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The Widmark formula for alcohol quantification
Abstract
In 1932 the Swedish scientist Eric P Widmark developed two formulae commonly used for the calculation of the amount of alcohol ingested and for assessing the concentration of alcohol at some time prior to the sampling. The most important statement in the respect to these calculations is to stress the unreliability and inaccuracy of attempting back-calculations in either direction. Only gross approximations can be achieved and no pretence at accuracy must be offered.
... This would involve consumption of 190 ml of spirits containing 40% ethanol. Assuming this volume, the blood ethanol concentration would be 26.5 mM in man according to Widmark's equation (Brouwer, 2004). Blood ethanol levels of 9.0-34.0 ...
... to be consumed to reach these acetaldehyde levels varies from 64.0-242.0 ml of spirits containing 40% ethanol (Brouwer, 2004). Consequently, acetaldehyde concentrations in the blood of heavy drinkers could easily exceed the minimal level that inhibited the phagocytosis of granulocytes and monocytes (0.005 mM) in our study. ...
Aims:
The aim of our study was to measure granulocyte and monocyte phagocytosis following treatment of cells with some metabolites of aliphatic alcohols alone and in combination with acetaldehyde.
Methods:
The cells were separated from human peripheral blood prior to determination of phagocytosis of opsonized zymosan particles by granulocytes and monocytes treated individually with metabolites of aliphatic alcohols including formaldehyde, 1-propanal, acetone, 1-butanal, and 2-butanone and in combination with acetaldehyde.
Results:
The findings revealed that metabolites of aliphatic alcohols inhibited phagocytosis by granulocytes and monocytes in a concentration-dependent manner and when combined with acetaldehyde, they caused a further decrease in phagocytic activity.
Conclusion:
Due to their additive effects, it is possible that, in combination with acetaldehyde, metabolites of aliphatic alcohols may inhibit phagocytosis at physiologically realistic concentrations in episodic heavy drinkers, thereby contributing to their increased susceptibility to infectious diseases.
... Widmark published the first detection method [8] and accompanying pharmacokinetics [9] of ethanol in the early 1920s and 1930s. This field of research was advanced by Elbel [10] when a forensic focus on blood alcohol research within the German speaking countries was established111213. In the same decade, Machata developed the first gas chromatography with flame ionization detection (GC-FID) method for analysis of simple volatiles in blood by direct [14] and headspace (HS-GC-FID) injections [15] . ...
... Back-calculation of the BAC [45, 46] is generally acceptable [47]. However, this will result in wide ranges [12] and likely over-or under- estimations [48]. The technique of double blood sampling where the magnitude and direction of the ethanol concentration in the second blood sample is compared to the first (and similarly for blood to urine comparisons) has been utilized in the past [27]. ...
For many decades traditional alcohol congener analysis has provided the concentrations of fermentation by-product congeners found in blood, to ascertain if the claims of an individual regarding the alcoholic beverage(s) they have consumed were feasible, assisting in cases where after-drinking is involved. However, this technique does not provide information on the exact alcoholic beverage(s) consumed. More recently, ingredient biomarker congeners specific to certain alcoholic beverages have been detected in blood, making it possible to identify the particular alcoholic beverage consumed and therefore the source of alcohol (albeit only for a limited number of beverages). This novel approach may reduce current limitations that exist with traditional methods of detecting fermentation by-product congeners, which restrict the use of alcohol congener analysis internationally and for other medico-legal scenarios. This review examines the forensic application of alcohol congener analysis in determining the source of alcohol and other techniques.
... In this study, an OR of 1.75 (95% CI: 1.43 -2.14) per 0.02 % rise in BAC was found, whereas for no-fatal motor vehicle injury the OR was 1.24 (95% CI: 1.18-1.31) for approximately a 1 drink increase (which generally results in a BAC of about 0.02%) (Brouwer, 2004). What's more, the risk curve for fatal injury was consistently far steeper than for non-fatal injury at all levels of alcohol consumption. ...
... Exposure data for studies of fatal injury tends to rely more on data from coroner's reports, mortality statistics, and police files compared to inhospital and in-person questionnaires of case-control or case-crossover data that characterizes investigations of alcohol-attributable non-fatal injuries, which tend to be based on self-reported consumption in emergency room settings (Gmel et al., 2009, Borges et al., 2005, Borges et al., 2008, making access to cases more difficult and time-intensive. As well, measuring the relationship between acute alcohol consumption and fatal injury may be more difficult than for non-fatal injury and may tend to underestimate the true relationship between alcohol and fatal injury, particularly given that BAC calculations may result in underestimation of true consumption (Gullberg, 2007, Brouwer, 2004. BAC is often measured long after the initial accident took place, which may underestimate the true exposure (e.g. ) and thus the dose-specific relative risk, making the results of the current analysis conservative. ...
Alcohol consumption causes motor vehicle accident (MVA) injury in a dose-response fashion. However, the relationship between how this risk is different with respect to fatal and nonfatal outcomes is not clear. A meta-analysis has already been completed for alcohol consumption and nonfatal MVA injury, but none exists for fatal injury. Thus, an analysis of the acute dose-response relationship between alcohol and motor vehicle injury death is warranted to generate single occasion- and dose-specific relative risks for the first time.
A systematic literature review and inverse-variance weighted, random effects meta-analysis were conducted to fill this gap. Fractional polynomial regression was used to model the dose-response relationship. Usual tests of heterogeneity and publication bias were run.
Five studies meeting the inclusion criteria of this analysis were selected. At all levels of blood alcohol concentration (BAC), the odds ratio (OR) of fatal motor vehicle injury was significant. Overall, the 5 combined studies yielded an OR of fatal injury of 1.74 (95% CI: 1.43-2.14) for every 0.02% increase in BAC. At 0.08, the legal limit in most countries, the OR was 13.0 (95% CI: 11.1-15.2).
This study is able to definitively show and quantify, for the first time, the significantly increased OR for fatal motor vehicle injury. This analysis showed some evidence of both study heterogeneity and publication bias, likely due to the increased variation we could expect from a small study number. The alcohol-caused fatal motor vehicle injury literature is sparse with respect to dose-response information. More studies investigating this relationship and other injury types are recommended in this area to be able to calculate stable estimates of risk overall and by injury type specifically.
... amount of alcohol needed to reach a certain blood alcohol concentration, as follows: amount of alcohol (gr) = weight (kg) × R × 0.6 (desired concentration), with R being a factor for body distribution: 0.7 for men, 0.6 for women [13]. The source of alcohol was beer (5%) or wine (12%) according to the participant's preference. ...
Background: Essential tremor (ET) is the most common movement disorder in adults and is considered to be highly heritable. A reduction of the tremor amplitude after alcohol consumption is reported in approximately half of the patients. In this study, we describe the alcohol response in our familial ET cohort by employing an alcohol responsivity test designed by Knudsen et al. outside its original research group for the first time. Methods: We recruited families with at least three trembling family members and confirmed ET diagnoses. During the in-hospital alcohol responsivity test, tremor was measured using Archimedes spirals before alcohol consumption (T0), one hour after alcohol intake (T1), and the next morning (T2). The spirals were rated by two independent raters using the Bain Findley scale. The average of these two scores was calculated as the Archimedes Spiral Rating (ASR) for each time point. Results: Twenty-four confirmed ET patients were included for analysis. The median ASR at T0 (5.0) and T2 (4.75) were significantly higher than the median ASR at T1 (3.25) (both p < 0.001). In 67% of patients, a difference in ASR between T0 and T1 (dASR) ≥ 2 pointed towards an improvement of tremor after consuming alcohol. Discussion: We confirmed that the alcohol responsiveness test of Knudsen et al. is useful in determining objective alcohol responsivity. We established a significantly reduced ASR after alcohol consumption in 67% of familial ET patients in our cohort. In the future, a larger population is needed to establish whether familial aggregation of alcohol responsivity occurs in essential tremor patients. Highlights The test designed by Knudsen et al. effectively established objective alcohol responsiveness outside its original research group. We found an objective alcohol response in 67% of our familial ET cohort. Subjective VAS scores were significantly lower after alcohol consumption. There was no correlation between the objective and subjective alcohol responsiveness. Familial aggregation of alcohol responsiveness in ET should be studied in a larger cohort.
... The participants were unblinded to which drink they were consuming as the effects and taste of the drinks would make a blinding process impossible. The amount of alcohol that was to be consumed on the alcohol day was calculated according to the Widmark formula [28] to reach the target blood alcohol level of 0.1% [29]. For this calculation, a Widmark factor (representing the volume of distribution) of 0.6 was used for the female and 0.7 for the male subjects. ...
Citation: Dreismickenbecker, E.; Zinn, S.; Romero-Richter, M.; Kohlhaas, M.; Fricker, L.R.; Petzel-Witt, S.; Walter, C.; Kreuzer, M.; Toennes, S.W.; Anders, M. Electroencephalography-Based Effects of Acute Alcohol Intake on the Pain Matrix. Brain Sci. 2023, 13, 1659. Abstract: The effects of acute and chronic intakes of high doses of alcohol on pain perception are well known, ranging from short-term analgesic effects to long-term sensitization and polyneuropathies. The short-term analgesic effects of ethanol consumption on subjective pain perception have been well studied in the literature. Recent advances in neuroimaging allow for an insight into pain-related structures in the brain, fostering the mechanistic understanding of the processing of nociceptive input and pain. We aimed to utilize EEG, combined with standardized noxious mechanical/thermal stimulation and subjective pain testing, to research the effects of acute alcohol intake on nociceptive processing and pain perception. We recruited 12 healthy subjects in an unblinded cross-over study design and aimed at achieving a blood alcohol level of 0.1%. Our data revealed a significant reduction in subjective pain ratings to noxious thermal and mechanical stimuli after alcohol ingestion. Our EEG data revealed suppressing effects on the cortical structures responsible for processing pain, the "pain matrix". We conclude that in addition to its analgesic effects, as expressed by the reduction in subjective pain, alcohol has a further impact on the "pain matrix" and directly affects the salience to a nociceptive stimulus.
... где Ct -концентрация этанола в крови в момент времени t, г/кг; d -относительный безвозвратный дефицит абсорбции, равный сумме удельных потерь этанола, обусловленных его метаболизмом желудочной алкогольдегидрогеназой и метаболизмом первого прохождения; β -почасовая скорость элиминации этанола, г/(кг·ч); t -время после приема алкоголя, ч; С0 представляет собой условную величину, равную rM m C = 0 , где m -масса принятого этанола, г; М -масса тела, кг; r -фактор редукции [6,7]. ...
The aim of the study is to construct a kinetic equation of zero-order ethanol elimination with first-order absorption, taking into account the presystemic metabolism of ethanol, with the possibility of determining the errors in estimating the parameters of the model, as well as the implementation of the model in the format of a computer program. Analytical mathematical modeling of the kinetics of a single oral intake of ethanol has been performed. A mathematical model of the kinetics of a single intake of ethanol with its zero-order elimination, absorption and first-order presystemic metabolism has been developed. A method is proposed for estimating the limiting absolute errors of the kinetic parameters of the constructed model based on the summation of the partial contributions of the initial physical quantities. The complex of the developed computational procedures is implemented in the format of the «Alcohol Calculator V 1.0» computer program. The conclusion is made about the expediency of using the developed information and computing technology in the forensic medical expert assessment of acute alcohol intoxication.
... где Ct -концентрация этанола в крови в момент времени t, г/кг; d -относительный безвозвратный дефицит абсорбции, равный сумме удельных потерь этанола, обусловленных его метаболизмом желудочной алкогольдегидрогеназой и метаболизмом первого прохождения; β -почасовая скорость элиминации этанола, г/(кг·ч); t -время после приема алкоголя, ч; С0 представляет собой условную величину, равную rM m C = 0 , где m -масса принятого этанола, г; М -масса тела, кг; r -фактор редукции [6,7]. ...
The aim of the study is to construct a kinetic equation of zero-order ethanol elimination with first-order absorption, taking into account the presystemic metabolism of ethanol, with the possibility of determining the errors in estimating the parameters of the model, as well as the implementation of the model in the format of a computer program. Analytical mathematical modeling of the kinetics of a single oral intake of ethanol has been performed. A mathematical model of the kinetics of a single intake of ethanol with its zero-order elimination, absorption and first-order presystemic metabolism has been developed. A method is proposed for estimating the limiting absolute errors of the kinetic parameters of the constructed model based on the summation of the partial contributions of the initial physical quantities. The complex of the developed computational procedures is implemented in the format of the «Alcohol Calculator V 1.0» computer program. The conclusion is made about the expediency of using the developed information and computing technology in the forensic medical expert assessment of acute alcohol intoxication.
... Apps for calculating blood alcohol concentration and sobering time mostly used the Widmark formula developed in 1932 [42]. There are studies suggesting that this formula considerably underestimates blood alcohol concentration [47,48]. Most apps recording personal alcohol consumption and apps with structured support to reduce alcohol use featured infographics, allowing the user to quickly and visually evaluate their alcohol consumption. ...
Background:
Personalized prevention tools such as mobile apps designed to reduce alcohol consumption are widespread in mobile app stores accessible in Russia. However, the quality and content of these mobile apps have not been systematically evaluated.
Objective:
This study aimed to identify Russian-language mobile apps for reducing alcohol use and to evaluate their quality and potential to change alcohol-related health behavior. It further aimed to identify apps that could facilitate screening and brief interventions in primary health care in Russia.
Methods:
A systematic search for mobile apps available in Russia was carried out between April 1 and 15, 2020, December 1 and 15, 2020, and in March 2021 in the iPhone App Store, Google Play Store, and the 4PDA forum. App quality was assessed using the Mobile App Rating Scale (MARS), and structured searches in electronic libraries and bibliographic databases were used to evaluate the apps’ evidence base. The number of features facilitating changes in lifestyle behavior was assessed using the App Behavior Change Scale (ABACUS).
Results:
We identified 63 mobile apps for reducing alcohol use. The mean MARS quality ratings were high for the subscales of functionality (3.92 out of 5, SD 0.58) and aesthetics (2.96, SD 0.76) and low for engagement (2.42, SD 0.76) and information (1.65, SD 0.60). Additional searches in electronic libraries and bibliographic databases (eLibrary, CyberLeninka, Google Scholar) yielded no studies involving the identified apps. ABACUS scores ranged from 1 to 15 out of 25, with a mean of 5 (SD 3.24). Two of the identified apps might be useful for screening and brief interventions in Russian primary health care after improvements in content and scientific testing.
Conclusions:
Russian-language mobile apps for reducing alcohol use are accessible in the app stores. Many of them are aesthetically pleasing, functional, and easy to use. However, information about their scientific trialing or testing is lacking. Most apps contain a low number of features that facilitate changes in lifestyle behavior. Further research should examine the context of Russian-language mobile apps for reducing alcohol use. Our findings underline the need to develop evidence-based apps to mitigate alcohol consumption in Russia and elsewhere.
... Applications for calculating blood alcohol concentration and sobering time mostly used the "Widmark" formula developed in 1932 [42]. There are studies suggesting that this formula considerably underestimates blood alcohol concentration [47,48]. Most applications recording personal alcohol consumption and applications with structured support to reduce alcohol use featured infographics, allowing the user to quickly and visually evaluate their alcohol consumption. ...
BACKGROUND
Personalized prevention tools such as mobile apps designed to reduce alcohol consumption are widespread in mobile app stores accessible in Russia. However, the quality and content of these mobile apps have not been systematically evaluated.
OBJECTIVE
This study aimed to identify Russian-language mobile apps for reducing alcohol use and to evaluate their quality and potential to change alcohol-related health behavior. It further aimed to identify apps that could facilitate screening and brief interventions in primary health care in Russia.
METHODS
A systematic search for mobile apps available in Russia was carried out between April 1 and 15, 2020, December 1 and 15, 2020, and in March 2021 in the iPhone App Store, Google Play Store, and the 4PDA forum. App quality was assessed using the Mobile App Rating Scale (MARS), and structured searches in electronic libraries and bibliographic databases were used to evaluate the apps’ evidence base. The number of features facilitating changes in lifestyle behavior was assessed using the App Behavior Change Scale (ABACUS).
RESULTS
We identified 63 mobile apps for reducing alcohol use. The mean MARS quality ratings were high for the subscales of functionality (3.92 out of 5, SD 0.58) and aesthetics (2.96, SD 0.76) and low for engagement (2.42, SD 0.76) and information (1.65, SD 0.60). Additional searches in electronic libraries and bibliographic databases (eLibrary, CyberLeninka, Google Scholar) yielded no studies involving the identified apps. ABACUS scores ranged from 1 to 15 out of 25, with a mean of 5 (SD 3.24). Two of the identified apps might be useful for screening and brief interventions in Russian primary health care after improvements in content and scientific testing.
CONCLUSIONS
Russian-language mobile apps for reducing alcohol use are accessible in the app stores. Many of them are aesthetically pleasing, functional, and easy to use. However, information about their scientific trialing or testing is lacking. Most apps contain a low number of features that facilitate changes in lifestyle behavior. Further research should examine the context of Russian-language mobile apps for reducing alcohol use. Our findings underline the need to develop evidence-based apps to mitigate alcohol consumption in Russia and elsewhere.
CLINICALTRIAL
PROSPERO International Prospective Register of Systematic Reviews CRD42020167458; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167458
... The ethyl alcohol used in this study was reagent grade 200% proof. The volume of alcohol administered to the animals was calculated using the Widmark [16] formula modified by Bouwer [17]. Alcohol concentrations used in this study was 10-30% to represent the three classes of alcoholic beverages commonly consumed by man. ...
Animal model development of alcohol administration in rats is of crucial importance as it gives indirect information to effects of alcohol in humans. An indirect assessment of this would be the biochemical and histological data that could arise from such experiments. 20 Male Wistar rats weighing (63.50±3.79 g), were divided into four groups (consisting 15 treated animals and 5 control animals) and administered with varying concentrations of ethanol (5% 15% and 40%) via intragastric intubation for a period of 28 days. Probic evaluations, liver biochemical enzymes and alteration in histology profile of gastrointestinal tract (GIT) and viscera organs (namely the liver, kidney, heart and lungs) were determined after experimental duration. At 40% ethanol administration, the rats showed biochemically significant decrease in serum gamma glutamyl transferase (GGT), serum aspartate (AST) and Alanine amino transferase (ALT) when compared to normal study while 5% and 15% ethanol administered rats were comparable with control values i.e. normal study. Probic evaluations such as body weight, water intake and food intake showed percentage decrease in 40% ethanol administrated rat when compared with controls. The photomicrographs of the 5% and 15% ethanol administered rats indicated mild damage in their histological profiles when compared to the normal study while there was more adverse damage occurring in the 40% ethanol administrated rats. Conclusion: From this study, serum aspartate (AST), gamma glutamyl transferase (GGT) and Alanine amino transferase (ALT), probic evaluation (body weight, food intake and water intake) coupled with histopathological investigation may be used as biomarker for the early diagnosis of ethanol toxicity in human beings.
... Second, the corresponding self-testing devices are not cheap and not all research projects can afford them, especially for the projects with a large sample size. Instead, researchers preferred to measure behavioral outcomes because the rough BAC can be calculated simply using Widmark formula once a participant reports his or her alcohol use [66]. In addition, the unique factor to affect the BrAC is alcohol intake. ...
Background
Unhealthy alcohol use (UAU) is one of the major causes of preventable morbidity, mortality, and associated behavioral risks worldwide. Although mobile health (mHealth) interventions can provide consumers with an effective means for self-control of UAU in a timely, ubiquitous, and cost-effective manner, to date, there is a lack of understanding about different health outcomes brought by such interventions. The core components of these interventions are also unclear.
Objective
This study aimed to systematically review and synthesize the research evidence about the efficacy of mHealth interventions on various health outcomes for consumer self-control of UAU and to identify the core components to achieve these outcomes.
Methods
We systematically searched 7 electronic interdisciplinary databases: Scopus, PubMed, PubMed Central, CINAHL Plus with full text, MEDLINE with full text, PsycINFO, and PsycARTICLES. Search terms and Medical Subject Headings “mHealth,” “text message,” “SMS,” “App,” “IVR,” “self-control,” “self-regulation,” “alcohol*,” and “intervention” were used individually or in combination to identify peer-reviewed publications in English from 2008 to 2017. We screened titles and abstracts and assessed full-text papers as per inclusion and exclusion criteria. Data were extracted from the included papers according to the Consolidated Standards of Reporting Trials-EHEALTH checklist (V 1.6.1) by 2 authors independently. Data quality was assessed by the Mixed Methods Appraisal Tool. Data synthesis and analyses were conducted following the procedures for qualitative content analysis. Statistical testing was also conducted to test differences among groups of studies.
Results
In total, 19 studies were included in the review. Of these 19 studies, 12 (63%) mHealth interventions brought significant positive outcomes in improving participants’ health as measured by behavioral (n=11), physiological (n=1), and cognitive indicators (n=1). No significant health outcome was reported in 6 studies (6/19, 32%). Surprisingly, a significant negative outcome was reported for the male participants in the intervention arm in 1 study (1/19, 5%), but no change was found for the female participants. In total, 5 core components reported in the mHealth interventions for consumer self-control of UAU were context, theoretical base, delivery mode, content, and implementation procedure. However, sound evidence is yet to be generated about the role of each component for mHealth success. The health outcomes were similar regardless of types of UAU, deployment setting, with or without nonmobile cointervention, and with or without theory.
Conclusions
Most studies reported mHealth interventions for self-control of UAU appeared to be improving behavior, especially the ones delivered by short message service and interactive voice response systems. Further studies are needed to gather sound evidence about the effects of mHealth interventions on improving physiological and cognitive outcomes as well as the optimal design of these interventions, their implementation, and effects in supporting self-control of UAU.
... The ethanol (alcohol) used in the study was reagent grade 200% proof. The volume of alcohol administered to the animals was calculated using the Widmark [8] formula modified by Bouwer, [9]. The means of administration was intra-gastric (IG) between 8.00am and 10.00am daily; this was done with sterilized needles and catheters. ...
Alcohol consumption is readily acceptable worldwide, and despite warnings and billions of dollars spent yearly on its deleterious effects; people still to the present day take copious amounts of it. The study investigated the comparative effects of pure and alcoholic beverages on Wistar rats to ascertain their level of safety. Thirty five male albino Wistar rats divided into 7 groups, were administered daily (v/v) pure and beverage alcohol comprising of; 5% (v/v) ethanol, 5.1% beer; 15% (v/v) ethanol, 13% red wine; and 40% (v/v) ethanol, 40% spirit; while the control group was administered saline, by intragastric route (IG) for 28 days. On the 29th day, the animals were sacrificed and blood collected for biochemical analysis. The rat brain, liver, kidney and lungs were excised for histopathological examinations and aliquots of the beverage alcohols were subjected to Gas chromatography-mass spectrometry (GC-MS) analysis. The activity of ALT was not significantly different in treatment groups when compared with controls. The GGT and AST activities of the treatment groups were significantly increased (p<0.05). The rat organ photomicrographs showed that the lungs was most adversely affected, followed by the liver, kidney and brain. The GC-MS chromatograms of the respective beverages contained the following: beer 19, red wine 10 and spirit 16 constituents. The plasma ALT, AST, GGT activities however, did not indicate excess alcohol consumption in the animals although unusual values were observed. The histological profile on the rat organs showed that there was some form of organ damage implying that these beverages may be injurious to health. In addition, the GC-MS spectroscopy revealed that these alcoholic beverages had different proportions of the chemical constituents which may portend some futuristic threat to health.
... Second, the corresponding self-testing devices are not cheap, not all research projects can afford them, especially for the projects with a large sample size. Instead, researchers preferred to measure behavioral outcomes because the rough BAC can be calculated simply using Widmark formula once a participant reports his/her alcohol use [66]. In addition, the unique factor to affect the BrAC is alcohol intake. ...
BACKGROUND:
Unhealthy alcohol use (UAU) is one of the major causes of preventable morbidity, mortality, and associated behavioral risks worldwide. Although mobile health (mHealth) interventions can provide consumers with an effective means for self-control of UAU in a timely, ubiquitous, and cost-effective manner, to date, there is a lack of understanding about different health outcomes brought by such interventions. The core components of these interventions are also unclear.
OBJECTIVE:
This study aimed to systematically review and synthesize the research evidence about the efficacy of mHealth interventions on various health outcomes for consumer self-control of UAU and to identify the core components to achieve these outcomes.
METHODS:
We systematically searched 7 electronic interdisciplinary databases: Scopus, PubMed, PubMed Central, CINAHL Plus with full text, MEDLINE with full text, PsycINFO, and PsycARTICLES. Search terms and Medical Subject Headings "mHealth," "text message," "SMS," "App," "IVR," "self-control," "self-regulation," "alcohol*," and "intervention" were used individually or in combination to identify peer-reviewed publications in English from 2008 to 2017. We screened titles and abstracts and assessed full-text papers as per inclusion and exclusion criteria. Data were extracted from the included papers according to the Consolidated Standards of Reporting Trials-EHEALTH checklist (V 1.6.1) by 2 authors independently. Data quality was assessed by the Mixed Methods Appraisal Tool. Data synthesis and analyses were conducted following the procedures for qualitative content analysis. Statistical testing was also conducted to test differences among groups of studies.
RESULTS:
In total, 19 studies were included in the review. Of these 19 studies, 12 (63%) mHealth interventions brought significant positive outcomes in improving participants' health as measured by behavioral (n=11), physiological (n=1), and cognitive indicators (n=1). No significant health outcome was reported in 6 studies (6/19, 32%). Surprisingly, a significant negative outcome was reported for the male participants in the intervention arm in 1 study (1/19, 5%), but no change was found for the female participants. In total, 5 core components reported in the mHealth interventions for consumer self-control of UAU were context, theoretical base, delivery mode, content, and implementation procedure. However, sound evidence is yet to be generated about the role of each component for mHealth success. The health outcomes were similar regardless of types of UAU, deployment setting, with or without nonmobile cointervention, and with or without theory.
CONCLUSIONS:
Most studies reported mHealth interventions for self-control of UAU appeared to be improving behavior, especially the ones delivered by short message service and interactive voice response systems. Further studies are needed to gather sound evidence about the effects of mHealth interventions on improving physiological and cognitive outcomes as well as the optimal design of these interventions, their implementation, and effects in supporting self-control of UAU.
... The "Widmark" formula is a predictive mathematical equation that was developed in 1932 that has largely been used forensic toxicologists to determine approximate BAC after a fatality for court proceedings [23]. There is a large and growing body of evidence that these calculations provide misleading and inaccurate information by underestimating actual BAC levels [24][25][26]. Replicating the findings of earlier research [16], the present study found that although calculators were largely conservative (overestimating BAC compared with national guidelines), they were inconsistent and some could lead to the provision of advice on readiness to drive when someone is still at risk of being over the legal alcohol limit, particularly for women. This is a concern particularly as the proportion of female drink drivers continues to rise [27]. ...
Background: Driving after the consumption of alcohol represents a significant problem globally. Individual prevention countermeasures such as personalized mobile app aimed at preventing such behavior are widespread, but there is little research on their accuracy and evidence base. There has been no known assessment investigating the quality of such apps.
Objective: This study aimed to determine the quality and accuracy of apps for drink driving prevention by conducting a review and evaluation of relevant mobile apps.
Methods: A systematic app search was conducted following PRISMA guidelines. App quality was assessed using the Mobile App Rating Scale (MARS). Apps providing blood alcohol calculators (hereafter “calculators”) were reviewed against current alcohol advice for accuracy.
Results: A total of 58 apps (30 iOS and 28 Android) met inclusion criteria and were included in the final analysis. Drink driving prevention apps had significantly lower engagement and overall quality scores than alcohol management apps. Most calculators provided conservative blood alcohol content (BAC) time until sober calculations. None of the apps had been evaluated to determine their efficacy in changing either drinking or driving behaviors.
Conclusions: This novel study demonstrates that most drink driving prevention apps are not engaging and lack accuracy. They could be improved by increasing engagement features, such as gamification. Further research should examine the context and motivations for using apps to prevent driving after drinking in at-risk populations. Development of drink driving prevention apps should incorporate evidence-based information and guidance, lacking in current apps.
... The Widmark formula is a commonly used formula to estimate the amount of alcohol needed to reach a certain maximum blood alcohol concentration. Employing the Widmark formula we calculated the alcohol needed to reach a blood alcohol concentration of 0.6‰ as follows: amount of alcohol (gr) ¼ 0.6 (‰)/(Body weight (kg) *r, with r ¼ 0.7 for men and r ¼ 0.6 for women [15]. Patients were asked to perform the test in the evening before any food intake and drink the alcohol within 20 min. ...
... Previous studies have shown that legally produced spirits such as ''Kirschwasser'' (German cherry spirit) and Scotch whiskey contained, respectively, 37. 4,46 . Assuming that spirits that also contained 40% ethanol had concentrations of AAs ranging up to the maximal concentrations of AAs reported in these spirits, we calculated how much would be needed to reach minimal inhibitory concentrations of AAs in the blood via Widmark's equation: A ¼ C  p  r; where A is the amount of alcohol consumed (g), C is the blood alcohol concentration (g/L), p is the body weight (kg), r is Widmark's factor (0.7 l/kg for men; 0.6 l/kg for women) 50 . Applying Widmark's factor for men to these levels of AAs and a product containing 40% ethanol, Table 1 presents the amount of recorded and unrecorded spirits that would have to be consumed to reach the minimal inhibitory concentrations of AAs (0.005 mM) in the blood and the corresponding blood ethanol levels. ...
Abstract A large volume of alcoholic beverages containing aliphatic alcohols is consumed worldwide. Previous studies have confirmed the presence of ethanol-induced immunosuppression in heavy drinkers, thereby increasing susceptibility to infectious diseases. However, the aliphatic alcohols contained in alcoholic beverages might also impair immune cell function, thereby contributing to a further decrease in microbicidal activity. Previous research has shown that aliphatic alcohols inhibit phagocytosis by granulocytes but their effect on human monocytes has not been studied. This is important as they play a crucial role in engulfment and killing of pathogenic microorganisms and a decrease in their phagocytic activity could lead to impaired antimicrobial defence in heavy drinkers. The aim of this study was to measure monocyte phagocytosis following their treatment with those aliphatic alcohols detected in alcoholic beverages. Monocytes were separated from human peripheral blood and phagocytosis of opsonized zymosan particles by monocytes treated with ethanol and aliphatic alcohols individually and in combination was determined. It was shown that these alcohols could suppress the phagocytic activity of monocytes in a concentration-dependent manner and when combined with ethanol, they caused a further decrease in phagocytosis. Due to their additive effects, it is possible that they may inhibit phagocytosis in a clinically meaningful way in alcoholics and episodic heavy drinkers thereby contribute to their increased susceptibility to infectious diseases. However, further research is needed to address this question.
... Widmark's equation continues to be widely used in forensic and research contexts including: (1) court proceedings where blood or breath alcohol evidence is introduced and estimates of alcohol consumption are requested, (2) experimental drinking labs as part of training courses for law enforcement and forensic personnel, (3) alcohol research studies, (4) development of alcohol consumption and blood alcohol concentration (BAC) nomograms, etc. Probably no computation in forensic toxicology is performed more frequently. Moreover, refinements to Widmark's equation continue to be of important research interest [3][4][5][6][7][8][9]. ...
No computation is performed more frequently by forensic toxicologists than that involving Widmark's equation. The equation is employed to estimate either the number of drinks consumed or the corresponding blood or breath alcohol concentration. Despite the wide use of Widmark's equation, rarely is an uncertainty estimate also provided. Estimates from Widmark's equation involve at least seven uncertain random variables. Uncertainty estimates are presented that rely on methods of general error propagation compared to a method developed by Widmark. Assuming reasonable variable and uncertainty estimates, the error propagation method yielded for N=10.4 drinks, a combined uncertainty (standard deviation) of 1.3 drinks (CV=12.3%). Similarly, estimating the blood alcohol concentration yielded for 0.120 g/100 ml, an uncertainty of 0.0255 g/100 ml (CV=21.2%). Widmark's uncertainty method yielded 1.6 drinks (CV=15.4%). The derivation of Widmark's uncertainty estimate is also presented, showing that he considered only rho and beta to be uncertain. Widmark estimates for the number of drinks should include a 2CV estimate of approximately 25% while the blood alcohol concentration estimate should include a 2CV estimate of approximately 42%. Including valid estimates of uncertainty should enhance the legal admissibility and confidence for Widmark estimations.
Substance use in victims of sexual assault, whether voluntary or involuntary, changes the aftermath and recovery process significantly, affecting the way memories are processed and recalled, the chances of developing significant mental health complications, and the disclosure reactions that the survivor receives. Clinicians must understand these differences in order to provide the best possible care to survivors. This article provides an overview of these topics, detailing some of the nuances of interviewing, testing, and the physiology of memory formation and how that affects the outcomes of prosecution in these crimes.
Intoxications with alcohol may lead to death depending on (maximum) blood alcohol concentration (BAC) and accompanying factors such as liver function, tolerance, and comedication. Death may occur due to ethanol-induced respiratory depression and/or aspiration of gastric content (due to an impaired gag reflex); thus, securing of the airway and ventilation is occasionally necessary. A case of a 58-year-old female patient with depression who demonstrated a very high BAC of 8.68 gm/L (0.868%) following ingestion of large amounts of alcohol with suicidal intent is presented. Intubation and ventilation were life-saving, and the patient did not develop any physical or consequential damage. As the patient had not regularly used alcohol or any other psychotropic agent, tolerance could be ruled out. This case emphasizes the necessity of rapid securing of the airway in patients with alcohol intoxication and respiratory depression and, furthermore, illustrates the large interindividual differences regarding ethanol susceptibility.
Using the lane change task (LCT) a comparison of driving performance was made between normal (baseline) driving, driving whilst using an in-vehicle information system (IVIS) and driving while intoxicated at the UK blood alcohol level (80 mg per 100 ml). The results provided clear evidence for impaired performance of the LCT when performing an IVIS task in comparison to both baseline (LCT alone) and alcohol conditions. However, the LCT was found to be insensitive to the effects of alcohol in the absence of a secondary task. It is concluded that LCT performance can be impaired more when undertaking certain IVIS tasks than by having a blood alcohol level at the UK legal limit but the LCT requires further development before it can be used as a convincing proxy for the driving task.
IntroductionToxins Responsible for Plant Poisoning and Poisoning with Herbal SupplementsRole of the Clinical Laboratory in Treating Patients with Plant Poisoning and Toxicity from Using Herbal RemediesDigoxin Immunoassay in Detecting Plant Poisoning and Herbal ToxicityAbnormal Liver Function Tests as an Indication for Plant Poisoning and Herbal ToxicityOther Abnormal Laboratory Tests as Indications for Plant Poisoning and Herbal ToxicityChromatographic Methods for the Diagnosis of Plant Poisoning and Herbal ToxicityMiscellaneous Plant and Herbal Medicine PoisoningsConclusions
References
Alcohol and Its Biomarkers: Clinical Aspects and Laboratory Determination is a concise guide to all currently known alcohol biomarkers, their clinical application, and the laboratory methods used to detect them. Pathologists can use this resource to understand the limitations and cost factors associated with each method for determining certain alcohol biomarkers. In addition, interferences in these determinations are discussed, so that clinicians can understand the causes of falsely elevated biomarkers and pathologists and laboratory scientists can potentially eliminate them. The book focuses on the analytical methods used to detect alcohol in blood and urine, the limitations of alcohol determination using enzymatic methods, and the differences between clinical and forensic alcohol measurement. Chapters also cover cutting-edge alcohol biomarkers for potential use.
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