Road injuries and relaxed licensing requirements for driving light motorcycles in Spain: a time-series analysis.

OBJECTIVE: To assess differences between the risk of injury for motorcycle riders before and after the passing of a law allowing licenced car drivers to drive light motorcycles without having to take a special motorcycle driving test. METHODS: We carried out a quasi-experimental study involving comparison groups, and a time-series analysis from 1 January 2002 to 30 April 2008. The study group was composed of people injured while driving or riding a light motorcycle (engine capacity 51-125 cubic centimetres), while the comparison groups consisted of riders of heavy motorcycles (engine capacity > 125 cc), mopeds (engine capacity

A simple and reliable procedure for the determination of psychoactive drugs in oral fluid by gas chromatography-mass spectrometry.

A simple and reliable gas chromatography-mass spectrometry method for identifying and quantifying psychoactive drugs in oral fluid is described. Substances under investigation were: psychostimulant drugs (amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine, 3,4-methylenedioxiamphetamine, 3,4-methylenedioxy-N-ethylamphetamine, phentermine), cocaine and metabolites (benzoylecgonine, cocaethylene, and ecgonine methyl esther), cannabinoids (delta-9-tetrahydrocannabinol, 11-nor-9-carboxy-delta-9-tetrahydrocannabinol, 11-hydroxy-delta-9-tetrahydrocannabinol, cannabinol and cannabidiol), opiates (6-monoacetylmorphine, morphine and codeine), hypnotics (flurazepam, flunitrazepam, dipotassium chlorazepate, alprazolam, diazepam and oxazepam), antidepressant drugs (amitryptiline, paroxetine and sertraline), antipsychotic drugs (haloperidol, chlorpromazine and fluphenazine) chlormethiazole, loratidine, hydroxyzine, diphenhydramine, valproic acid and gabapentin. After the addition of deuterated analogues of morphine, 3,4-methylenedioxymethamphetamine, (+/-)-11-nor-9-carboxy-delta-9-tetrahydrocannabinol and clonazepam as internal standards, all the compounds were simultaneously extracted from oral fluid by solid-phase extraction procedure. Acid compounds were eluted with acetone while basic and neutral compounds with dichloromethane:isopropanol:ammonium (80:20:2, v/v/v). Chromatography was performed on a methylsilicone capillary column and analytes, derivatized with N-Methyl-N-(trimethylsilyl)trifluoroacetamide, were determined in the selected-ion-monitoring (SIM) mode. Mean recovery ranged between 44.5 and 97.7 % and quantification limit between 0.9 and 44.2 ng/ml oral fluid for the different analytes. The developed analytical methodology was applied to investigate the presence of psychoactive drugs in oral fluid from injured individuals attending the emergency room (MACIUS project).

Tratamiento con brace termoplástico para fracturas de húmero / Thermoplastic brace treatment for humerus fractures

Objetivo: Evaluar la satisfacción con el uso del brace termoplástico y el resultado funcional del tratamiento conservador en pacientes con fracturas de la diáfisis del húmero. Materiales y métodos: Estudio retrospectivo de pacientes con fracturas de húmero cerradas, tratados con brace termoplástico hasta su consolidación y un seguimiento mínimo de 12 meses. Se registraron los siguientes datos: tipo de fractura y localización, mecanismo de lesión, miembro lesionado, tiempo de inmovilización con yeso y uso del brace, complicaciones y tiempo de consolidación. Se evaluaron el dolor mediante la escala analógica visual, la satisfacción con la escala de Likert, el balance articular con la escala de Constant y la funcionalidad según el puntaje QuickDASH. Resultados: Se incluyó a 17 pacientes (16 mujeres, 1 hombre; edad promedio 67 años). La inmovilización inicial con yeso fue de 13 días (rango 0-32). Los pacientes usaron el brace por 8.6 semanas (rango 3-16) hasta la consolidación radiográfica en la décima semana. El seguimiento promedio fue de 24 meses (rango 12-60) y el puntaje de dolor, de 0,5 (rango 1-3). El 59% estuvo muy satisfecho con los resultados y el 41%, satisfecho. El 59% logró una flexión del hombro >150°, el 47%, una abducción >150°, el 41%, una rotación interna con pulgar entre escápulas y el 47%, una rotación externa de 70°. El puntaje QuickDASH promedio fue de 9. Conclusiones: Los pacientes se mostraron muy satisfechos con el uso del brace termoplástico para el tratamiento incruento de las fracturas de húmero y los resultados funcionales fueron aceptables. Nivel de Evidencia: IV

Purpose: To evaluate the satisfaction with the use of a thermoplastic brace and the functional outcomes in the conservative treatment of patients with humeral shaft fractures. Materials and methods: Retrospective study of patients with closed humerus fractures, treated with a thermoplastic brace until union and with a minimum follow-up of 12 months. We recorded the type and location of the fracture, mechanism of injury, injured limb, time of immobilization with plaster and use of brace, complications, and time of consolidation. The evaluation was performed using the visual analog scale (VAS) for pain, the Likert scale for patient satisfaction, the Constant scale for joint balance, and the QuickDash score for functionality. Results: 17 patients were included (16 female, 1 male), with an average age of 67 years. The initial plaster immobilization lasted 13 days (range 0-32). The patients wore the brace for 8.6 weeks (range 3-16) until radiographic consolidation in the 10th week. The average follow-up was 24 months (range 12-60) and the pain score was 0.5 (range 1-3). 59% were very satisfied with the results and 41% were satisfied. 59% achieved a shoulder flexion >150°; 47%, an abduction >150°; 41%, an internal rotation with thumb between scapulae; and 47%, an external rotation of 70°. The average QuickDASH score was 9. Conclusion: The use of a thermoplastic brace in the conservative treatment of humerus fractures presented high patient satisfaction and acceptable functional outcomes for the affected limb.Keywords: Humerus; fractures; thermoplastic brace; conservative treatment. Level of Evidence:IV

[Short-term effectiveness of brief interventions in alcohol-positive traffic casualties]. / Efectividad a corto plazo de las intervenciones breves realizadas en pacientes lesionados por accidente de tráfico con alcoholemia positiva.

OBJECTIVES: To investigate the effectiveness of brief interventions to reduce alcohol intake in traffic casualties with a positive blood alcohol concentration. METHODS: Nine hundred forty-eight eligible casualties (97.6% of eligible casualties within a universe of 1106) were screened for alcohol and 126 (13.3%) were identified as positive. Interventions were performed in 85, randomly allocated to a minimal intervention (simple advice) or a brief intervention (motivational intervention). Telephone follow-up was scheduled for months 3, 6 and 12. The present study reports the results of follow-up at month 3. RESULTS: Fifty-seven patients (67%) were followed up at month 3. A total of 73.7% had reduced their alcohol intake and this percentage was greater in the group who underwent the brief intervention (p = 0.06; effect size 0.5) and among heavy drinkers (p < 0.05). CONCLUSIONS: The data indicate the effectiveness of the brief intervention, although the sample size does not allow definitive conclusions to be drawn.

Nevirapine-containing regimens in HIV-infected naive patients with CD4 cell counts of 200 cells/microl or less.

We retrospectively evaluated the effectiveness of nevirapine-containing regimens in 118 naive patients initiating highly active antiretroviral therapy with CD4 cell counts S 200 cells/jl. After 24 months, 51% of patients continued nevirapine, 43 and 83% had viral loads < 50 copies/ml by intent-to-treat and on-treatment analyses, and a mean increase of +246 CD4 cells/microl occurred. More than 80% of patients who continued with nevirapine had viral loads < 50 copies/ml and CD4 cell counts > 200 cells/pl.

Does the short form of the Alcohol Use Disorders Identification Test (AUDIT-C) work at a trauma emergency department?

The accuracy of the consumption items of AUDIT (AUDIT-C) was analyzed, using the full AUDIT score as gold standard, in 120 traffic casualties (78% men and 22% women), median age 27 years (IQR = [22-34]), entering an urban emergency room between 2001 and 2003, with (67%) and without (33%) a positive blood alcohol level (> or =0.2 g/L). Sensitivity, specificity, predictive value, overall accuracy, and receiver operating characteristics of AUDIT-C were measured. Diagnostic accuracy was 0.79, using cutoff indices of > or =5 for males and > or =4 for females. AUDIT-C may be useful in emergency departments for a stepwise screening. Further validation of this test with larger samples and different settings is warranted.

[Characteristics of road accident victims with positive blood alcohol levels]. / Características de los lesionados por accidente de tráfico con alcoholemia positiva.

OBJECTIVE: To identify the differential features of positive blood alcohol level (BAL) in people injured in road crashes who were attended an acute care service. METHODS: Cross-sectional study of persons aged 18 years old or older injured in motor vehicle crashes who were attended in the Traumatology Emergency Department of Vall d'Hebron Hospital (Spain) between July 2001 and February 2002. RESULTS: The study sample included 431 patients. A positive alcohol test was found in 13.7% of the sample. A statistically significant and independent association was found between positive BAL and male sex (odds ratio [OR] = 2.5 [95% CI, 1.3-5.4]), hospital admission (OR = 2.7 [95% CI, 1.3-5.4]), being attended on a weekend (OR = 3.7 [95% CI, 2.0-6.9]) and being attended during the night and early morning (OR = 4.6 [95% CI, 2.0-10.3]) or in the morning (OR = 3.6 [95% CI, 1.5-8.4]). CONCLUSIONS: The present study identifies a subgroup of people injured in motor vehicle crashes with a greater likelihood of positive BAL, in whom more active screening and secondary prevention activities should be implemented within traumatology and acute care settings.

Efectividad a corto plazo de las intervenciones breves realizadas en pacientes lesionados por accidente de tráfico con alcoholemia positiva / Short-term effectiveness of brief interventions in alcoholpositive traffic casualties

Objetivos: Investigar la efectividad de las intervenciones breves para reducir el consumo de alcohol en los pacientes lesionados por accidente de tráfico con alcoholemia positiva. Métodos: Se cribó la presencia de alcohol en 948 lesionados en accidente de tráfico (el 97,6% de los elegibles de un universo de 1.106), con 126 (13,3%) positivos. Se intervino en 85 individuos, aleatoriamente distribuidos en intervención mínima (consejo simple) e intervención breve (intervención de tipo motivacional), y se programó un seguimiento telefónico a los 3, 6 y 12 meses. En este trabajo se presentan los resultados del seguimiento a los 3 meses. Resultados: A los 3 meses se ha seguido a 57 pacientes (67%). EL 73,7% ha reducido el consumo, porcentaje que fue mayor en el grupo intervención breve (p = 0,06; tamaño del efecto, 0,5) y en los incluidos en la categoría de los bebedores de riesgo (p < 0,05). Conclusiones: Se registró la efectividad de la intervención breve, aunque el tamaño de la muestra no permite establecer conclusiones definitivas

Objectives: To investigate the effectiveness of brief interventions to reduce alcohol in take in traffic casualties with apositive blood alcohol concentration. Methods: Nine hundred forty-eight eligible casualties (97.6%of eligible casualties with in a universe of 1106) were screened for alcohol and 126 (13.3%) were identified as positive. Interventions were performed in 85, randomly allocated to a minimal intervention (simple advice) or a brief intervention (motivational intervention). Telephone follow-up was scheduled for months 3, 6 and 12. The present study reports the results of follow-up at month 3. Results: Fifty-seven patients (67%) were followed up at month 3. A total of 73.7% had reduced their alcohol intake and this percentage was greater in the group who underwent the brief intervention (p = 0.06; effect size 0.5) and among heavy drinkers(p < 0.05).Conclusions: The data indicate the effectiveness of the brief intervention, although the sample size does not allow definitive conclusions to be drawn

Características de los lesionados por accidente de tráfico con alcoholemia positiva / Characteristics of road accident victims with positive blood alcohol levels

Objetivo: Identificar de las características diferenciales de positividad a alcohol en lesionados en accidentes de tráfico atendidos en un servicio de urgencias hospitalario. Métodos: Estudio transversal con sujetos de 18 años o mayores, lesionados en accidentes de tráfico, atendidos en el servicio de urgencias del Área de Traumatología del Hospital Vall d'Hebron, entre julio de 2001 y febrero de 2002. Resultados: La muestra incluyó a 431 pacientes. El 13,7% resultó positivo a la determinación de alcohol: se hallaron diferencias en los varones (odds ratio [OR] = 2,5; IC del 95%, 1,3-5,4) y los lesionados ingresados (OR = 2,7; IC del 95%, 1,3-5,4) y en los que fueron asistidos en fin de semana o festivo (OR = 3,7; IC del 95%, 2,0-6,9), de noche y madrugada (OR = 4,6; IC del 95%, 2,0-10,3) o durante la mañana (OR = 3,6; IC del 95%, 1,5-8,4). Conclusiones: Se ha determinado la existencia de subgrupos de lesionados en accidentes de tráfico con una mayor probabilidad de alcoholemia positiva, en los cuales deberían aplicarse programas de cribado y prevención secundaria más activos desde los servicios de urgencias y de traumatología (AU)

Objective: To identify the differential features of positive blood alcohol level (BAL) in people injured in road crashes who were attended an acute care service. Methods: Cross-sectional study of persons aged 18 years old or older injured in motor vehicle crashes who were attended in the Traumatology Emergency Department of Vall d'Hebron Hospital (Spain) between July 2001 and February 2002. Results: The study sample included 431 patients. A positive alcohol test was found in 13.7% of the sample. A statistically significant and independent association was found between positive BAL and male sex (odds ratio [OR] = 2.5 [95% CI, 1.3-5.4]), hospital admission (OR = 2.7 [95% CI, 1.3-5.4]), being attended on a weekend (OR = 3.7 [95% CI, 2.0-6.9]) and being attended during the night and early morning (OR = 4.6 [95% CI, 2.0-10.3]) or in the morning (OR = 3.6 [95% CI, 1.5-8.4]). Conclusions: The present study identifies a subgroup of people injured in motor vehicle crashes with a greater likelihood of positive BAL, in whom more active screening an (..) (AU)