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Self-medication using alcohol is a common coping response among individuals dealing with trauma as is driving under the influence of alcohol (DUI). A common intervention for drivers convicted of DUI, is an alcohol ignition interlock device (IID)-which requires breath samples before starting the car. If the sample is above a predetermined limit (.025), the car will not start, thus preventing impaired driving. IIDs are an effective intervention to reduce rates of drinking and driving among high risk populations; however, limited research has examined how traumatic experiences may impact performance on IIDs.This study is an archival analysis of the Managing Heavy Drinking (MHD) study of drivers in New York state. The MHD is a comprehensive study of drivers convicted of a DUI from 2015-2020. Participants (N = 121) completed questionnaires and provided consent to retrieve information from interlock providers. Outcome variable included high BAC lockout ratios (number of high BAC lockouts [BAC.08]/number of clean blows [BAC ≤ .025]). Other variables included demographic variables, alcohol treatment history, trauma experiences, and prior DUI history. Variables were entered into a structural equation model.In the final structural model, pathways that demonstrated aThe current study provides a useful framework upon which to understand the role traumatic experiences have on alcohol IID performance. Traumatic experiences are in of themselves insufficient to impact IID performance directly, but it may indirectly impact IID performance through increasing alcohol use.

The overarching aim of this study is to assess driving while impaired by alcohol (DWI) and riding with an impaired driver (RWID) rates among young adult Latinx immigrants to Miami-Dade County, Florida, within a year of arrival in the U.S.A. More specifically, this study aims to: (i) describe the demographic and socioeconomic characteristics of Latinx immigrants to Miami-Dade County within a year of arrival; (ii) examine their alcohol use, DWI, and RWID; and (iii) identify factors influencing these behaviors. This study uses baseline data from an ongoing National Institutes of Health-funded longitudinal study examining drinking and driving trajectories among young adult recent Latinx immigrants to Miami-Dade County. During the baseline assessment, retrospective pre-immigration data and post-immigration data were obtained via personal interviews. Inclusion criteria included being a Latinx immigrant, 18–34 years old, who recently immigrated (within one year before baseline assessment) to the U.S.A. from a Latin American country with the intention of staying in the U.S.A. for at least three years beyond baseline. Respondent-driven sampling was applied. Results showed that since arriving in the U.S.A. approximately 6.3% of all participants had engaged in DWI at least once and 20% reported RWID. Although household income and being male were significant factors, the factor that influenced post-immigration DWI/RWID the most was pre-immigration DWI (odds ratio = 13.1) and pre-immigration RWID (odd ratio = 24.5). Interventions aimed to prevent recent immigrants from engaging in DWI and RWID should take cultural factors and pre-immigration behaviors into account.

Each year, about 200 children aged 14 years old (y/o) or less die and another 4,000 are physically injured while being driven by an adult that has been drinking (aged 21 y/o or more). Concerned by this phenomenon, there are a growing number of States implementing Driving Under the Influence – Child Endangerment (DUI-CE) laws to prevent adults from driving under the influence with children. These laws however, have failed to reduce the rates of DUI-CE injuries and fatalities. It has been hypothesized that such a failure occurs, at least in part, because these laws are being pled-down in courts, this study examines this hypothesis. We analyzed DUI-CE related court information collected by court monitors available in the Court Monitoring Database (CMD) provided by the Mothers Against Drunk Driving (MADD). Despite investigating data that included only DUI offenders who were driving with at least one child passenger at the time of the arrest, only 10% of those charged with a DUI felony and 11% of those charged with a misdemeanor were also found guilty of a DUI-CE violation. These findings support the hypothesis that DUI-CE offenses are being pled down in court and probably contribute to the ineffectiveness of DUI-CE laws. Unfortunately, data limitations preclude any decisive conclusions. Future research should focus on increasing our understanding of the DUI-CE problem and understanding why DUI-CE laws are not working toward the goal of deterring and punishing those who endanger the lives of children.

With greater understanding of preferred and frequently used modes of transportation, urban planners can design and promote efficient, equitable, and sustainable living environments. Few studies have examined the transportation needs immigrants who have recently arrived in the United States. Most of our limited understanding of this subset of the population is based on research obtained from immigrants who have resided in the United States for extended periods of time. Moreover, little is known about how post-immigration travel behaviors are affected by pre-immigration travel behaviors. This study examines how pre-immigration travel behaviors of Latinx immigrants affect their post-immigration travel behaviors within one year of their arrival to Miami-Dade County, Florida. The findings of this study align with previous research suggesting that, among this immigrant group, multiple modes of transportation are used—with variations by sex, income, and country of origin. Unlike previous studies, however, our results reveal a relatively high prevalence of driving, particularly among men, indicating the uniqueness of Latinx travel behavior in Miami-Dade County. An important and novel study finding is that transportation behaviors of immigrants soon after arrival are highly influenced by transportation behaviors in their country of origin. This knowledge can potentially be highly relevant to transportation planners in the United States, as it facilitates the adoption of early behavioral interventions to address immigrants’ transportation needs.

Occupational therapists may recommend and support technology use for facilitating independence, safety, wellbeing, and participation. There are high expectations for technology for people living with dementia. However, there is recognition that technologies will need to improve to deliver these expected benefits. People living with dementia have historically been excluded from direct involvement in research and design. A program of participatory research was undertaken to codesign technologies and technology research with people living with dementia and care partners. This work aims to capture the requirements, actions, and barriers experienced in forming these partnerships in technology research and design.A shared metareflection of experiences was conducted by members (5) of the research teams involved in three participatory research and technology design studies. The team comprising living experience experts, an occupational therapist, and interaction designer reflected on their experiences and derived recommendations. Key considerations for effective partnerships were drawn inductively by the authors from study experiences, materials, and reflexive discussion.Six core areas were identified. These were four action areas-(1) Agree on the value; (2) The time to start partnering is now; (3) Ask not assume; and (4) Push back on 'we always have'-(5) barriers and tensions, and (6) unexpected benefits. The reflections indicated that genuine partnerships and engagements were possible with living experience experts in research and design teams. These required resourcing and focussed actions to promote partnership. Despite some structural changes that encourage partnering, there are considerable barriers to this engagement; however, benefits beyond the expected ones can be realised.Genuine partnerships in technology research and design with living experience experts are possible and lead to benefits for the team, research outcomes, and technologies. Recommended actions could support expansion of effective partnerships with people living with dementia and care partners as well as other partnerships in research.

INTRODUCTION Literature notes the efficacious use of alcohol ignition interlock devices (IID) in reducing rates of drinking and driving while installed on the vehicle. Some drivers who are convicted of driving while intoxicated (DWI) elect to have their license suspended/revoked instead of installing the device. These individuals represent a high-risk subsample of drivers, yet limited literature has addressed this concern. The current study seeks to fill this gap using qualitative interviews addressing: (i) why do non-installers make the choice to not install a mandated IID; and (ii) how are non-installers managing without the IID? METHODS The study utilises the Managing Heavy Drinkers study of drivers in Erie County, New York, USA. Participants were purposively sampled from a group of non-installers (n = 6; four females, two males) who completed semi-structured interviews. Constructed grounded theory was used to develop a theoretical understanding of participant's experiences. RESULTS To understand why participants elect not to install the IID, thematic analysis revealed: alleviating constraints, predominantly the financial burdens associated with an IID, and institutional mistrust. Additionally, data revealed that participants are managing without the IID by mitigating apprehension. This included driving cautiously to avoid detection and utilising alternative transportation. DISCUSSION AND CONCLUSIONS This study furthers understanding of why drivers convicted of a DWI elect not to install an IID. Future research should seek to identify barriers to IID installation. This work provides evidence for establishing institutional protocols that ensure drivers convicted of a DWI receive consistent and correct information about the IID process.

Background Half of the offenders convicted of impaired driving in the United States are sentenced to install alcohol ignition interlock devices (IIDs), which prevent them from starting their vehicles if they have been drinking. No research has yet explored offenders' patterns of alcohol consumption and driving under the influence of alcohol (DUI) from the time before the arrest to the time period after the IID is installed. This study aims to fill that gap in knowledge. Methods Using the Timeline Follow-back interview procedure, we assessed the daily drinking of 153 convicted DUI offenders' self-reported total alcohol consumption and rates of self-reported driving after drinking over 4 phases: before DUI arrest, between arrest and IID installation, during the phase on the interlock, and after the interlock is removed. Because information about behaviors in each period was not available for every participant, comparisons were made using paired-sample contrasts. Results Compared with before the arrest, total alcohol use decreased by 50% in the 4-month phase following arrest and before IID installation, though it did not change much afterward. The frequency of drinking and driving decreased sharply after the arrest (-82%), with further decrease upon installation of the interlock (-58%, p = 0.05). The frequency of drinking and driving after the IID was removed returned to preinstallation drinking and driving status (+58%, p = 0.01). Conclusions Participants made significant adjustments to their drinking behavior by adhering to the traditional DUI driving restrictions in the postarrest phase. Although installation of an IID was not associated with a significant change in drinking, it further reduced the frequency of drinking and driving. Evaluations of the IID experience should take into account information on an individual's drinking and DUI behaviors not only before the IID was installed, but before the individual was arrested.

Background With increasing focus on living well with dementia, technology has been identified as having potential benefits for safety, independence and wellbeing. Despite a large growth in specialised technology development, there has been limited uptake. There is a need to understand the current use and needs related to technology for people living with dementia and their care partners (informal carers). Methods As part of a participatory design study, a qualitative inquiry into technology experiences and needs was undertaken within an interpretive description approach. A cross-disciplinary team including living experience experts (people living with dementia, unpaid care partners) was involved. Semi-structured interviews, including sharing technology locations and supports, were conducted, audio-recorded and transcribed. Key aspects of the technology use experience were constructed. Findings Thirteen people living with dementia and 21 care partners participated in the study. Two core aspects of technology use were identified: Lots of moving parts: the complex context, and A technology cycle: the use and non-use. The findings indicated that the context involved an individual configuration of multiple factors including the user, their technology identity, their supporters, the technology and the environment. The experience is underpinned by shifting foundations created by constantly changing technologies and user characteristics. The cycle of use and non-use identified the processes required to maintain technology engagement. Conclusion The use of technology for people living with dementia is complex and personal. Future technology development, policies and practices need to consider this complexity and the effort required to keep using technology to realise the benefits.

INTRODUCTION: Alcohol ignition interlock devices (IID) reduce rates of drinking and driving. The interlock offers an opportune time for tailoring targeted interventions to develop habits to separate drinking from driving among this high-risk population. This study identified different types of IID users upon whom targeted interventions could be developed. METHODS: Participants (N = 114) were assessed at IID installation and again six months later. Latent class analysis (LCA) was conducted using drinking environment, drinking motivation, social support, drug use, and problem drinking behaviors as indicators. Multivariate regression analyses were conducted comparing latent class assignment with impaired driving attempts. RESULTS: LCA supported a 4-class model where 14.8% of participants fell into the low use/high awareness class; 30.6% fell into the heavy use/high awareness class; 30.6% fell into the mixed use/high awareness class; and 24.0% fell into the moderate use/low awareness class. Drivers in the moderate use/low awareness condition had increased early morning BAC lockouts. CONCLUSIONS: These typologies demonstrate important differences within high risk drivers. Indeed, drivers who fell into the moderate use/low awareness class may not have considered their alcohol-related behaviors problematic. This information could lend itself to the development of targeted interventions to address subgroups of drinking drivers.

Involving people living with dementia in service design and planning has become more common in high-income countries. It remains rare in low- and middle-income countries where two-thirds of the world’s people with dementia live. In this commentary article, we explore the barriers to inclusion of people living with dementia in planning in low- and middle-income countries and make a case for the inclusion of people living with dementia in care and service planning. We suggest how this can be done at individual, community or national and state level using the following principles: 1) respecting the rights of people living with dementia to self-determination; 2) valuing people living with dementia’s unique understanding of dementia; 3) creating a culture of active inclusion which creates a space for people living with dementia to participate and 4) ensuring appropriate accommodations are in place to maximise participation.

This human campylobacteriosis sentinel surveillance project was based at two sites in Oxfordshire and North East England chosen (i) to be representative of the English population on the Office for National Statistics urban-rural classification and (ii) to provide continuity with genetic surveillance started in Oxfordshire in October 2003. Between October 2015 and September 2018 epidemiological questionnaires and genome sequencing of isolates from human cases was accompanied by sampling and genome sequencing of isolates from possible food animal sources. The principal aim was to estimate the contributions of the main sources of human infection and to identify any changes over time. An extension to the project focussed on antimicrobial resistance in study isolates and older archived isolates. These older isolates were from earlier years at the Oxfordshire site and the earliest available coherent set of isolates from the national archive at Public Health England (1997/8). The aim of this additional work was to analyse the emergence of the antimicrobial resistance that is now present among human isolates and to describe and compare antimicrobial resistance in recent food animal isolates. Having identified the presence of bias in population genetic attribution, and that this was not addressed in the published literature, this study developed an approach to adjust for bias in population genetic attribution, and an alternative approach to attribution using sentinel types. Using these approaches the study estimated that approximately 70% of Campylobacter jejuni and just under 50% of C. coli infection in our sample was linked to the chicken source and that this was relatively stable over time. Ruminants were identified as the second most common source for C. jejuni and the most common for C. coli where there was also some evidence for pig as a source although less common than ruminant or chicken. These genomic attributions of themselves make no inference on routes of transmission. However, those infected with isolates genetically typical of chicken origin were substantially more likely to have eaten chicken than those infected with ruminant types. Consumption of lamb’s liver was very strongly associated with infection by a strain genetically typical of a ruminant source. These findings support consumption of these foods as being important in the transmission of these infections and highlight a potentially important role for lamb’s liver consumption as a source of Campylobacter infection. Antimicrobial resistance was predicted from genomic data using a pipeline validated by Public Health England and using BIGSdb software. In C. jejuni this showed a nine-fold increase in resistance to fluoroquinolones from 1997 to 2018. Tetracycline resistance was also common, with higher initial resistance (1997) and less substantial change over time. Resistance to aminoglycosides or macrolides remained low in human cases across all time periods. Among C. jejuni food animal isolates, fluoroquinolone resistance was common among isolates from chicken and substantially less common among ruminants, ducks or pigs. Tetracycline resistance was common across chicken, duck and pig but lower among ruminant origin isolates. In C. coli resistance to all four antimicrobial classes rose from low levels in 1997. The fluoroquinolone rise appears to have levelled off earlier and among animals, levels are high in duck as well as chicken isolates, although based on small sample sizes, macrolide and aminoglycoside resistance, was substantially higher than for C. jejuni among humans and highest among pig origin isolates. Tetracycline resistance is high in isolates from pigs and the very small sample from ducks. Antibiotic use following diagnosis was relatively high (43.4%) among respondents in the human surveillance study. Moreover, it varied substantially across sites and was highest among non-elderly adults compared to older adults or children suggesting opportunities for improved antimicrobial stewardship. The study also found evidence for stable lineages over time across human and source animal species as well as some tighter genomic clusters that may represent outbreaks. The genomic dataset will allow extensive further work beyond the specific goals of the study. This has been made accessible on the web, with access supported by data visualisation tools.

BACKGROUND: Some alcohol interventions have been found to have the adverse outcome of increasing non-alcohol-related substance use. It is unknown, however, how changes in alcohol use over the course of alcohol ignition interlocks - a common DUI intervention - may impact other substance use. METHODS: Alcohol and cannabis use were measured using hair ethylglucuronide and Delta-9-Tetrahydrocannabinol concentrations in blood, respectively. Participants (N = 69) were measured at the interlock installation period and again 6-months later while the interlock was installed. A mixed ANOVA was conducted to examine changes in levels of ethanol and THC over time. RESULTS: On measures of marijuana use, there was a significant interaction effect between the group that increased alcohol use and time F(2, 66) = 7.863, p =.001; partial η(2) =.192; as well as a main effect for time F(2, 66) = 21.106, p

Evidence from middle-income countries indicates high and increasing prevalence of dementia and need for services. However, there has been little investment in care, treatment or support for people living with dementia and their carers. The Strengthening Responses to Dementia in Developing Countries (STRiDE) project aims to build both research capacity and evidence on dementia care and services in Brazil, Indonesia, India, Jamaica, Kenya, Mexico and South Africa. This article presents the Theory of Change (ToC) approach we used to co-design our research project and to develop a strategic direction for dementia care, treatment and support, with stakeholders. ToC makes explicit the process underlying how a programme will achieve its impact. We developed ToCs in each country and across the STRiDE project with researchers, practitioners, people living with dementia, carers and policymakers at different levels of government. This involved (1) an initial ToC workshop with all project partners (43 participants); (2) ToC workshops in each STRiDE country (22–49 participants in each); (3) comparison between country-specific and overall project ToCs; (4) review of ToCs in light of WHO dementia guidelines and action plan and (5) a final review. Our experiences suggest ToC is an effective way to generate a shared vision for dementia care, treatment and support among diverse stakeholders. However, the project contribution should be clearly delineated and use additional strategies to ensure appropriate participation from people living with dementia and their carers in the ToC process.

Background Before the COVID‐19 pandemic, very little was known about the impact of social isolation on individuals’ alcohol use and misuse. This study examines how socially isolated individuals with a history of heavy drinking used alcohol during the pandemic. Methods Data for this study came from an add‐on to the Managing Heavy Drinking (MHD) longitudinal study of drivers convicted of DWI that was conducted in Erie County, New York. Pre‐COVID information (October 2019–March 2020) was augmented with a COVID‐19 questionnaire collected between July and August 2020. A total of 92 participants completed the COVID‐19 survey. Results The sample of problem drinkers showed a significant increase after the pandemic outbreak in the average number of drinking days from 1.99 to 2.49 per week (p = 0.047), but a significant decrease in the average number of drinks per drinking day, from 3.74 to 2.74 (p = 0.003). The proportion of individuals who drank more frequently was greater among those who, before the outbreak had an Alcohol Use Disorders Identification Test (AUDIT) score 8 (13%). Alcohol treatment was also associated with the frequency of drinking, with individuals who were not in alcohol treatment showing a 16% increase in frequency compared with a 10% increase among those in treatment. Further, individuals who, after the outbreak worried about their health (30%) or finances (37%) reported greater increases in the frequency of drinking than those who did not worry about their health (17%) or finances (10%). Conclusions Overall, the individuals in our sample showed small changes in the frequency andheaviness of drinking after the outbreak of COVID‐19, effects that opposite in direction from one another and thus resulted in no overall change in drinks consumed. Nonetheless, we identified factors that influenced the effects of the pandemic ond rinking behavior among individuals convicted of DWI, which emphasizes the need to individualize these individuals’ treatment, particularly in the context of dramatic environmental change.

BACKGROUND: Alcohol ignition interlock devices (IIDs) reduce rates of drinking and driving when installed on the vehicles of offenders. While the IID is installed on their vehicle, some drivers adapt their drinking behaviors, while others cannot. Heavy alcohol use and mental health concerns reduce treatment adherence in clinical settings, but it has not yet known how they pertain to behavioral adaptation to IIDs. OBJECTIVES: This study focuses on identifying driver typologies as predictors of performance while on alcohol IIDs. METHODS: The study utilizes the Managing Heavy Drinking study of drivers in New York state. Participants (N = 101; 59 males, 42 females) completed questionnaires assessing demographic information, drinking behaviors, driving history and mental health measures. All participants had been convicted of a DUI, and installed an IID. Latent class analysis was used to establish typologies and predict lockout ratios. RESULTS: Four typologies emerged and drivers with elevations in mental health concerns had significantly worse lockout ratios than those in other classes. CONCLUSIONS: The current study may provide support for interventions designed to identify drivers with comorbid mental health concerns and tailor appropriate interventions to administer while the IID is installed with the aim of improving behavioral adaptation to the device.

OBJECTIVES: The purpose of this investigation was to compare the drinking patterns and experiences (both positive and negative) among DUI offenders who had installed an ignition interlock. The association between those experiences and interlock performance as measured by the number of times they had a lockout, was also assessed. METHODS: Over 300 DUI offenders who installed an interlocks in the State of Florida were recruited and completed an on-line survey at the beginning and end of their interlock restriction. A record of the interlock performance data from each was downloaded and used to determine how many lockouts they experienced during their interlock restriction period. Offenders were defined into two groups; successful cases (having 0 or 1 lockout) or poor performers (have 2 or more lockouts). Chi-square and binary regressions were used to assess differences between groups. RESULTS: Poor performers reported significantly more drinking and were more likely to drink in a context of emotional comfort, yet they were more likely to report positive experiences with the interlock, especially as to its ability to remind them to avoid another DUI by reducing their drinking and driving. No difference was found between these two groups for the interlock’s ability to reduce drinking. CONCLUSIONS: People with a more serious drinking pattern and who may be most at risk for recidivating may be more inclined to recognize the potential benefits of the interlock as a DUI preventive countermeasure. More research is needed to identify and influence high risk DUI offenders while on the interlock to increase its effectiveness once the interlock is removed.

OBJECTIVE: There is a substantial body of evidence that the recidivism of impaired-driving offenders is reduced while an ignition interlock device (IID) is on their vehicles. This study examines changes in driving behaviors and drinking behaviors used by DWI offenders to manage driving with the IID. METHODS: A total of 166 IID participants who completed two surveys covering the period from arrest to IID installation (T1) and during IID use (T2) were examined. Four domains were covered: demographics, driving environments and transportation needs, reported driving activity, and reported drinking activities. Participants were on average 38 years old, 43% were female, 35% completed college, 34% had an income of more than $50,000, and 83% were employed. For those who provided it, the mean blood alcohol content (BAC) at arrest was .184 g/dL, with only 8 (5%) individuals below .08 g/dL, and 93 (56%) at over .18 g/dL. About 45% were repeat DWI offenders. RESULTS: Between T1 and T2 there was a slight increase in acknowledging public transportation was available (p=.001), an increase in other individuals driving the interlock-equipped vehicle (p=.002), an increase in the number of vehicles in the household not registered to the DWI offender (p< .001), and an increase in the number of participants who reported that driving was important to their lifestyle (p=.008). Initial (T1) expectations about whether the interlock would be a problem were significantly different from actual experiences reported in T2 (p

INTRODUCTION: To effectively address concerns associated with alcohol-related traffic laws, communities must apply comprehensive and well-coordinated interventions that account for as many factors as possible. The goal of the current research article is to examine and evaluate the simultaneous contribution of 20 underage drinking laws and 3 general driving safety laws, while accounting for demographic, economic, and environmental variables. METHODS: Annual fatal crash data (1982 to 2010), policies, and demographic, economic, and environmental information were collected and applied to each of the 51 jurisdictions (50 states and the District of Columbia). A structural equation model was fit to estimate the relative contribution of the variables of interest to alcohol-related crashes. RESULTS: As expected, economic factors (e.g., unemployment rate, cost of alcohol) and alcohol outlet density were found highly relevant to the amount of alcohol teens consume and therefore to teens' impaired driving. Policies such as those regulating the age of bartenders, sellers, or servers; social host civil liability laws; dram shop laws; internal possession of alcohol laws; and fake identification laws do not appear to have the same impact on teens' alcohol-related crash ratios as other types of policies such as those regulating alcohol consumption or alcohol outlet density. CONCLUSIONS: This effort illustrates the need for comprehensive models of teens' impaired driving. After simultaneously accounting for as many factors as possible, we found that in general (for most communities) further reductions in alcohol-related crashes among teens might be more rapidly achieved from efforts focused on reducing teens' drinking rather than on reducing teens' driving. Future efforts should be made to develop models that represent specific communities. PRACTICAL APPLICATIONS: Based on this and community-specific models, simulation programs can be developed to help communities understand and visualize the impact of various policy alternatives. Language: en

OBJECTIVE: Polydrug users have been shown to be at higher risk for alcohol consumption and crash involvement. However, research has shown that polydrug groups differ in some important ways. It is currently unknown how polydrug-using groups differ in terms of crash involvement and alcohol consumption. METHOD: The current study used latent class analysis to examine subgroups of polydrug users (n = 384) among a sample of drivers in Virginia Beach, Virginia (N = 10,512). A series of logistic regression analyses were conducted to determine the relationship between polydrug use categories and crash involvement and alcohol consumption. RESULTS: Four distinct subclasses of users were identified among polydrug-using drivers: Class 1 is the “marijuana-amphetamines class” and accounts for 21.6% of polydrug users. Class 2 is the “benzo-antidepressant class” and accounts for 39.0% of polydrug users. Class 3 is the “opioid-benzo class” and accounts for 32.7% of polydrug users. Finally, Class 4 is the “marijuana-cocaine class” and accounts for 6.7% of the study sample. Drivers in the opioid-benzo class were significantly more likely than those in any other class as well as non–drug users and single-drug users to be involved in a crash and were more likely than those in most other conditions to consume alcohol. No significant difference was found between marijuana-amphetamine users or benzo-antidepressant users and non–drug users on crash risk. CONCLUSIONS: Some polydrug users are indeed at greater risk for crash involvement and alcohol consumption; however, not all polydrug users are significantly worse than single-drug users and/or non–drug users, and the practice of lumping polydrug users together when predicting crash risk runs the risk of inaccurately attributing crash involvement to certain drivers.

Numerous studies have demonstrated that vehicle alcohol ignition interlocks installed on the cars of impaired-driving offenders reduce recidivism by approximately two-thirds in comparison to similar offenders whose licenses have been suspended. An unresolved issue is the extent to which the effectiveness of interlock programs can be improved by close monitoring of the offenders' performance while in the program. This article describes 5 types of monitoring currently being used in interlock programs in the United States.The programs reviewed vary from those that simply ensure that the interlock is on the offender's vehicle and functioning, to those that use the interlock log data to extend the length of time the offender is required to be in the interlock program, and those that use the interlock data to initiate special monitoring and treatment programs that must be completed before removal of the interlock device. The strengths and limitations of each type of program are described. Also reviewed are current technological developments that appear to be leading to the development of fully automated interlock monitoring systems.Initial evidence shows that more intensive monitoring provides benefits in improved performance on the interlock, as indicated by fewer high blood alcohol concentration (BAC) breath tests when attempting to drive. Although effective, supervision that is more intensive increases government program costs.The relative cost-effectiveness of the differing types of monitoring requires investigation. Treatment programs need to be integrated with the interlock installation period. New technologies can potentially reduce interlock offender monitoring costs and effectiveness. Integrating treatment with the interlock could have postinterlock benefits.

Background Evidence that hand hygiene (HH) reduces healthcare-associated infections has been available for almost two centuries. Yet HH compliance among healthcare professionals continues to be low, and most efforts to improve it have failed. Objective To improve healthcare workers' HH, and reduce healthcare-associated infections. Design 3-year interrupted time series with multiple sequential interventions and 1-year post-intervention follow-up. Setting Teaching hospital in rural New Hampshire. Interventions In five categories: (1) leadership/accountability; (2) measurement/feedback; (3) hand sanitiser availability; (4) education/training; and (5) marketing/communication. Measurement Monthly changes in observed HH compliance (%) and rates of healthcare-associated infection (including Staphylococcus aureus infections, Clostridium difficile infections and bloodstream infections) per 1000 inpatient days. The subset of S aureus infections attributable to the operating room served as a tracer condition. We used statistical process control charts to identify significant changes. Results HH compliance increased significantly from 41% to 87% (p

The Irish community is the oldest minority ethnic community in Britain. Despite an older age profile than general or minority ethnic populations, as well as excesses of mental and physical ill-heal...

There is concern that by failing to understand fully the risks associated with driving under the influence (DUI), some Latino immigrants-undocumented in particular-may be overrepresented in alcohol-related crashes. Until now, data on undocumented immigrants has been absent. Data came from an ongoing longitudinal sample of Latino immigrants to Miami-Dade County, FL. Descriptive analyses and regression techniques were applied. Compared with permanent residents, undocumented drivers are more likely to binge drink, less likely to understand DUI laws, and less likely to perceive the risks associated with DUI-three factors largely associated with high DUI rates. Despite facing these risk factors, undocumented immigrants showed low DUI rates, partly due to their limited amount of driving. Differences in risk perceptions and actual DUI events between Latino immigrants of different residency statuses suggest the possibility of early interventions aimed at reducing DUI among Latino immigrants.

Lowering state blood alcohol concentration (BAC) limits to 0.08, though controversial, has been supported by most evaluation studies to date. The Illinois .08 BAC law implemented in 1997 provided a unique opportunity to evaluate the effect of the law without the simultaneous passage of an administrative license revocation (ALR) law, which has clouded some previous evaluations of the .08 laws. The proportion of all drinking drivers in fatal crashes was compared before versus after implementing the .08 law using time-series analysis to evaluate 12 years of fatal crash data for Illinois and five bordering states. The results showed that the proportion of drinking drivers in fatal crashes decreased by 14% in Illinois and increased by 3% in bordering states. The proportion of drinking drivers in fatal crashes in Illinois, though increasing since 1995, was sharply reduced after passage of the .08 law in 1997, saving more than 100 lives in 1998 and 1999 than it would have without the .08 law.

In 2001 the Child Development Unit (CDU) in Brisbane piloted a series of monthly multidisciplinary case discussions via videoconference in the area of child development. During 2001 two sessions were provided; during 2004 there were 40. The substantial growth in 2004 was due to the expansion of child development services to include special interest group meetings and multipoint case conference meetings. In 2004, a total of 49 h of videoconferencing was conducted. The average session length was 75 min. Education and training sessions were delivered to 32 hospitals and health centres in Queensland and northern New South Wales. The maximum number of sites involved during a single videoconference was 25. The average number of attendees for each videoconference was five per site, including allied health staff, nurses and paediatricians. The delivery of child development services via videoconference has been shown to be useful in Queensland, especially for allied health staff working in regional and remote areas. The growth of the programme indicates its acceptance as a mainstream child development service in Queensland.

Objective.To determine the impact of known observers on hand hygiene performance in inpatient care units with differing baseline levels of hand hygiene compliance.Design.Observational study.Setting.Three inpatient care units, selected on the basis of past hand hygiene performance, in a hospital where hand hygiene observation and feedback are routine.Participants.Three infection control practitioners (ICPs) and a student intern observed hospital staff.Methods.Beginning in late 2005, the 3 ICPs, who were well known to the hospital staff, performed frequent, regular observations of hand hygiene in all 3 inpatient care units of the hospital, as part of routine surveillance. During the study period (January-May 2007), a student intern who was unknown to the hospital staff also performed observations of hand hygiene in the 3 inpatient care units. The rates of hand hygiene compliance observed by the 3 ICPs were compared with those observed by the student intern.Results.The 3 ICPs observed 332 opportunities for hand hygiene during 15 observation periods, and the student intern observed 355 opportunities during 19 observation periods. The overall rate of hand hygiene compliance observed by the ICPs was 65% (ie, in 215 of the 332 opportunities, the performance of proper hand hygiene by hospital staff was observed), and the overall rate of hand hygiene compliance observed by the student intern was 58% (ie, in 207 of the 355 opportunities, the performance of proper hand hygiene by hospital staff was observed) (P = .1). Both the ICPs and the student intern were able to distinguish between inpatient care units with a high rate of hand hygiene compliance (hereafter referred to as high-performing units) and those with a low rate (hereafter referred to as low-performing units). However, in the 2 high-performing units, the ICPs observed significantly higher compliance rates than did the student intern, whereas in the low-performing unit, both the ICPs and the student intern measured similarly low rates of hand hygiene compliance.Conclusions.Recognized observers are associated with higher rates of hand hygiene compliance, even in a healthcare setting where such observations have become routine. This effect (ie, the Hawthorne effect) is more pronounced in high-performing units and insignificant in low-performing units. The use of unrecognized observers may be important for verifying high performance but is probably unnecessary for documenting poor performance. Moreover, the Hawthorne effect may be a useful tool for sustaining and improving hand hygiene compliance.

Clonal spread of vancomycin-resistant Enterococcus faecium among seven patients on one ward of a community teaching hospital was identified by contour-clamped homogeneous electric-field gel electrophoresis. Environmental cultures isolated the same strain from the handle of a shared electronic ear-probe thermometer. Cross-contamination of the clonal strain between two geographically separate units on this ward, sharing equipment but not personnel, suggests the possibility of an environmental source.