Vilma Leyton

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.

Amphetamine, cocaine and cannabinoids use among truck drivers on the roads in the State of Sao Paulo, Brazil

Drugs are important risk factors for traffic accidents. In Brazil, truck drivers report using amphetamines to maintain their extensive work schedule and stay awake. These drugs can be obtained without prescription easily on Brazilian roads. The use of these stimulants can result in health problems and can be associated with traffic accidents. There are Brazilian studies that show that drivers use drugs. However, these studies are questionnaire-based and do not always reflect real-life situations. The purpose of this study was to demonstrate the prevalence of drug use by truck drivers on the roads of Sao Paulo State, Brazil, during 2009. Drivers of large trucks were randomly stopped by police officers on the interstate roads during morning hours. After being informed of the goals of the study, the drivers gave written informed consent before providing a urine sample. In addition, a questionnaire concerning sociodemographic characteristics and health information was administered. Urine samples were screened for amphetamines, cocaine, and cannabinoids by immunoassay and the confirmation was performed using gas chromatography-mass spectrometry (GC-MS). Of the 488 drivers stopped, 456 (93.4%) provided urine samples, and 9.3% of them (n=42) tested positive for drugs. Amphetamines were the most commonly found (n=26) drug, representing 61.9% of the positive samples. Ten cases tested positive for cocaine (23.8%), and five for cannabinoids (11.9%). All drivers were male with a mean age of 40 ± 10.8 years, and 29.3% of them reported some health problem (diabetes, high blood pressure and/or stress). A high incidence of truck drivers who tested positive for drug use was found, among other reported health problems. Thus, there is an evident need to promote a healthier lifestyle among professional drivers and a need for preventive measures aimed at controlling the use of drugs by truck drivers in Brazil.

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.).

Drug Use by Truck Drivers in Brazil

In Brazil, those who are suspected of driving under the influence of drugs are tested only for ethanol. Professional drivers, especially truck drivers, use stimulant drugs to prevent sleeping during long-distance driving. Surveys on the patterns of use of illicit drugs in the workplace have rarely been conducted in Brazil, in spite of the high costs and the potential risk to public health. Since 1996, the authors have been compiling the results of tests, performed in their laboratories, for drugs in urine samples from truck drivers. The drugs analyzed were: amphetamine, methamphetamine, cannabinoids and cocaine. Urine samples (728) were collected in three out of the five geographical regions of Brazil: southeast (517 samples), northeast (161 samples) and south (50 samples). Fluorescence polarization immunoassay and capillary gas chromatography/mass spectrometry were utilized for the urinalyses. The results obtained were as follows: 41 samples (5.63% of the total) tested positive for the drugs being studied. The frequency of positivity of samples was quite similar for the three regions: 6% in the south, 6% in the southeast and 4.35% in the northeast. However, distribution of the drugs in the samples showed regional variations. Results such as those that we have obtained can provide an estimation of the extent of drug use by truck drivers in Brazil.

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.

Detecting Alcohol and Illicit Drugs in Oral Fluid Samples Collected from Truck Drivers in the State of Sao Paulo, Brazil

Objective: Alcohol and drug use by truck drivers is a current problem in Brazil. Though there is evidence that alcohol consumption is occurring in higher proportions, the use of stimulant drugs to avoid fatigue and to maintain the work schedule has also been reported. The purpose of this study was to estimate the incidence of alcohol and illicit drug use among truck drivers on São Paulo state roads. São Paulo is the most populous state in Brazil and has the largest industrial park and economic production in the country. Methods: Data were assessed not only using a questionnaire but also, and more reliably, through toxicological analysis of oral fluid samples. Between the years 2002 and 2008, 1250 oral fluid samples were collected from truck drivers on the roads during morning hours. The samples were tested for the presence of alcohol, cocaine, tetrahydrocannabinol (THC), and amphetamine/methamphetamine. A previously published, validated gas chromatographic (gas chromatography–flame ionization detection and gas chromatography–mass spectrometry) method was applied to the samples for alcohol and drug detection. Results: Of the total analyzed samples, 3.1 percent (n = 39) were positive: 1.44 percent (n = 18) were positive for alcohol, 0.64 percent (n = 8) for amphetamines, 0.56 percent (n = 7) for cocaine, and 0.40 percent (n = 5) for THC. In one case, cocaine and THC were detected. The results are indicative of the extent of alcohol and drug use by truck drivers in the state of São Paulo, Brazil. Conclusions: This research provides evidence that not only alcohol but also illicit drug use is a real problem among professional drivers. The use of these substances should be controlled to better promote safe driving conditions on Brazilian roads.

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.

Determination of opiates in whole blood and vitreous humor: a study of the matrix effect and an experimental design to optimize conditions for the enzymatic hydrolysis of glucuronides.

Undoubtedly, whole blood and vitreous humor have been biological samples of great importance in forensic toxicology. The determination of opiates and their metabolites has been essential for better interpretation of toxicological findings. This report describes the application of experimental design and response surface methodology to optimize conditions for enzymatic hydrolysis of morphine-3-glucuronide and morphine-6-glucuronide. The analytes (free morphine, 6-acetylmorphine and codeine) were extracted from the samples using solid-phase extraction on mixed-mode cartridges, followed by derivatization to their trimethylsilyl derivatives. The extracts were analysed by gas chromatography-mass spectrometry with electron ionization and full scan mode. The method was validated for both specimens (whole blood and vitreous humor). A significant matrix effect was found by applying the F-test. Different recovery values were also found (82% on average for whole blood and 100% on average for vitreous humor). The calibration curves were linear for all analytes in the concentration range of 10-1,500 ng/mL. The limits of detection ranged from 2.0 to 5.0 ng/mL. The method was applied to a case in which a victim presented with a previous history of opiate use.

Hollow-fiber liquid-phase microextraction and gas chromatography-mass spectrometry of barbiturates in whole blood samples

Here, we present a method for measuring barbiturates (butalbital, secobarbital, pentobarbital, and phenobarbital) in whole blood samples. To accomplish these measurements, analytes were extracted by means of hollow-fiber liquid-phase microextraction in the three-phase mode. Hollow-fiber pores were filled with decanol, and a solution of sodium hydroxide (pH 13) was introduced into the lumen of the fiber (acceptor phase). The fiber was submersed in the acidified blood sample, and the system was subjected to an ultrasonic bath. After a 5 min extraction, the acceptor phase was withdrawn from the fiber and dried under a nitrogen stream. The residue was reconstituted with ethyl acetate and trimethylanilinium hydroxide. An aliquot of 1.0 μL of this solution was injected into the gas chromatograph/mass spectrometer, with the derivatization reaction occurring in the hot injector port (flash methylation). The method proved to be simple and rapid, and only a small amount of organic solvent (decanol) was needed for extraction. The detection limit was 0.5 μg/mL for all the analyzed barbiturates. The calibration curves were linear over the specified range (1.0 to 10.0 μg/mL). This method was successfully applied to postmortem samples (heart blood and femoral blood) collected from three deceased persons previously exposed to barbiturates.