Conducción y sustancias psicoactivas (alcohol, drogas y medicamentos): de la magnitud del problema a la intervención en seguridad vial.

Con la investigación realizada para el presente trabajo se analizan diferentes aspectos del “factor humano” relacionados con la conducción, como son, el consumo de sustancias por parte de los conductores (alcohol, drogas ilegales y medicamentos) y la agresividad vial (Road rage). Respecto al consumo, se ha analizado la prevalencia de sustancias en conductores y además, en el caso del alcohol y el THC, se ha analizado su relación con la prevalencia de signos de deterioro, dependiendo de la concentración de estas sustancias en el organismo. Por otra parte, se contemplan dos intervenciones llevadas a cabo en materia de seguridad vial: la introducción del pictograma sobre medicamentos y conducción en el envase de algunos medicamentos, y la realización de controles aleatorios de carretera, en los que recientemente se ha introducido el fluido oral como matriz para determinar el consumo de drogas por parte de los conductores.Departamento de Biología Celular, Histología y Farmacologí

Older drivers, medical condition, medical impairment and crash risk

Producción CientíficaNew evidence has appeared to support the fact that the over-involvement of older drivers in traffic accidents disappears when the low mileage bias is taken into account. As a group, older drivers are as safe as or safer than other age groups, and only low mileage older drivers have a high crash rate. Furthermore, the role of the medical condition of older drivers in traffic accidents, as well as the fitness to drive evaluation, are objects of controversy.We examined all this with a cohort of 4316 drivers attending Medical Driving Test Centres for a mandatory fitness to drive evaluation. Our data shows that older drivers (≥75) have a lower crash rate. Medical conditions that impair fitness to drive, as a tendency, increased with advanced age and with lower mileage group. The multivariate analysis of variance showed that there is an effect (p < 0.0001) of age-range and mileage on the annual crash rate per million kilometres driven, while a medical restriction (“fit to drive with restriction”) has no effect (p > 0.05). Our data suggests that health status is not associated with increased crash risk for the low mileage group, although further studies are needed

Cannabis and driving: results from a general population survey.

Producción CientíficaThe role of illicit drugs on driving, and particularly of cannabis and driving, is the object of increasing awareness. While there is increasing evidence of their effect on psychomotor performance and increased risk of involvement in traffic accidents, limited information is available concerning factors that can predict the likelihood of driving under the influence of cannabis. The present study aims to determine the past year prevalence of driving under the influence of cannabis, and of being a passenger in a vehicle driven by a person under the influence of cannabis, as well as to examine the correlations with a broad range of potential risk factors. A total of 2500 people, aged between 14 and 70 and living in Castille and Leon (Spain), were surveyed in 2004 with regard to their consumption of alcohol and illicit drugs. Among those who reported cannabis use in the previous year, further assessment was carried out. 15.7% of those surveyed reported cannabis consumption in the previous 12 months, of whom 9.7% reported driving a vehicle under the influence of cannabis during this period, on average eight times. One out of five (19.9%) reported being a passenger in a vehicle driven by a person under the influence of cannabis, on average five times in the previous 12 months. The predictors of driving under the influence of cannabis were the population size of community, the number of drugs consumed, reference to cannabis-related problems and to being a passenger in a vehicle driven by a person under the influence of alcohol. The data show that cannabis consumption and driving is common, and requires more attention from policy makers

Establishment of framework for classification/categorisation and labelling of medicinal drugs and driving

The establishment of criteria for a European categorisation will have to serve most of the needs of all parties involved: health professionals, drug regulatory agencies, drug manufacturers and patients. Clear warnings and symbols are needed so patients use their medicines in the most optimal (and safest) way possible The DRUID WP4 expert group established and agreed that, according to its influence on the ability to drive, a medicine could, regarding to driving, be categorized as followed: • category 0 (no or negligible influence on fitness to drive), • category I (minor influence on fitness to drive), • category II (moderate influence on fitness to drive), • and category III (severe influence on fitness to drive). The DRUID methodology on categorisation/labelling on medicines and driving. In summary, categorisation of a medicine on driving includes several steps of evaluation after taken into account the conditions of use of the medicine on the European Union market: 1. Pharmacodynamic and pharmacokinetic data 2. Pharmacovigilance data (including prevalence of unwanted effects reported in the SmPC) 3. Experimental and epidemiological data 4. Additional data derived from the Patient Information Leaflet (PIL) and existing categorisation systems 5. Synthesis Básically conditions of use of the medicine, pharmacodynamics, pharmacokinetic data, and pharmacovigilance data (including prevalence of unwanted effects) were derived from the SmPC, while section 3 was based on a scientific literature serach. Additional data step consisted of reviewing section 4.7 of the SmPC “Effects on ability to drive and use machines” and the PIL section on “driving and using machines” as well as reviewing the previous categorisations (if available) of the medicine in Belgium, France, Spain as well as to the ICADTS list. After evaluating all the available data, a provisional category was assigned to each active substance. The provisional category was proposed and discussed during WP4 meetings where a final and definitive category was assigned and approved by all WP4 partners.Biología Celular, Histología y Farmacologí

Mortalidad prematura y años potenciales de vida perdidos relacionados con el consumo de alcohol en España y en las comunidades autónomas en el año 2004

Producción CientíficaObjetivo: Analizar la mortalidad prematura relacionada con el consumo de alcohol 2004 en España y en las diferentes comunidades autónomas (CC.AA.) españolas. Diseño: Se partió de los datos de las muertes atribuibles al consumo de alcohol en 2004 para España y las distintas CC.AA.; a partir de éstos se calcularon los años potenciales de vida perdidos (APVP) hasta los 70 años para cada categoría diagnóstica, sexo y grupos quinquenales de edad. Emplazamiento: España: 17 CC.AA., Ceuta y Melilla. Participantes: Datos de defunciones según causa de muerte, desagregados por sexo y edad para cada una de las 17 CC.AA., Ceuta y Melilla. Mediciones principales: Los APVP, el porcentaje sobre el total de APVP y la media de APVP por muerte atribuible al consumo de alcohol. Resultados: Durante 2004 se perdieron 118.411 APVP, 4 veces más en varones, y la media por cada muerte atribuible al consumo de alcohol fue de 22,6 años (34,7 años en Ceuta y 20,2 años en Asturias). Las causas agudas (el 68,0% de los APVP) y en particular los accidentes no intencionales (el 47,9% de los APVP) son los que más contribuyen a la mortalidad prematura relacionada con el consumo de alcohol en España y las distintas CC.AA. Conclusiones: La estimación de los APVP pone de manifiesto el elevado impacto del consumo de alcohol en la mortalidad prematura en las CC.AA. españolas. El consumo de alcohol es una causa evitable de mortalidad y deberían adoptarse medidas de prevención para reducir la exposición al consumo, así como para detectar y tratar precozmente los posibles problemas relacionados con el consumo de alcohol

Alcohol and drug use by Spanish drivers: Comparison of two cross-sectional road-side surveys (2008–9/2013)

Producción CientíficaDriving under the influence of substances (DUI) other than alcohol has been the subject of increasing interest over the past few decades (Schulze et al., 2012). As with alcohol, research has shown that drug intake increases the risk of road traffic accidents (Elvik, 2013; Schulze et al., 2012; Verstraete & Legrand, 2014). Intervention in this area is a priority. A key factor for deterring DUI is to convince drug-using drivers that the risk of detection is high (Jones, Donnelly, Swift, & Weatherburn, 2006; Watling, Palk, Freeman, & Davey, 2010) thus, adequate law enforcement, and the continuity of roadside testing for drug use among drivers, play an important role (Shepherd, 2001; Watson & Freeman, 2007). For the European Project DRUID (Driving under the Influence of Drugs, Alcohol and Medicines; http://www.druid-project.eu), roadside surveys were conducted in 13 European countries and results showed large differences in the prevalence of alcohol and drug intake by country (Schulze et al., 2012). The highest prevalence was found in Southern Europe (Italy, Spain and Portugal). In Spain, avoiding driving after alcohol or drug use has been recognized as crucial to improving road safety. Five years after the DRUID project, a new roadside survey was conducted following a similar methodology in order to study whether the use of alcohol and drugs among Spanish drivers had changed

Classification of medicinal drugs and driving : coordination and synthesis report

In total, 16 systems were found (table 9). Some of these systems are no true categorization systems: Germany directly reproduced ratings from Wolschrijn, and 5 systems have not defined categories (Greece, the Netherlands, Norway, Denmark and Finland). Only one true categorization system also included warning labels (France II). Clear relations can be seen between the different systems (figure 3). In this way, all categorizations (except Portugal) are linked to Wolschrijn. When looking at the structure of the systems, the largest evolution has been the number (and descriptions) of categories. The list by Wolschrijn included 7 categories. At first, the categories were copied (Belgium), but later on the categories were summarized and only three categories remained (Spain I). The most recent and extensive lists (France II and ICADTS) have maintained these three categories, but have added practical guidelines for patient and doctor. One list (ICADTS) introduced a calibration to BAC levels.biología Celular, Histología y Farmacologí

Drogas ilegales, alcohol y agresividad vial

El consumo de alcohol, cocaína y cannabis se asocia a comportamientos agresivos, a ser víctima de lesiones de diversas causas, y a accidentes de tráfi co, pero existen pocos estudios acerca de cómo afecta el consumo de estas sustancias la experiencia de agresividad vial. El objetivo de este estudio es analizar la bibliografía existente sobre el tema y extraer conclusiones claras respecto de su verdadero impacto. Se analizaron cinco publicaciones. Más de un tercio de los conductores tuvieron alguna experiencia de agresividad vial. Los predictores sociodemográfi cos fueron: sexo masculino, edad joven, vivir en grandes ciudades, nivel educativo alto y no vivir en pareja. Diferentes variables relacionadas con el alcohol resultaron predictoras de victimización y/o perpetración, en particular para agresiones severas y frecuentes. Considerando tres subescalas del test AUDIT, la 'dependencia' se asoció sólo a ser agresor verbal, mientras que el 'consumo' y especialmente los 'problemas' se relacionaron con casi todas las formas de agresividad vial. La frecuencia de consumo y el conducir después de haber bebido no aumentaron la agresividad vial, a menos que se condujera estando ebrio. Conducir bajo la infl uencia de cannabis se relacionó con ser perpetrador de agresividad vial. Los estimulantes (cocaína y éxtasis) se asociaron a victimización, agresión, y de manera signifi cativa a formas severas de agresividad vial. Existe una asociación entre consumo de drogas ilegales o alcohol y agresividad vial, particularmente para los ítems de perpetración. La medida en que estos hallazgos representan efectos farmacológicos, procesos psicosociales, o ambos, es un tema importante para futuras investigacionesUse of alcohol, stimulants, cocaine and cannabis is known to be associated with aggressive behavior, suffering injuries for various causes and traffi c accidents, but there are few studies on how this consumption is related to road rage experience. Our aim is to analyze the existing bibliography on this topic and draw clear conclusions as regards its real impact. Five publications were analyzed. Over one third of drivers had had a road rage experience. Sociodemographic predictors were: being male, young, living in a large city, high educational level and not living with a partner. Different variables related with alcohol were predictors for victims and for perpetrators of road rage, particularly frequent and serious aggressions. Considering three subscales of the AUDIT test, 'Dependence' was associated only with perpetrators of verbal aggression, while 'Consumption' and 'Problems' were related to almost all forms of road rage. Alcohol use frequency and drink-driving had no impact on road rage except when drivers were really drunk. Driving under the infl uence of cannabis was related with road rage perpetration. Stimulants (cocaine and ecstasy) were associated with victimization, aggression and, to a signifi cant degree, with serious road rage. There is an association between illegal drugs or alcohol consumption and road rage, particularly concerning perpetration items. The extent to which these fi ndings represent pharmacological effects, psychosocial processes, or both, is an important topic for future research

Procalcitonin and white blood cells, combined predictors of infection in cardiac surgery patients

Producción CientíficaBackground: Sepsis is strongly associated with an increased risk of postoperative mortality, longer length of hospital stay, and elevated health care costs. Early clinical symptoms overlap with those of systemic inflammatory response syndrome, a response that commonly occurs after cardiac surgery with cardiopulmonary bypass. Since a combination of biomarkers has been demonstrated to improve the prediction of postoperative infection, the objective of the present study was to test whether the combination of C-reactive protein (CRP), white blood cells (WBC), and procalcitonin (PCT) is able to predict postoperative infection in a large cohort of cardiac surgery patients. Material and methods: Case-control study involving 423 patients who underwent cardiac surgery with cardiopulmonary bypass. Patients were retrospectively classified into two groups based on whether they developed severe sepsis or septic shock during the postoperative period. Blood samples for biological measurements (PCT, CRP, and WBC) were drawn on the first day in the intensive care unit, then once daily in the morning until the 10th postoperative day. Results: CRP median values were similar in both groups. WBC and PCT median values were significantly higher in patients with infection than without during the first 10 postoperative days. With elevation cutoffs ≤3 times (OR: 4.058; 95% CI: 2.206-7.463; P = 0.001) and ≥4 times (OR: 10.274, 95% CI: 3.690-28.604; P < 0.001), the median value for PCT (1.7 ng/mL) and/or WBC (13,000 cells/mm3) on the second postoperative day was significantly associated with the development of infection. Conclusions: The goal of this study was to use a large cohort of cardiac surgery patients to ensure that the results were representative of this population. The combination of PCT and WBC levels over the first three postoperative days was able to predict postoperative infection within the 30 d following cardiac surgery.Instituto de Salud Carlos III (grant PI15/01451)Junta de Castilla y León (grant GRS1270/A/16

Ventilator-associated pneumonia is an important risk factor for mortality after major cardiac surgery

Producción CientíficaVentilator-associated pneumonia (VAP) is the main infectious complication in cardiac surgery patients and is associated with an important increase in morbidity and mortality. The aim of our study was to analyze the impact of VAP on mortality excluding other comorbidities and to study its etiology and the risk factors for its development. MATERIALS AND METHODS: This prospective cohort study included 1610 postoperative cardiac surgery patients' status post cardiopulmonary bypass (CPB) between July 2004 and January 2008. The primary outcome measures were the development of VAP and in-hospital mortality. RESULTS: Ventilator-associated pneumonia was observed in 124 patients (7.7%). Patients with VAP had a longer length of hospitalization (40.7 ± 35.1 vs 16.1 ± 30.1 days, P <.0001) and greater in-hospital mortality (49.2% [61/124] vs 2.0% [30/1486], P =.0001) in comparison with patients without VAP. After performing the Cox multivariant analysis adjustment, VAP was identified as the most important independent mortality risk factor (adjusted hazard ratio [HR], 8.53; 95% confidence interval, 4.21-17.30; P =.0001). Other independent risk factors of in-hospital mortality were chronic renal failure (HR, 2.56), diabetes mellitus (HR, 1.90), CPB time (HR, 1.51), respiratory failure (HR, 2.13), acute renal failure (HR, 2.39), and mediastinal bleeding of at least 1000 mL (HR, 1.81)