blood Alcohol Concentration Limit - A Poisson Regression Analysis and Descriptive Approach.

BACKGROUND: In Chile, a new law introduced in March 2012 lowered the blood alcohol concentration (BAC) limit for impaired drivers from 0.1% to 0.08% and the BAC limit for driving under the influence of alcohol from 0.05% to 0.03%, but its effectiveness remains uncertain. The goal of this investigation was to evaluate the effects of this enactment on road traffic injuries and fatalities in Chile. STUDY DESIGN: A retrospective cohort study. METHODS: Data were analyzed using a descriptive and a Generalized Linear Models approach, type of Poisson regression, to analyze deaths and injuries in a series of additive Log-Linear Models accounting for the effects of law implementation, month influence, a linear time trend and population exposure. A review of national databases in Chile was conducted from 2003 to 2014 to evaluate the monthly rates of traffic fatalities and injuries associated to alcohol and in total. RESULTS: It was observed a decrease by 28.1 percent in the monthly rate of traffic fatalities related to alcohol as compared to before the law (P<0.001). Adding a linear time trend as a predictor, the decrease was by 20.9 percent (P<0.001).There was a reduction in the monthly rate of traffic injuries related to alcohol by 10.5 percent as compared to before the law (P<0.001). Adding a linear time trend as a predictor, the decrease was by 24.8 percent (P<0.001). CONCLUSIONS: Positive results followed from this new 'zero-tolerance' law implemented in 2012 in Chile. Chile experienced a significant reduction in alcohol-related traffic fatalities and injuries, being a successful public health intervention.

Alterations in affective behavior during the time course of alcohol hangover.

Alcohol hangover is a temporary state described as the unpleasant next-day effects after binge-like drinking. Hangover begins when ethanol is absent in plasma and is characterized by physical and psychological symptoms. Affective behavior is impaired during the acute phase of alcohol intoxication; however, no reports indicate if similar effects are observed during withdrawal. The aim of this work was to study the time-extension and possible fluctuations in affective behavior during a hangover episode. Male Swiss mice were injected i.p. either with saline (control group) or with ethanol (3.8g/kg BW) (hangover group). Anxiety, fear-related behavior and despair phenotype were evaluated at a basal point (ZT0) and every 2h up to 20h after blood alcohol levels were close to zero (hangover onset). Also, anhedonia signs and pain perception disabilities were studied. Mice exhibited an increase in anxiety-like behavior during 4h and 14h after hangover onset when evaluated by the elevated-plus maze and open field test respectively (p<0.05). Fear-related behavior was detected in hangover animals by the increase of freezing and decrease of line crossings and rearing frequency during 16h after hangover onset (p<0.001). Depression signs were found in hangover mice during 14h (p<0.05). Hangover mice showed a significant decrease in pain perception when tested by tail immersion test at the beginning of hangover (p<0.05). Our findings demonstrate a time-extension between 14 and 16h for hangover affective impairments. This study shows the long lasting effects of hangover over the phase of ethanol intoxication.

Validação do método titulométrico para determinação de etanol em sangue utilizando ácido nítrico 54 e ácido sulfúrico concentrado / Validation of chemical titration for blood-alcohol determination using nitric acid 54 and concentrated sulfuric acid

A causa da maioria dos acidentes automobilisticos tern sido há muito associada ao consumo de álcool e, visando diminuir esses acidentes, os países tem estabelecido limites de alcoolemia para os condutores. A determinação da alcoolemia tem se tornado importante para fins de aprendizagem, clínico-legais, administrativos, e particularmente no cumprimento da lei, com aplicação específica nas violações automobilísticas, podendo subsequentemente assumir relevância forense como evidência de intoxicação. A quantificação sanguínea de etanol por titulometria é bastante utilizada, fornecendo boa correlação linear, sensibilidade, precisão, exatidão, baixo custo e relativa facilidade de execução. Devido à proibição da venda de ácido nítrico concentrado pela Polícia Federal, Polfcia Civil e Exército Brasileiro, o objetivo desse trabalho foi avaliar as características de desempenho do método utilizando outros reagentes em substituição ao ácido nítrico concentrado, com isso garantindo a eficiência na quantificação do etanol em sangue. Os melhores resultados foram obtidos com ácido nítrico 54%, necessitando apenas de ajustes em relação aos volumes utilizados na técnica original. A solução sulfocrômica mostrou-se de difícil manipulação em função de sua viscosidade. Os resultados demonstraram que o método modificado apresentou linearidade, precisão e exatidão, de acordo com a resolução especificada pela ANVISA, Agência Brasileira Regulatória.

All over the world, the main cause of traffic accidents has been associated to alcohol use. In many countries, laws have been introduced to control drink-driving, reducing accidents. Accurate blood-alcohol determination has become increasingly important for learning, clinical, forensic and administrative purposes. It is required in law enforcement, with specific application to automobile traffic violations. Blood ethanol determinations carried out for diagnostic purposes can subsequently assume forensic relevance as evidence of intoxication. Blood-alcohol determinations by chemical titration has been used for many years, it supplies good linear correlation, sensitivity, precision, accuracy, low cost and relative easiness of execution. Due to sale prohibition of concentrated nitric acid by Federal Policy, Civil Policy and Brazilian Army is the aim of this work to carry through assays with other reagents in substitution to that one, to evaluate its performance characteristics and to guarantee its efficiency. The best ones resulted had been gotten with nitric acid 54%, needing only volumes adjustments beside original technique. Chromic acid solution prepared with concentrated sulfuric acid had viscosity of difficult manipulation. Based on the results, the method presented good linear correlation, was accurate and precise according to specific resolution from ANVISA, the Brazilian Regulatory Agency.

Prevalência de alcoolemia em óbitos por acidente de transporte e por outras causas externas / Prevalence of alcoholemy in deaths from traffic accidents and other external causes

Introdução: Trauma é a principal causa de óbitos em indivíduos entre 18 e 44 anos de vida no Brasil. Por mais de um século, o álcool tem sido reconhecido como um dos principais fatores de risco para acidentes fatais, desempenhando um importante papel na etiologia do trauma. O objetivo deste estudo foi comparar o diagnóstico de alcoolemia entre mortos por acidentes de trânsito e outras causas externas (afogamento, homicídio e suicídio). Métodos: Foi realizado um estudo transversal onde se utilizaram dados secundários do Departamento de Medicina Legal de Porto Alegre no período de janeiro a dezembro de 2001. As variáveis estudadas foram o nível de alcoolemia e óbitos por causas externas. Resultados: Foram analisados 1.588 óbitos. Os homicídios ocorreram na faixa etária entre 19 e 45 anos, representando 80% dos casos. As causas externas ocorrem com mais frequência em homens e a maior causa de óbitos entre mulheres foi por acidente de trânsito, com menor alcoolemia. Os pacientes que apresentam alcoolemia positiva tiveram uma razão de prevalência de 1,18 (IC 95%:1,05 a 1,32) em relação ao óbito por acidente de trânsito em comparação ao suicídio. Conclusão: Este estudo demonstra que o álcool é fator contribuinte de morte por causas externas, especialmente aquelas causadas por acidentes de trânsito e homicídio

Introduction: Trauma is the leading cause of death in individuals between 18 and 44 years of age living in Brazil. For over a century, alcohol has been recognized as a major risk factor for fatal accidents, playing an important role in the etiology of trauma. The aim of this study was to compare the diagnosis of alcoholemy in individuals who died in traffic accidents and from other external causes (drowning, homicide and suicide). Methods: We conducted a cross-sectional study based on secondary data from the Department of Forensic Medicine of Porto Alegre from January to December 2001. The variables were blood alcohol content (BAC) and deaths from external causes. Results: We analyzed 1,588 deaths. The murders occurred between the ages of 19-45 years, accounting for 80% of the cases. External causes occur more frequently in men, and traffic accidents are the leading cause of death among women, with lower blood alcohol levels. Patients with positive blood alcohol content had a prevalence ratio of 1.18 (95% CI: 1.05 to 1.32) in relation to death by traffic accidents as compared to suicide. Conclusion: This study demonstrates that alcohol is a contributing factor of death from external causes, especially those caused by traffic accidents and homicide