̽��ֱ�� of Cambridge - Kai Hensel

Drinkers risk exceeding legal driving limit by underestimating how drunk they are

cjb250 — Tue, 07 Dec 2021 00:01:27 +0000

Worldwide, drunk driving is a major problem, despite decades of health promotion activities. Road traffic injuries have become the leading killer of people aged five to 29 years, and recently, the World Health Organization has said that alcohol-related traffic accidents are one of the major causes. In 2019, between 210 and 250 people were killed in accidents in Britain where at least one driver was over the drink-drive limit, the highest level since 2009.

Drinking alcohol causes significant impairment to our motor function, and the more we drink, the worse this becomes. Drunk drivers may struggle to keep their vehicle in lane and have slow reaction times, as well as being more likely to take risks.

In research published today in the Harm Reduction Journal, a team of researchers from Witten/Herdecke ̽��ֱ�� and the ̽��ֱ�� of Cambridge studied how accurately participants were able to estimate their fitness to drive after drinking alcohol.

Ninety students (average age 24 years old) took part in an experiment on two separate days. Participants were split into two groups: a study group and a control group. Both groups consumed either beer or wine or both until they reached a maximum breath alcohol concentration (BrAC) of 0.11%.

̽��ֱ��research was carried out in Germany, where the legal driving limit is a BrAC of 0.05% (in England and Wales, the level is 0.08%).

In the study group, participants were told at the start that when they reached a BrAC of 0.05%, they would be switched from beer to wine or vice versa, though it was not explicitly explained that this was the legal driving limit.

̽��ֱ��researchers monitored each participant’s breath alcohol concentration using breathalysers. With each measurement, they asked the participants to estimate their own breath alcohol concentration. All participants were asked to come forward when they thought they had reached the legal driving limit.

̽��ֱ��team found that on the first study day, more than a third (39%) of participants who believed they had reached the legal driving limit had in fact already exceeded this threshold. On the second day this proportion increased to more than half (53%).

Dr Kai Hensel from Witten/Herdecke ̽��ֱ�� and the ̽��ֱ�� of Cambridge, who led the study, said: “In countries with legal alcohol limits, it’s usually the driver who makes a judgement about how much they’ve drunk and how fit they are to drive. But as we’ve shown, we are not always good at making this judgement. As many as one in two people in our study underestimated how drunk they were – and this can have devastating consequences.”

̽��ֱ��researchers also noticed that participants became poorer at estimating their BrAC level the drunker they became. “This could have serious consequences in England and Wales, where the legal driving limit is higher, as it suggests that a significant number of people might misjudge how drunk they are and consider themselves fit to drive when in fact they have a potentially dangerously high level of alcohol in their blood,” added Dr Hensel.

To see whether people were able to improve their ability to estimate how drunk they are, the researchers compared the volunteers’ self-estimation of having reached the legal driving limit between the two study days. For the study group participants were better able to estimate how drink they were on the second day, but this was not the case for the control group.

Dr Hensel added: “Drinking and driving is a major risk fact for road traffic accidents. Anything that can be done to reduce these numbers is worth trying. With guidance, our participants were able to improve their judgement. It could be that pop-up stalls set up around drinking establishments to help people understand their breath alcohol concentration might help.

“Really, the best advice is that if you’re driving, just don’t drink. But if you really do feel like a drink, then look into your own alcohol tolerance. This differs from one person to the next, depending on your sex, weight and age, and there are some reliable apps out there that can help guide you.”

Carlsberg donated 420 litres of beer to be utilised for research purposes only, but had no role in the design, conduct, or analyses of the study.

Reference
Köchling, J et al. ̽��ֱ��hazardous (mis)perception of Self-estimated Alcohol intoxication and Fitness to drivE – an avoidable health risk: the SAFE randomised trial. Harm Reduction Journal; 7 Dec 2021; DOI: 10.1186/s12954-021-00567-4

As many as a half of all drinkers underestimated how drunk they were, judging themselves still safe to drive despite having exceeded the legal driving limit, in new research published today.

In countries with legal alcohol limits, it’s usually the driver who makes a judgement about how much they’ve drunk and how fit they are to drive. But as we’ve shown, we are not always good at making this judgement

Kai Hensel

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Opinion: Why too much focus on COVID-19 could be harming our children

cjb250 — Thu, 25 Jun 2020 11:15:38 +0000

In preparation for the COVID-19 pandemic and the anticipated overwhelming demand on hospitals, the NHS moved towards of a policy of providing only essential treatments. Doctors were asked to postpone all non-urgent clinical activities including face-to-face outpatient visits, diagnostic procedures and hospital-based therapies.

As nations declared themselves ‘at war’ against the virus, they may have become blinded to the impact on other conditions. “There seems to be almost only one relevant diagnosis these days: the new virus,” writes Hensel.

This has meant that, thanks to the preparations, a major hospital could have more than 450 empty beds and less than 50% surgical theatre activity.

“ ̽��ֱ��message is unmistakable: we are prepared. But this comes at a price… Antenatal care is widely reduced, cancer surgeries are limited and emergency room attendance has decreased to far less than 50% as compared with pre-coronavirus times. Where are all the sick patients that usually keep us busy?”

In fact, the level of busyness may depend entirely on the medical specialty in question. Healthcare workers in adult intensive care units face facing long hard shifts treating severely unwell patients, while most paediatric specialties are seeing a drastically decreased workload.

“Healthcare allocation, in times of COVID-19 more than ever, is a risk management game. But the ‘flatten-the-curve imperative’ inevitably comes at a price, and the bill is yet to come. As one curve is plateauing, others may even rise.”

Hensel argues that children may be getting “a bad deal” as a result of healthcare policies. They tend to have milder disease if infected, yet are missing out on other important services.

He presents the example of a two-year-old boy who was referred to his team for suspected very-early-onset inflammatory bowel disease (IBD). This is usually confirmed by endoscopy or MRI. It was only by the team successfully pressing for the boy to be considered an exception that endoscopy revealed that his symptoms were caused by a single juvenile rectal polyp (abnormal tissue growth), which was then removed. ̽��ֱ��remainder of the procedure was normal, and the boy was discharged without further medical treatment. If the team had not urged for the boy to be placed on one of the few emergency lists, he would have been mistakenly diagnosed with IBD and given immunosuppressant drugs with potential side effects while he continued to suffer symptoms.

Policies to manage resources during COVID-19 risks having a disproportionate impact on children, writes Hensel. Three months since the UK first went into lockdown, more and more negative public health consequences are beginning to unfold. Lockdown regulations and school closures are making vulnerable children even harder to reach, prompting the World Health Organization to issue a joint leaders’ statement entitled “Violence against children: a hidden crisis of the COVID-19 pandemic”.

“Tragically, detrimental social and health effects will hit the socioeconomically disadvantaged communities disproportionally harder,” writes Dr Hensel. “Food insecurity and loss of academic achievement are expected to significantly contribute to the exacerbation of the already existing inequalities.” He argues that a public health approach is urgently needed to improve child health in these challenging times, to manage domestic violence and to fight under-the-radar child neglect.

With the performance of policy-makers being judged according to internationally comparable coronavirus numbers, Dr Hensel says it is the job of physicians to speak up on behalf of underrepresented patient groups.

“We need to advocate, to give our patients a voice and to spread the message: in COVID-19 times, there is not just one diagnosis that matters.”

Reference
Hensel, KO. Double-edged sword of limiting healthcare provision for children in times of COVID-19: the hidden price we pay. BMJ; 23 June 2020; DOI: 10.1136/archdischild-2020-319575

COVID-19 hurts even those who escape infection – particularly children, writes paediatrician Dr Kai Hensel from the ̽��ֱ�� of Cambridge in the journal Archives of Disease in Childhood.

There seems to be almost only one relevant diagnosis these days: the new virus

Kai Hensel

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Wine before beer, or beer before wine? Either way, you’ll be hungover, study finds

cjb250 — Fri, 08 Feb 2019 00:01:39 +0000

Most people will at some point in their life experience one of the many downsides of excess drinking: the hangover. Importantly, hangovers can lead to reduced productivity, impaired performance (including missing work or academic underperformance) and even risk to daily tasks such driving or operating heavy machinery.

Hangover symptoms occur when higher-than-normal blood alcohol concentrations drop back to zero. Surprisingly, the phenomenon is not particularly understood, though it is thought that their underlying causes include dehydration, our immune response, and disturbances of our metabolism and hormone. Hangovers are likely to be influenced by ingredients other than the pure alcohol content. Colourings and flavourings have been suggested as making hangovers worse, which might explain why, at the same alcohol concentration, Bourbon causes a more severe hangover than vodka.

There are no effective hangover remedies – instead, societies appear to rely on folk remedies (such as ‘hair of the dog’) and old folk sayings. Such sayings exist in numerous languages: other examples in English include "Grape or grain, but never the twain”, while Germans claim “Wein auf Bier, das rat’ ich Dir—Bier auf Wein, das lass’ sein” and the French say “Bière sur vin est venin, vin sur bière est belle manière”.

There is little evidence available to support or refute these sayings, so, to put an end to this uncertainty, researchers at Witten/Herdecke ̽��ֱ�� in Germany and the ̽��ֱ�� of Cambridge in the UK evaluated scientifically whether or not this time-honoured wisdom truly reduces a hangover burden. ̽��ֱ��results of their study are published today in the American Journal of Clinical Nutrition.

Ninety volunteers, aged between 19 and 40 years old, were recruited and split into three groups. ̽��ֱ��first group consumed around two and a half pints of beer followed by four large glasses of wine. ̽��ֱ��second group consumed the same amounts of alcohol, but in reverse order. Subjects in the third, control group consumed either only beer or only wine.

̽��ֱ��big strength of this study was its crossover design: a week later, participants in study groups one and two were switched to the opposite drinking order. Control group subjects who drank only beer the first time around received only wine on the second study day (and vice versa). This way, the groups were not only compared to each other, but each participant was their own control, too.

Participants were asked about their wellbeing at regular intervals and were asked to judge their perceived level of drunkenness on a scale between 0 and 10 at the end of each study day. Before going to bed at the study site, all participants received an individualised amount of refrigerated drinking-water tailored to their body weight. All volunteers were kept under medical supervision overnight.

̽��ֱ��following day, participants were asked about their hangover and given a score from 0-56 (the so-called Acute Hangover Scale) based on factors including thirst, fatigue, headache, dizziness, nausea, stomach ache, increased heart rate and loss of appetite.

̽��ֱ��researchers found that none of the three groups had a significantly different hangover score with different orders of alcoholic drinks. Women tended to have slightly worse hangovers than men. While neither blood and urine tests, nor factors such as age, sex, body weight, drinking habits and hangover frequency, helped to predict hangover intensity, vomiting and perceived drunkenness were associated with heavier hangover.

“Using white wine and lager beer, we didn’t find any truth in the idea that drinking beer before wine gives you a milder hangover than the other way around,” says first author Jöran Köchling from Witten/Herdecke ̽��ֱ��.

“ ̽��ֱ��truth is that drinking too much of any alcoholic drink is likely to result in a hangover. ̽��ֱ��only reliable way of predicting how miserable you’ll feel the next day is by how drunk you feel and whether you are sick. We should all pay attention to these red flags when drinking.”

Dr Kai Hensel, a senior clinical fellow at the ̽��ֱ�� of Cambridge and senior author of the study, adds: “Unpleasant as hangovers are, we should remember that they do have one important benefit, at least: they are a protective warning sign that will certainly have aided humans over the ages to change their future behaviour. In other words, they can help us learn from our mistakes.”

Dr Hensel says that there were two main reasons for carrying you the study. “Firstly,” he says, “a clear result in favour of one particular order could help to reduce hangovers and help many people have a better day after a long night out – though we encourage people to drink responsibly. Unfortunately, we found that there was no way to avoid the inevitable hangover just by favouring one order over another.

“But this study was also about showing, in a public-friendly manner, how a rigorously-conducted study can provide a solid answer to a specific question and be engaging at the same time. We hope it will help inspire next generation of young doctors and researchers to be engaged in a research-driven environment.”

Reference
Köchling, J et al. Grape or grain but never the twain? A randomized controlled multiarm matched-triplet crossover trial of beer and wine. American Journal of Clinical Nutrition; 8 Feb 2019; DOI: 10.1093/ajcn/nqy309

'Beer before wine and you’ll feel fine; wine before beer and you’ll feel queer' goes the age-old aphorism. But scientists have now shown that it doesn’t matter how you order your drinks – if you drink too much, you’re still likely to be ill.

Unpleasant as hangovers are, we should remember that they do have one important benefit... they can help us learn from our mistakes

Kai Hensel

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