Influence Of Psychoactive Substances Research Articles

Driving under the influence of psychoactive substances.„Influence” an issue in judicial practice?

"At the end of the 19th century, the punitive celebration disappears, punishment becomes the most hidden part of the criminal process, leaving the domain of everyday perception to enter in abstract consciousness," recorded Michel Foucault in his famous work "Discipline and Punish: The Birth of the Prison" (Foucault, 1997). Therefore, it tends to a change of paradigm, it is desired that the effectiveness of the punishment is not the product of its visible intensity, but of the high degree of certainty. Metamorphosed from a theatrical act (often violent and public) into an administrative act, hidden from the eyes of citizens, criminal policy had to be adapted to encompass the new valence of the act of justice. One of the main means of punitive efficiency by referring to the abstract consciousness is that of the punishment limits that the legislator adjusts according to the criminal phenomenon, aiming both at an inhibitory, repressive and educational effect. It has often been assumed that the criminal recrudescence is due to low sentencing limits, and thus increasing the sentencing limits has been considered to fight all crime, omitting the adaptation of the entire legal norm to contemporary realities. Even the judicial act was not spared from this approach, although the scientific processes evolved and the probation together with them, in the face of a rigid legal norm, the judicial practice refuses to adapt to the new reality. Against the background of a national hysteria due to the scourge of drugs, legal arguments take precedence over scientific arguments.

Mental Health Among Men Who Have Sex with Men Under the Influence of Psychoactive Substances: a Systematic Review

AbstractSex under the influence of psychoactive substances (SUIPS) has gained much attention in the press and scientific literature over the last years, especially among men who have sex with men (MSM). Concerns have thus far been expressed in relation to short-term physical health risks, like contracting bloodborne diseases, like viruses. However, much less is known about long-term mental health consequences of SUIPS, like depression, anxiety, and substance use disorders (SUD). Therefore, we systematically reviewed literature for evidence on mental health complications of SUIPS in MSM. SUIPS was associated with a lower general mental health status, and higher rates of depression, anxiety disorders and suicide ideation in 15 studies, and higher rates of SUD were found among MSM practicing SUIPS in four studies. Motives of SUIPS were increasing sexual performance, fear of rejection, anxiety, and low self-esteem among others. Furthermore, long-term mental health risks, as associated with some of the most frequently reported psychoactive substances in the context of SUIPS, include psychosis and substance dependence. Therefore, the present findings indicate that SUIPS is associated with mental disorders and that they are probably closely intertwined with motives for SUIPS and the long-term effects of using psychoactive substances. This underlines the need to address the presence of mental disorders in people practicing SUIPS, alongside the physical risks.

Prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda

BackgroundThe use of psychoactive substances such as alcohol, heroin and marijuana is associated with negative health outcomes such as sexual violence and unintended pregnancies, and risky sexual behaviours. Although there is evidence linking psychoactive substance use and risky sexual behaviours such as inconsistent condom use and multiple sexual relationships, there is limited data on sex under the influence of psychoactive substances among young people. This study aimed to investigate the prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda.MethodsA cross-sectional study was conducted among 744 sexually active young psychoactive substance users in informal settlements in Kampala, Uganda. Data were collected through face-to-face interviews using a digitalized structured questionnaire, preloaded on the Kobocollect mobile application. The questionnaire captured data on the socio-demographic characteristics of the respondents, history of psychoactive substance use, and sexual behaviours. Data were analysed using STATA Version 14.0. A modified Poisson regression model was used to determine the predictors of sex under the influence of psychoactive substances.. Adjusted prevalence ratios at a p-value value ≤ 0.05 with a 95% confidence interval were considered.ResultsAbout 61.0% (454/744) of the respondents had had sex under the influence of psychoactive substances in the last 30 days. The predictors of sex under the influence of psychoactive substances were being female (PR 1.18, 95% CI: 1.04–1.34), being 20–24 years of age (PR: 1.22, 95% CI: 1.04–1.44), being married (PR 1.15, 95% CI: 1.01–1.31) or divorced/separated (PR 1.43, 95% CI: 1.26–1.61), not living with biological parents or guardians (PR 1.22, 95% CI: 0.99–1.50), earning 71 USD and below (PR 0.86, 95% CI: 0.79–1.03) and using alcohol (PR 1.43, 95% CI: 1.25–1.69), marijuana (PR 1.16, 95% CI: 1.02–1.31) and khat (PR 1.25, 95% CI: 1.10–1.42) in the last 30 days.ConclusionThe study found that a high proportion of sexually active young people in informal settlements in Kampala, Uganda had engaged in sex under the influence of psychoactive substances in the past 30 days. The study also identified several factors associated with sex under the influence of psychoactive substances, including being female, being aged 20–24 years, being married or divorced or separated, not living with biological parents or guardians, and using alcohol, marijuana, or khat in the past 30 days. Our findings suggest the need for targeted sexual and reproductive health programs that incorporate risk-reduction interventions aimed at reducing sex under the influence of psychoactive substances, especially among females and those who do not live with their parents.

Randomly controlled drivers using minimally invasive sampling: assessment of drug prevalence in Western Switzerland over two time periods

BackgroundAccording to the World Health Organization, road traffic injuries lead to 1.3 million deaths each year and represent the leading cause of death for young adults under 30 years old. The use of psychoactive substances, including alcohol, drugs and pharmaceuticals, is a well-known risk factor for road traffic injuries. Our study aims to assess the prevalence of substances consumed by drivers in western Switzerland. Such studies are pivotal to improving prevention and developing public awareness campaigns.MethodsTo assess the prevalence of psychoactive substances among drivers, roadside controls were performed in collaboration with local police, using their classical sampling procedures to detect drivers under the influence of drugs or alcohol over two time periods (P1: 2006-2008, P2: 2017-2020). When impaired driving was not suspected by the police, minimally invasive sampling strategies (i.e., oral fluids during P1 and dried blood spots during P2) were performed on volunteer drivers after a road safety survey. A posteriori analyses and statistical interpretation were then performed.ResultsAmong the 1605 drivers included in the study, 1048 volunteers provided an oral fluid sample, while 299 provided a dried blood spot sample. The percentage of drivers testing positive for at least one substance that can impact driving abilities was stable over time, with a rate of 10.5% positivity measured over both periods. Considering the different categories of substances, a slight variation was observed between both periods, with 7.6 and 6.3% of pharmaceuticals and 3.6 and 4.9% of illicit drugs for P1 and P2, respectively. Regarding the consumption of illicit drugs, the highest percentage of positivity was measured in biological fluids of drivers under the age of 35, during nights and week-ends, periods which are considered particularly prone to fatal accidents for this age group. Disturbingly, the road safety survey highlighted that drivers’ perception of the risk of getting positively controlled while driving after drug consumption is low (3.3 on a 1-to-10 scale, N = 299).ConclusionThe number of positive cases measured in voluntary drivers who passed the preliminary police check demonstrates the importance of systematic biofluid sampling strategies regarding driving under the influence of psychoactive substances. Although the number of fatal road accidents globally has decreased over time, the results of this study reveal the need for both better prevention and deterrent processes that could potentially reduce the risk of fatal road accidents associated with drug consumption.

Driving a Vehicle Under the Influence of Psychoactive Substances: A Criminal Law and Forensic Toxicology Overview

Driving a Vehicle Under the Influence of Psychoactive Substances: A Criminal Law and Forensic Toxicology Overview

Ethyl glucuronide in hair: A 5-years retrospective cohort study among drivers under the influence of psychoactive substances and alcohol

The main aim of the study was to investigate ethyl glucuronide (EtG) hair levels and alcohol consumption behaviour of a large cohort of driving under the influence (DUI) subjects between 2015–2019. Since alcohol is the most widespread psychoactive substance in the world, evaluation of alcohol drinking behaviours can help in preventing alcohol misuse or, at least, limit high-risk situation, such as driving under the influence of ethanol. Ethyl glucuronide in hair is a sensitive and specific biomarker for estimating previous continuative alcohol consumption within a relatively long period, depending on hair length. EtG in hair tests, measured in the period 2015–2019, to all the 18 years old subjects that were resident in the Province of Pavia, were collected and evaluated. The province of Pavia has been divided into three districts, namely the main city together with hinterland (district I), the agricultural flat area (district II) and the rural hilly area (district III). EtG level was defined as ordinal variable, thus dividing data into three groups depending on the drinking behaviour (teetotallers or occasional drinkers, moderate continuative users, and chronic excessive alcohol users). Effects of age, gender and district on alcohol consumption behaviour are investigated with an ordinal logit model. A state sequence analysis was used to study people's alcohol consumption behaviour over time. In total, 22.2% of the drivers provided EtG in hair values. Among positive cases, a prevalence of males (96.3%), aged 35–44 (32.6%), coming from district I (38.2%) was observed. All age classes have a reduced drinking risk if compared to the ≥ 55 years old class: subjects aged 18–24 have 70% (OR≈0.29, P < 0.001) lower risk, 63% (OR≈0.37, P < 0.001) lower risk for the 25–34, half (OR≈0.51, P < 0.001) for the 35–44 and 36% (OR≈0.64, P < 0.001) for the 45–54. A general decreasing trend in EtG values over time was observed for the subjects who have undergone at least 4 repeated EtG measurements ( n = 460). Our study indicates that, compared to 2015, in the last few years the portion of heavy drinkers, among subjects tested for hEtG due to DUI issues, has decreased. When drinking habits were related to age, we observed that overall high-risk increased with increasing age. The characteristics of the territory are also associated with different drinking patterns: in the district mainly devoted to the cultivation of vineyards (district III) there is a 31% higher risk of being a drinker compared to people living in district I. The data obtained from this retrospective observational study suggested that the inclusion of EtG in hair test in the protocol for driving license renewal (DLR) could have contributed to raise awareness among people about the new diagnostic tools available for monitoring alcohol chronic behaviors, thus partially limiting ethanol consumption habits associated with high-risk issues. EtG in hair test in the drive license reissuing protocol appeared to contribute in decreasing alcohol misuse behaviors. Moreover, this study highlighted some potential risk factors related to alcohol drinking habits among drivers such as being male sex, age ≥ 55 years, and coming from rural areas.

Consumption, risk factors, and the impact of psychoactive substances in road transport by professional drivers: a review

Traffic accidents are a serious public health problem, especially in developing countries. Driving under the influence of psychoactive substances, such as illicit drugs, can significantly increase the risk of motor vehicle accidents. This fact potentiates the probability of serious traffic accidents occurring, making it necessary to combat them with seriousness and urgency. Many road traffic crashes are related to sleepiness and/or fatigue. In addition to long driving hours, important contributors to fatigue among professional drivers are insufficient night-time sleep and insufficient rest breaks. Research data on the topic show that several psychoactive drugs alter the motor and cognitive capacity of users, however, most of these studies pointed out such outcomes based on the prevalence of illicit drug use in professional hospitalized drivers. Despite the existence of laws against driving doped, the effectiveness of these laws in controlling the problem is questionable. For this research, the study was conducted to highlight and discuss, by a descriptive review, the consumption of psychoactive substances among professional drivers, and the role of working conditions in the prediction of such use. Data about drug use were obtained in this review aims to contribute for the development of preventive measures, especially public policies on the risks of driving while under the influence of psychoactive drugs.

Crime of domestic violence (Article 126-1 of the Criminal Code of Ukraine): analysis of judicial practice

The scientific article is devoted to the analysis of judicial practice of the crime of domestic violence. The urgency of the topic is due to the need to develop Ukraine as a modern democratic state governed by the rule of law and further expand legal regulation in the field of prevention and combating domestic violence. Methodology. Methodological tools are selected in accordance with the purpose, objectives, object and subject of research. The methodological basis of the study are philosophical, general and special-scientific methods of cognition. The theoretical basis of the study were the prescriptions of regulations of current legislation of Ukraine and scientific works of domestic scientists on domestic violence. Taking into account the specifics and complexity of the chosen subject of research, interdisciplinary and complex approaches were used, which allowed to work out and interpret the results of empirical research. The generally accepted principles of scientific knowledge are applied, in particular, the principle of determinism, the principle of conformity, the principle of subsidiarity.&#x0D; The methods, techniques, principles used made it possible to identify, distinguish, distinguish and prolong the relationship of part and whole, single and total selected sample, emphasizing the dialectical unity and difference between the properties, relationships and aspects of the subject.&#x0D; The empirical basis of the study is the information obtained from the analysis of case law, namely: acts of criminal law (court verdicts), the period of adoption from 01.01.2020 to 01.01.2021, the decisions of which are placed in the Unified State Register of Judgments of Ukraine. In the course of the research the concept, legal consequences and composition of the crime of Article 126-1 were revealed and characterized. Domestic violence of the Criminal Code of Ukraine. The variability of structural units of criminal-legal interaction of the offender-victim with the indication of the family-legal status of the participants in the crime of domestic violence is emphasized. Attention is paid to fragments of legal reality and to certain orientation units of lawful and wrongful behavior. The influence of genetic and environmental factors on the formation of the behavior of participants in deep conflict domestic violence is noted.&#x0D; Attention is paid to the commission of crimes based on personal hostility. Also, the interpretation of the sample data revealed that a significant number of crimes of domestic violence were committed by the perpetrator (suspect / accused) in a state of intoxication or under the influence of psychoactive substances (alcoholic beverages), which in turn indicates the problem of interdependent, addictive behaviors, psychologic emotional imbalance. Thus, the modular interrelationships of the participants in the deep conflict in the field of domestic violence, taking the form of a criminal act, are determined by a set of interconnected, interdependent factors of biological and social nature. This gives grounds to argue about the need to improve measures to prevent and correct deviant behavior in society.&#x0D; Based on the results of the study, conclusions and recommendations were formed regarding the improvement of social and legal influence in the field of prevention and counteraction to domestic violence. Among other things, it is expedient to modernize social policy, form, develop the institution of "family", "general family", as well as the development and implementation of targeted comprehensive programs for the prevention of domestic violence, legal education, structured according to psychological age, hierarchy of activities, neoplasms of consciousness and personality. The general conditions of such an approach are the successful acquisition of knowledge and skills of self-regulation of behavior, as well as the formation of motivational and demanding sphere of personality of the right direction.&#x0D; The obtained results can be used: in research work — for further research of legal, psychological specifics and structure of domestic violence; in law-making — to improve the legal regulation of the system of prevention, counteraction to domestic violence; — law enforcement activities — in the implementation of state policy in the field of prevention, combating domestic violence; in the educational process — in the preparation of lectures, seminars, practical classes; in legal and educational activities — to improve the modular guidelines of socio-legal behavior of the individual, aimed at raising the level of legal awareness, legal culture; as well as for all other professionals who deal with domestic violence.

Do sexual expectancies and inhibitions predict high-risk sexual behaviours? Evidence from a cross-sectional survey among young psychoactive substance users in informal settlements in Kampala, Uganda

BackgroundPsychoactive substance use is a public health challenge among young people in informal settlements. Though rarely examined, psychoactive substance use is linked to sexual expectancies and inhibitions, and consequently high-risk sexual behaviours. This study examined the association between sexual expectancies and inhibitions, and high-risk sexual behaviours among young psychoactive substance users (PSUs) in informal settlements in Kampala, Uganda.MethodsThis cross-sectional study recruited 744 young PSUs from informal settlements in Kampala. Respondent driven sampling was used to recruit respondents. A ‘modified’ Poisson regression model was used for inferential statistics. Data were analysed using the Stata 14 software.ResultsOf the 744 study participants, 45.6% believed that psychoactive substance use improves sexual performance; 43.3% believed that psychoactive substances make sex more pleasurable, and 53.3% believed that psychoactive substances give courage or confidence to approach a partner for sex. The belief that psychoactive substance use improves sexual performance (PR 1.14, 95% CI: 1.01–1.30), increases the likelihood of engaging in sex (PR 1.20, 95% CI: 1.04–1.40) or gives courage or confidence to approach a sexual partner (PR 1.21, 95% CI: 1.05–1.39) were associated with having sex while under the influence of psychoactive substances. The belief that a psychoactive substance user under the influence of psychoactive substances is more likely to engage in sex (PR 1.48, 95% CI: 1.15–1.90), and likely to find it difficult to refuse sex (PR 1.28, 95% CI: 1.06–1.55) were positively associated with engaging in multiple sexual partnerships. The belief that one easily forgets to use a condom when under the influence of psychoactive substances was positively associated with inconsistent condom use (PR 1.26, 95% CI: 1.09–1.45).ConclusionPsychoactive substance use expectancies associated with high-risk sexual behaviours included the belief that psychoactive substances improve sexual performance and improve confidence in approaching a sexual partner. Psychoactive substance use inhibitions associated with high-risk sexual behaviours included an increased likelihood of engaging in sexual intercourse, difficulties in refusing to engage in sexual intercourse, and forgetting to use condoms while intoxicated. Interventions targeting a reduction in high-risk sexual behaviour should integrate the impact of psychoactive substance use on sexual behaviour.

Research on methods for detecting respiratory rate from photoplethysmographic signal

The persons detained by the Police require constant monitoring of their life functions. Many of them may have unidentified disease or be under the influence of psychoactive substances. The paper discusses the specifics of the considered problem and propose the solution that intercorporate registration of the photoplethysmographic signal (PPG). The heart rate, oxygen saturation and respiration rate (RR) are determined based on this signal. The main purpose of this paper is improvement and evaluation of RR estimation based on PPG signal. Although some of algorithms of this estimation are known, the problem is sensor placement and poor measuring conditions in case of detainees affecting the algorithms accuracy. For this purpose, a new approach was proposed using the enhanced empirical wavelet transform algorithm. The results obtained were compared with selected conventional methods using the PPG signal envelope, empirical mode decomposition and empirical wavelet transform. The selected measurement windows were used to reduce the inaccuracy of RR estimation (resulting from the phenomenon of spectrum leakage) based on the respiratory associated signal. The experimental data obtained from laboratory studies and clinical database were used in the research. The metrological interpretation of the results obtained from the research is discussed and conclusions are presented.

Wpływ substancji psychoaktywnych na układ odpornościowy i działanie mózgu za pośrednictwem mechanizmów immunologicznych

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Famitafreshi H, Karimian M. Influence of psychoactive substances on the immune system and involvement of the brain through immunologically-mediated mechanisms. Alcoholism and Drug Addiction/Alkoholizm i Narkomania. 2022. doi:10.5114/ain.2021.113514. APA Famitafreshi, H., & Karimian, M. (2022). Influence of psychoactive substances on the immune system and involvement of the brain through immunologically-mediated mechanisms. Alcoholism and Drug Addiction/Alkoholizm i Narkomania. https://doi.org/10.5114/ain.2021.113514 Chicago Famitafreshi, Hamidreza, and Morteza Karimian. 2022. "Influence of psychoactive substances on the immune system and involvement of the brain through immunologically-mediated mechanisms". Alcoholism and Drug Addiction/Alkoholizm i Narkomania. doi:10.5114/ain.2021.113514. Harvard Famitafreshi, H., and Karimian, M. (2022). Influence of psychoactive substances on the immune system and involvement of the brain through immunologically-mediated mechanisms. Alcoholism and Drug Addiction/Alkoholizm i Narkomania. https://doi.org/10.5114/ain.2021.113514 MLA Famitafreshi, Hamidreza et al. "Influence of psychoactive substances on the immune system and involvement of the brain through immunologically-mediated mechanisms." Alcoholism and Drug Addiction/Alkoholizm i Narkomania, 2022. doi:10.5114/ain.2021.113514. Vancouver Famitafreshi H, Karimian M. Influence of psychoactive substances on the immune system and involvement of the brain through immunologically-mediated mechanisms. Alcoholism and Drug Addiction/Alkoholizm i Narkomania. 2022. doi:10.5114/ain.2021.113514.

Driving Under the Influence of Drugs: A Single Parallel Monitoring-Based Quantification Approach on Whole Blood

Driving under the influence of psychoactive substances is a major cause of motor vehicle crashes. The identification and quantification of substances most frequently involved in impaired-driving cases in a single analytic procedure could be an important asset in forensic toxicology. In this study, a highly sensitive and selective liquid chromatography (LC) approach hyphenated with Orbitrap high-resolution mass spectrometry (HRMS) was developed for the quantification of the main drugs present in the context of driving under the influence of drugs (DUID) using 100 μL of whole blood. This procedure involves a simple sample preparation and benefit from the selectivity brought by parallel reaction monitoring (PRM) allowing to solve most DUID cases using a single multi-analyte injection. The method was fully validated for the quantification of the major classes of psychoactive substances associated with impaired-driving (cannabinoids, cocaine and its metabolites, amphetamines, opiates and opioids, and the major benzodiazepines and z-drugs). The validation guidelines set by the “Société Française des Sciences et des Techniques Pharmaceutiques” (SFSTP) were respected for 22 psychoactive substances using 15 internal standards. Trueness was measured to be between 95.3 and 107.6% for all the tested concentrations. Precision represented by repeatability and intermediate precision was lower than 12% while recovery (RE) and matrix effect (ME) ranged from 49 to 105% and from −51 to 3%, respectively. The validated procedure provides an efficient approach for the simultaneous and simple quantification of the major drugs associated with impaired driving benefiting from the selectivity of PRM.

The association between psychoactive substance use and violence

Introduction. The association between substance use and aggression derives from the fact that among violent crime offenders there is a large number of people with alcohol and drug abuse. The objective of the study was to determine the incidence of psychoactive substance addicts in the population of violent crime offenders, as well as to consider possible measures to reduce the crime rates in this population. Material and Methods. Forensic psychiatric reports were used to assess 94 violent offenders from 2001 to 2018. The expert reports were obtained from the Psychiatry Clinic in Novi Sad, Serbia, including court case files, medical records, and psychiatric and psychological records of all offenders. Results. We have found that of the total of 94 violent crime offenders, as many as 25% suffered from some form of mental disorder. More than half of those with mental disorders from this group suffered from disorders induced by psychoactive substances, which means that as many as 15% of all offenders had some form of addiction. On the other hand, as much as 50% of all the offenders were under the influence of psychoactive substances at the time of the offense, predominantly by alcohol. Conclusion. Further research is needed in order to develop specific programs for the prevention of violence in the population using psychoactive substances.

Predictive factors associated with driving under the influence among Brazilian drug-using drivers

The incidence of driving under the influence of psychoactive substances (DUI) and its recidivism can be curtailed by the proper identification of specific and predictive characteristics among drug users. In this sense, interpersonal violence (IV), psychiatric comorbidity and impulsivity seem to play an important role in DUI engagement according to previous studies. There are, however, limited data originated from low and middle income countries. In the present study, drug-using Brazilian drivers reporting DUI (n = 75) presented a higher prevalence of bipolar disorders (BD; DUI: 8% vs. non-DUI: 0%, p < 0.001), lower prevalence of obsessive-compulsive disorder (OCD; DUI: 0% vs. non-DUI: 12.6%, p < 0.001), and higher prevalence of childhood trauma (DUI: 65.3% vs. non-DUI: 46.8%, p = 0.022) than those not reporting DUI (n = 79). The evaluation of impulsivity though the Barratt Impulsivity Scale, which give impulsivity scores ranging from 30 to 120, showed higher impulsivity scores in the DUI group (80.4 ± 8) than in the non-DUI group (77.2 ± 10, p = 0.045). In general, subjects were young adults (mean age of 36 ± 9 years), Caucasians (58.4%), not married (61.0%), and with elementary schooling (40.3%) with no significant differences in demographic characteristics between drivers with and without DUI behavior. A multiple Poisson regression model showed that individuals reporting IV as perpetrators and history of childhood trauma were more likely to report DUI (PR: 1.66, 95%CI 1.22–2.7; PR: 1.57, 95%CI 1.02–2.42, respectively). The overlapping of violent situations (childhood trauma, IV and DUI) in some individuals presented here corroborates literature data suggesting that DUI can be an externalizing expression of a range of risky behavior, such as impulsiveness and aggressiveness. Moreover, while BD and higher impulsivity scores seem to act as risk factors for DUI, OCD was shown as a protective factor. These results corroborate the hypothesis that individuals with high risk for DUI could probably be identified by multidimensional assessment of cognitive, risky taking, and personality traits, which perhaps could facilitate the development of focused interventions.

Forensic and pharmaceutical study of road traffic accidents happened under influence of psychoactive substances

Forensic and pharmaceutical study of road traffic accidents happened under influence of psychoactive substances

Mechanical restraint in an emergency department: a consecutive series of 593 cases.

The objective is to describe the characteristics of mechanically restrained patients in the emergency department (ED) of a university hospital and to evaluate the quality of restraint documentation that was filled out according to the dedicated protocol with respect to the law on restraint. All adult patients (≥16years) who were admitted to the ED from January 2009 to December 2010 and were mechanically restrained were included. We assessed medical and demographic characteristics, the completeness of the dedicated protocol, and the concomitant use of chemical sedation. 72,844 patients were admitted to the ED. Of these, 593 (0.81%) were mechanically restrained. Two types of patients were restrained: young patients under the influence of psychoactive substances who were usually discharged home, and confused older patients who were hospitalized. 186 dedicated protocols were missing (31.4%). From the 407 filled-out protocols, only 119 (29.2%) were complete. Of the mechanically restrained patients, 215 (36.2%) received additional chemical sedation. Even though restraint is strictly regulated by law, many protocols justifying the privation of liberty were not filled out. This emphasizes the need for strict respect of the dedicated protocol and the use of guidelines and training sessions for nursing and medical staff that address specific procedures for the two categories of patients needing to be restrained.

Análise do comportamento sexual de risco à infecção pelo hiv em adultos da população em geral

Objetivou identificar e comparar os comportamentos sexuais de risco e sua relação com o sexo, idade e religião. Participaram 596 adultos da população em geral, de ambos os sexos, com idades variando entre 18 a 73 anos (M = 27,31 DP = 9,37), sendo 59,2 % do sexo feminino, estado civil solteiro (76,2%), deste total 83,2% se declararam heterossexual. Utilizou-se como instrumento questionários sobre dados sociodemográficos e comportamento sexual. Para análise dos dados utilizou-se o pacote estatístico SPSS versão 22. Identificou-se que as relações sexuais sob o efeito de substâncias psicoativas foi predominante entre homens. Em relação às diferenças dos comportamentos sexuais dos grupos de idades, neste estudo foi identificado que as pessoas da população em geral com idades de 18-41 anos em sua maioria tinham uma vida sexual ativa. Espera-se que estes dados possam subsidiar futuras intervenções em saúde para prevenção de doenças sexualmente transmissíveis.

Sex, drugs and self-control: why chemsex is fast becoming a public health concern

The sexual landscape of the UK is ever changing. Taboos and norms are in constant fluctuation, and what was perceived as odd 10 years ago is now commonplace. One growing...

Prevalence of driving under the influence of psychoactive substances and road traffic crashes among Brazilian crack-using drivers

BackgroundSubstance use disorders are associated with the increased risk of driving under the influence (DUI), but little is known about crack-cocaine and its relationship with road traffic crashes (RTC). MethodA multicenter sample of 765 crack-cocaine users was recruited in six Brazilian capitals in order to estimate the prevalence of DUI and RTC involvement. Legal, psychiatric, and drug-use aspects related with traffic safety were evaluated using the Addiction Severity Index − 6th version (ASI-6) and the Mini International Neuropsychiatric Interview. ResultsSeventy-six (28.3%) current drivers reported accident involvement following crack-cocaine use. Among drivers (n=269), 45.7% and 30.5% reported DUIs in the past 6 months and 30 days, respectively. Drivers reporting DUI's in the past month (n=82) had higher scores in the “psychiatric”, “legal”, and “family problems” subscales from the ASI-6, and lower scores in the “family social support” subscale in comparison to those without a history of DUIs (n=187). An overall high prevalence of psychiatric comorbidity and substance consumption was observed. Participants with 5+ years of crack-cocaine use were more likely to have been in a RTC (RR=1.52, 95%IC: 1.02-2.75), independently of marijuana use, binge drinking and psychiatric comorbidities. ConclusionThe high prevalence of RTC and DUI involvement among crack-using drivers supports the idea that they are at a high risk group regarding traffic safety. Years of crack consumption seem to be associated with RTC involvement. Also, the presence of psychiatric comorbidities, poly-drug use, and cognitive impairment usually associated with crack addiction could yield additional risk of accidents.

Ethical Considerations Related to Impaired Driving After Orthopaedic Injuries.

A 35-year-old man sustained a right trimalleolar ankle fracture after a fall. He was treated uneventfully with open reduction and internal fixation. At his first postoperative appointment, he was transitioned out of a splint to a controlled ankle movement walking boot and was instructed to remain non-weight-bearing. The patient expressed relief to be out of the splint because he could now return to his job as a commercial bus driver. When the physician explained to the patient that he was not yet ready to drive, the patient reported that he had been driving with the splint in place and needed to work for the income. Despite the physician’s insistence that it would be unsafe to drive, the patient was emphatic that he must return to work. The physician understood the patient’s desire to drive, but was worried about the patient’s safety and the safety of others. Impaired driving is a major cause of morbidity and mortality in the United States. Accidents involving alcohol-impaired drivers were responsible for 10,076 deaths in 20131. Although driving under the influence of psychoactive substances constitutes the primary type of driving impairment, many other conditions (e.g., visual impairment, dementia, and seizure disorders) can cause impaired driving. Orthopaedic injuries can likewise cause impaired driving. Lower-extremity injuries and surgical procedures slow brake-reaction times2. It generally takes 9 weeks after an ankle-fracture surgical procedure for brake-reaction times to return to normal3 and 6 weeks for brake-reaction times to normalize after the initiation of weight-bearing after major lower-extremity trauma4. Brake-reaction times are also substantially impaired with knee or ankle immobilization5. In this case scenario, the patient intended to resume driving against medical advice, despite the inherent dangers. This scenario raises several ethical concerns related to autonomy, confidentiality, and safety. The ethical …