{"id":3526,"date":"2022-11-15T10:00:49","date_gmt":"2022-11-15T07:00:49","guid":{"rendered":"https:\/\/tatd.org.tr\/toksikoloji\/?p=3526"},"modified":"2022-09-07T20:13:23","modified_gmt":"2022-09-07T17:13:23","slug":"alkol-esrar-driving","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/toksikoloji\/2022\/11\/15\/alkol-esrar-driving\/","title":{"rendered":"Alkol ve Esrar\u0131n G\u00f6rme Fonksiyonu ve S\u00fcr\u00fc\u015f Performans\u0131na Etkileri"},"content":{"rendered":"

Trafik kazalar\u0131 \u00f6nde gelen \u00f6l\u00fcm sebeplerindendir. Alkol ve esrar al\u0131m\u0131 sonras\u0131nda kaza ihtimalleri artmaktad\u0131r ve ciddi bir yol g\u00fcvenli\u011fi sorunu olu\u015fturmaktad\u0131r. Avrupa\u2019da trafik kontrollerinden haz\u0131rlanm\u0131\u015f, 13 \u00fclkeden 50.000 s\u00fcr\u00fcc\u00fc ile belki de \u015fimdiye kadar yap\u0131lm\u0131\u015f en kapsaml\u0131 \u00e7al\u0131\u015fmada1<\/sup> vakalar\u0131n %3,5\u2019inde alkol ve % 1,9\u2019unda yasad\u0131\u015f\u0131 madde al\u0131m\u0131 oldu\u011fu g\u00f6sterilmi\u015ftir. Yasad\u0131\u015f\u0131 maddeler aras\u0131nda en s\u0131k tespit edilen madde ise esrar\/kannabistir. Son d\u00f6nemlerde yap\u0131lan \u00e7al\u0131\u015fmalarda ara\u00e7 kullan\u0131m\u0131 s\u0131ras\u0131nda en \u00e7ok kar\u015f\u0131la\u015f\u0131lan madde al\u0131m\u0131n\u0131n hala alkol olmas\u0131na ra\u011fmen alkol kullan\u0131m\u0131nda oransal olarak bir azalma, esrar kullan\u0131m\u0131nda ise oransal olarak bir art\u0131\u015f oldu\u011fu g\u00f6zlenmi\u015ftir. 2,3<\/sup> Bu yaz\u0131m\u0131zda alkol ve yayg\u0131n olarak kullan\u0131lan esrar\u0131n g\u00f6rme fonksiyonlar\u0131 ve s\u00fcr\u00fc\u015f performans\u0131n\u0131 inceleyen yaz\u0131dan bahsedece\u011fiz. Keyifli okumalar diliyorum.<\/p>\n

1. G\u0130R\u0130\u015e<\/strong><\/h2>\n

Ara\u00e7 kullan\u0131m\u0131 gereksinimlerine m\u00fcmk\u00fcn oldu\u011funca \u00e7abuk yan\u0131t vermek ve b\u00f6ylece kabul edilebilir bir g\u00fcvenlik d\u00fczeyini korumak i\u00e7in dinamik bir ortamdan gelen duyusal bilgilerin entegrasyonu esast\u0131r. S\u00fcr\u00fc\u015f performans\u0131na alkol\u00fcn etkileri uzun zamand\u0131r bilinmekle beraber, esrar\u0131n etkileri a\u00e7\u0131s\u0131ndan bilimsel veriler s\u0131n\u0131rl\u0131d\u0131r. BAC (kandaki alkol konsantrasyonu) ile s\u00fcr\u00fc\u015f bozuklu\u011fu aras\u0131ndaki ili\u015fki, %0,05’ten daha y\u00fcksek de\u011ferlerle (en yayg\u0131n olarak kullan\u0131lan yasal s\u0131n\u0131r, 0,25 mg\/I BrAC’ye e\u015fde\u011fer) do\u011frusald\u0131r ve ara\u00e7 kullanmak i\u00e7in gerekli i\u015flevlerde bozulmalara neden olur.4<\/sup> Ancak esrar\u0131n psikoaktif etkilerine sebep olan tetrahidrokannabinol (THC) ve kannabidiol (CBD) konsantrasyonlar\u0131 ile s\u00fcr\u00fc\u015f bozuklu\u011fu aras\u0131nda benzer bir do\u011frusal ili\u015fki g\u00f6z\u00fckmemektedir. Hatta kanda veya oral \u00f6rneklerde THC saptanmas\u0131 her zaman etkilenim anlam\u0131na gelmemektedir.5<\/sup> CBD fiziksel ve mental bir sedasyon durumuna sebep oluyor gibi g\u00f6r\u00fcnmektedir.6<\/sup> CBD’nin epilepsi, anksiyete veya kronik a\u011fr\u0131 gibi durumlar\u0131n tedavisi i\u00e7in artan kullan\u0131m\u0131 ve b\u00fcy\u00fcyen CBD (d\u00fc\u015f\u00fck dozlarda) sa\u011fl\u0131k \u00fcr\u00fcnleri pazar\u0131, bu maddeyi s\u00fcr\u00fc\u015fle ilgili son ara\u015ft\u0131rmalarda \u00f6n plana \u00e7\u0131karm\u0131\u015ft\u0131r. Bu kapsamda Johnson ve arkada\u015flar\u0131 oral \u00f6rneklerde y\u00fcksek THC konsantrasyonu bulunan ve ayr\u0131ca CBD pozitif bulunan s\u00fcr\u00fcc\u00fclerde ani h\u0131zlanma davran\u0131\u015flar\u0131 oldu\u011funu g\u00f6stermi\u015ftir.7<\/sup> Kar\u015f\u0131t g\u00f6r\u00fc\u015f olarak yap\u0131lan baz\u0131 \u00e7al\u0131\u015fmalarda THC ve CBD\u2019nin s\u00fcr\u00fc\u015f \u00fczerine herhangi bir etkisi olmad\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir.8<\/sup> Yak\u0131n zamanda yap\u0131lan bir ara\u015ft\u0131rmada plasebo ile buharla\u015ft\u0131r\u0131lm\u0131\u015f CBD bask\u0131n esrar t\u00fcketimi sonras\u0131nda ara\u00e7 kullan\u0131\u0131m\u0131 s\u0131ras\u0131nda \u015ferit kayd\u0131rma a\u00e7\u0131s\u0131ndan \u00f6nemli farkl\u0131l\u0131klar bulunamam\u0131\u015ft\u0131r.9<\/sup><\/p>\n

Alkol ve\/veya esrar\u0131n s\u00fcr\u00fc\u015f performans\u0131 \u00fczerinde olu\u015fturabilece\u011fi k\u00f6t\u00fc y\u00f6nde etkilenim, \u00f6zellikle bu t\u00fcr maddelerin kullan\u0131m\u0131n\u0131n \u00e7evre alg\u0131s\u0131n\u0131 da de\u011fi\u015ftirebilece\u011fi d\u00fc\u015f\u00fcn\u00fcld\u00fc\u011f\u00fcnde, farkl\u0131 s\u00fcr\u00fcc\u00fclerin yeteneklerindeki azalmadan kaynaklanmaktad\u0131r. Akut intoksikasyon s\u0131ras\u0131nda hem alkol\u00fcn hem de esrar\u0131n g\u00f6rme keskinli\u011fi, kontrast duyarl\u0131l\u0131\u011f\u0131, derinlik alg\u0131s\u0131, parlama duyarl\u0131l\u0131\u011f\u0131, renk ayr\u0131m\u0131 ve uyum gibi \u00f6nemli parametreler i\u00e7in g\u00f6rme i\u015flevinde de\u011fi\u015fiklikler olu\u015fturdu\u011fu g\u00f6sterilmi\u015ftir.10,11<\/sup> Bu parametrelerden baz\u0131lar\u0131n\u0131n bozulmas\u0131n\u0131n, alkol ve esrar etkisi alt\u0131ndaki ki\u015filerde s\u00fcr\u00fc\u015f performans\u0131n\u0131 olumsuz y\u00f6nde etkiledi\u011fi g\u00f6sterilmi\u015ftir; fakat g\u00f6rme problemi veya Parkinson hastal\u0131\u011f\u0131 gibi di\u011fer durumlara sahip olan ki\u015filerde de bu parametrelerde bozulma oldu\u011fu g\u00f6sterilmi\u015ftir. D\u00fcnya \u00e7ap\u0131nda en yayg\u0131n kullan\u0131lan psikoaktif maddeler olmas\u0131na ra\u011fmen, esrar ve alkol\u00fcn g\u00f6rme i\u015flevi ve s\u00fcr\u00fc\u015f performans\u0131 \u00fczerindeki etkileri hen\u00fcz kar\u015f\u0131la\u015ft\u0131r\u0131lmam\u0131\u015ft\u0131r. Ara\u00e7 kullan\u0131m\u0131 \u00f6ncesi madde kullan\u0131m\u0131ndaki art\u0131\u015f e\u011filimleri, alkol ve esrar kullan\u0131m\u0131 ve bunlar\u0131n etkileri hakk\u0131nda daha fazla bilgi toplama ihtiyac\u0131na i\u015faret etmektedir.<\/p>\n

Bu bilgiler \u0131\u015f\u0131\u011f\u0131nda, bu \u00e7al\u0131\u015fmada, alkol ve esrar kullan\u0131m\u0131n\u0131n, kullan\u0131c\u0131lar\u0131n g\u00f6rsel i\u015flevinde tetikledi\u011fi etkilerin yan\u0131 s\u0131ra, bu maddelerin yaratt\u0131\u011f\u0131 di\u011fer alg\u0131 de\u011fi\u015fikliklerine ili\u015fkin bulgular\u0131 kar\u015f\u0131la\u015ft\u0131rma ama\u00e7lanm\u0131\u015ft\u0131r. Ayr\u0131ca, alkol veya esrar kullan\u0131m\u0131n\u0131n s\u00fcr\u00fc\u015f performans\u0131 \u00fczerindeki etkisini ve yine bu iki maddenin olu\u015fturdu\u011fu g\u00f6rsel i\u015flev de\u011fi\u015fiklikleri aras\u0131ndaki ili\u015fkiyi kar\u015f\u0131la\u015ft\u0131rma ama\u00e7lanm\u0131\u015ft\u0131r.<\/p>\n

2. ARA\u00c7 VE Y\u00d6NTEM<\/strong><\/h2>\n

2.1 Kat\u0131l\u0131mc\u0131lar<\/strong><\/h3>\n

Bu \u00e7al\u0131\u015fma alkol ve\/veya esrar kullan\u0131c\u0131s\u0131 olan 64 gen\u00e7 kat\u0131l\u0131mc\u0131 (ortalama \u00b1SS; 24.3\u00b14.5y\u0131l;19-43 ya\u015f aral\u0131\u011f\u0131) i\u00e7ermektedir. Kat\u0131l\u0131mc\u0131lara Granada \u00dcniversitesi\u2019nden e-mail ve reklam arac\u0131l\u0131\u011f\u0131yla ula\u015f\u0131lm\u0131\u015ft\u0131r. \u00c7al\u0131\u015fmaya alma kriterleri; alkol ya da esrar kullan\u0131c\u0131s\u0131 olmak, \u00e7al\u0131\u015fma s\u00fcresince sa\u011fl\u0131kl\u0131 olmak, bir y\u0131ldan fazla s\u00fcredir ehliyete sahip olmak ve (varsa) habit\u00fcel d\u00fczeltme ile en az 6\/6 (Snellen) monok\u00fcler g\u00f6rme keskinli\u011fi. \u00c7al\u0131\u015fmadan d\u0131\u015flama kriterleri; mevcut ya da ge\u00e7mi\u015f hastal\u0131k, Alcohol Use Disorder Identification Test (AUDIT) <\/em>ve revize Cannabis Use Disorder Identificaition<\/em> Test <\/em>(CUDIT-r)\u2019ye g\u00f6re sorunlu ya da zararl\u0131 alkol veya esrar kullan\u0131m\u0131 olan ki\u015filer (AUDIT > 12 (kad\u0131n) veya 14 (erkek), ve CUDIT-r > 12).11<\/sup> Di\u011fer d\u0131\u015flama kriterleri aras\u0131nda binok\u00fcler g\u00f6rme problemleri, di\u011fer ila\u00e7 ya da madde kullan\u0131m\u0131, gebelik veya emzirme, sim\u00fclat\u00f6r hastal\u0131\u011f\u0131 bulunmaktad\u0131r. Kat\u0131l\u0131mc\u0131lar paralel olarak alkol veya esrar kullananlar olarak iki gruba ayr\u0131lm\u0131\u015ft\u0131r. G\u00f6n\u00fcll\u00fcler esrar ve alkol\u00fcn ortak kullan\u0131c\u0131lar\u0131 olduklar\u0131n\u0131 belirttiklerinde, esrar kullan\u0131c\u0131s\u0131 olan kat\u0131l\u0131mc\u0131lar\u0131n daha az s\u0131kl\u0131kta ve ayn\u0131 zamanda yayg\u0131n olarak alkol kulland\u0131klar\u0131 i\u00e7in esrar ve alkol grubuna 2:1 oran\u0131nda yerle\u015ftirilmi\u015fler. B\u00f6ylece alkol grubuna 33 kat\u0131l\u0131mc\u0131 (ortalama ya\u015f\u00b1SS; 25.2 \u00b1 3.7 y\u0131l; 16 kad\u0131n) ve esrar grubuna 31 kat\u0131l\u0131mc\u0131 (ortalama ya\u015f \u00b1 SS; 23.4 \u00b1 5.1 y\u0131l; 11 kad\u0131n) ayr\u0131lm\u0131\u015ft\u0131r. Ya\u015f farkl\u0131l\u0131klar\u0131n\u0131n her iki grup aras\u0131nda istatistiksel olarak anlaml\u0131 oldu\u011fu g\u00f6sterildi (Z = 2.690; p = 0.007).<\/p>\n

Etik kurul onay\u0131 al\u0131nm\u0131\u015f ve her kat\u0131l\u0131mc\u0131dan teker teker ayd\u0131nlat\u0131lm\u0131\u015f onam imzalat\u0131lm\u0131\u015f.<\/p>\n

2.2 G\u00f6rsel fonksiyon de\u011ferlendirmesi<\/strong><\/h3>\n

Binok\u00fcler kontrast duyarl\u0131l\u0131\u011f\u0131 (CS), kontrast e\u015fi\u011fini (yani, tek tip bir arka plan \u00fczerinde g\u00f6rsel bir hedefi tespit etmek i\u00e7in gereken minimum kontrast\u0131) elde etmek i\u00e7in POLA Vista Vision G\u00f6rsel Tablo Sisteminde (DMD Med Tech srl. Torino, \u0130talya) bulunan \u00e7izelge kullan\u0131larak 3 metrede test edilmi\u015f. Farkl\u0131 uzaysal frekanslar test edildi (0.75, 1.5, 3, 6, 12 ve 18 d\u00f6ng\u00fc\/derece (cpd)) ve analiz i\u00e7in ortalama kontrast duyarl\u0131l\u0131\u011f\u0131 dikkate al\u0131nm\u0131\u015f.<\/p>\n

Stereokeskinlik, yani nesnelerin uzamsal veya \u00fc\u00e7 boyutlu konumunu alg\u0131lama yetene\u011fi, Vista Vision monit\u00f6r\u00fcnde bulunan test kullan\u0131larak 5,5 metrede \u00f6l\u00e7\u00fclm\u00fc\u015ft\u00fcr. Stereokeskinlik testi, polarize dikey \u00e7ubuk s\u0131ralar\u0131 kullan\u0131larak farkl\u0131 e\u015fitsizliklerin (300″ ila 10″) test edilmesini sa\u011flar. Kat\u0131l\u0131mc\u0131lardan, s\u0131radaki di\u011ferlerine g\u00f6re “y\u00fczer” g\u00f6r\u00fcnen \u00e7ubu\u011fu tan\u0131mlamalar\u0131 istenmi\u015f.<\/p>\n

Optik ortamdaki sa\u00e7\u0131lan \u0131\u015f\u0131\u011f\u0131n retina g\u00f6r\u00fcnt\u00fcs\u00fc \u00fczerindeki etkisini \u00f6l\u00e7en bir parametre olan g\u00f6z i\u00e7i ka\u00e7ak \u0131\u015f\u0131\u011f\u0131 \u00f6l\u00e7\u00fclm\u00fc\u015f. Bu sa\u00e7\u0131lan \u0131\u015f\u0131k, g\u00f6r\u00fcnt\u00fc kontrast\u0131n\u0131 azaltan ve parlamay\u0131 art\u0131ran retina \u00fczerinde \u00f6rt\u00fcl\u00fc bir parlakl\u0131k (bir ba\u015f\u0131bo\u015f \u0131\u015f\u0131k perdesi) olu\u015fturur. Telafi kar\u015f\u0131la\u015ft\u0131rma y\u00f6ntemini kullanan C-Quant ka\u00e7ak \u0131\u015f\u0131k \u00f6l\u00e7er (Oculus Optikgeriite GmbH, Almanya), log(lar) olarak ifade edilen intraok\u00fcler ka\u00e7ak \u0131\u015f\u0131\u011f\u0131 \u00f6l\u00e7mek i\u00e7in kullan\u0131lm\u0131\u015f.<\/p>\n

Genel G\u00f6rsel Skor (OVS), bu b\u00f6l\u00fcmde a\u00e7\u0131klanan bireysel g\u00f6rsel parametrelerden, g\u00f6rsel kalitenin genel bir \u00f6l\u00e7\u00fcs\u00fc olarak elde edilmi\u015ftir. Bu puan\u0131 elde etme prosed\u00fcr\u00fc, istatistiksel analiz alt b\u00f6l\u00fcm\u00fcnde a\u00e7\u0131klanm\u0131\u015ft\u0131r.<\/p>\n

2.3 S\u00fcr\u00fc\u015f Performans\u0131 De\u011ferlendirmesi<\/strong><\/h3>\n

180\u00b0 g\u00f6r\u00fc\u015f sa\u011flayan \u00fc\u00e7 adet y\u00fcksek \u00e7\u00f6z\u00fcn\u00fcrl\u00fckl\u00fc 27″ ekrana sahip sabit tabanl\u0131 bir s\u00fcr\u00fc\u015f sim\u00fclat\u00f6r\u00fc kullan\u0131lm\u0131\u015f. S\u00fcr\u00fc\u015f sim\u00fclat\u00f6r\u00fc i\u00e7in SIMAX DRIVING SIMULATOR v.4.0.8 BETA kullan\u0131lm\u0131\u015ft\u0131r.<\/p>\n

Kat\u0131l\u0131mc\u0131lar, yakla\u015f\u0131k 15 dakika s\u00fcren yakla\u015f\u0131k 12,5 km’lik bir rotay\u0131 tamamlad\u0131lar. G\u00fczergah, b\u00f6l\u00fcnm\u00fc\u015f yol, da\u011f yolu ve \u015fehir olmak \u00fczere \u00fc\u00e7 farkl\u0131 b\u00f6l\u00fcmden olu\u015fmaktayd\u0131. B\u00f6l\u00fcnm\u00fc\u015f yolun h\u0131z s\u0131n\u0131r\u0131 120 km\/s, ayn\u0131 y\u00f6nde iki \u015feritli trafik, d\u00fcz segmentler, yumu\u015fak virajlar ve \u0131l\u0131ml\u0131 trafik ak\u0131\u015f\u0131n\u0131 i\u00e7ermekteydi. Da\u011f yolu, 40 ve 90 km\/s h\u0131z limitleri, her y\u00f6nde tek \u015ferit (kar\u015f\u0131dan gelen trafik) ve \u0131l\u0131ml\u0131 trafik ak\u0131\u015f\u0131n\u0131 i\u00e7eriyordu. Bu b\u00f6l\u00fcm daha dolamba\u00e7l\u0131yd\u0131, yumu\u015fak ama ayn\u0131 zamanda keskin virajlar\u0131 vard\u0131. Son olarak, \u015fehir kesiminde 40 ve 50 km\/s h\u0131z s\u0131n\u0131rlar\u0131, ayn\u0131 y\u00f6nde bir veya iki \u015ferit trafik, \u00e7e\u015fitli kav\u015faklar, d\u00f6ner kav\u015faklar, trafik \u0131\u015f\u0131klar\u0131 ve yayalar vard\u0131. Trafik ak\u0131\u015f\u0131 \u0131l\u0131ml\u0131yd\u0131.<\/p>\n

Sim\u00fclat\u00f6r, a\u015fa\u011f\u0131dakilerin analiz i\u00e7in dikkate al\u0131nd\u0131\u011f\u0131 farkl\u0131 de\u011fi\u015fkenler \u00fcretir: ortalama h\u0131z (km\/sa), kar\u015f\u0131 \u015feridi i\u015fgal ederek katedilen mesafe (m), sert banket \u00fczerinde gidilen mesafe (m), \u015feridin d\u0131\u015f\u0131nda s\u00fcr\u00fclen toplam mesafe (m), lateral konumun standart sapmas\u0131 (SDLP) (m), direksiyon simidinin a\u00e7\u0131sal h\u0131z\u0131n\u0131n standart sapmas\u0131 (rad\/s), parkurlar\u0131n tamamlanmas\u0131 i\u00e7in toplam s\u00fcre ve reaksiyon s\u00fcresi (s). Kullan\u0131c\u0131lar\u0131n fren yap\u0131\u015flar\u0131na g\u00f6re reaksiyon s\u00fcresi tespit edilmi\u015f: Sim\u00fclat\u00f6r, da\u011f yolunun g\u00fczergah\u0131 boyunca rastgele konumlarda \u00fc\u00e7 frenleme olay\u0131 olu\u015fturmaktayd\u0131. Bu konumda, \u00f6nde gelen ara\u00e7lar\u0131 takip etmek yayg\u0131n g\u00f6r\u00fclmektedir. Bu durum meydana geldi\u011finde ve s\u00fcr\u00fcc\u00fc yeterli h\u0131za ula\u015ft\u0131\u011f\u0131nda, sim\u00fclat\u00f6r \u00f6ndeki araca ani bir frenleme yapt\u0131rtt\u0131. Reaksiyon s\u00fcresi, \u00f6nde giden arac\u0131n fren lambas\u0131n\u0131 yakt\u0131\u011f\u0131 an ile kat\u0131l\u0131mc\u0131n\u0131n sim\u00fclat\u00f6r fren pedal\u0131na bast\u0131\u011f\u0131 an aras\u0131ndaki zaman aral\u0131\u011f\u0131 olarak hesaplanm\u0131\u015f.<\/p>\n

Son olarak, genel bir s\u00fcr\u00fc\u015f performans\u0131 \u00f6l\u00e7\u00fcs\u00fc olarak, genel s\u00fcr\u00fc\u015f performans\u0131 puan\u0131 (ODPS) hesapland\u0131. ODPS’yi elde etmek i\u00e7in, se\u00e7ilen h\u0131z\u0131n daha iyi veya daha k\u00f6t\u00fc performans\u0131 temsil etmedi\u011fi g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, ortalama h\u0131z ve toplam s\u00fcre dikkate al\u0131nmad\u0131. Benzer \u015fekilde, bu parametrenin sert banket \u00fczerindeki mesafeyi ve kar\u015f\u0131 \u015feridi i\u015fgal ederek kat edilen mesafeyi i\u00e7erdi\u011fi g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, da\u011f yolunda sadece \u015ferit d\u0131\u015f\u0131nda s\u00fcr\u00fclen toplam mesafe dikkate al\u0131nm\u0131\u015ft\u0131r. Z-skorlar\u0131, pozitif skorlar\u0131n ortalamadan daha iyi bir performans\u0131 temsil etmesi i\u00e7in d\u00f6n\u00fc\u015ft\u00fcr\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n

T\u00fcm kat\u0131l\u0131mc\u0131lara, deney oturumlar\u0131nda kullan\u0131lanlara benzer rotalar kullan\u0131larak sim\u00fclat\u00f6r ile iki e\u011fitim oturumu uygulanm\u0131\u015f.<\/p>\n

2.4 Prosed\u00fcrler<\/strong><\/h3>\n

Deneysel prosed\u00fcr \u015eekil 1’de a\u00e7\u0131klanm\u0131\u015ft\u0131r. Kat\u0131l\u0131mc\u0131lar laboratuvara her bir ziyaretleri aras\u0131nda birer hafta olmak \u00fczere d\u00f6rt veya be\u015f ziyaret yapm\u0131\u015flar. \u0130lk iki ziyaret, dahil edilme kriterlerini kontrol etmek, kat\u0131l\u0131mc\u0131lar\u0131 \u00e7al\u0131\u015fma prosed\u00fcrleri hakk\u0131nda bilgilendirmek ve s\u00fcr\u00fc\u015f sim\u00fclat\u00f6r\u00fc e\u011fitim protokol\u00fcn\u00fc ger\u00e7ekle\u015ftirmek i\u00e7in kullan\u0131lm\u0131\u015f. E\u011fitim s\u00fcresi tamamland\u0131ktan sonra, esrar grubuna atanan kat\u0131l\u0131mc\u0131lar iki oturumu tamamlam\u0131\u015flar: bir ba\u015flang\u0131\u00e7 \u200b\u200boturumu (B) ve bir di\u011feri esrar i\u00e7tikten sonra (C) (rastgele s\u0131rada). Alkol grubuna ayr\u0131lan kat\u0131l\u0131mc\u0131lar \u00fc\u00e7 deneysel oturumu tamamlam\u0131\u015flar: ba\u015flang\u0131\u00e7 \u200b\u200b(B), alkol 1 (Al) ve alkol 2 (A2), yine rastgele s\u0131rada. Deneysel oturumlar \u00f6\u011fleden sonra 16.00 ile 20.00 saatleri aras\u0131nda ger\u00e7ekle\u015ftirilmi\u015ftir. G\u00f6rsel testler ve s\u00fcr\u00fc\u015f sim\u00fclat\u00f6r\u00fc rotas\u0131, t\u00fcketimden sonra ge\u00e7en s\u00fcrenin etkisinden ka\u00e7\u0131nmak i\u00e7in deneysel oturumlar s\u0131ras\u0131nda rastgele s\u0131rayla ger\u00e7ekle\u015ftirilmi\u015ftir.<\/p>\n

\"\"

\u015eekil 1: \u00c7al\u0131\u015fmada kullan\u0131lan prosed\u00fcr\u00fcn \u015fematik g\u00f6sterimi<\/p><\/div>\n

2.4.1 Esrar kullan\u0131m\u0131<\/strong><\/h4>\n

Ad libitum prosed\u00fcr\u00fc takip edilmi\u015f. Buna g\u00f6re, kat\u0131l\u0131mc\u0131lara esrar i\u00e7tikten 20 dakika sonra esrar seans\u0131 (C) uyguland\u0131. Kat\u0131l\u0131mc\u0131lar esrar\u0131 normalde al\u0131\u015f\u0131lm\u0131\u015f t\u00fcketimlerinde yapt\u0131klar\u0131 gibi haz\u0131rlay\u0131p i\u00e7mi\u015fler, tek \u015fart\u0131 yakla\u015f\u0131k 10 dakika i\u00e7inde bitirmek olarak belirlenmi\u015f. Her seanstan \u00f6nce kat\u0131l\u0131mc\u0131lara esrar, amfetamin, benzodiazepin, kokain, metamfetamin, opiyat, metadon ve ketamin t\u00fcketimini belirlemek i\u00e7in Drager DrugTest 5000 (Drager Safety AG & Co. KGaA, Liibeck, Almanya) ile t\u00fck\u00fcr\u00fck uyu\u015fturucu testi uygulanm\u0131\u015f. Temel oturumda (B), analiz edilen t\u00fcm maddeler i\u00e7in negatif \u00e7\u0131kmalar\u0131 gerekmekteymi\u015f ve esrar oturumunda(C) esrar pozitif, di\u011fer maddeler i\u00e7in negatif \u00e7\u0131kmalar\u0131 yeterli olarak belirlenmi\u015f. Ayr\u0131ca Drager Alcotest 6820 nefes analiz cihaz\u0131n\u0131 (Drager Safety AG & Co. KGaA. Lubeck, Almanya) kullanarak nefesten alkol i\u00e7eri\u011fini (BrAC) \u00f6l\u00e7erek kat\u0131l\u0131mc\u0131lar\u0131n alkol i\u00e7ip i\u00e7mediklerini kontrol edilmi\u015f. Deneysel oturumlardan \u00f6nce kat\u0131l\u0131mc\u0131lara 24 saat alkol ve 4 g\u00fcn esrar veya ba\u015fka herhangi bir madde kullanmamalar\u0131 talimat\u0131 verilmi\u015f.<\/p>\n

\u00a02.4.2 Alkol kullan\u0131m\u0131<\/strong><\/h4>\n

Sosyal i\u00e7me ortam\u0131n\u0131 sim\u00fcle etmek i\u00e7in kat\u0131l\u0131mc\u0131lara alkol i\u00e7eri\u011fi %13,5 olan k\u0131rm\u0131z\u0131 \u015farap verilmi\u015f. Kat\u0131l\u0131mc\u0131lara deney seanslar\u0131ndan 24 saat \u00f6nce kafein veya alkol t\u00fcketmemeleri s\u00f6ylenmi\u015f. T\u00fcm deney oturumlar\u0131 \u00f6\u011fle yeme\u011finden iki saat sonra ger\u00e7ekle\u015ftirilmi\u015f. Ba\u015flang\u0131\u00e7 \u200b\u200bseans\u0131n\u0131n d\u0131\u015f\u0131nda, alkol grubuna alkol\u00fcn etkilerini belirlemek i\u00e7in iki seans uygulanm\u0131\u015f: biri 300 ml i\u00e7tikten sonra (d\u00fc\u015f\u00fck-orta al\u0131m, yakla\u015f\u0131k 32.4 g alkole e\u015fde\u011fer) ve di\u011feri 450 ml i\u00e7tikten sonra (orta-y\u00fcksek al\u0131m, yakla\u015f\u0131k olarak 48.6 g alkole e\u015fde\u011ferdir). Her iki seansta da gerekli miktarda i\u00e7meleri i\u00e7in 40 dakika s\u00fcre verilmi\u015f. Dozu bitirdikten otuz dakika sonra nefesten alkol i\u00e7eri\u011fi (BrAC) \u00f6l\u00e7\u00fcld\u00fckten sonra deney oturumu ba\u015flat\u0131lm\u0131\u015f. Daha sonra her 20 dakikada bir BrAC tekrar \u00f6l\u00e7\u00fclm\u00fc\u015f. Bu ama\u00e7la Drager Alcotest 6820 nefes analiz cihaz\u0131n\u0131 kullan\u0131lm\u0131\u015f. BrAC seviyesinin \u00b1 0.05 mg\/I\u2019den fazla de\u011fi\u015fmemesini sa\u011flamak i\u00e7in seans s\u0131ras\u0131nda gerekirse ikinci bir doz sa\u011flanm\u0131\u015f. D\u00f6rt kat\u0131l\u0131mc\u0131n\u0131n ikinci doz ihtiyac\u0131 olmu\u015f. Ki\u015fiye verilmesi gereken alkol miktar\u0131n\u0131 bulmak i\u00e7in, ki\u015finin a\u011f\u0131rl\u0131\u011f\u0131 (laboratuvara ilk ba\u015fvuruda \u00f6l\u00e7\u00fcld\u00fc), distrib\u00fcsyon fakt\u00f6r\u00fc (0.60 kad\u0131n, 0.70 erkek) ve ki\u015finin \u015fu ana kadar \u00f6l\u00e7\u00fclm\u00fc\u015f ortalama BrAC parametrelerini kullanarak Widmark form\u00fcl\u00fc uygulanm\u0131\u015f. BrAC(mg\/l), konversiyon fakt\u00f6r\u00fc 2:1 olarak al\u0131narak BAC (g\/l)\u2019a d\u00f6n\u00fc\u015ft\u00fcr\u00fcld\u00fc. Nihai BrAC seviyesi, al\u0131nan d\u00f6rt \u00f6l\u00e7\u00fcm\u00fcn ortalama de\u011feriydi.<\/p>\n

2.5 \u0130statistiksel Analiz<\/strong><\/h3>\n

T\u00fcm istatistiksel prosed\u00fcrler, SPSS v.26 yaz\u0131l\u0131m paketi (SPSS Inc., Chicago, IL) kullan\u0131larak ger\u00e7ekle\u015ftirilmi\u015ftir. Veri da\u011f\u0131l\u0131m\u0131n\u0131n normalli\u011fi Shapiro-Wilk testi kullan\u0131larak kontrol edilmi\u015f. Bu teste g\u00f6re normal da\u011f\u0131lan tek parametre \u015fehirdeki ortalama h\u0131z olarak g\u00f6r\u00fclm\u00fc\u015f. Gruplar aras\u0131 kar\u015f\u0131la\u015ft\u0131rma yapmadan \u00f6nce, \u00e7al\u0131\u015fman\u0131n esrar veya alkol kollar\u0131na tahsis edilen kat\u0131l\u0131mc\u0131lar\u0131n g\u00f6rsel parametreler ve s\u00fcr\u00fc\u015f performans\u0131 a\u00e7\u0131s\u0131ndan farkl\u0131l\u0131k g\u00f6stermedi\u011fini kontrol edilmi\u015f. Bu ama\u00e7la ba\u011f\u0131ms\u0131z \u00f6rneklemler i\u00e7in veri da\u011f\u0131l\u0131m\u0131na ba\u011fl\u0131 olarak t testleri veya Mann Whitney U testi kullan\u0131lm\u0131\u015ft\u0131r. Esrar ve alkol gruplar\u0131ndaki kat\u0131l\u0131mc\u0131lar\u0131n g\u00f6rsel i\u015flev ve s\u00fcr\u00fc\u015f performanslar\u0131nda herhangi bir farkl\u0131l\u0131k olmad\u0131\u011f\u0131 belirlendikten sonra, farkl\u0131 seanslar aras\u0131nda kar\u015f\u0131la\u015ft\u0131rmalar yap\u0131lm\u0131\u015ft\u0131r. Normal da\u011f\u0131l\u0131ml\u0131 veriler i\u00e7in (\u015fehirdeki ortalama h\u0131z), gruplar (ba\u015flang\u0131\u00e7 \u200b\u200bd\u00fczeyi, alkol 1, alkol 2 ve esrar) aras\u0131ndaki kar\u015f\u0131la\u015ft\u0131rmalar tek y\u00f6nl\u00fc bir ANOVA kullan\u0131larak ger\u00e7ekle\u015ftirilmi\u015ftir. Post hoc kar\u015f\u0131la\u015ft\u0131rmalar Bonferroni d\u00fczeltmesi uygulanarak yap\u0131lm\u0131\u015ft\u0131r. Veri da\u011f\u0131l\u0131m\u0131n\u0131n normalli\u011fi kabul edilemedi\u011finde, birka\u00e7 ba\u011f\u0131ms\u0131z \u00f6rnek i\u00e7in ikili kar\u015f\u0131la\u015ft\u0131rmal\u0131 parametrik olmayan bir test uygulanm\u0131\u015ft\u0131r (Kruskal-Wallis).<\/p>\n

Genel g\u00f6rsel puan\u0131 (OVS) ve genel s\u00fcr\u00fc\u015f performans\u0131 puan\u0131n\u0131 (ODPS) elde etmek i\u00e7in, ayr\u0131 parametrelerden Z puanlar\u0131 elde edildi. Farkl\u0131 g\u00f6rsel de\u011fi\u015fkenlerin ortalama Z puan\u0131na OVS ve s\u00fcr\u00fc\u015f de\u011fi\u015fkenlerinin ortalama Z puan\u0131na ODPS ad\u0131 verilmi\u015f. Z puan\u0131, grubun alt\u0131nda veya \u00fcst\u00fcnde ne kadar standart sapman\u0131n, bireysel bir de\u011fer oldu\u011fu anlam\u0131na geldi\u011finin bir \u00f6l\u00e7\u00fcm\u00fc olarak tan\u0131mlan\u0131r. Ba\u015fka bir deyi\u015fle, bir konunun sonucunu t\u00fcm grubun sonucuyla kar\u015f\u0131la\u015ft\u0131rmak i\u00e7in kullan\u0131lan bir istatistiktir. B\u00f6ylece, Z-puan\u0131 \u015fu \u015fekilde hesaplanm\u0131\u015ft\u0131r: z = (x – \u00b5) \/ CT (burada x, belirli bir konu i\u00e7in de\u011fi\u015fken de\u011ferdir; \u00b5, t\u00fcm grupta bu de\u011fi\u015fkenin ortalamas\u0131d\u0131r; ve CT, t\u00fcm gruptaki de\u011fi\u015fken). Pozitif puanlar\u0131n ortalamadan daha iyi bir performans\u0131 temsil etmesini sa\u011flamak i\u00e7in Z puanlar\u0131 d\u00f6n\u00fc\u015ft\u00fcr\u00fclm\u00fc\u015ft\u00fcr. G\u00f6rsel durum ve s\u00fcr\u00fc\u015f performans\u0131 aras\u0131ndaki ili\u015fkiyi incelemek i\u00e7in, genel s\u00fcr\u00fc\u015f performans\u0131 puan\u0131 (ODPS) ve genel g\u00f6rsel puan (OVS) ile bir korelasyon analizi (Spearman) yap\u0131lm\u0131\u015f. Son olarak, ya\u015f veya biyolojik cinsiyet gibi di\u011fer olas\u0131 fakt\u00f6rlerin ODPS \u00fczerindeki etkisini incelemek i\u00e7in, ba\u011f\u0131ml\u0131 de\u011fi\u015fken olarak ODPS, fakt\u00f6r olarak durum ve biyolojik cinsiyet, ya\u015f ve alkol veya esrar s\u0131kl\u0131\u011f\u0131 ve OVS’yi ortak de\u011fi\u015fkenler olarak kabul edip Genelle\u015ftirilmi\u015f Do\u011frusal Model uygulanm\u0131\u015f. 0.05 anlaml\u0131l\u0131k d\u00fczeyi belirlendi.<\/p>\n

3. Sonu\u00e7lar<\/strong><\/h2>\n

3.1 Alkol veya esrar\u0131n etkisi alt\u0131nda ara\u00e7 kullanma s\u0131kl\u0131\u011f\u0131 ve ki\u015finin alg\u0131lad\u0131\u011f\u0131 g\u00f6rme kalitesi ve ara\u00e7 kullanma performans\u0131<\/strong><\/h3>\n

Genel olarak, kat\u0131l\u0131mc\u0131lar\u0131n kendi bildirdikleri kullan\u0131m s\u0131kl\u0131\u011f\u0131 esrar i\u00e7in alkolden daha y\u00fcksekti (Tablo 1). Buna g\u00f6re alkol grubundaki kat\u0131l\u0131mc\u0131lar\u0131n %24’\u00fc haftal\u0131k (haftada 1 ila 7 g\u00fcn aras\u0131) t\u00fcketti\u011fini belirtirken, esrar grubundaki kat\u0131l\u0131mc\u0131lar\u0131n %55’i bu s\u0131kl\u0131kta uyu\u015fturucu kullanm\u0131\u015ft\u0131r. Benzer \u015fekilde, kendi bildirdikleri madde\/alkol etkisi alt\u0131nda ara\u00e7 kullanma s\u0131kl\u0131\u011f\u0131 (DUI) genellikle esrar grubunda daha y\u00fcksekti. B\u00f6ylece, esrar kullan\u0131c\u0131lar\u0131n\u0131n %55’i esrar\u0131 2-3 defa veya 4 defadan fazla kulland\u0131ktan sonra ara\u00e7 kulland\u0131\u011f\u0131n\u0131 bildirirken, alkol grubunda bu de\u011fer %38’dir. Bu bulguyla uyumlu olarak, DUI’nin alg\u0131lanan etkilerine ili\u015fkin soru, alkol grubunda daha y\u00fcksek risk fark\u0131ndal\u0131\u011f\u0131 g\u00f6stermi\u015f. Dolay\u0131s\u0131yla, alkol grubundaki kat\u0131l\u0131mc\u0131lar\u0131n %62’si alkol\u00fcn etkisi alt\u0131nda ara\u00e7 kullanma performanslar\u0131n\u0131n \u00e7ok daha k\u00f6t\u00fc oldu\u011funu belirtirken, esrar kullan\u0131c\u0131lar\u0131n\u0131n \u00e7o\u011funlu\u011fu (%68) esrar\u0131n etkisi alt\u0131nda ara\u00e7 kullanmalar\u0131n\u0131n sadece biraz daha k\u00f6t\u00fc oldu\u011funu belirtmi\u015ftir. Ayr\u0131ca esrar grubundaki kat\u0131l\u0131mc\u0131lar\u0131n %13’\u00fc herhangi bir de\u011fi\u015fiklik hissetmedi\u011fini veya s\u00fcr\u00fc\u015flerinde iyile\u015fme oldu\u011funu belirtirken, alkol grubundakilerden sadece %3\u2019\u00fc ayn\u0131 \u015feyi belirtmi\u015f. Kat\u0131l\u0131mc\u0131lara \u015eekil 2’de g\u00f6sterildi\u011fi gibi s\u00fcr\u00fc\u015f performans\u0131n\u0131 etkileyebilecek g\u00f6rsel de\u011fi\u015fiklikleri alg\u0131lay\u0131p alg\u0131lamad\u0131klar\u0131 soruldu\u011funda da benzer bir e\u011filim g\u00f6zlemlenmi\u015f. Bu durumda, \u00e7o\u011fu kat\u0131l\u0131mc\u0131 g\u00f6rsel kalitelerinin g\u00fcnd\u00fcz (%50) veya gece (%68) s\u00fcr\u00fc\u015f i\u00e7in \u00e7ok daha k\u00f6t\u00fc oldu\u011funu alg\u0131larken, esrar grubundaki \u00e7o\u011fu kat\u0131l\u0131mc\u0131 g\u00fcnd\u00fcz (%52) ve gece (%58) s\u00fcr\u00fc\u015f s\u0131ras\u0131nda g\u00f6r\u00fc\u015flerinin sadece biraz daha k\u00f6t\u00fc oldu\u011funu belirtmi\u015f. Ayr\u0131ca, g\u00f6r\u00fc\u015flerinde herhangi bir de\u011fi\u015fiklik olmad\u0131\u011f\u0131n\u0131 alg\u0131layan kat\u0131l\u0131mc\u0131lar\u0131n y\u00fczdesi, esrar grubunda (g\u00fcnd\u00fcz ve gece i\u00e7in s\u0131ras\u0131yla %32 ve %26), alkol grubuna g\u00f6re (g\u00fcnd\u00fcz ve gece i\u00e7in s\u0131ras\u0131yla %3 ve %3) daha y\u00fcksek saptanm\u0131\u015f.<\/p>\n

Tablo 1. Kat\u0131l\u0131mc\u0131n\u0131n s\u00fcr\u00fc\u015f s\u0131kl\u0131\u011f\u0131, etki alt\u0131nda ara\u00e7 kullanma ve kendi alg\u0131lad\u0131\u011f\u0131 g\u00f6rsel ve s\u00fcr\u00fc\u015f de\u011fi\u015fiklikleri.<\/strong><\/p>\n

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\u015eekil 2: G\u00fcnd\u00fcz ve gece alkol ve esrar kulland\u0131ktan sonra s\u00fcr\u00fc\u015f i\u00e7in g\u00f6rsel kalitede kendi kendine alg\u0131lanan de\u011fi\u015fiklik<\/p><\/div>\n

3.2 Alkol veya esrar kullan\u0131m\u0131 sonras\u0131 g\u00f6rsel performans<\/strong><\/h3>\n

Alkol grubu i\u00e7in, alkol 1 grubu (A1) i\u00e7in ula\u015f\u0131lan ortalama BrAC 0.19 \u00b1 0.08 mg\/l (aral\u0131k: 0.05-0.33 mg\/l) ve Alkol 2 grubu (A2) i\u00e7in 0.33 \u00b1 0.12 mg\/l (aral\u0131k: 0.12-0.60 mg\/l). Bu alkol intoksikasyonu d\u00fczeylerinde ve ayr\u0131ca esrar i\u00e7tikten sonra g\u00f6rme i\u015flevi \u00f6nemli \u00f6l\u00e7\u00fcde de\u011fi\u015fmi\u015ftir (Tablo 2). Ortalama binok\u00fcler kontrast duyarl\u0131l\u0131k i\u015flevi A1 i\u00e7in %6 ve A2 i\u00e7in %9 oran\u0131nda azalmas\u0131na ra\u011fmen, bu parametre esrar grubu (C) i\u00e7in temel \u00e7izgiye g\u00f6re %12’lik bir azalma sergileyerek \u00f6nemli \u00f6l\u00e7\u00fcde azalm\u0131\u015ft\u0131r. Stereokeskinlik, ba\u015flang\u0131\u00e7 \u200b\u200bseans\u0131na g\u00f6re A1, A2 ve C i\u00e7in s\u0131ras\u0131yla %77, %128 ve %210 art\u0131\u015flarla \u00f6nemli bozulmalar g\u00f6sterilmi\u015ftir. A2 ve C i\u00e7in ba\u015f\u0131bo\u015f \u0131\u015f\u0131k parametresi de \u00f6nemli \u00f6l\u00e7\u00fcde artarken, A1 grubu taban \u00e7izgisine g\u00f6re \u00f6nemli bir art\u0131\u015f g\u00f6stermemi\u015ftir. Son olarak, Genel G\u00f6rsel Skor, g\u00f6rsel performans\u0131n genel bir \u00f6l\u00e7\u00fcs\u00fc olarak, taban \u00e7izgisine (B) g\u00f6re t\u00fcm ko\u015fullar (A1, A2 ve C) i\u00e7in \u00f6nemli bozulmalar g\u00f6stermi\u015ftir. G\u00f6rsel performanstaki en b\u00fcy\u00fck d\u00fc\u015f\u00fc\u015f esrar kullan\u0131m\u0131 i\u00e7in bulunmu\u015f, bunu A2 ve A1 izlemi\u015ftir (Tablo 2, \u015eekil 3).<\/p>\n

Tablo 2. Ba\u015flang\u0131\u00e7 seans\u0131nda ve alkol ve esrar\u0131n etkileri alt\u0131nda g\u00f6rsel fonksiyon parametrelerinin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131. Medyan \u00b1 \u00e7eyreklikler aras\u0131 aral\u0131k dahildir.<\/strong><\/p>\n

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\u015eekil 3: Her grup i\u00e7in elde edilen genel g\u00f6rsel puan (OVS).<\/p><\/div>\n

3.3 Alkol veya esrar kullan\u0131m\u0131 sonras\u0131 s\u00fcr\u00fc\u015f performans\u0131<\/strong><\/h3>\n

Tablo 3, s\u00fcr\u00fc\u015f performans\u0131 analizi s\u0131ras\u0131nda elde edilen t\u00fcm parametreleri \u00f6zetlemektedir. \u00c7ift anayolda s\u00fcr\u00fc\u015f i\u00e7in, grup kar\u015f\u0131la\u015ft\u0131rmalar\u0131 \u00f6nemli bir fark g\u00f6stermemi\u015ftir. Ancak da\u011f yolundaki s\u00fcr\u00fc\u015f performans\u0131 en \u00e7ok A2 grubunun etkilendi\u011fini ortaya koyulmu\u015ftur. \u015eeritte kalman\u0131n, emniyet \u015feridinde s\u00fcr\u00fclen mesafe a\u00e7\u0131s\u0131ndan \u00f6nemli \u00f6l\u00e7\u00fcde farkl\u0131 oldu\u011fu bulunmu\u015f; bu, taban \u00e7izgisine ve C’ye k\u0131yasla A2 i\u00e7in \u00f6nemli \u00f6l\u00e7\u00fcde daha uzundur. Benzer \u015fekilde, esrar grubuna k\u0131yasla A2 i\u00e7in direksiyon kontrol\u00fc \u00f6nemli \u00f6l\u00e7\u00fcde bozulmu\u015ftur ve direksiyon simidinin a\u00e7\u0131sal h\u0131z\u0131n\u0131n standart sapmas\u0131 %34 daha y\u00fcksektir. \u015eehirde, direksiyon simidinin a\u00e7\u0131sal h\u0131z\u0131 i\u00e7in standart sapma, A2 i\u00e7in taban \u00e7izgisinden veya C’den \u00f6nemli \u00f6l\u00e7\u00fcde daha y\u00fcksekti. Toplam parkur analizindeki de\u011fi\u015fkenler, esrar\u0131n etkisi alt\u0131ndaki kat\u0131l\u0131mc\u0131lar\u0131n parkuru tamamlamak i\u00e7in her iki alkol grubundan \u00f6nemli \u00f6l\u00e7\u00fcde daha uzun s\u00fcreye ihtiya\u00e7 duydu\u011funu ortaya koymu\u015ftur. Ayr\u0131ca, taban \u00e7izgisine g\u00f6re A2 i\u00e7in reaksiyon s\u00fcresi \u00f6nemli \u00f6l\u00e7\u00fcde artm\u0131\u015ft\u0131r. ODPS; A1 ve A2 gruplar\u0131 i\u00e7in s\u00fcr\u00fc\u015f performans\u0131n\u0131n ba\u015flang\u0131\u00e7 \u200b\u200bgrubuna g\u00f6re k\u00f6t\u00fcle\u015fti\u011fini g\u00f6sterirken, esrar kullan\u0131m\u0131 genel puanda sadece hafif bir k\u00f6t\u00fcle\u015fmeye yol a\u00e7m\u0131\u015ft\u0131r (\u015eekil 4). Bu nedenle, analiz, A2 grubu i\u00e7in B ve C’ye g\u00f6re \u00f6nemli \u00f6l\u00e7\u00fcde daha k\u00f6t\u00fc s\u00fcr\u00fc\u015f performans\u0131 g\u00f6stermi\u015ftir.<\/p>\n

Tablo 3: Ba\u015flang\u0131\u00e7 seans\u0131nda ve alkol ve esrar\u0131n etkileri alt\u0131nda s\u00fcr\u00fc\u015f performans\u0131 de\u011fi\u015fkenlerinin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131. Ortalama \u00b1 standart sapman\u0131n sunuldu\u011fu \u015fehirdeki ortalama h\u0131z d\u0131\u015f\u0131nda, medyan \u00b1 \u00e7eyrekler aras\u0131 aral\u0131k dahil edilmi\u015ftir.<\/strong><\/p>\n

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\u015eekil 4: Her grup i\u00e7in elde edilen genel s\u00fcr\u00fc\u015f performans\u0131 puan\u0131 (ODPS).<\/p><\/div>\n

3.4 G\u00f6r\u00fc\u015f ve s\u00fcr\u00fc\u015f: Esrar ve alkol kullan\u0131m\u0131 sonras\u0131 s\u00fcr\u00fc\u015f yetene\u011fi \u00fczerine g\u00f6r\u00fc\u015f bozuklu\u011funun etkileri<\/strong><\/h3>\n

Sonu\u00e7lar, g\u00f6rsel durum ve s\u00fcr\u00fc\u015f performans\u0131n\u0131n t\u00fcm ko\u015fullar dahil olmak \u00fczere \u00f6nemli \u00f6l\u00e7\u00fcde ili\u015fkili oldu\u011funu g\u00f6stermi\u015ftir (rho= 0.163; p = 0.039). Bu ili\u015fki \u015eekil 5’te g\u00f6sterilmi\u015ftir. Her ko\u015ful i\u00e7in ba\u011f\u0131ms\u0131z olarak, ba\u015flang\u0131\u00e7taki ODPS ve OVS aras\u0131nda anlaml\u0131 bir korelasyon bulunmu\u015ftur (rho = 0.265; p = 0.034), ancak bu korelasyon di\u011fer ko\u015fullar i\u00e7in istatistiksel olarak anlaml\u0131 de\u011fildi. (C, Al ve A2). GLM’nin sonu\u00e7lar\u0131 (Tablo 4), durumun ODPS \u00fczerinde \u00f6nemli bir ana etkiye sahip oldu\u011funu ve taban \u00e7izgisine (referans kategorisi) g\u00f6re yaln\u0131zca alkol 2 grubu i\u00e7in \u00f6nemli d\u00fc\u015f\u00fc\u015fler oldu\u011funu g\u00f6stermi\u015ftir. Cinsiyetin de \u00f6nemli bir fakt\u00f6r oldu\u011fu g\u00f6sterilmi\u015ftir, tahminler kad\u0131n olman\u0131n erkek olmaktan 0.308 birim daha az ODPS temsil etti\u011fini g\u00f6stermektedir. Son olarak, OVS’deki bir birim de\u011fer d\u00fc\u015f\u00fckl\u00fc\u011f\u00fcn\u00fcn ODPS’de 0,16 birimlik bir de\u011fer d\u00fc\u015f\u00fckl\u00fc\u011f\u00fc ile sonu\u00e7lanaca\u011f\u0131n\u0131 g\u00f6steren tahminlerle, OVS’nin \u00f6nemli bir ana etkisi bulunmu\u015ftur. Ya\u015f ve esrar veya alkol kullan\u0131m s\u0131kl\u0131\u011f\u0131 ODPS \u00fczerinde \u00f6nemli bir ana etki g\u00f6stermemi\u015ftir.<\/p>\n

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\u015eekil 5: ODPS ve OVS aras\u0131ndaki ili\u015fkiyi temsil eden da\u011f\u0131l\u0131m grafi\u011fi.<\/p><\/div>\n

Tablo 4: Genelle\u015ftirilmi\u015f lineer modelin sonu\u00e7lar\u0131.<\/strong><\/p>\n

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4.Tart\u0131\u015fma<\/strong><\/h2>\n

G\u00fcn\u00fcm\u00fcze kadar yap\u0131lm\u0131\u015f birka\u00e7 \u00e7al\u0131\u015fmada, alkol ve esrar\u0131n etkileri alt\u0131nda g\u00f6rme i\u015flevi i\u00e7in olumsuz sonu\u00e7lar bildirilmi\u015ftir. Nicholson ve arkada\u015flar\u0131 d\u00fc\u015f\u00fck dozda (ortalama BAC = %0.015) ve orta dozda (ortalama BAC = %0.04) alkol al\u0131m\u0131ndan sonra kontrast duyarl\u0131l\u0131\u011f\u0131ndaki (CS) de\u011fi\u015fikli\u011fi incelemi\u015flerdir.12<\/sup> Bu yazarlar, \u00e7al\u0131\u015fmam\u0131zdaki A1 durumuna e\u015fde\u011fer olan orta doz i\u00e7in CS’de \u00f6nemli bir bozulma bulmu\u015flard\u0131r (BrAC 0.19 mg\/l\u2248BAC 0.04%). A1 ve A2 gruplar\u0131 i\u00e7in ortalama CS azalm\u0131\u015f olsa da, fark taban \u00e7izgisine g\u00f6re istatistiksel olarak anlaml\u0131 de\u011fildi. Casares-Lopez ve arkada\u015flar\u0131 CS \u00fczerinde benzer bir etki bulmu\u015ftur, ancak bu yazarlar yaln\u0131zca 6 ve 12 cpd i\u00e7in alkol kullan\u0131m\u0131ndan sonra \u00f6nemli farkl\u0131l\u0131klar bulmu\u015flard\u0131r.10<\/sup> Yap\u0131lan \u00e7al\u0131\u015fmada da esrar kullan\u0131m\u0131 durumunda, \u00f6nceki \u00e7al\u0131\u015fmalarla uyumlu olarak ortalama CS’de \u00f6nemli bir bozulma bulunmu\u015ftur. 13<\/sup> Ayr\u0131ca, esrar\u0131n etkisi alt\u0131nda g\u00f6rsel i\u015flevde alg\u0131lanan k\u00f6t\u00fcle\u015fmenin CS taraf\u0131ndan mod\u00fcle edildi\u011fi ve bu durumun etkisi alt\u0131nda ara\u00e7 kullan\u0131p kullanmama karar\u0131n\u0131 belirleyebilece\u011fi \u00f6ne s\u00fcr\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n

Alkol ve esrar nesnelerin \u00fc\u00e7 boyutlu konumunu da etkiler. Stereokeskinlik bahsedilen b\u00fct\u00fcn al\u0131mlarda etkilenmekle beraber en fazla esrar al\u0131m\u0131nda etkilenmi\u015ftir. Bu bulgu, alkol ve esrar\u0131n binok\u00fcler performans\u0131 etkiledi\u011fini ve s\u00fcr\u00fc\u015f i\u00e7in zararl\u0131 sonu\u00e7lar\u0131 oldu\u011funu g\u00f6steren \u00f6nceki \u00e7al\u0131\u015fmalarla uyumludur. Ba\u015f\u0131bo\u015f \u0131\u015f\u0131k parametresi i\u00e7in, A2 ve C’deki \u00f6nemli bozulma \u00f6nceki \u00e7al\u0131\u015fmalarla uyumludur. Casares-Lopez ve arkada\u015flar\u0131 bu \u00e7al\u0131\u015fmayla benzer \u015fekilde farkl\u0131 dozlarda alkol al\u0131m\u0131ndan sonra log (lar) da bir art\u0131\u015f bulmu\u015ftur.10<\/sup> A1 grubunda belirgin fark olmamakla beraber \u00e7al\u0131\u015fmada tespit edilen en b\u00fcy\u00fck fark A2 ve esrar grubunda benzer \u015fekilde etkilenim g\u00f6stermi\u015f olup bu durum esrar kullan\u0131m\u0131 ve orta-fazla alkol al\u0131m\u0131nda (\u00e7al\u0131\u015fmada oldu\u011fu hali 400 ml k\u0131rm\u0131z\u0131 \u015farap) gece parlak \u0131\u015f\u0131kla kar\u015f\u0131la\u015f\u0131ld\u0131\u011f\u0131nda sorun ya\u015fanabilir. Son olarak, OVS, t\u00fcm ko\u015fullar (Al, A2 ve C) i\u00e7in g\u00f6rsel i\u015flevde genel olarak \u00f6nemli bir bozulma g\u00f6stermi\u015ftir. Esrar kullan\u0131m\u0131n\u0131n OVS’de alkolden \u00e7ok daha fazla bozulma olu\u015fturmas\u0131na ra\u011fmen, kat\u0131l\u0131mc\u0131lar\u0131n ankete verdikleri yan\u0131tlarda alkol\u00fcn g\u00f6r\u00fc\u015f\u00fc daha b\u00fcy\u00fck \u00f6l\u00e7\u00fcde bozdu\u011funu belirtmeleri ilgin\u00e7tir. Bu sonu\u00e7, genellikle alkol\u00fcn hafif bir madde olarak alg\u0131lanan esrardan daha zararl\u0131 oldu\u011funa inan\u0131lan bir fark\u0131ndal\u0131\u011f\u0131n oldu\u011funu ve ayn\u0131 zamanda g\u00f6rsel sistem i\u00e7in de benzer bir d\u00fc\u015f\u00fcncenin olmas\u0131 g\u00f6sterebilir.<\/p>\n

Esrar veya alkol kullan\u0131m\u0131ndan sonra g\u00f6rme veya di\u011fer i\u015flevlerde bozulma alg\u0131s\u0131, bir kullan\u0131c\u0131y\u0131 bu gibi durumlarda ara\u00e7 kullanmaya yatk\u0131n hale getirebilir ki; bu durum, \u00e7al\u0131\u015fma sonu\u00e7lar\u0131nda \u00f6zel bir \u00f6nemle g\u00f6sterildi\u011fi \u00fczere s\u00fcr\u00fc\u015f\u00fcn farkl\u0131 parametrelerinin \u00f6nemli seviyede etkilendi\u011fini g\u00f6rebilmekteyiz. Bu nedenle, s\u00fcr\u00fc\u015f performans\u0131n\u0131n, \u00f6zellikle A2 grubu i\u00e7in \u00f6nemli \u00f6l\u00e7\u00fcde azald\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. Martin ve arkada\u015flar\u0131 s\u00fcr\u00fc\u015f g\u00f6revinde k\u0131s\u0131tl\u0131 yetenekler i\u00e7in kesme s\u0131n\u0131r\u0131 olarak %0.05’lik bir BAC i\u00e7in bilimsel destek oldu\u011fu sonucuna varm\u0131\u015ft\u0131r.4<\/sup> Yukar\u0131da belirtildi\u011fi gibi, bu \u00e7al\u0131\u015fmada elde edilen alkolle ilgili ana bulgular, 0,33 mg\/l ortalama BrAC’ye (BAC\u2248 0,07 %) kar\u015f\u0131l\u0131k gelen A2 durumu i\u00e7indir. Moskowitz ve Robinson’\u0131n sonucuna g\u00f6re, bu grup i\u00e7in ortalama BAC’nin yazarlar taraf\u0131ndan \u00f6nerilen s\u0131n\u0131rdan (BrAC 0.19 mg\/l \u2248, BAC 0.04 %) daha y\u00fcksek oldu\u011fu g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, A1 grubu i\u00e7in s\u00fcr\u00fc\u015f performans\u0131 da \u00f6nemli \u00f6l\u00e7\u00fcde etkilenmelidir. Bununla birlikte, A1 grubu i\u00e7in \u00e7al\u0131\u015fmam\u0131zda bulunan ortalama BrAC, \u0130spanya ve di\u011fer \u00fclkelerde araba kullanmak i\u00e7in yasal s\u0131n\u0131rlar i\u00e7indedir ve Martin ve arkada\u015flar\u0131n\u0131n incelemesinde tan\u0131mlanan BAC s\u0131n\u0131r\u0131 ile uyumludur. Alkol i\u00e7in bulunan sonu\u00e7lar\u0131n aksine, esrar s\u00fcr\u00fc\u015f performans\u0131nda \u00f6nemli bir bozulmaya neden olmam\u0131\u015ft\u0131r. Esrar etkisi alt\u0131nda ara\u00e7 kullanmak yasa d\u0131\u015f\u0131d\u0131r ve etki alt\u0131ndaki \u015fof\u00f6rleri tespit etmek i\u00e7in farkl\u0131 y\u00f6ntemler kullan\u0131lmaktad\u0131r. Esrar\u0131n psikoaktif bile\u015feni olan THC’nin kan konsantrasyonu ile s\u00fcr\u00fc\u015f bozuklu\u011fu aras\u0131nda do\u011frusal bir ili\u015fki yoktur, bu nedenle alkol durumunda oldu\u011fu gibi yasal bir s\u0131n\u0131r belirlenmesini zorla\u015ft\u0131rmaktad\u0131r. \u00c7o\u011funlukla gen\u00e7 ve ara s\u0131ra kullan\u0131c\u0131lar\u0131 i\u00e7eren baz\u0131 ara\u015ft\u0131rmalar, esrar\u0131n s\u00fcr\u00fcc\u00fclerde uzunlamas\u0131na veya yanal kontrol gibi y\u00f6nleri olumsuz etkileyebilece\u011fini bulmu\u015ftur.14<\/sup> Bununla birlikte, yak\u0131n tarihli bir sistematik inceleme, bu maddenin s\u00fcr\u00fc\u015f performans\u0131 \u00fczerindeki etkisi i\u00e7in \u015fu anda yaln\u0131zca orta ila d\u00fc\u015f\u00fck g\u00fcven oldu\u011fu sonucuna varm\u0131\u015ft\u0131r.15<\/sup> Anket sonu\u00e7lar\u0131na g\u00f6re, kat\u0131l\u0131mc\u0131lar\u0131n esrardan \u00e7ok alkolden daha olumsuz etkilendi\u011fini d\u00fc\u015f\u00fcnd\u00fcklerini belirtmek \u00f6nemlidir. Bu anlamda, ODPS’de yaln\u0131zca en y\u00fcksek alkol dozu i\u00e7in, yasal s\u0131n\u0131r\u0131n \u00fczerinde bir ortalama BrAC ile \u00f6nemli bir bozulma buldu\u011fumuz i\u00e7in, kat\u0131l\u0131mc\u0131lar her iki maddenin neden oldu\u011fu bozulmay\u0131 de\u011ferlendirmede do\u011fru g\u00f6r\u00fcnmektedirler. Bu nedenle, di\u011fer \u00e7al\u0131\u015fmalar ve mevcut \u00e7al\u0131\u015fma taraf\u0131ndan elde edilen sonu\u00e7lar, esrar\u0131n etkisi alt\u0131nda ara\u00e7 kullanman\u0131n ger\u00e7ek riskinin yoruma a\u00e7\u0131k oldu\u011funu ve ne t\u00fcr bir t\u00fcketim\/kullan\u0131c\u0131 profilinin ara\u00e7 kullanmay\u0131 etkileyebilece\u011fini a\u00e7\u0131kl\u0131\u011fa kavu\u015fturmak i\u00e7in daha fazla ara\u015ft\u0131rmaya ihtiya\u00e7 oldu\u011funu g\u00f6stermektedir.<\/p>\n

Alkol ve esrar\u0131n ara\u00e7 kullanmak i\u00e7in gereken temel i\u015flevler (bili\u015fsel, motor ve duyusal) \u00fczerindeki etkisi, alkoll\u00fc ara\u00e7 kullan\u0131rken varsay\u0131lan riski belirleyebilir. G\u00f6rsel durumun, ara\u00e7 kullanma yetene\u011fi ile \u00f6nemli \u00f6l\u00e7\u00fcde ili\u015fkili oldu\u011fu bulunmu\u015ftur. Genel g\u00f6rsel skor (OVS) ile genel s\u00fcr\u00fc\u015f performans skoru (ODPS) aras\u0131nda bulunan korelasyon anlaml\u0131 ve pozitif bulunmu\u015ftur, bu da g\u00f6rsel durumu daha k\u00f6t\u00fc olan s\u00fcr\u00fcc\u00fclerin daha k\u00f6t\u00fc s\u00fcr\u00fc\u015f performans\u0131na sahip oldu\u011funu g\u00f6stermektedir. Ayr\u0131ca GLM, OVS’nin ODPS \u00fczerinde \u00f6nemli bir ana etkiye sahip oldu\u011funu g\u00f6stererek bu bulguyu do\u011frulam\u0131\u015ft\u0131r. Araba s\u00fcrmek ger\u00e7ekten de g\u00f6r\u00fc\u015fe ba\u011fl\u0131 bir i\u015ftir ve bu duyusal mekanizmay\u0131 etkileyen herhangi bir durumun s\u00fcr\u00fc\u015f performans\u0131 ve g\u00fcvenli\u011fi \u00fczerinde yans\u0131malar\u0131 olabilir. \u00c7al\u0131\u015fman\u0131n bulgular\u0131, alkol ve esrar t\u00fcketicileri i\u00e7in \u00f6ncekilerle ayn\u0131 fikirdedir. Esrar durumunda, stereo keskinli\u011fin k\u00f6t\u00fcle\u015fmesi ile arac\u0131n \u015feritteki konumunun kontrol\u00fcn\u00fcn kayb\u0131 aras\u0131nda bir ili\u015fki bildirilmi\u015ftir. Ayr\u0131ca esrar kullan\u0131c\u0131lar\u0131 i\u00e7in, maddeyi kulland\u0131ktan sonra kontrast duyarl\u0131l\u0131\u011f\u0131ndaki bir de\u011fi\u015fikli\u011fin, ortalama h\u0131z ve SDLP’deki de\u011fi\u015fiklikleri belirleyen fakt\u00f6rlerden biri olabilece\u011fi \u00f6ne s\u00fcr\u00fclm\u00fc\u015ft\u00fcr. Kontrast duyarl\u0131l\u0131\u011f\u0131 ve retinal ka\u00e7ak \u0131\u015f\u0131k gibi g\u00f6rsel \u00f6l\u00e7\u00fcmlerin \u00f6nemi, sa\u011fl\u0131kl\u0131 s\u00fcr\u00fcc\u00fclerde, kataraktl\u0131 s\u00fcr\u00fcc\u00fclerde ve Parkinson hastal\u0131\u011f\u0131 olan s\u00fcr\u00fcc\u00fclerde de g\u00f6sterilmi\u015ftir. Spesifik olarak, esrar veya alkol t\u00fckettikten sonra bulunan ba\u015f\u0131bo\u015f \u0131\u015f\u0131k seviyesindeki art\u0131\u015f, kullan\u0131c\u0131lar\u0131n gece araba kullan\u0131rken daha fazla sorun ya\u015fayacaklar\u0131 ve daha y\u00fcksek parlama ve hale g\u00f6rme insidans\u0131 olaca\u011f\u0131 anlam\u0131na gelir. Gelecekteki \u00e7al\u0131\u015fmalar, birka\u00e7 gece g\u00f6r\u00fc\u015f testini de\u011ferlendirerek ve bunlar\u0131 gece s\u00fcr\u00fc\u015f performans\u0131yla ili\u015fkilendirerek bu soruyu ara\u015ft\u0131rmal\u0131d\u0131r. \u00c7o\u011fu durumda, alkol veya uyu\u015fturucu etkisi alt\u0131nda ara\u00e7 kullanman\u0131n, sosyal e\u011filimler nedenli geceleri meydana geldi\u011fi g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, bu \u00f6nemlidir.<\/p>\n

Elde edilen sonu\u00e7lara ra\u011fmen, her iki gruptaki kullan\u0131c\u0131lar\u0131n da g\u00f6rme bozuklu\u011funu hafife ald\u0131klar\u0131 unutulmamal\u0131d\u0131r. Esrar, OVS’de en b\u00fcy\u00fck bozulmay\u0131 olu\u015ftursa da, bu sonu\u00e7 s\u00fcr\u00fc\u015f performans\u0131nda (ODPS) \u00f6nemli bir bozulmaya d\u00f6n\u00fc\u015fmemi\u015ftir. Bu, s\u00fcr\u00fc\u015f performans\u0131nda k\u00f6t\u00fcle\u015fme buldu\u011fumuz alkol\u00fcn etkisi alt\u0131nda s\u00fcr\u00fc\u015f s\u0131ras\u0131nda de\u011fil, esrar etkisi alt\u0131nda s\u00fcr\u00fc\u015f s\u0131ras\u0131nda g\u00f6rme bozuklu\u011fu i\u00e7in telafi edici mekanizmalar oldu\u011funu g\u00f6stermektedir. S\u00fcr\u00fc\u015f yeteneklerindeki d\u00fc\u015f\u00fc\u015f\u00fc telafi etmek i\u00e7in kullan\u0131lan mekanizmalardan biri h\u0131z \u00f6z d\u00fczenlemesidir. Sonu\u00e7lar\u0131m\u0131z\u0131 hem b\u00f6l\u00fcnm\u00fc\u015f yolda hem de \u015fehirde g\u00f6zlemlersek, esrar grubu ba\u015flang\u0131\u00e7, alkol 1 ve alkol 2 gruplar\u0131na g\u00f6re en d\u00fc\u015f\u00fck h\u0131z\u0131 benimsemi\u015ftir. Genel olarak, esrar\u0131n etkisi alt\u0131ndaki s\u00fcr\u00fcc\u00fcler, bu ko\u015fullar alt\u0131nda s\u00fcr\u00fc\u015f h\u0131z\u0131nda bir d\u00fc\u015f\u00fc\u015f g\u00f6stermi\u015ftir. Downey ve arkada\u015flar\u0131n\u0131n \u00e7al\u0131\u015fmas\u0131, farkl\u0131 dozlarda alkol ve\/veya esrar alt\u0131nda s\u00fcr\u00fc\u015f performans\u0131n\u0131 kar\u015f\u0131la\u015ft\u0131rmaktad\u0131r. Yazarlar, esrar\u0131n etkisi alt\u0131ndaki deneklerin, otobana girerken daha uzun takip mesafeleri ve daha yava\u015f h\u0131zlarla ara\u00e7 kullanma olas\u0131l\u0131klar\u0131n\u0131n daha y\u00fcksek oldu\u011funu ve bunun da daha dikkatli bir s\u00fcr\u00fc\u015f tarz\u0131na i\u015faret etti\u011fini bulmu\u015flard\u0131r.16<\/sup> Ek olarak, esrar kullan\u0131m\u0131n\u0131n neden oldu\u011fu bili\u015fsel bozulma, kat\u0131l\u0131mc\u0131lar i\u00e7in daha tan\u0131d\u0131k bir g\u00f6revi temsil eden, s\u00fcr\u00fc\u015ften \u00e7ok g\u00f6rsel testte elde edilen sonu\u00e7lar\u0131 etkileyebilir. Gelecekteki \u00e7al\u0131\u015fmalar m\u00fcmk\u00fcn oldu\u011funca objektif g\u00f6rsel testler i\u00e7ermeli ve bili\u015fsel ve motor performans\u0131 kontrol etmelidir. Bu \u015fekilde motor, bili\u015fsel ve g\u00f6rsel etkilerin s\u00fcr\u00fc\u015f \u00fczerindeki etkisi daha k\u0131sa ve \u00f6z olarak g\u00f6sterilebilir.<\/p>\n

Son olarak, burada sunulan sonu\u00e7lar yorumlan\u0131rken baz\u0131 s\u0131n\u0131rlamalar\u0131n dikkate al\u0131nmas\u0131 gerekmektedir. \u0130lk olarak, kat\u0131l\u0131mc\u0131lar al\u0131\u015f\u0131lm\u0131\u015f t\u00fcketimlerinde genellikle yapt\u0131klar\u0131 gibi esrar sigaras\u0131n\u0131 haz\u0131rlam\u0131\u015f ve kullanm\u0131\u015flard\u0131r. Bu, doz-etki ili\u015fkileri kurmaya izin vermemi\u015ftir. Bununla birlikte, esrar i\u00e7en bir ki\u015finin normal bir g\u00fcnde ger\u00e7ek kullan\u0131m\u0131n\u0131 sim\u00fcle etme ama\u00e7lanm\u0131\u015ft\u0131r, ard\u0131ndan araba kullanmaya e\u011filimli olabilirler. Ayr\u0131ca, esrar kullan\u0131c\u0131lar\u0131n\u0131n kullan\u0131m s\u0131kl\u0131klar\u0131n\u0131n geni\u015f bir a\u011fda olmas\u0131 da sonu\u00e7lar\u0131 etkilemi\u015f olabilir. Gelecekteki \u00e7al\u0131\u015fmalar, olas\u0131 tolerans etkilerini ara\u015ft\u0131rmak i\u00e7in daha b\u00fcy\u00fck \u00f6rneklem boyutlar\u0131n\u0131 i\u00e7ermelidir. Son olarak, s\u00fcr\u00fc\u015f performans\u0131n\u0131n bir s\u00fcr\u00fc\u015f sim\u00fclat\u00f6r\u00fc arac\u0131l\u0131\u011f\u0131yla incelenmesi, farkl\u0131 durumlarda s\u00fcr\u00fc\u015fe ve bu t\u00fcr bir \u00e7al\u0131\u015fman\u0131n kontroll\u00fc ve g\u00fcvenli ko\u015fullar alt\u0131nda y\u00fcr\u00fct\u00fclmesine izin veren g\u00fcvenli bir ortam olmas\u0131na ra\u011fmen, ger\u00e7ek s\u00fcr\u00fc\u015f\u00fcn t\u00fcm ger\u00e7ek\u00e7ili\u011fini sa\u011flamad\u0131\u011f\u0131 g\u00f6z \u00f6n\u00fcnde bulundurulmal\u0131d\u0131r.<\/p>\n

5.Sonu\u00e7<\/strong><\/h2>\n

Alkol ve esrar t\u00fcketimi, g\u00f6rme i\u015flevinde, \u00f6zellikle binok\u00fcler kontrast duyarl\u0131l\u0131\u011f\u0131nda, stereo seste ve ba\u015f\u0131bo\u015f \u0131\u015f\u0131kta \u00f6nemli de\u011fi\u015fikliklere neden olur. G\u00f6rsel i\u015flevde en \u00f6nemli bozulmay\u0131 esrar olu\u015ftursa da, bu t\u00fcketiciler esrar t\u00fcketiminin g\u00f6rsel etkisinin alkol grubuna g\u00f6re daha az fark\u0131ndad\u0131r. S\u00fcr\u00fc\u015f performans\u0131 sonu\u00e7lar\u0131, yaln\u0131zca daha y\u00fcksek alkol dozunun (yasal s\u0131n\u0131r\u0131n \u00fczerinde bir ortalama BrAC seviyesiyle) \u00f6nemli zararl\u0131 etkilere yol a\u00e7t\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir. Bu ko\u015fullar alt\u0131nda, s\u00fcr\u00fcc\u00fcler emniyet \u015feridi \u00fczerinde daha uzun mesafeler kat etmi\u015flerdir, direksiyon simidinin a\u00e7\u0131sal h\u0131z\u0131 i\u00e7in daha y\u00fcksek bir standart sapma ve daha uzun tepki s\u00fcreleri sergilemi\u015flerdir. Bu durumda alkol grubundaki kat\u0131l\u0131mc\u0131lar, alkoll\u00fc ara\u00e7 kullan\u0131rken esrar grubundakilere g\u00f6re ara\u00e7 kullanmalar\u0131n\u0131n daha fazla etkilendi\u011fini ve tepkilerinin bir dereceye kadar nesnel verilere yans\u0131d\u0131\u011f\u0131n\u0131 belirtmi\u015flerdir. Son olarak, alkol veya esrar kullan\u0131m\u0131ndan sonra g\u00f6rme performans\u0131nda g\u00f6r\u00fclen bozulma, s\u00fcr\u00fc\u015f kabiliyeti \u00fczerinde \u00f6nemli bir etkiye sahip olabilir. Hal b\u00f6yle olunca da t\u00fcketicilerin bu ila\u00e7lar\u0131n olumsuz etkileri konusunda daha bilin\u00e7li hale getirilmesi \u00f6nemlidir.<\/p>\n

_____________________<\/strong><\/p>\n

KAYNAKLAR<\/strong><\/h2>\n
    \n
  1. Schulze H, Schumacher M, Urmeew R, et al. Driving under the influence of drugs, alcohol and medicines in Europe\u2014findings from the DRUID project. 2012;<\/li>\n
  2. Domingo-Salvany A, Herrero MJ, Fernandez B, et al. Prevalence of psychoactive substances, alcohol and illicit drugs, in Spanish drivers: A roadside study in 2015. Forensic Sci Int<\/em>. 2017;278:253-259.<\/li>\n
  3. Christophersen AS, M\u00f8rland J, Stewart K, Gjerde H. International Trends in Alcohol and Drug Use Among Motor Vehicle Drivers. Forensic science review<\/em>. 2016;28(1)<\/li>\n
  4. Martin TL, Solbeck PA, Mayers DJ, Langille RM, Buczek Y, Pelletier MR. A review of alcohol\u2010impaired driving: The role of blood alcohol concentration and complexity of the driving task. J Forensic Sci<\/em>. 2013;58(5):1238-1250.<\/li>\n
  5. Huestis MA. Cannabis-impaired driving: a public health and safety concern. Oxford University Press; 2015. p. 1223-1225.<\/li>\n
  6. Zhornitsky S, Potvin S. Cannabidiol in humans\u2014the quest for therapeutic targets. Pharmaceuticals<\/em>. 2012;5(5):529-552.<\/li>\n
  7. Johnson MB. A feasibility test of the in vivo driving impairment research method: examining cannabinoid concentrations as predictors of risky drinking. Cannabis (Research Society on Marijuana)<\/em>. 2019;2(2):144-150.<\/li>\n
  8. Brands B, Di Ciano P, Mann RE. Cannabis, impaired driving, and road safety: an overview of key questions and issues. Frontiers in psychiatry<\/em>. 2021:1269.<\/li>\n
  9. Arkell TR, Vinckenbosch F, Kevin RC, Theunissen EL, McGregor IS, Ramaekers JG. Effect of cannabidiol and \u03949-tetrahydrocannabinol on driving performance: a randomized clinical trial. JAMA<\/em>. 2020;324(21):2177-2186.<\/li>\n
  10. Casares-L\u00f3pez M, Castro-Torres JJ, Martino F, Ortiz-Peregrina S, Ortiz C, Anera RG. Contrast sensitivity and retinal straylight after alcohol consumption: effects on driving performance. Sci Rep<\/em>. 2020;10(1):1-12.<\/li>\n
  11. Adams AJ, Brown B, Haegerstrom-Portnoy G, Flom MC, Jones RT. Evidence for acute effects of alcohol and marijuana on color discrimination. Percept Psychophys<\/em>. 1976;20(2):119-124.<\/li>\n
  12. Nicholson ME, Andre JT, Tyrrell RA, Wang M, Leibowitz HW. Effects of moderate dose alcohol on visual contrast sensitivity for stationary and moving targets. J Stud Alcohol<\/em>. 1995;56(3):261-266.<\/li>\n
  13. Lalanne L, Ferrand-Devouge E, Kirchherr S, et al. Impaired contrast sensitivity at low spatial frequency in cannabis users with early onset. Eur Neuropsychopharmacol<\/em>. 2017;27(12):1289-1297.<\/li>\n
  14. Hartman RL, Brown TL, Milavetz G, et al. Cannabis effects on driving longitudinal control with and without alcohol. J Appl Toxicol<\/em>. 2016;36(11):1418-1429.<\/li>\n
  15. Alvarez L, Colonna R, Kim S, et al. Young and under the influence: A systematic literature review of the impact of cannabis on the driving performance of youth. Accid Anal Prev<\/em>. 2021;151:105961.<\/li>\n
  16. Downey LA, King R, Papafotiou K, et al. The effects of cannabis and alcohol on simulated driving: Influences of dose and experience. Accid Anal Prev<\/em>. 2013;50:879-886.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Trafik kazalar\u0131 \u00f6nde gelen \u00f6l\u00fcm sebeplerindendir. Alkol ve esrar al\u0131m\u0131 sonras\u0131nda kaza ihtimalleri artmaktad\u0131r ve ciddi bir yol g\u00fcvenli\u011fi sorunu olu\u015fturmaktad\u0131r. Avrupa\u2019da…<\/p>\n","protected":false},"author":1240,"featured_media":3541,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10014,10019],"tags":[47,10043,148,10022,406],"class_list":["post-3526","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-akademik-blog-yazisi","category-tft","tag-alkol","tag-arac-kullanimi","tag-esrar","tag-tft","tag-toksikoloji"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3526","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/users\/1240"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/comments?post=3526"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/posts\/3526\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media\/3541"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/media?parent=3526"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/categories?post=3526"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/toksikoloji\/wp-json\/wp\/v2\/tags?post=3526"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}