Psychometric properties of alcohol screening tests in the emergency department in Argentina, Mexico and the United States

Enjoyment in Sport and Alcohol Use among Adolescents: Examining the Mediating Role of Engagement

BACKGROUND

Alcohol consumption among young people is a significant public health concern. Previous studies have indicated that participation in sports, through the positive experiences it offers, may function as a protective factor against alcohol intake. This study aimed to examine the influence of enjoyment and personal fulfillment on adolescent alcohol use, exploring the role of engagement with sports as a mediating variable.

METHODS

A total of 370 adolescents (mean age = 15.08; SD = 1.48) participated in the study and completed the Alcohol Use Disorder Identification Test, the Enjoyment in Sports Scale, and the Athlete Engagement Questionnaire.

RESULTS

The results demonstrated that enjoyment is related to lower alcohol consumption through personal fulfillment and engagement in sporting activity.

CONCLUSIONS

It is crucial to facilitate positive experiences in sport that promote engagement and generate a sense of personal fulfillment, as these factors may reduce the likelihood of risky alcohol consumption.

Athlete's Personal Values and the Likelihood of Alcohol Use and Heavy Drinking during Adolescence

Sport is considered an exceptional activity for promoting healthy lifestyles, but the relationship between sport and alcohol consumption is inconclusive. Research on personal values may shed light on this issue and thus make it possible to find effective ways to prevent alcohol misuse in adolescents. The main objectives of this study were to explore the relationships between personal values and alcohol consumption amongst adolescent athletes and to validate the Portrait Values Questionnaire-21 (PVQ-21) in this population. A total of 914 athletes (aged 11-19; 55.4% female) participated in this study. Confirmatory multidimensional scaling analysis and confirmatory factor analysis were performed. Logistic regression models were fitted to assess the predictive power of personal values on alcohol use. Openness to change values positively predicted high-frequency alcohol use and high-frequency heavy episodic drinking, whereas the opposite occured with athletes who held conservation values. Furthermore, the probability of presenting heavy episodic drinking was negatively associated with conservation values. Finally, the PVQ-21 presented adequate psychometric properties to assess personal values among adolescent athletes. It is crucial to consider the personal values of adolescent athletes when promoting healthy lifestyles through sport.

Screening for harmful substance use in emergency departments: a systematic review

BACKGROUND

Substance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use.

METHODS

We included derivation or validation studies, with or without comparator, that included adult (≥ 18 years) ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use. Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained reviewers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2) independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results.

RESULTS

Our search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North American population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered by research staff (n = 21), self-administered by patients (n = 10), or non-research healthcare providers (n = 1). Most studies evaluated alcohol use screens (n = 26), most commonly the Alcohol Use Disorders Identification Test (AUDIT; n = 14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n = 13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/RAPS4-QF; n = 12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North American patients (AUDIT ≥ 8; CAGE ≥ 2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-2] ≥ 1; RAPS ≥ 1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/Amnesia/K-Cut down [TWEAK] ≥ 3) reported both sensitivities and specificities ≥ 83%. Two studies evaluating a single alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X = 4 for women; X = 5 for men) reported sensitivities 82-85% and specificities 70-77%. Five evaluated screening tools for general substance abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT] ≥ 3, Drug Abuse Screening Test [DAST] ≥ 4, single drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] ≥ 42/18), reporting sensitivities 64%-90% and specificities 61%-100%. Studies' risk of bias were mostly high or uncertain.

CONCLUSIONS

Six screening tools demonstrated both sensitivities and specificities ≥ 83% for detecting alcohol abuse/dependence in EDs. Tools with the highest sensitivities (AUDIT ≥ 8; RAPS ≥ 1) and that prioritize simplicity and efficiency (SASQ) should be prioritized.

Depression and suicidal ideation in Mexican medical students during COVID-19 outbreak. A longitudinal study

Introduction

The COVID-19 pandemic has been particularly difficult for populations at risk for mental health problems, such as healthcare professionals and medical students. In the present study, we evaluated the effect of the pandemic on mental health in a sample of Mexican medical students with and without a mental health diagnosis.

Method

Longitudinal and descriptive study based on scales of suicidal ideation, depressive symptoms and risk of alcohol consumption, conducted in April and December 2020.

Results

Sample includes 247 medical students, 64.4% are women. Prevalence of depression increased between April and December from 19.84% to 40.08%. In the case of women from 23.67% to 42.60% (χ2 = 0.000) and in men from 11.54% to 34.62% (χ2 = 0.001). In April 16.92% of healthy students presented some sign of depression and in December the percentage increased to 40.80% (χ2 = 0.000). Regarding medicated students, the prevalence in April was 32.61% and in December it was 36.96% (χ2 = 0.662). In April, the medicated students with risk of suicidal ideation were 17 out of 46 (36.96%), compared to the students without a diagnosis of psychiatric illness were 29 out of 201 (13.43%) (χ2 = 0.000). For December, the non-medicated students at risk of suicidal ideation were 34 out of 201 (16.91%), and the medicated students were 12 out of 46 (26.09%) (χ2 = 0.149).

Conclusions

The pandemic has increase the rate of depression in medical students, being more severe in women. Students under psychiatric treatment showed a higher prevalence of depression; however, the fact of being under treatment resulted in a protective factor for the increase in the prevalence of depression. It is important to deepen the understanding of the causes of depression and to disseminate among the university community the benefits of early detection and treatment of people with socio-emotional disorders.

Emotion dysregulation and hazardous drinking in relation to suicidal ideation among Spanish-speaking Latinx daily-smokers

OBJECTIVE

Suicidal ideation has increased among Latinx individuals in the last decade. Smoking increases the likelihood of suicidal ideation but work on Latinx smokers is minimal. Hazardous drinking and emotion dysregulation could be factors related to suicidal ideation among Latinx smokers, as has been evident in non-Latinx White samples. The current study sought to examine the main and interactive effects of emotion dysregulation and hazardous drinking in relation to suicidal ideation among Latinx daily-smokers.

METHODS

Participants were 371 Spanish-speaking daily-smokers (58.8% female; M_age = 33.3; SD_age = 9.8) recruited from the United States through Qualtrics. We used structural equation modeling (SEM) to test an interactive model of emotion dysregulation and hazardous alcohol consumption in relation to suicidal ideation; we also tested the effect of emotion dysregulation on suicidal ideation as a function of hazardous drinking status.

RESULTS

Results indicated that latent emotional dysregulation was associated with greater suicidal ideation (p < 0.001); however, hazardous drinking was not related to suicidal ideation (p = 0.186). The interactive term of emotional dysregulation and hazardous drinking was significantly related to suicidal ideation (p = 0.017). Specifically, greater emotion dysregulation was significantly related to suicidal ideation among Latinx smokers who engaged in hazardous drinking (p < 0.001) but not those who did not engage in hazardous drinking (p = 0.123).

CONCLUSIONS

The current findings suggest that smoking combined with hazardous drinking may be related to increased suicidal ideation among Latinx smokers. Findings are discussed in relation to the potential role of intervention strategies that focus on emotion dysregulation and hazardous drinking among Latinx current daily smokers to mitigate suicidal risk among this established health disparities population.

Efficacy of Brief Intervention for Alcohol Consumption during Pregnancy in Argentinean Women: A Randomized Controlled Trial

INTRODUCTION

Although Brief Intervention (BI) has proven to reduce alcohol consumption during pregnancy in high income countries, there is no evidence from the Southern Cone of America. Thus, we conducted a study to assess BI efficacy among Argentinean pregnant women.

METHOD AND MATERIALS

We collected data on pregnant women receiving prenatal care at the public health system in Mar del Plata, Argentina. Women with less than 26 weeks of gestation (n = 486) were randomized to brief advice (BA) or BI. Three months later they were re-assessed; women with more than 26 weeks of gestation constituted a screening only control group (SC) (n = 154). Self-reported quantity and frequency of alcohol consumption, frequency of binge drinking, and related problems after three months were used as outcomes. We performed generalized estimating equations and clinical significance analyses. Also, we obtained newborn health indicators from the city's health system database to use as objective outcomes. Women who did not participate in any of the three former conditions were randomly selected to constitute a non-screening control group (NSC) (n = 150). We compared objective outcomes among BI, BA, and NSC groups using the Wilcoxon rank test.

RESULTS

In comparison with SC, BI and BA reduced alcohol consumption, without differences between the latter two. Newborns of women who received BI and BA had better health indicators compared with the NSC group.

CONCLUSIONS

performing either a BI or BA reduces alcohol consumption among Argentinean pregnant women and might lead to healthier newborns.

Screening for Alcohol Use in Pregnancy: a Review of Current Practices and Perspectives

Global trends of increasing alcohol consumption among women of childbearing age, social acceptability of women's alcohol use, as well as recent changes in alcohol use patterns due to the COVID-19 pandemic may put many pregnancies at higher risk for prenatal alcohol exposure (PAE), which can cause fetal alcohol spectrum disorder (FASD). Therefore, screening of pregnant women for alcohol use has become more important than ever and should be a public health priority. This narrative review presents the state of the science on various existing prenatal alcohol use screening strategies, including the clinical utility of validated alcohol use screening instruments. It also discusses barriers for alcohol use screening in pregnancy, such as practitioner constraints, unplanned pregnancies, delayed access to prenatal care, and stigma associated with substance use in pregnancy, providing recommendations to address these barriers. By implementing consistent alcohol use screening, prenatal care providers have the opportunity to facilitate access to counseling and brief interventions and thus, to prevent new cases of FASD and improve maternal and child health.

Depression in Mexican medical students: A path model analysis

Background

Depression is a mental health disorder present in medical students that foster cumulative disadvantages throughout life and that may compromise patient care. Yet, in Mexico there is a dearth of research concerning prediction models for depression in this population.

Methods

The aim of this cross-sectional study was to develop and test a path model analysis of depression in 103 freshmen Mexican medical students ages 18–23 years old selected non-randomly. Anxiety, emotion dysregulation, and coping skills were used as factors influencing depression. Mexican self-report scales were used as assessment measures.

Results

Main results showed that anxiety and emotion dysregulation had a significant direct influence on depression. Emotion dysregulation had a significant direct effect on coping skills and anxiety, while anxiety had a significant direct effect on problem drinking and alcohol problems. Fit indexes obtained indicate an excellent adjustment to data. R square indicates that 53.7% of the variance in depression can be explained by this model.

Limitations

The results are exploratory rather than confirmatory. The sample size was not large enough and the research focused on only Mexican freshmen medical students. Other factors associated to depression in medical students were not considered.

Conclusions

The current research provides unique findings in terms of a model of depression in Mexican medical students through which it is possible to design and implement interventions that decrease depression, thus positively affecting their well-being, their future careers as medical doctors and their abilities to serve the society adequately, especially in the context of Latin American cities.

Acculturative Stress, Anxiety Sensitivity, and Smoking among Spanish-Speaking Latinx Adult Smokers

Objectives: Although acculturative stress is a known individual difference factor related to poor health, little is understood about its relationship to smoking among Latinx adults. One transdiagnostic factor that may serve a mediational role in the relation between acculturative stress and smoking is anxiety sensitivity. The current study evaluated whether anxiety sensitivity mediated the relations between acculturative stress and smoking among a large sample of adult Spanish-speaking Latinx smokers. Method: Participants were 359 Spanish-speaking Latinx daily smokers (58.8% female, M_age= 33.2 years, SD = 9.7) who provided self-report data on acculturative stress, anxiety sensitivity, and smoking outcomes of cigarette dependence, perceived barriers for quitting cigarettes, and severity of problems during past quit attempts. Independent mediation models were conducted for each smoking outcome, with acculturative stress entered as the predictor and anxiety sensitivity entered as the proposed explanatory factor. Results: There were statistically significant indirect effects of acculturative stress via anxiety sensitivity in relation to cigarette dependence, perceived barriers for quitting cigarettes, and severity of problems during past quit attempts. Conclusions: The present findings provide novel evidence that anxiety sensitivity serves a mediational role in relations between acculturative stress and smoking outcomes among Latinx adult smokers.

Evaluation of the impacts of a district-level mental health care plan on contact coverage, detection and individual outcomes in rural Uganda: a mixed methods approach

Background

The burden of mental disorders in low- and middle-income countries is large. Yet there is a major treatment gap for these disorders which can be reduced by integrating the care of mental disorders in primary care.

Aim

We aimed to evaluate the impact of a district mental health care plan (MHCP) on contact coverage for and detection of mental disorders, as well as impact on mental health symptom severity and individual functioning in rural Uganda.

Results

For adults who attended primary care facilities, there was an immediate positive effect of the MHCP on clinical detection at 3 months although this was not sustained at 12 months. Those who were treated in primary care experienced significant reductions in symptom severity and functional impairment over 12 months. There was negligible change in population-level contact coverage for depression and alcohol use disorder.

Conclusion

The study found that it is possible to integrate mental health care into primary care in rural Uganda. Treatment by trained primary care workers improves clinical and functioning outcomes for depression, psychosis and epilepsy. Challenges remain in accessing the men for care, sustaining the improvement in detection over time, and creating demand for services among those with presumed need.

Emotion dysregulation and cigarette dependence, perceptions of quitting, and problems during quit attempts among Spanish-speaking Latinx adult smokers

Latinx smokers in the United States (U.S.) represent an understudied health disparities group in terms of tobacco use. Despite scientific interest to elucidate individual difference risk factors for smoking, there is limited understanding of how emotional dysregulation relates to smoking outcomes among Spanish-speaking Latinx smokers. The purpose of the present investigation was therefore to explore emotion dysregulation in relation to cigarette dependence, perceived barriers for quitting, and severity of problems experienced during prior quit attempts. Participants were 363 Spanish-speaking Latinx daily smokers (58.7% female, M_age = 33.3 years, SD = 9.81). Results indicated that emotion dysregulation was significantly related to cigarette dependence, perceived barriers for quitting, and problems experienced during past quit attempts. Notably, the effects accounted for 7% to 15% of variance and were evident after adjusting for gender, income, education, number of medical conditions, depression symptoms, non-alcohol drug use, and alcohol consumption. The findings provide novel evidence that emotion dysregulation may represent an important individual difference factor for better understanding smoking-related outcomes among Latinx smokers and supports the need for greater attention to this affective vulnerability during smoking cessation treatment.

Verbal fluency in Mexican Spanish-speaking subjects with high educational level: Ranking of letters and semantic categories

Introduction: Verbal fluency tasks are useful tools in clinical practice and research studies across languages and contexts, but specific data obtained using Spanish phonological tasks and semantic tasks with different levels of difficulty are lacking. The present study aimed to determine the difficulty level of a phonological tasks and semantic tasks among Spanish-speakers. Method: Both tasks were ordered across five difficulty levels based on the frequency of use in Mexican Spanish (phonological) and the number of elements given by a group of participants (semantic). One hundred healthy Mexican Spanish-speaking participants (aged 24-63 years; 55 females) were presented with five phonological and five semantic categories. The participants also underwent a neuropsychological test and sociodemographic interview. The number of words correctly produced in each category within one minute was calculated. An ANOVA and a Kruskal-Wallis analysis were conducted in order to know if there were different levels of difficulty in the tasks. Additionally, correlation analyzes were performed to test the effect of the sociodemographic and cognitive variables on the participants' responses. Results: According to the analyzes, there were different levels of difficulty in the categories; P was the easiest and O was the most difficult category in the phonological tasks, and body parts and precious stones were the easiest and most difficult, respectively, in the semantic tasks. Age had a negative correlation with four-legged animals and a positive correlation with O; Positive correlations were also found between education and professions, vegetables, and alcoholic beverages; and between IQ and D, N, musical instruments, sports, vegetables, and trees. Conclusions: Both tasks offer categories with different level of difficulty based on the performance of a highly educated Mexican population. These data may be useful for clinical and research purposes.

Pain intensity and tobacco smoking among Latinx Spanish-speaking adult smokers

Some research suggests that pain intensity is greater among Latinx persons compared to non-Hispanic-Whites, and that the experience of more intense pain among this group is related to poorer mental health and impairment. Yet, the degree to which pain-smoking relations generalize to Latinx smokers is unknown. The present study tested whether past-month pain intensity among adult Latinx smokers was related to cigarette dependence, perceived barriers for quitting, and problems experienced during past quit attempts. Participants were 363 Spanish-speaking Latinx daily smokers (58.7% female, M_age = 33.3 years, SD = 9.81). Consistent with prediction, current pain intensity was significantly related to greater cigarette dependence, perceived barriers for quitting, and problems experienced during past quit attempts. These novel data provide preliminary evidence that individual differences in the intensity of experienced pain in the past month is related to a range of clinically-significant smoking variables among a large sample of Latinx smokers. The findings suggest that pain intensity may be important to Latinx smokers, a group that often showcases pain-related disparities compared to other racial/ethnic groups.

Anxiety sensitivity and smoking among Spanish-speaking Latinx smokers

Despite the documented health disparities for smoking among the Latinx population, there is limited understanding of transdiagnostic constructs that may help explain smoking among Spanish-speaking Latinx smokers. The present study examined one promising transdiagnostic factor, anxiety sensitivity (fear of anxiety and related sensations), in relation to cigarette dependence, perceived barriers for quitting, and severity of problems experienced when trying to quit among a large sample of Latinx smokers. Participants were 367 Spanish-speaking Latinx daily smokers (59.1% female, M_age = 33.20 years, SD = 11.81). As hypothesized, anxiety sensitivity was significantly related to the severity of cigarette dependence, perceived barriers for quitting, and problems when trying to quit. Inspection of the lower-order dimensions of anxiety sensitivity indicated that Physical Concerns was significantly related to cigarette dependence whereas Cognitive Concerns was associated with greater perceived barriers for quitting and severity of problems experienced during past quit attempts. The present study provides novel empirical evidence that anxiety sensitivity is related to a moderate, yet clinically meaningful, proportion of the variance in cigarette dependence, perceived barriers for quitting, and problems experienced during quit attempts. These findings underscore the value of examining anxiety sensitivity among Latinx smokers and focusing greater attention on this construct in efforts to reduce or quit smoking among this population.

Cross-Cultural Adaptation and Psychometric Properties of the AUDIT and CAGE Questionnaires in Tanzanian Swahili for a Traumatic Brain Injury Population

Aims

To develop Swahili versions of the Alcohol Use Disorders Identification Test (AUDIT) and CAGE questionnaires and evaluate their psychometric properties in a traumatic brain injury (TBI) population in Tanzania.

Methods

Swahili versions of the AUDIT and CAGE were developed through translation and back-translation by a panel of native speakers of both English and Swahili. The translated instruments were administered to a sample of Tanzanian adults from a TBI registry. The validity and reliability were analyzed using standard statistical methods.

Results

The translated versions of both the AUDIT and CAGE questionnaires were found to have excellent language clarity and domain coherence. Reliability was acceptable (>0.85) for all tested versions. Confirmatory factor analysis of one, two and three factor solution for the AUDIT and one factor solution for the CAGE showed adequate results. AUDIT and CAGE scores were strongly correlated to each other (R > 0.80), and AUDIT scores were significantly lower in non-drinkers compared to drinkers.

Conclusions

This article presents the first Swahili and Tanzanian adaptations of the AUDIT and CAGE instruments as well as the first validation of these questionnaires with TBI patients. Both instruments were found to have acceptable psychometric properties, resulting in two new useful tools for medical and social research in this setting.

Psychological adaptation of Indian expeditioners during prolonged residence in Antarctica

BACKGROUND

In view of the growing human activities in Antarctica and increasing exposure of humans to prolonged isolation under extreme conditions, such as space travel and deep sea diving, it is necessary to study the psychological adaptation to such an environment. The current study aimed to assess the psychological adaptation of Indian expeditioners to prolonged residence in Antarctica.

MATERIALS AND METHODS

Twenty-four winter team members of 27^th Indian Scientific Expedition to Antarctica were administered seven instruments 5 times during the expedition. The instruments measured cognition and memory, general psychological health and tobacco, and alcohol consumption.

RESULTS

Alcohol consumption was maximum during the initial days of arrival on the continent and decreased thereafter, with another spike during the peak of the winter season. Externalized psychological reactions peaked during the midwinter period. Anxiety and insomnia peaked during the coldest period whereas depressive symptoms did not change throughout the expedition. Cognition was at its worst during the final phase of Antarctic residence. No significant change was noted in the third quarter of wintering.

CONCLUSION

Each phase of Antarctic residence could be equated with a particular stage in psychological adaptation. There was no third quarter phenomenon.

Psychometric Properties of Brief Screening Tests for Alcohol Use Disorders during Pregnancy in Argentina

Background Considering the physical, mental and behavioral problems related to fetal alcohol exposure, prenatal clinical guides suggest a brief evaluation of alcohol consumption during pregnancy to detect alcohol intake and to adjust interventions, if required. Even if any alcohol use should be considered risky during pregnancy, identifying women with alcohol use disorders is important because they could need a more specific intervention than simple advice to abstain. Most screening tests have been developed and validated in male populations and focused on the long-term consequences of heavy alcohol use, so they might be inappropriate to assess consumption in pregnant women. Objective To analyze the internal reliability and validity of the alcohol screening instruments Alcohol Use Disorders Identification Test (AUDIT), Alcohol Use Disorders Identification Test - Consumption (AUDIT-C), Tolerance, Worried, Eye-Opener, Amnesia and Cut-Down (TWEAK), Rapid Alcohol Problems Screen - Quantity Frequency (RAPS-QF) and Tolerance, Annoyed, Cut-Down and Eye-Opener (T-ACE) to identify alcohol use disorders in pregnant women. Methods A total of 641 puerperal women were personally interviewed during the 48 hours after delivery. The receiver operating characteristics (ROC) curves and the sensitivity and specificity of each instrument using different cut-off points were analyzed. Results All instruments showed areas under the ROC curves above 0.80. Larger areas were found for the TWEAK and the AUDIT. The TWEAK, the T-ACE and the AUDIT-C showed higher sensitivity, while the AUDIT and the RAPS-QF showed higher specificity. Reliability (internal consistency) was low for all instruments, improving when optimal cut-off points were used, especially for the AUDIT, the AUDIT-C and the RAPS-QF. Conclusions In other cultural contexts, studies have concluded that T-ACE and TWEAK are the best instruments to assess pregnant women. In contrast, our results evidenced the low reliability of those instruments and a better performance of the AUDIT in this population.

Alcohol use and suicidality in firefighters: Associations with depressive symptoms and posttraumatic stress

Both suicidality and alcohol use disorders are significant public health concerns among firefighters, and alcohol use is associated with increased suicide risk. In addition, firefighters endorse high rates of symptoms of depression and posttraumatic stress disorder (PTSD). Thus, the current investigation examined associations between alcohol dependence and suicide risk among a large sample of firefighters. Specifically, this study examined the indirect effects of alcohol dependence on suicidality outcomes via both depression and posttraumatic stress, using structural equation modeling. A total of 2883 male firefighters completed a self-report survey, containing measures of alcohol use, suicidality, PTSD, and depressive symptoms. Results indicated good model fit. The latent alcohol dependence variable was directly related to the latent suicide risk variable. However, when depression and posttraumatic stress latent variables were added into the model, alcohol dependence was no longer associated with suicide risk. Furthermore, alcohol dependence was indirectly related to suicide risk via latent depression and posttraumatic stress variables. Indirect effects were established after controlling for relevant covariates. Clinical implications are discussed.

Behavioral health screening and intervention for women in Argentina: a preliminary model for the childbearing years

Untreated behavioral disorders in pregnant women and in women of childbearing age pose physical and psychological safety concerns and are barriers to the well-being of both mother and neonate. The present paper underlines the importance of screening in Argentina for behavioral problems in women of childbearing age, particularly pregnant women and their newborns. Emphasized is the need to formalize this comprehensive screening in a protocol that includes domains of mental disorders, behavioral disorders, education, social environment, employment, desire for maternity, substance use including non-prescription use of prescription medications, eating disorders, suicide risk, interpersonal violence, stress, and trauma. Implementation of such a model would require agreement and cooperation between the public and private health sectors as well as in the development of research for validation of the various screening and interventions tools that would be adopted for general use.

[Data quality in surveys on alcohol consumption among university students]

Different survey modalities have been developed to assess alcohol consumption and related problems. Research that compares data quality between survey modalities is scarce in Latin America. The aim of this study was to assess data quality in three survey modalities on alcohol consumption: self-administered online, self-administered hard-copy, and face-to-face interviews. Data were obtained from three probabilistic samples of students (n = 60 each) from the National University of Mar del Plata, Argentina, using the same questionnaire. Data quality was measured for each modality by overall response rate, item response rate, and accuracy. Data accuracy was evaluated as the percentage of self-reported binge drinking, positive results on AUDIT, and internal consistency of AUDIT for each modality. The overall and item response rates were lower in the online modality and similar between the other two. No differences were found between modalities in the accuracy of responses.

Alcohol intake and risk of injury

Injuries constitute a leading cause of morbidity and mortality in the world, with intentional injuries and those related to traffic most important, due to their social impact and high prevalence. Although alcohol consumption has been identified as a risk factor for injuries, few studies have assessed risk separately for intentional injuries and unintentional injuries caused by traffic, and by other causes. The objective of this paper was to estimate the risk of injuries after acute alcohol consumption for intentional injuries and unintentional traffic and non-traffic injuries, using, alternatively, two exposure measures: self-reported drinking prior to the event and blood alcohol concentration. A probability sample was collected of 540 patients from the emergency department of a hospital in Argentina. Logistic regressions were performed, with and without adjusting for gender, age and drinking pattern. Higher risks were found when blood alcohol concentration was used as a measure of consumption, compared to self-report. The highest risk estimates were obtained for intentional injuries, followed by unintentional traffic and, lastly, by unintentional non-traffic injuries. After controlling for confounders, risks for intentional and unintentional traffic injuries appeared similar for those above and below the legal limit. Results point to a significant involvement of alcohol in the regional context.

How CAGE, RAPS4-QF, and AUDIT Can Help Practitioners for Patients Admitted with Acute Alcohol Intoxication in Emergency Departments?

AIMS

To help clinicians to identify the severity of alcohol use disorders (AUDs) from optimal thresholds found for recommended scales. Especially, taking account of the high prevalence of alcohol dependence among patients admitted to the emergency department (ED) for acute alcohol intoxication (AAI), we propose to define thresholds of severity of dependence based on the AUDIT score.

METHODS

All patients admitted to the ED with AAI (blood alcohol level >0.8 g/L), in a 2-month period, were assessed using the CAGE, RAPS-QF, and AUDIT, with the alcohol dependence/abuse section of the mini international neuropsychiatric interview (MINI) used as the gold standard. To explore the relation between the AUDIT and the MINI the sum of the positive items on the MINI (dependence) as a quantitative variable and as an ordinal parameter were analyzed. From the threshold score found for each scale we proposed intervals of severity of AUDs.

RESULTS

The mean age of the sample (122 males, 42 females) was 46 years. Approximately 12% of the patients were identified with alcohol abuse and 78% with dependence (DSM-IV). Cut points were determined for the AUDIT in order to distinguish mild and moderate dependence from severe dependence. A strategy of intervention based on levels of severity of AUD was proposed.

CONCLUSION

Different thresholds proposed for the CAGE, RAPS4-QF, and AUDIT could be used to guide the choice of intervention for a patient: brief intervention, brief negotiation interviewing, or longer more intensive motivational intervention.

Validation of SURE, a four-item clinical checklist for detecting decisional conflict in patients

BACKGROUND

We sought to determine the psychometric properties of SURE, a 4-item checklist designed to screen for clinically significant decisional conflict in clinical practice.

METHODS

This study was a secondary analysis of a clustered randomized trial assessing the effect of DECISION+2, a 2-hour online tutorial followed by a 2-hour interactive workshop on shared decision making, on decisions to use antibiotics for acute respiratory infections. Patients completed SURE and also the Decisional Conflict Scale (DCS), as the gold standard, after consultation. We evaluated internal consistency of SURE using the Kuder-Richardson 20 coefficient (KR-20). We compared DCS and SURE scores using the Spearman correlation coefficient. We assessed sensitivity and specificity of SURE scores (cut-off score ≤3 out of 4) by identifying patients with and without clinically significant decisional conflict (DCS score >37.5 on a scale of 0-100).

RESULTS

Of the 712 patients recruited during the trial, 654 completed both tools. SURE scores showed adequate internal consistency (KR-20 coefficient of 0.7). There was a significant correlation between DCS and SURE scores (Spearman's ρ = -0.45, P < 0.0001). The prevalence of clinically significant decisional conflict as estimated by the DCS was 5.2% (95% CI 3.7-7.3). Sensitivity and specificity of SURE ≤3 were 94.1% (95% CI 78.9-99.0) and 89.8% (95% CI 87.1-92.0), respectively.

CONCLUSIONS

SURE shows adequate psychometric properties in a primary care population with a low prevalence of clinically significant decisional conflict. SURE has the potential to be a useful screening tool for practitioners, responding to the growing need for detecting clinically significant decisional conflict in patients.

CAGE, RAPS4, RAPS4-QF and AUDIT screening tests for men and women admitted for acute alcohol intoxication to an emergency department: are standard thresholds appropriate?

AIMS

A number of screening instruments are routinely used in Emergency Department (ED) situations to identify alcohol-use disorders (AUD). We wished to study the psychometric features, particularly concerning optimal thresholds scores (TSs), of four assessment scales frequently used to screen for abuse and/or dependence, the cut-down annoyed guilty eye-opener (CAGE), Rapid Alcohol Problem Screen 4 (RAPS4), RAPS4-quantity-frequency and AUD Identification Test (AUDIT) questionnaires, particularly in the sub-group of people admitted for acute alcohol intoxication (AAI).

METHODS

All included patients [AAI admitted to ED (blood alcohol level ≥0.8 g/l)] were assessed by the four scales, and with a gold standard (alcohol dependence/abuse section of the Mini International Neuropsychiatric Interview), to determine AUD status. To investigate the TSs of the scales, we used Youden's index, efficiency, receiver operating characteristic (ROC) curve techniques and quality ROC curve technique for optimized TS (indices of quality).

RESULTS

A total of 164 persons (122 males, 42 females) were included in the study. Nineteen (11.60%) were identified as alcohol abusers alone and 128 (78.1%) as alcohol dependents (DSM-IV). Results suggest a statistically significant difference between men and women (P < 0.05) in performance of the screening tests RAPS4 (≥1) and CAGE (≥2) for detecting abuse. Also, in this population, we show an increase in TSs of RAPS4 (≥2) and CAGE (≥3) for detecting dependence compared with those typically accepted in non-intoxicated individuals. The AUDIT test demonstrates good performance for detecting alcohol abuse and/or alcohol-dependent patients (≥7 for women and ≥12 for men) and for distinguishing alcohol dependence (≥11 for women and ≥14 for men) from other conditions.

CONCLUSION

Our study underscores for the first time the need to adapt, taking into account gender, the thresholds of tests typically used for detection of abuse and dependence in this population.

DRINKING PATTERNS AND DSM-IV ALCOHOL USE DISORDERS' CRITERIA IN ARGENTINEAN EMERGENCY DEPARTMENT PATIENTS

BACKGROUND: Previous studies have shown cultural variations in normative drinking and furthermore, in the quantity and frequency of drinking related to alcohol use disorders. AIM: The main goal of this study is to characterize alcohol drinking patterns in Argentinean Emergency Department patients, and secondly, to explore the association between those drinking patterns and DSM-IV alcohol use disorders. METHOD: Data were collected from a probability sample of patients admitted to the Emergency Department of a large public hospital in Mar del Plata, Argentina. Data analyzed here pertain to those who reported consuming at least one drink during the last twelve months (n=529). A factor analysis of multiple correspondences and a hierarchic classification were performed. For the factor analysis, usual quantity and frequency of drinking (for the last 12 months) were considered active variables; number of DSM-IV dependence criteria met, positive or negative diagnostic status for abuse, positive or negative diagnostic status for dependence (both for the last 12 months), and socio-demographic characteristics (age, gender and economic level) were considered illustrative variables. RESULTS: The first five factorial axes were retained, accounting for 88% of the total variance. Hierarchic classification resulted in six distinctive classes of drinking patterns. Two patterns were associated with a positive diagnosis of abuse and dependence, respectively. One, drinking between 4 and 6 drinks per occasion mostly on a weekly basis, was associated with a diagnosis of abuse; this pattern was also associated with meeting one or two dependence criteria (dependence orphans). The other, drinking 7 or more drinks per occasion, was associated with a diagnosis of dependence, and also with a diagnostic orphan condition. This class, composed primarily of males, was not characterized by any particular frequency of drinking. The other four drinking patterns were not associated with a positive diagnosis of an alcohol use disorder. Two of them were characterized by drinking low quantities with a low frequency (either monthly or yearly). Participants in both of these classes tended to be female. The other two patterns were characterized by drinking less than 3 drinks per occasion, either daily or weekly: the former associated with being older than 35 years, and the later with no distinctive socio-demographic characteristics. CONCLUSIONS: Results demonstrated six distinct drinking patterns, two of them related to a positive diagnosis of an alcohol use disorder. Our findings support previous research indicating that dependence orphans share some characteristics with abuse and dependence cases. Given the lack of similar studies in the region, these findings, although descriptive, enrich the knowledge of alcohol use disorders in the regional context. Furthermore, they may contribute to the development of local drinking guidelines and prevention strategies.