Julio de Carvalho Ponce

Reducing the legal blood alcohol concentration limit for driving in developing countries: a time for change? Results and implications derived from a time–series analysis (2001–10) conducted in Brazil

AIMS In Brazil, a new law introduced in 2008 has lowered the blood alcohol concentration limit for drivers from 0.06 to 0.02, but the effectiveness in reducing traffic accidents remains uncertain. This study evaluated the effects of this enactment on road traffic injuries and fatalities. DESIGN Time-series analysis using autoregressive integrated moving average (ARIMA) modelling. SETTING State and capital of São Paulo, Brazil. PARTICIPANTS   A total of 1,471,087 non-fatal and 51,561 fatal road traffic accident cases in both regions. MEASUREMENTS Monthly rates of traffic injuries and fatalities per 100,000 inhabitants from January 2001 to June 2010. FINDINGS The new traffic law was responsible for significant reductions in traffic injury and fatality rates in both localities (P<0.05). A stronger effect was observed for traffic fatality (-7.2 and -16.0% in the average monthly rate in the State and capital, respectively) compared to traffic injury rates (-1.8 and -2.3% in the State and capital, respectively). CONCLUSIONS Lowering the blood alcohol concentration limit in Brazil had a greater impact on traffic fatalities than injuries, with a higher effect in the capital, where presumably the police enforcement was enhanced.

Alcohol-related traffic accidents with fatal outcomes in the city of Sao Paulo

AIMS The aims of the present study were to characterize fatal traffic accident victims in a major urban center in Brazil and their association with alcohol consumption. METHODS Cross-sectional study of 907 fatal traffic accident victims in Sao Paulo, in 2005. RESULTS Adult males between the ages of 25 and 54 represented the majority of cases with positive blood alcohol concentrations (BAC). Overall, males had a higher proportion of BAC and mean BAC than females. Pedestrians, particularly those with no detectable BAC, were typically older than other victims. Most accidents (total and BAC-positive) happened on weekends between midnight and 6 a.m. Considering all victims, 39.4% were positive (BAC over 0.1g/l). When only drivers (automobile, motorcycle and bicycle) were evaluated, 42.3% had BAC over the legal limit (0.6g/l). CONCLUSIONS Alcohol is associated with nearly half of all traffic accident deaths in the city of Sao Paulo, especially for days and times associated with parties and bars (weekends between 12 a.m. and 6 a.m.).

Neuropsychological Assessment of Current and Past Crack Cocaine Users

Background: Cognitive changes due to crack cocaine consumption remain unclear. Methods: For clarification, 55 subjects were assigned to three groups: control group, crack cocaine current users, and ex-users. Participants were submitted to Mini-Mental State Examination (MMSE) and tasks evaluating executive functioning and verbal memory. Mood state was also measured. Intergroup comparisons were carried out. Results: Control group performance on the MMSE was better than that of users and ex-users. Verbal memory performance for logical memory of users was impaired. Ex-users scored lower on DSST and Trail Making Test (Part B). Conclusion: Chronic crack cocaine use seems to disrupt general cognitive functioning (MMSE), verbal memory, and attentional resources, but findings suggest that some of these effects could be reversed by abstinence.

Drug consumption among medical students in São Paulo, Brazil: influences of gender and academic year.

OBJECTIVE To analyze alcohol, tobacco and other drug use among medical students. METHOD Over a five-year period (1996-2001), we evaluated 457 students at the Universidade de São Paulo School of Medicine, located in São Paulo, Brazil. The students participated by filling out an anonymous questionnaire on drug use (lifetime, previous 12 months and previous 30 days). The influence that gender and academic year have on drug use was also analyzed. RESULTS During the study period, there was an increase in the use of illicit drugs, especially inhalants and amphetamines, among the medical students evaluated. Drug use (except that of marijuana and inhalants) was comparable between the genders, and academic year was an important influencing factor. DISCUSSION Increased inhalant use was observed among the medical students, especially among males and students in the early undergraduate years. This is suggestive of a specific behavioral pattern among medical students. Our findings corroborate those of previous studies. CONCLUSION Inhalant use is on the rise among medical students at the Universidade de São Paulo School of Medicine. Because of the negative health effects of illicit drug use, further studies are needed in order to deepen the understanding of this phenomenon and to facilitate the development of preventive measures.

Álcool em vítimas de suicídio em São Paulo

CONTEXTO: A tendencia a comportamentos violentos e impulsivos e aumentada apos o consumo de alcool, sendo importante para a etiologia de mortes por causas externas. Nesse contexto, os suicidios aparecem como uma atitude impulsionada pelo consumo de alcool, ou como uma expressao da mesma patologia que leva ao abuso de substância. OBJETIVOS: Como carecemos de dados nacionais sobre suicidios sob a influencia de alcool, o objetivo do presente estudo foi analisar a prevalencia do consumo de alcool previamente ao suicidio. METODOS: Leitura direta de 632 laudos necroscopicos de vitimas de suicidios necropsiadas no Instituto Medico-Legal do Estado de Sao Paulo no ano de 2005. RESULTADOS: Dos 632 casos analisados, 33,1% apresentaram alcoolemia positiva, sendo essa prevalencia maior para os homens (37,1%) do que para as mulheres (20,1%). Os enforcamentos apresentaram a maior prevalencia de alcoolizados, com 38,9% dos casos; as intoxicacoes apresentaram a maior media, com 1,78 g/L. CONCLUSOES: Os resultados mostram que cerca de um terco dos suicidios na amostra foram cometidos subsequentemente ao consumo de alcool, com diferencas entre os diversos metodos.

Drogas ilícitas e trânsito: problema pouco discutido no Brasil

CONTEXTO: Dirigir e uma tarefa complexa na qual o condutor recebe informacao continuamente, analisa-a e reage a respeito desta. Substâncias que influem nas funcoes cerebrais ou em processos mentais envolvidos na conducao certamente irao afetar o desempenho do condutor. Alteracoes motoras provocadas por drogas ilicitas tem recebido crescente atencao em anos recentes como uma possivel ameaca a seguranca no trânsito. Pesquisas tem indicado a presenca de drogas psicoativas em motoristas mortos ou feridos em acidentes de trânsito, e estudos experimentais mostram prejuizo na performance de individuos sob efeito de drogas. OBJETIVOS: Em razao de esse problema ser pouco discutido em nosso pais, embora seja preocupante, este trabalho visa fornecer dados sobre o problema do uso de drogas por motoristas, a legislacao brasileira vigente sobre drogas e direcao veicular e quais sao as medidas que podem ser adotadas para que os acidentes de trânsito relacionados ao uso de drogas sejam reduzidos. METODOS: Revisao bibliografica de trabalhos publicados nos ultimos quinze anos. RESULTADOS: Os trabalhos mais relevantes apontaram claros indicios de prejuizo na capacidade de dirigir sob efeito de drogas psicotropicas. CONCLUSOES: Todas as drogas psicotropicas causam prejuizos nas funcoes psicomotoras e riscos aumentados de envolvimento em acidentes de trânsito, sendo necessaria uma legislacao especifica que aborde esse tema. BACKGROUND: Driving is a complex task in which the driver receives, analyzes and reacts to information continuously. Substances that influence brain functions and/or mental processes involved in driving will certainly affect the driverAEs performance. Psychomotor alterations caused by illegal drugs have received growing attention in recent years as a possible threat to roadway safety. Research has shown the presence of psychoactive drugs in drivers who were killed or injured in driving accidents, and experimental studies have shown impairment in the performance of individuals under the influence of drugs. OBJECTIVES: This study aims to present data on the problem of drug abuse by drivers, the current Brazilian legislation on driving and drug abuse, and what possible measures might be adopted in order to reduce drug-related driving accidents. METHODS: The method applied was a literature review of the last fifteen years of publications. RESULTS: The most relevant publications indicate clear evidence of impairment in driving skills under the influence of psychotropic drugs. CONCLUSIONS: All psychotropic drugs cause impairment in psychomotor functions and as such, a higher risk of involvement in driving accidents, which makes specific legislation dealing with this issue necessary.CONTEXTO: Dirigir e uma tarefa complexa na qual o condutor recebe informacao continuamente, analisa-a e reage a respeito desta. Substâncias que influem nas funcoes cerebrais ou em processos mentais envolvidos na conducao certamente irao afetar o desempenho do condutor. Alteracoes motoras provocadas por drogas ilicitas tem recebido crescente atencao em anos recentes como uma possivel ameaca a seguranca no trânsito. Pesquisas tem indicado a presenca de drogas psicoativas em motoristas mortos ou feridos em acidentes de trânsito, e estudos experimentais mostram prejuizo na performance de individuos sob efeito de drogas. OBJETIVOS: Em razao de esse problema ser pouco discutido em nosso pais, embora seja preocupante, este trabalho visa fornecer dados sobre o problema do uso de drogas por motoristas, a legislacao brasileira vigente sobre drogas e direcao veicular e quais sao as medidas que podem ser adotadas para que os acidentes de trânsito relacionados ao uso de drogas sejam reduzidos. METODOS: Revisao bibliografica de trabalhos publicados nos ultimos quinze anos. RESULTADOS: Os trabalhos mais relevantes apontaram claros indicios de prejuizo na capacidade de dirigir sob efeito de drogas psicotropicas. CONCLUSOES: Todas as drogas psicotropicas causam prejuizos nas funcoes psicomotoras e riscos aumentados de envolvimento em acidentes de trânsito, sendo necessaria uma legislacao especifica que aborde esse tema.

Crack Cocaine Use in Barcelona: A Reason of Worry

In Spain, crack cocaine use is silently increasing. In Barcelona, an intentional sample was selected to describe the general characteristics of this consumption. Participants were submitted to an interview and data were analyzed through qualitative research procedures. Users are young males and of low socioeconomic status and formal education. The major pattern of use is compulsive. Illegal income activities are the choice for crack cocaine or money acquisition, increasing individual and social health costs. Polydrug use is a matter of concern. Although these findings can not be generalized, they should be considered for the development of public policies to adequately address crack cocaine users’ needs.

Alcohol consumption in homicide victims in the city of São Paulo.

AIMS To assess the association between alcohol use and victimization by homicide in individuals autopsied at the Institute of Legal Medicine in São Paulo, Brazil. DESIGN Cross-sectional study. SETTING Excessive consumption of alcohol is a serious public health issue and a major factor in triggering violent situations, which suggests a strong association between alcohol ingestion and becoming a victim of homicide. PARTICIPANTS Data from 2042 victims of homicides in 2005 were obtained from medical examiner reports. MEASUREMENTS The victims gender, age, ethnicity and blood alcohol concentration (BAC) were collected. The method of death and homicide circumstances, as well as the date, time and place of death were also studied. FINDINGS Alcohol was detected in blood samples of 43% of the victims, and mean BAC levels were 1.55 +/- 0.86 g/l. The prevalence of positive BAC levels was higher among men (44.1%) than women (26.6%), P < 0.01. Firearms caused most of the deaths (78.6%), and alcohol consumption was greater among victims of homicide by sharp weapons (P < 0.01). A greater proportion of victims with positive BAC were killed at weekends compared to weekdays (56.4 and 38.5%, respectively; P < 0.01), and the correlation between homicide rates and the average BAC for the central area of the city was positive (r(s) = 0.90; P < 0.01). CONCLUSIONS These results highlight alcohol as a contributing factor for homicide victimization in the greatest urban center in South America, supporting public strategies and future research aiming to prevent homicides and violence related to alcohol consumption.

Blood alcohol levels in suicide by hanging cases in the state of Sao Paulo, Brazil

Suicide is one of the main causes of violent death worldwide, and has become a public health issue. Since alcohol consumption is associated with the increase in the number of suicides and hanging is one of the main methods used worldwide, the present study consists of an epidemiological analysis of BACs in victims of suicide by hanging autopsied in the State of Sao Paulo, Brazil. The objective of the present work was to establish an epidemiological profile and evaluate blood alcohol concentrations in victims of suicide by hanging in the State of São Paulo, Brazil, in the year of 2007. A cross-sectional retrospective study was conducted by collection of secondary data from autopsy reports of victims of hanging. According to the present study, positive results for alcohol were higher in male victims, but the mean BAC was higher in women.

PW 0982 Prevalence of behavioral risk factors for road traffic injuries in the city of sao paulo: findings from the bloomberg initiative for global road safety (BIGRS) 2015–2017

Background Sao Paulo is one of the world’s largest urban areas and it was selected as one of the ten cities for the Bloomberg Initiative for Global Road Safety (BIGRS) project. With nearly 12 million inhabitants and 8 million vehicles, the city has reached a significant decline in road traffic mortality during the last decade (7 deaths per 1 00 000 inhabitants in 2016). Objective To evaluate the performance of interventions aiming to reduce the prevalence of four key road safety risk factors (speeding, drink and driving, seatbelt and helmet use) during 2015–2017 in the city of Sao Paulo, Brazil. Methods Following a baseline study performed in 2015, observational studies monitoring these risk factors were performed twice a year. Six to eight different locations were randomly selected to represent the main regions of the city, where drivers’ behaviors were observed during all days of the week using an internationally validated protocol. Findings The prevalence of speeding at baseline (10%) decreased substantially to 5% in 2016 following citywide speed limit reduction interventions, but increased again (9%) by the end of 2017 after interventions were reverted. Drivers testing above the legal blood alcohol concentration (BAC) limit (0.01%) presented a decreasing trend (from 4.1% to 1.2%); however, more than half of drivers currently refuse breathalyzer tests. Driver’s seatbelt use rate has kept constant at approximately 90%, as well as rear’s passengers usage rate, but at a much smaller proportion (22%). Helmet use among drivers and passengers presented a highly consistent percentage, with nearly all motorcycle drivers wearing helmets correctly. Conclusion and policy implications Speeding and drink driving are the most prevalent risk factors observed among drivers, but interventions addressing these behaviors have demonstrated a positive association with their reduction. Future strategies addressing rear seatbelt use and correct helmet wearing should also be promoted.