Relationship Between Alcohol Use and Firearm-Involved Suicide: Findings From the National Violent Death Reporting System, 2003-2020

INTRODUCTION

Acute alcohol intoxication is a contributing factor in firearm-involved suicides. However, knowledge of the relationship between alcohol intoxication and firearm-involved suicide by age and sex (defined herein as the biological sex of the decedent) is limited. The purpose of the current study was to evaluate the sex- and age group-specific relationship between alcohol intoxication and firearm-involved suicide.

METHODS

Data from the National Violent Death Reporting System, 2003-2020, on suicide decedents (18+ years of age) were utilized. Age-group- and sex-specific multivariate binary logistic regression analyses were conducted. Statistical analyses were performed in 2023.

RESULTS

Alcohol intoxication (i.e., having a blood alcohol concentration of 0.08 g/dL or more) was significantly associated with using a firearm as the method of suicide for young (18-34 years; relative risk (RR)=1.31, 95% CI: 1.22-1.40) and middle-aged (35-64 years; RR=1.34, 95% CI: 1.27-1.39) females but not among older females (65+ years; RR=1.01, 95% CI: 0.87-1.17). Among males, the association was significant for all age-groups (young: RR=1.28, 95% CI: 1.25-1.30; middle-aged: RR=1.17, 95% CI: 1.15-1.19; and older: RR=1.04, 95% CI: 1.01-1.07).

CONCLUSIONS

Among males of all ages and young and middle-aged females, alcohol intoxication was associated with increased risk of suicide by firearm-an extremely lethal method that accounts for a majority of suicides in the U.S.-compared to their non-intoxicated counterparts. Interventions targeting excessive alcohol consumption may be effective in reducing suicide mortality rates.

Alcohol and drug use among road users involved in fatal crashes in Norway

OBJECTIVE

To study the prevalence of alcohol and drugs in biological samples from drivers, motorcycle riders, bicyclists, and pedestrians involved in fatal road traffic crashes (RTCs) during 2016-2018 in Norway, both among fatally injured victims and those who survived fatal RTCs.

METHODS

Anonymous information was extracted from police data. No personal data were recorded.

RESULTS

There were 330 fatal RTCs with 349 killed road users and 384 survivors during the study period; this included 179 passengers who were excluded from the study. In total, 90% of the studied killed road users and 67% of the survivors were investigated for alcohol or drug use by analyzing biological samples. Alcohol or drugs in concentrations above the legal limits were detected in 21% of the analyzed samples. The proportion impaired by alcohol or drugs (blood alcohol concentrations equal to or greater than 0.05%, or drug concentrations above equivalent limits) was highest among killed bicyclists (43%), higher than among killed pedestrians (24%), car and van drivers (28%) and motorcyclists (20%), and significantly higher than among drivers who survived fatal crashes (4%).

CONCLUSIONS

Impairment due to use of alcohol or drugs was often a contributing factor among bicyclists, pedestrians and motor vehicle drivers who died in RTCs. Driving under the influence of alcohol or drugs was more often a contributing factor in cases where the motor vehicle driver was killed than in cases where the driver survived.

Suicide, Alcohol Intoxication, and Age Among Whites and American Indians/Alaskan Natives

BACKGROUND

Among American Indians/Alaskan Natives (AI/ANs), suicides are disproportionately high among those younger than 40 years of age. This paper examines suicide and alcohol intoxication (postmortem BAC ≥ 0.08 g/dl) by age among Whites and AI/ANs to better understand the reasons for the high rate of suicide among AI/ANs for those younger than 40.

METHODS

Data come from the restricted 2003 to 2016 National Violent Death Reporting System (NVDRS), with postmortem information on 79,150 White and AI/AN suicide decedents of both genders who had a BAC test in 32 states of the United States.

RESULTS

Among Whites, 39.3% of decedents legally intoxicated are younger than 40 years of age, while among AI/ANs the proportion is 72.9% (p < 0.001). Multivariable logistic regression with data divided by age shows that in the 18 to 39 age group, AI/ANs are about 2 times more likely than Whites to have a postmortem BAC ≥ 0.08. Veteran status compared to nonveteran, and history of alcohol problems prior to suicide were also associated with BAC ≥ 0.08. Suicide methods other than by firearm and a report of the presence of 2 or more suicide precipitating circumstances were protective against BAC ≥ 0.08. Results for the age group 40 years of age and older mirror those for the younger group with 1 exception: Race/ethnicity was not associated with BAC level.

CONCLUSIONS

The proportion of suicide decedents with a BAC ≥ 0.08 is higher among AI/ANs than Whites, especially among those 18 to 39 years of age. However, acute alcohol intoxication does not fully explain differences in suicide age structure between AI/ANs and Whites.

Minimum Legal Drinking Age and Youth Health: Evidence From Japan

OBJECTIVE

Recent studies showed that reducing the minimum legal drinking age (MLDA) could cause negative health outcomes among youth. This evidence was drawn primarily from a limited set of geographical regions. This study seeks to widen available evidence by using data from Japan, where the government started considering reducing the MLDA from 20 to 18.

METHOD

Using a regression discontinuity design, we compared emergency service event rates related to alcohol intoxication and mortality rates through external causes between those who were slightly younger and older than the age of 20.

RESULTS

We showed that granting legal access to alcohol at age 20 doubled the use of emergency services used for alcohol intoxication but had little impact on mortality as measured by traffic fatalities, suicide, and other accidents.

CONCLUSIONS

Our findings suggest that lowering the MLDA in Japan will increase (potentially reckless and excessive) drinking behavior among young adults ages 18 and 19 but will not increase their mortality from accidents.

The Relationship Between a Person's Criminal History, Immediate Situational Factors, and Lethal Versus Non-Lethal Events

When investigating serious violence, studies tend to look primarily at offenders and their background. This study investigates the influence of offenders' and victims' criminal history and immediate situational factors on the likelihood that violent events will end lethally. For this purpose, we compare lethal with non-lethal events, and combine Dutch criminal records with data from court files of those involved in lethal (i.e., homicide, n = 126) versus non-lethal events (i.e., attempted homicide, n = 141). Results reveal that both criminal history and immediate situational factors clearly matter for the outcome of violent events; however, immediate situational factors have the strongest effect on violent outcomes.

Age of first drunkenness and risks for all-cause mortality: A 27-year follow-up from the epidemiologic catchment area study

BACKGROUND

Early-onset drunkenness is associated with an increased risk of developing an alcohol use disorder (AUD), which predicts excess mortality risk. Here, we estimated mortality risk for drinkers with and without early drunkenness.

METHODS

For 14,848 adult participants interviewed about drinking, drunken episodes, and AUD in 1981-83 for the Epidemiologic Catchment Area in New Haven (Connecticut), Baltimore (Maryland), St. Louis (Missouri), and Durham (North Carolina), we linked National Death Index records through 2007.

RESULTS

Cox regression modeling estimates showed excess mortality for drinkers with age of first drunkenness earlier than 15 years old (hazard ratio, HR: 1.47, 95% CI: 1.25, 1.72) and when first drunkenness occurred at or after age 15 (HR: 1.20, 95% CI: 1.11, 1.29), as compared with adults who had never been drunk. Consistent results were observed, irrespective of AUD history. That is, early drunkenness signaled excess mortality risk even in absence of AUD.

CONCLUSIONS

In a large community sample from four cities in the US, early age of onset of drunkenness predicts mortality risk. We discuss experiments to investigate the possible causal significance of this predictive association.

[Alcohol-associated mortality in Russia (based on the materials for the period from 2011 till 2016)]

The objective of the present study was to evaluate the frequency of alcoholic drunkenness documented during forensic medical expertises (investigations) of the corpses carried out in this country throughout the period from 2011 till 2016. The investigations were conducted with the use of medical statistics methods by calculating the fractional difference, dynamics, and rates of detection of the cases of alcoholic intoxication depending on the cause of death. The study has demonstrated the high frequency of the cases of alcoholic drunkenness revealed during forensic medical expertises (investigations) of the corpses that amounted to 30.5% [15, 16]. The total number of the corpses examined in 2016 was 8.6% higher than in 2011. The frequency of the documented cases of alcoholic drunkenness during the same period decreased by 19.7%. The frequency of the documented cases of alcoholic drunkenness in the cases of violent death was 2.8 times that in the cases of death from various diseases (52.8 and 19.0% respectively). The enhanced frequency of alcoholic drunkenness in relation to the number of the conducted forensic medical expertises was documented in the cases of death by drowning and from hypothermia whereas the lowest frequency of alcoholic intoxication was recorded for the corpses of the people who had died from malignant tumours and diseases of the nervous system. Various regions of Russia differed in terms of the frequency of alcoholic drunkenness recorded among the recently deceased people.

Influence of alcohol use on mortality and expenditure during hospital admission: a cross-sectional study

OBJECTIVES

This study was designed to investigate the effect of alcohol intoxication on clinical presentation of hospitalised adult trauma patients at a Level I trauma centre using propensity score matching.

DESIGN

Cross-sectional study.

SETTING

Taiwan.

PARTICIPANTS

Detailed data of 929 hospitalised adult trauma patients with alcohol intoxication, aged 20-65 years, and 10 104 corresponding patients without alcohol intoxication were retrieved from the Trauma Registry System between 1 January 2009 and 31 December 2014. Alcohol intoxication was defined as a blood alcohol concentration (BAC) ≥50 mg/dL.

MAIN OUTCOME MEASURES

In-hospital mortality and expenditure.

RESULTS

Patients with alcohol intoxication presented with significantly higher short-term mortality (OR: 3.0, 95% CI 2.0 to 4.4; p<0.001) than patients without alcohol intoxication. However, on comparison with propensity score-matched patients with respect to sex, age, comorbidity, Glasgow Coma Scale (GCS), injury region based on Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), alcohol intoxication did not significantly influence mortality (OR: 0.8, 95% CI 0.5 to 1.4; p=0.563). This implied that the higher mortality of alcohol-intoxicated patients was attributable to patient characteristics such as a higher injury severity rather than alcohol intoxication. Even on comparison with sex-matched, age-matched and comorbidity-matched patients without alcohol intoxication, patients with alcohol intoxication still had significantly higher total expenditure (17.4% higher), cost of operation (40.3% higher), cost of examination (52.8% higher) and cost of pharmaceuticals (38.3% higher).

CONCLUSIONS

The associated higher mortality of adult trauma patients with alcohol intoxication was completely attributable to other patient characteristics and associated injury severity rather than the effects of alcohol. However, patients with alcohol intoxication incurred significantly higher expenditure than patients without alcohol intoxication, even on comparison with sex-matched, age-matched and comorbidity-matched patients without alcohol intoxication.

Uber and Metropolitan Traffic Fatalities in the United States

Uber and similar rideshare services are rapidly dispersing in cities across the United States and beyond. Given the convenience and low cost, Uber has been characterized as a potential countermeasure for reducing the estimated 121 million episodes of drunk driving and the 10,000 resulting traffic fatalities that occur annually in the United States. We exploited differences in the timing of the deployment of Uber in US metropolitan counties from 2005 to 2014 to test the association between the availability of Uber's rideshare services and total, drunk driving-related, and weekend- and holiday-specific traffic fatalities in the 100 most populated metropolitan areas in the United States using negative binomial and Poisson regression models. We found that the deployment of Uber services in a given metropolitan county had no association with the number of subsequent traffic fatalities, whether measured in aggregate or specific to drunk-driving fatalities or fatalities during weekends and holidays.

[PROGNOSTIC SIGNIFICANCE OF CHANGES OF BLOOD GLUCOSE LEVEL IN PATIENTS WITH THORACOABDOMINAL INJURIES.]

Background Currently, one of the causes of high morbidity and mortality is injuries. Predict the outcome of injuries - it is an important task of the treating physician. Trauma is a stress factor so to predict the outcome, you can use markers of stress, the most accessible ofwhich is blood glucose.

THE AIM

to reveal the dynamics of the relationship between blood glucose levels and the outlook for the life ofpatients with thoracoabdominal injuries.

MATERIALS AND METHODS

A retrospective analysis of medical records of hospitalized patients were divided into two groups, depending on the outlook for the life of (favorable or unfavorable), and each of the groups - into two subgroups according to the presence or absence of signs of intoxication at admission. The subgroups were calculated and compared the mean blood glucose levels at different hours of hospital treatment.

RESULTS

It was found that the average blood glucose levels at various hours of hospital stay were significantly higher in patients with poor outcome. The most noticeable was the difference in the first days of hospital treatment. Signs of intoxication was associated with lower values of glucose and a tendency to hypoglycaemia. In addition, among patients with high blood glucose ( 8 mg / dL) was observed over deaths in the first day of hospital stay.

CONCLUSION

High blood glucose levels ( 8,0 mmol / L) in the first day of hospital treatment is a predictor ofpoor outcome in patients with thoracoabdominal injuries.

Alcohol-related deaths - a retrospective study from the region of northern Slovakia

The study of cases with post mortem blood ethanol concentration of 2.00 g/kg and higher was performed at the Institute of Forensic Medicine in Martin, covering the region of North Slovakia. The aim of the study was to quantify the fatal consequences of acute ethanol administration reflecting in the annual mortality range, establish the causes of death, age and gender distribution of the deceased population, place and time parameters of deaths. The analyzed period was throughout the years 1993-2012.

[Specific features of suicides committed in a state of alcoholic intoxication]

The objective of the present work was to study the specific features of suicides committed in a state of alcoholic intoxication in 1985, 1995, and 2010 based on the materials collected by the Central Bureau of Forensic Medical Expertise, Ministry of Health of Republic Uzbekistan. It was shown that the blood alcohol content in the subjects committing suicide tended to decrease during the aforementioned periods which does not confirm the opinion that limitations on alcohol consumption reduces the frequency of suicide attempts. Most cases of completed suicide among the residents of Tashkent were recorded in a group of men of the medium and advanced age in the state of alcoholic intoxication. The immediate cause of death in the majority of such cases was mechanical asphyxia due to hanging.

Recent Developments in Health Insurance, Life Insurance, and Disability Insurance Law

This year's article covers key recent developments in life, health, and disability insurance law, including Supreme Court decisions on the constitutionality of the Affordable Care Act's contraception coverage provisions and on the enforceability of legal actions limitations period provisions in Employee Retirement Income Security Act (ERISA) plan documents; an alarming (but potentially short-lived) expansion of restitution as a form of "equitable relief" under ERISA; the latest battles in the stranger originated life insurance (STOLI) wars; and perennial issues arising out of disability and accident insurance cases.

[The determination of the low and medium molecular weight substances in the blood serum as the additional diagnostic criterion in the cases of lethal poisoning with narcotic drugs]

The objective of the present study was the comparative analysis of the concentrations of the low and medium molecular weight substances in the blood serum in the cases of lethal poisoning with narcotic drugs, alcoholic intoxication, and endogenous intoxication associated with various diseases. The spectrogram profile of the low and medium molecular weight substances present in the blood serum obtained in the case of lethal poisoning with narcotic drugs exhibited a peak at 260-274 nm that was not found in an analogous profile in the case of alcoholic intoxication or a disease. It is concluded that the proposed analysis can be used as an additional diagnostic criterion for the documentation of poisoning with narcotic drugs and/or other potent agents.

Analysis of factors associated with injury severity in crashes involving young New Zealand drivers

Young people are a risk to themselves and other road users, as motor vehicle crashes are the leading cause of their death. A thorough understanding of the most important factors associated with injury severity in crashes involving young drivers is important for designing well-targeted restrictive measures within youth-oriented road safety programs. The current study estimates discrete choice models of injury severity of crashes involving young drivers conditional on these crashes having occurred. The analysis examined a comprehensive set of single-vehicle and two-vehicle crashes involving at least one 15-24 year-old driver in New Zealand between 2002 and 2011 that resulted in minor, serious or fatal injuries. A mixed logit model accounting for heterogeneity and heteroscedasticity in the propensity to injury severity outcomes and for correlation between serious and fatal injuries proved a better fit than a binary and a generalized ordered logit. Results show that the young drivers' behavior, the presence of passengers and the involvement of vulnerable road users were the most relevant factors associated with higher injury severity in both single-vehicle and two-vehicle crashes. Seatbelt non-use, inexperience and alcohol use were the deadliest behavioral factors in single-vehicle crashes, while fatigue, reckless driving and seatbelt non-use were the deadliest factors in two-vehicle crashes. The presence of passengers in the young drivers' vehicle, and in particular a combination of males and females, dramatically increased the probability of serious and fatal injuries. The involvement of vulnerable road users, in particular on rural highways and open roads, considerably amplified the probability of higher crash injury severity.

[Recreational boating accidents--Part 2: Causes of accidents and deaths]

According to Naeve, forensic medicine also deals with medical topics concerning accidents associated with watercrafts. This field is not limited to the open sea but also refers to rivers and lakes. In the presented study, fatal boating accidents were investigated over a period of four decades. The majority of the victims died from hypothermia and drowning. The article points out the difficulty to prove hypothermia in cases with a short survival time. Medical expert opinions on deaths due to boating accidents must not ignore the results of the technical and nautical investigations--the more so as the hydrometeorological situation may be crucial for the outcome. Too little attention is still paid to circulatory shock occurring in connection with the pathophysiology of hypothermia and drowning, although it may have a decisive influence on the effectiveness of rescue measures. The final assessment of fatalities in users of watercrafts should always be left to experienced specialists.

Does alcohol intoxication protect patients from severe injury and reduce hospital mortality? The association of alcohol consumption with the severity of injury and survival in trauma patients

Alcohol-related motor vehicle collisions are a major cause of mortality in trauma patients. This prospective observational study investigated the influence of antecedent alcohol use on outcomes in trauma patients who survived to reach the hospital. From 2005 to 2011, all patients who were older than 18 years and were admitted as a result of motor vehicle crashes were included. Blood alcohol concentration (BAC) was routinely measured for each patient on admission. Patients were divided into four groups based on their BAC level, which included nondrinking, BAC less than 100, BAC 100 to 200, and BAC 200 mg/dL or greater. Patient demographics, physical status and injury severity on admission, length of hospital stay, and outcome were compared between the groups. Odds ratios of having a severe injury, prolonged hospital stay, and mortality were estimated. Patients with a positive BAC had an increased risk of sustaining craniofacial and thoracoabdominal injuries. Odds ratios of having severe injuries (Injury Severity Score [ISS] 16 or greater) and a prolonged hospital stay were also increased. However, for those patients whose ISS was 16 or greater and who also had a brain injury, risk of fatality was significantly reduced if they were intoxicated (BAC 200 mg/dL or greater) before injury. Alcohol consumption does not protect patients from sustaining severe injuries nor does it shorten the length of hospital stay. However, there were potential survival benefits related to alcohol consumption for patients with brain injuries but not for those without brain injuries. Additional research is required to investigate the mechanism of this association further.

Alcohol intoxication in road traffic accidents leads to higher impact speed difference, higher ISS and MAIS, and higher preclinical mortality

Alcohol is one of the most important personal risk factors for serious and fatal injuries, contributing to approximately one third of all deaths from accidents. It is also described that alcohol intoxication leads to a higher mortality in the clinical course. In this study, we hypothesized that alcohol intoxication leads to different accident kinematics, a higher ISS (Injury Severity Score), and higher preclinical mortality compared to sober patients. A technical and medical investigation of alcohol intoxicated road users was performed on the scene of the crash and at the primary admitting hospital. Alcohol testing was performed with either breath alcohol tests or measurement of blood alcohol concentration (BAC) in a standard laboratory test. Between 1999 and 2010, 37,635 road traffic accidents were evaluated by the Accident Research Unit. Overall 20,741 patients were injured, 2.3% of the patients were killed. Among the injured patients, 2.2% with negative BAC were killed, compared to 4.6% fatal injuries in patients with a positive BAC (p < 0.0001). Of the patients with a positive BAC, 8.0% were severely injured, compared to 3.6% in the BAC negative group (p < 0.0001). Regarding the relative speed at impact (Δv for motorized drivers, vehicle collision speed for pedestrians and bikers), there was a significant higher difference for BAC positive patients (30 ± 20) compared to the BAC negative patients (25 ± 19, p < 0.0001). Alcohol intoxication in trauma patients leads to higher preclinical mortality, higher impact speed difference, and higher injury severity. The subgroup analysis for different alcohol concentrations shows no difference in ISS, MAIS, and relative speed, but a correlation of increasing age of patients with higher alcohol concentrations.

[The dynamics of population mortality due to acute alcoholic intoxications in the Russian Federation]

The article deals with the study of dynamics of population mortality in the Russian Federation as a result of acute intoxications in 2001-2010. In the Russian Federation, during the examined period, population mortality due to casual acute alcoholic intoxications decreased up to 2.1 times. The most rapid race of mortality decrease occurred in the Central Federal Okrug and the slowest race was established in the Siberian Okrug. The highest population mortality rate as a result of alcoholic intoxications is in the Siberian Okrug and the lowest ones--in the South Okrug. The analysis of mortality rates as a result of chemical intoxications and their dynamics will allow to assess the toxicological situation and to determine the strategic directions of preventive activities in the area of chemical security on the regional level.

Immediate fatal outcome vs. fatal outcome within the first 48 hours following a severe traffic trauma--analysis of the possible effect of alcohol intoxication on the outcome

This paper is a retrospective analysis of data on 278 persons with fatal outcomes in traffic accidents in Osjecko--baranjska County, Croatia, during a five-year period. The observed sample of casualties was divided according to the time of fatal outcome into three groups: immediately deceased (139 or 50.0%), deceased within the first 48 hours (84 or 30.2%) and deceased after 48 hours (55 or 19.8%). A comparison of data was made for the first two groups of casualties, based on the level of alcohol intoxication, and an analysis of the possible influence of alcohol intoxication on an early outcome of severe trauma, which was defined as immediate fatal outcome and fatal outcome within the first 48 hours following the trauma. Casualties from the group of immediately deceased had a significantly higher average blood alcohol level than casualties from the group of persons deceased within the first 48 hours (shown through arithmetic mean of 0.81 g/kg vs. 0.33 g/kg, p =0.000). A binary logistic regression analysis showed that every increase in blood alcohol level by 1 g/kg also increased the odds of an immediate fatal outcome by 1.92 times (p=0.004).

CONCLUSION

Beside increased risks of traffic accidents, the collected data showed that alcohol intoxication of accident participants also increases their chances of an immediate fatal outcome.

[Causes of the people death from drunkenness and alcoholism]

We analyzed causes of 1008 people death, who abused by alcohol. Among them 2 groups were separated out: people died due to drunkenness and due to alcoholism. The structure of the death was similar in the both groups, however depended on alcoholism stages. The major cause of the death in group of drunkenness people was acute heart insufficiency, less commonly--lung pathology, and very rarely--brain vessels pathology and liver cirrhosis. In group of people, who died due to alcoholism, lung pathology was the major cause of these deaths, acute heart insufficiency was occurred less commonly, and very rare brain pathology because of delirium tremens or alcohol withdrawal syndrome, as so liver cirrhosis with complications. Hemorrhagic pancreonecrosis after alcoholic excess was found out in both groups, but it was more often in people, who died due to drunkenness. Obtained results show importance of chronic alcoholism identification as a disease with several stages including drunkenness and alcoholism.

[Dosis sola facit venenum: outcome of intoxications in a Swiss university hospital]

Poisoning is a frequent disease in an emergency division. During four years we observed patients with poisoning related to there reason of intoxication, the degree of severity, age group and sex, and tried to make conclusions about lethal outcome on behalf of our data. The severity was defined by the «poison severity scale» (PSS). 1515 patients with intoxication in four years were documented. 152 (10%) of them had a severe intoxication or lethal outcome. In women suicide predominated as reason of severe intoxication, whereas in men an abuse of alcool and drugs was mostly seen. A multidisciplinary approach is important for handling intoxicated patients. Our investigation showed a good somatical outcome of patients with severe intoxication. Mortality was 5% (7/152 patients).

Substance use and social, health and safety-related factors among fatally injured drivers

OBJECTIVE

The aim of this study was to examine different socio-demographic, health and safety-related factors, and psychoactive substance use among fatally injured drivers in road traffic accidents in Finland during 2006-2008.

METHODS

An accident information register maintained by the Traffic Safety Committee of Insurance Companies (VALT) of the Finnish Motor Insurers' Centre was used as basic data, and the basic data were complemented with further toxicological analytical information retrieved from autopsy reports from the Department of Forensic Medicine, Helsinki University. The data included all the drivers (n=556) who were driving a motor vehicle and who died in a road traffic accident in Finland during 2006-2008.

RESULTS

Of all the 556 fatally injured drivers 43% (n=238) had psychoactive substance findings. 51% (n=121) of substance positive drivers had a finding for alcohol only, the rest had a finding for one or more illicit/medicinal drugs impairing driving ability, and possibly also alcohol. Fatally injured drivers with alcohol findings were significantly younger (mean age 34 years) than sober drivers (mean age 44 years) or drivers with findings for drugs (mean age 45 years). Socio-demographic background did not differ substantially among drunken/drugged and sober drivers, although drivers with alcohol findings had a slightly lower education and socioeconomic position. Previous substance abuse problems were highly prevalent among drivers with substance findings and mental or both mental and physical health problems were more common among drivers with drug findings. The non-use of safety equipment and driving at a high speed were more common among fatally injured drivers with substance findings.

CONCLUSIONS

Substance abuse and mental health problems, as well as reckless driving behavior were more pronounced among fatally injured drivers with substance findings when compared to sober drivers. Thus, prevention and early intervention concerning substance abuse, mental health problems and DUI are essential. Improved traffic safety cannot be achieved by means of traffic policy only, but integration with other policies, such as health and social policy should be strengthened.

The effectiveness of alcohol control policies on alcohol-related traffic fatalities in the United States

Multiple alcohol control policies have been enacted since the early 1980s to keep drunk drivers off the roads and to prevent more alcohol-related traffic fatalities. In this paper, we analyze nine traffic policies to determine the extent to which each policy contributes to effective alcohol-related fatality prevention. Compared with the existing literature, this paper addresses a more comprehensive set of traffic policies. In addition, we used a panel GLS model that holds regional effects and state-specific time effects constant to analyze their impact on alcohol-related fatalities with two distinct rates: alcohol-related traffic deaths per capita and alcohol-related traffic deaths per total traffic deaths. While per capita alcohol-related traffic deaths is used more often in other studies, alcohol-related traffic deaths per total traffic deaths better reflects the impact of policies on deterring drunk driving. In addition, regional analyses were conducted to determine the policies that are more effective in certain regions. The findings of this study suggest that zero tolerance laws and increased beer taxes are the most effective policies in reducing alcohol-related fatalities in all regions.

Main characteristics of train-pedestrian fatalities on Finnish railroads

The aim of this study was to describe the frequency of fatalities, timing of collisions and characteristics of persons killed in train-pedestrian collisions on Finnish railways during 2005-2009. In addition, the Finnish results were compared with those collected in Sweden. The Finnish data were combined from five different sources. The results showed that 311 pedestrians were killed in train-pedestrian collisions, including 264 suicides, 35 accidents and 12 unclassified events. For each event type, most of the victims were male. Most suicide victims were in the 20-29 year age group and on average younger than people who chose some other form of suicide. About half of all victims were intoxicated by alcohol, medicines and/or drugs. Both suicides and accidents occurred most often at the end of the week but no specific peak for time of year was found. Suicides occurred most frequently from afternoon to night and accidents during the rush hours. Most train-pedestrian fatalities happened in densely populated areas. In conclusion, the effective prevention of railway suicides and accidents calls for a systems approach involving effective measures introduced by authorities responsible for urban planning, railways, education and public health.

[The effect of alcohol consumption on the severity of injuries, prognosis and mortality--a review of literature]

The paper is a review of the most current academic literature published in the English language and addressing the effect of alcohol consumption on the severity of injuries, prognosis and mortality with special emphasis placed on the consultative usefulness of such publications. The report was inspired by repeated questions asked in association with expert opinions on the effects of injuries and addressing a possible effect of alcohol consumption by the victims on the severity of injuries and prognosis. In case of such questions, a valuable supplement to an opinion based on on the expert's professional experience may be found in an analysis of publications focusing on the subject. The present review was based on two databases "Web of science" and "Medline" (2000-2011). Initially, 372 abstracts were taken into account. Subsequently, 42 articles were thoroughly studied. The analyzed material represented both experimental and research approaches to the problem. The experimental approach was based on tests carried out on animals in laboratories, whereas the research approach was based on the observations of patients admitted to hospitals with injuries. The literature overview indicates a neuroprotective feature of alcohol and an improved prognosis in intoxicated people suffering from isolated head injuries, even though the severity of their injuries is much higher than in the cases of sober people. In cases of polytrauma injuries, the influence of alcohol is explicitly negative, but does not increase mortality.

Diminishing trend in alcohol poisoning mortality in Estonia: reality or coding peculiarity?

AIMS

To examine whether the changes in coding practice could reduce alcohol poisoning mortality rates in Estonia.

METHODS

Individual death records in 1983-2009 (age at death 25-64) were used to calculate the 3-year moving averages of age-standardized mortality rates. From 2000 onwards, there was a sharp increase in mortality from mental disorders due to alcohol, and at the same time a remarkable decrease in alcohol poisoning mortality. We calculated expected alcohol poisoning mortality rates for 2000-2009, assuming that mortality rate ratio of alcohol poisoning and mental disorders due to alcohol remained stable.

RESULTS

Alcohol poisoning mortality rates fluctuated considerably, being the lowest in 1988 and the highest in 1994-1995. A sharp decline started in 2000. Expected alcohol poisoning mortality rates continued their growth from 2000 onwards with a small decrease in 2006-2009. Mortality rates of mental disorders due to alcohol followed the same curve as alcohol poisoning rates up to 1999, being roughly 10 times lower than alcohol poisoning rates in both genders. From 2000 onwards, mortality from mental disorders due to alcohol increased rapidly, exceeding alcohol poisoning mortality in 2006.

CONCLUSION

This study demonstrates an obvious misclassification in coding of alcohol poisoning and mental disorders due to alcohol as underlying causes of death in the Estonian Causes of Death Registry.

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.).

Alcohol, psychoactive drugs and fatal road traffic accidents in Norway: a case-control study

A case-control study was conducted on 204 drivers fatally injured in road traffic accidents in south-eastern Norway during the period 2003-2008. Cases from single vehicle accidents (N = 68) were assessed separately. As controls, 10540 drivers selected in a roadside survey in the same geographical area during 2005-2006 were used. Blood samples were collected from the cases and oral fluid (saliva) samples from the controls. Samples were analysed for alcohol, amphetamines, cannabis, cocaine, opioid analgesics, hypnotics, sedatives and a muscle relaxant; altogether 22 psychoactive substances. Equivalent cutoff concentrations for blood and oral fluid were used. The risk for fatal injury in a road traffic accident was estimated using logistic regression adjusting for gender, age, season of the year, and time of the week. The odds for involvement in fatal road traffic accidents for different substances or combination of substances were in increasing order: single drug < multiple drugs < alcohol only < alcohol+drugs. For single substance use: medicinal drug or THC < amphetamine/methamphetamine < alcohol. For most substances, higher ORs were found when studying drivers involved in single vehicle accidents than for those involved in multiple vehicle accidents, but confidence intervals were wider.

[On the importance of a comprehensive study for diagnostics of death from acute ethanol poisoning and coronary heart disease]

Over 30 000 cases of acute poisoning with ethyl alcohol and its surrogates are recorded annually in this country. Differential diagnostics between fatal poisoning and death from coronary heart disease encounters serious difficulties. The authors report a comprehensive forensic chemical, morphometric, and pathomorphological study of the activity of ethanol-oxidizing enzyme systems in the internal organs. The results of histochemical examination provide a basis for the extension of diagnostic potential of the available methods and the enhancement of the objective value of expert reports.

Risk factors for fatal crashes in rural Australia

This paper presents findings from the rural and remote road safety study, conducted in Queensland, Australia, from March 2004 till June 2007, and compares fatal crashes and non-fatal but serious crashes in respect of their environmental, vehicle and operator factors. During the study period there were 613 non-fatal crashes resulting in 684 hospitalised casualties and 119 fatal crashes resulting in 130 fatalities. Additional information from police sources was available on 103 fatal and 309 non-fatal serious crashes. Over three quarters of both fatal and hospitalised casualties were male and the median age in both groups was 34 years. Fatal crashes were more likely to involve speed, alcohol and violations of road rules and fatal crash victims were 2½ times more likely to be unrestrained inside the vehicle than non-fatal casualties, consistent with current international evidence. After controlling for human factors, vehicle and road conditions made a minimal contribution to the seriousness of the crash outcome. Targeted interventions to prevent fatalities on rural and remote roads should focus on reducing speed and drink driving and promoting seatbelt wearing.

Characteristics of fatal motorcycle crashes into roadside safety barriers in Australia and New Zealand

This paper reports on the findings of a retrospective case series study of fatal motorcyclist-roadside barrier collisions. Cases were retrieved from the National Coroners Information System (NCIS), the coronial case files of Australian jurisdictions, and the Crash Analysis System (CAS) of the New Zealand Transport Agency. Seventy seven (77) motorcycle fatalities involving a roadside barrier in Australia and New Zealand were examined. The fatalities usually involved a single vehicle crash and young men. The roadside barriers predominantly involved were steel W-beams, typically on a bend in the horizontal alignment of the road. A majority of fatalities occurred on a weekend, during daylight hours, on clear days with dry road surface conditions indicating predominantly recreational riding. Speeding and driving with a blood alcohol level higher than the legal limit contributed to a significant number of these fatalities.

The endurance of the effects of the penalty point system in Spain three years after. Main influencing factors

In this work we have used ARIMA time series models to analyse the contribution of the penalty point system, the most important legislative measure for driving licences, in reducing the number of fatalities over 24h on the roads in Spain during the study period (January 1995 to June 2009). In addition, because of this long period of analysis, other control variables were introduced to model the enactment of the Reform of the Penal Code in December 2007, together with other more specific effects needed to fit the model correctly. The ARIMA intervention models methodology combines the basic features of specific times series models: it controls the trend and seasonal variation in data that is present when modelling the structure through autoregressive and moving average parameters and allows for inserting step or impulse input variables for checking and evaluating the effects of deterministic measures, such as legislative changes which are the object of study in this work. This paper analyses the surveillance and control measures introduced in the periods before and after the implementation of the penalty point system and helps to partly explain its apparent endurance over time. The results show that the introduction of the penalty point system in Spain had a very positive effect in reducing the number of fatalities (over 24h) on the road, and that this effect has endured up to the present time. This success may be due to the continuing increase in surveillance measures and fines as well the significantly growing interest shown by the news media in road safety since the measures were introduced. All this has led to positive changes in driver behaviour. It is, therefore, a combination of three factors: the penalty point system, the gradual stepping up of surveillance measures and sanctions, and the publicity given to road safety issues in the mass media would appear to be the key to success. The absence of any of these three factors would have predictably led to a far less positive evolution of the accident rate on Spanish roads.

Early predictors of injury mortality among Swedish conscripts: a 35-year cohort study

Injuries represent an important cause of mortality among young adults. We studied the associations between adolescents' family, psychological, behavioural and drug-related risk factors in relation to unintentional injury death. A population-based cohort of 49,411 Swedish conscripts aged 18-20 years was followed for 35 years. The end-point of study was injury death up to 2004. The relationship between two family, four psychological and eight behavioural risk factors and injury death were analysed with Cox proportional hazards analyses and χ(2) tests. Among 485 unintentional injury deaths, 40% occurred in subjects aged 25 years or under. The incidence per 1000 person years was 0.29 (95% CI, 0.26-0.31) and the mean age of death was 33 years. Problem drinking at both adolescent and adulthood was more strongly associated with injury death (HR=5.40) than illicit drug use (HR=2.70) even after adjusted for behavioural risk factors: (HR=3.43) and (HR=1.75), respectively. Adolescent risk factors such as contact with police and juvenile authorities, low emotional control, conduct problems at school and low social maturity were significant predictors of injury death in multivariate analyses. Young adults with social, behavioural and psychological problems and especially alcohol and drug use at both adolescent and adulthood have a high mortality rate due to road traffic injuries and all kind of injuries. Early identification of vulnerable groups of adolescents with psychological and behavioural problems including alcohol and drug use at local levels could make a difference.

Alcohol poisonings and fatal accidents in Belarus

BACKGROUND

High accidental deaths rate in the former Soviet republics (FSR) and its profound fluctuation over the past decades have attracted considerable interest. The mounting body of evidence point to binge drinking pattern as a potentially important contributor to accident mortality crisis in FSR.

AIM

The aim of this study was to estimate the aggregate-level effect of binge drinking on the accident mortality rate in the former Soviet Slavic republic Belarus.

METHOD

Trends in fatal alcohol poisoning (as a proxy for binge drinking) and accidental deaths rates from 1979 to 2007 were analyzed employing a distributed lag analysis in order to asses bivariate relationship between the two time series.

RESULTS

According to Bureau of Forensic Medicine autopsy reports the number of deaths due to accidents and injuries increased by 94.5% (from 38.7 to 75.6 per 100.000 of residents), and fatal alcohol poisoning rate increased by 108.6% (from 12.8 to 26.7 per 100.000 of residents) in Belarus between 1979 and 2007. Alcohol in blood was found in 51.4% victims of deaths from accidents and injuries for the whole period, with the minimum figure 43.1% in 1986 and maximum 59.1% in 2005. The outcome of distributed lags analysis indicated statistically significant association between the number of alcohol poisoning deaths and the number BAC (blood alcohol concentration)- positive deaths from accidents and injuries at zero lag.

CONCLUSION

The outcome of this study supports the hypothesis that alcohol and deaths from accidents and injuries are closely connected in culture with prevailing intoxication-oriented drinking pattern. This research evidence points to binge drinking pattern as a potentially important contributor to accident mortality crisis in Belarus.

Temporal variations in road traffic fatalities in South Africa

The annual road traffic fatality (RTF) burden of 43 deaths per 100000 inhabitants in South Africa (SA) is disproportionately high in comparison to the world average of 22 per 100000 population. Recent research revealed strong geographical variations across district councils in the country, as well as a substantial peak in mortality occurring during December. In this study, the factors that explain temporal variations in RTFs in SA are examined. Using weekly data from the period 2002-2006 for the country's nine provinces, non-linear auto-regression exogenous (NARX) regression models were fitted to explain variations in RTFs and to assess the degree to which the variations between the provinces were associated with the temporal variations in risk factors. Results suggest that a proportion of the variations in weekly RTFs could be explained by factors other than the size of the province population, with both temporal and between-province residual variance remaining after accounting for the modelled risks. Policies directed at reducing the effects of the modifiable risks identified in our study will be important in reducing RTFs in SA.

The risk of pedestrian injury and fatality in collisions with motor vehicles, a social ecological study of state routes and city streets in King County, Washington

This study examined the correlates of injury severity using police records of pedestrian-motor-vehicle collisions on state routes and city streets in King County, Washington. Levels of influence on collision outcome considered (1) the characteristics of individual pedestrians and drivers and their actions; (2) the road environment; and (3) the neighborhood environment. Binary logistic regressions served to estimate the risk of a pedestrian being severely injured or dying versus suffering minor or no injury. Significant individual-level influences on injury severity were confirmed for both types of roads: pedestrians being older or younger; the vehicle moving straight on the roadway. New variables associated with increased risk of severe injury or death included: having more than two pedestrians involved in a collision; and on city streets, the driver being inebriated. Road intersection design was significant only in the state route models, with pedestrians crossing at intersections without signals increasing the risk of being injured or dying. Adjusting for pedestrians' and drivers' characteristics and actions, neighborhood medium home values and higher residential densities increased the risk of injury or death. No other road or neighborhood environment variable remained significant, suggesting that pedestrians were not safer in areas with high pedestrian activity.

[Characteristic of mortality in the Russian Federation]

The objective of the present work was to estimate the overall mortality in the Russian Federation and to elucidate the structure and characteristics of violent and non-violent mortality in this country. The study is largely based on the materials of reports on the activities of local bureaus of forensic medical expertise for the period from 2003 to 2008; in addition, the data from the official demographic and statistical yearbooks issued by the Russian State Statistical Committee (Goskomstat) in 2008-2009 were used. It is shown that cardiovascular pathology appears to be currently the leading cause of general mortality in the Russian Federation. A substantial fraction in the structure of general mortality is constituted by mechanical injuries most of which are inflicted in car accidents. More than half of the fatal cases caused by external factors and around one third of the deaths from cardiovascular diseases are associated with alcohol intoxication. Statistical treatment of the results of analysis conducted in the present study provided materials for the development of recommendations designed to improve the demographic situation in the Russian Federation.

Comparison of factors influencing emergency department visits and hospitalization among drivers in work and nonwork-related motor vehicle crashes in Utah, 1999-2005

This study identified contributing factors in the occurrence of motor vehicle crashes (MVCs) and the severity of crashes according to work-related status in Utah. Analyses were based on probabilistically linked data involving police crash reports and hospital inpatient and emergency department (ED) records for the years 1999-2005. Of 643,647 drivers involved in crashes, 73,437 (11.4%) went to the emergency department (ED) and 4989 (0.8%) were hospitalized. Of the drivers in crashes visiting the ED, 2330 (3.2%) were working at the time of the crash and of drivers in crashes who were hospitalized, 235 (4.7%) were working at the time of the crash. There was no significant difference between those working versus not working at the time of the crash in safety belt use (82% [53,947/66,188] for ED cases and 60% [2,489/4,176] for hospitalized cases) or fatigue (4% [2,697/70,536] for ED cases and 9% [450/4,824] for hospitalized cases) among drivers in crashes, but there was a significant difference with respect to alcohol drinking between workers versus nonworkers (ED: 1% [31/2,237] vs. 5% [3,455/68,299], P<0.001; hospitalized: 3% [7/228] vs. 15% [673/4,596], P<0.001). Of those attending the ED because of a crash, workers were significantly more likely to have broken bones, bleeding wounds, or to die. Of those hospitalized because of a crash, workers were significantly less likely to have caused the crash (65% [145/223] vs. 73% [3,315/4,566], P<0.001). Yet although those drivers who were working at the time of the crash compared with those not working were less likely to have alcohol involved or to have caused the crash, there remains room for improvement among workers with respect to these factors, as well as safety belt use and fatigue.

Reduction of the blood alcohol concentration limit in Norway--effects on knowledge, behavior and accidents

From January 1, 2001, the legal blood alcohol concentration (BAC) limit in Norway was reduced from 0.5 to 0.2 g/l. A before-and-after telephone survey concerning the effects of the reduced BAC limit was carried out. 3001 driver's license holders were interviewed before and after the amendment. The percentage of drivers claiming that they will drink no alcohol before driving has increased from 82 to 91 percent, thus the distinction between driving a motor vehicle and drinking alcohol has become clearer. Drivers influenced by alcohol and involved in accidents have on the average much higher BACs than 0.5 g/l. Statistics on alcohol-related accidents are not available for the years before and after the legal amendment, but single-vehicle night-time and weekend personal-injury and fatal crashes are used as surrogate measures. There are no significant decreases in these proxies from the six years before to the six years after the reductions of the legal limit.

A note on modeling pedestrian-injury severity in motor-vehicle crashes with the mixed logit model

Pedestrian-injury severity has been traditionally modeled with approaches that have assumed that the effect of each variable is fixed across injury observations. This assumption ignores possible unobserved heterogeneity which is likely to be particularly important in pedestrian injuries because unobserved physical health, strength, and behavior may significantly affect the pedestrians' ability to absorb collision forces. To address such unobserved heterogeneity, this research applies a mixed logit model to analyze pedestrian-injury severity in pedestrian-vehicle crashes. Using police-reported collision data from 1997 through 2000 from North Carolina, several factors were found to more than double the average probability of fatal injury for pedestrians in motor-vehicle crashes including: darkness without streetlights (400% increase in fatality probability), vehicle is a truck (370% increase), freeway (330% increase), speeding involved (360% increase), and collisions involving a motorist who had been drinking (250% increase). It was also found that the effect of pedestrian age was normally distributed across observations, and that as pedestrians became older the probability of fatal injury increased substantially. Heterogeneity in the mean of the random parameters for the freeway and pedestrian-solely-at-fault collision indicators was related to pedestrian gender, and heterogeneity in the mean of the random parameters for the traffic-sign and motorist-back-up indicators was related to pedestrian age.

[Prevention of the alcoholic visceropathy]

In the medical institutions of the Ministry of Defence of the Russian Federation was undertook the study with the aim of inclusion of the physicians to the understanding of the danger of alcoholic intoxication through the knowledge provisioning about the influence of the alcohol to the atherogenesis, progression of liver cirrhosis and liver cancer. 2033 patients who had had surgical revascularization were examined. It was found that each of those patients had drunk different doses of alcohol, but it didn't alert the atherogenesis. Also 1283 patients with liver cirrhosis and 126 died of it during 1996-2009 were examined. It was found that alcohol is the most dangerous cause of liver cirrhosis. Anonymous questionnaire of physicians for clearing up their attitude to the alcohol. It was found that only 43% of physicians deny healthful doses of alcohol. According to this fact it is necessary to intensify explanatory work among physicians.

[Prevention of acute chemical poisonings as a hygienic problem]

Acute exposures, more than 98% of which now occur under household conditions, are an important constituent of the chemical load of the urbanized environment on man and causes of a considerable group of non-communicable diseases, such as chemical poisonings. The cardinal way of their prevention is toxicological monitoring that allows authorities of all levels to use information on the quantitative and qualitative characteristics of acute chemical poisoning in this area and to set up an adequate system of prophylactic measures, including the optimization of toxicological care to the population. Nationwide measures to regulate human contacts with toxicants are of great importance. A system of informing (primarily sanitary education) all sectors of society about possible toxic effects of various-application chemical substances and their safe handling regulations system is to be modernized.

Extreme blood alcohol level is associated with increased resource use in trauma patients

This study aims to examine resource utilization and outcomes of trauma patients with extremely high blood alcohol concentrations. We hypothesized that higher blood alcohol concentration (BAC) predicts greater resource utilization and poorer outcomes. A retrospective analysis was performed on trauma patients admitted to an urban Level I trauma center over a 5-year period. Admission BAC categories were constructed using standard laboratory norms and legal definitions. Demographic data, premorbid conditions, injury severity scores (ISS), resource utilization (intensive care unit (ICU) admission rates/length of stay, total hospital days, use of consultants), and mortality were analyzed. Positive BAC on admission was associated with increased ISS (P < 0.001), length of stay (P < 0.003), and total ICU days (P < 0.001). Increased BAC admission level of patients was associated with a decreased ISS score (P = 0.0073), a higher probability of ICU admission (P = 0.0013), and an increased percentage of ICU days (P = 0.001). A positive BAC at admission was a significant predictor of both ICU admission and mortality (odds ratios 1.72 and 1.27, respectively). This study demonstrates that a positive BAC is associated with increased ISS, increased resource utilization, and worsened outcomes. Extreme levels of BAC are associated with increased resource utilization despite lower injury severity scores.

Elevated blood alcohol level may be protective of trauma patient mortality

To determine whether a positive blood alcohol level (BAL) affects morbidity and mortality at a Level I trauma center, a retrospective review of trauma patients 18 years of age and older was performed. There were 7985 trauma patients and 8 per cent (645) had a positive BAL. BAL(+) patients had lower Injury Severity Score (ISS) (8 vs 11, P < 0.01), lower rate of penetrating injury (9 vs 25%, P < 0.01), and were older (38 vs 32 years, P = 0.01). Overall there were 559 deaths (7%); (1% mortality in BAL(+) patients and 7% in BAL(-) patients; P < 0.0001). There were 352 (4.4%) complications with similar rates among BAL(-) and (+) patients. On univariate analysis, a positive BAL was inversely associated with death (OR, 0.17) as was blunt trauma (OR, 0.29), whereas older age (OR 1.009) and increased ISS (OR 1.13) were associated with death. On multivariable analysis, after adjusting for age, ISS, and mechanism of injury, a positive BAL remained protective against death (OR 0.35) as did blunt trauma (OR 0.2). Age (OR 1.04) and increased ISS (OR 1.19) were associated with mortality. In conclusion, a positive BAL was associated with a decreased mortality risk in trauma patients, which persisted after adjusting for multiple confounding variables.

Ethnicity, age, and trends in alcohol-related driver fatalities in the United States

OBJECTIVE

To evaluate the 8-year ethnic-specific declining trend in the proportion of alcohol-impaired driver deaths in the United States.

METHODS

We used the Fatality Analysis Reporting System (FARS), which is a census of all fatal motor vehicle collisions occurring in public properties in all 50 states, the District of Columbia, and Puerto Rico since 1975. For this study we only focused on driver fatalities. Data on ethnicity were not included in the FARS database until 1999, limiting the analysis to the years 1999-2006.

RESULTS

The proportion of alcohol-impaired driver deaths was higher among males compared to females, with Hispanics constituting the highest proportion in all age groups. During the past 8 years, only the decline in the proportion of alcohol-impaired driver deaths among male Hispanics 16-20 years old and male Whites 21-64 years old were significant. We were not able to identify any significant declining trend in the corresponding proportions among other age groups, or among female drivers, regardless of their age category.

CONCLUSION

Though existing strategies have seemed to be successful in preventing an uptrend in alcohol-related fatal collisions in the country, their effectiveness in decreasing such incidents has been limited. Future studies should identify the factors that might influence the effectiveness of current anti-drunk driver policies.

[Impact of acute alcoholism on the women's mortality in the northern region of Slovak Republic]

Problem of women's alcoholism doesn't belong among main topics of Slovak or Czech public discussions. Though everyone meeting the phenomenon of women's alcoholism can feel the fatal consequences of this mistake, our society used to perceive alcoholism as a men's problem. The authors performed the complex analysis of the mortuary files with particular focusing on the cases of women's deaths caused by alcohol intoxication, and the cases of deaths where an alcohol played the dominating role, in the northern regions of Slovak republic. Submitted article is author's next referring to urgent need of public discussion concerning the alcohol consumption in Slovakia, the phenomenon being widely tolerated by the society.

Alcohol and suicide in Belarus

BACKGROUND

It is well recognized that both acute and chronic alcohol use are among the major behaviorally modifiable factors that are associated with suicidal behavior. There is suggestive evidence that binge drinking pattern, i.e. excessive consumption of strong spirits results in quicker and deeper level of intoxication, increasing the propensity for alcohol-related suicide. Although alcohol seems to be an important contributor to the burden of violent mortality in Belarus, little systematic research has been undertaken on its impact on suicide mortality in this country. The aim of the present study was to address this particular deficit by using aggregate-level data on the suicide and alcohol poisoning rates from 1979 to 2007.

SUBJECTS AND METHODS

Trends in suicides and alcohol poisoning mortality rate (as a proxy for binge drinking) from 1979 to 2007 were analyzed employing an ARIMA analysis in order to assess bivariate relationship between the two time series.

RESULTS

According to Bureau of Forensic Medicine autopsy reports the suicide rate increased by 41.2%, and fatal alcohol poisoning rate increased 2.1 times in Belarus. Alcohol in blood was found in 62% suicide victims for the whole period, with the minimum figure 49.3% in 1988 and maximum 68.5% in 1981. Alcohol-related suicides were more affected by the restriction of alcohol availability during the anti-alcohol campaign: between 1984 and 1986 the number of BAC-positive suicide cases drop by 54.2%, while number of BAC-negative suicides decreased by 7.1%. The results of time-series analysis indicated a statistically significant relationship between fatal alcohol poisoning rate and total suicides number, as well as number of BAC-positive suicides.

CONCLUSION

The results of the present study, as well as findings from other settings indicate that a restrictive alcohol policy can be considered as an effective measure of suicide prevention in countries where rates of both alcohol consumption and suicide are high.

[Cases of acute fatal alcohol poisoning in the material of the Department of Forensic Medicine, Medical University in Białystok, in the years 1984-2004]

The paper presents the analysis of acute fatal ethanol poisonings in the material of the Forensic Medicine Institute in Białystok. Our study has shown that a predominant majority of the deceased died during the phase of alcohol elimination. Moreover, these people were often in good health and generally fit. In view of the immense material analyzed by the present authors and the 20-year time span under investigation, it may be concluded that middle-aged men constitute a group the highest risk of death resulting from acute alcohol poisoning. The assessment of alcohol concentration in blood and other body liquids, for example in urine, allows for defining the phase when death of an alcohol-imbibing individual occurred. In medico-legal and clinical practice, such a determination is very important in terms of initiating appropriate treatment or specifying the mechanism of death.