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Chiu YM, Dufour I, Courteau J, Vanasse A, Chouinard MC, Dubois MF, Dubuc N, Elazhary N, Hudon C. Profiles of frequent emergency department users with chronic conditions: a latent class analysis. BMJ Open 2022; 12:e055297. [PMID: 36175089 PMCID: PMC9528600 DOI: 10.1136/bmjopen-2021-055297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Frequent emergency department users represent a small proportion of users while cumulating many visits. Previously identified factors of frequent use include high physical comorbidity, mental health disorders, poor socioeconomic status and substance abuse. However, frequent users do not necessarily exhibit all these characteristics and they constitute a heterogeneous population. This study aims to establish profiles of frequent emergency department users in an adult population with chronic conditions. DESIGN This is a retrospective cohort study using administrative databases. SETTING All adults who visited the emergency department between 2012 and 2013 (index date) in the province of Quebec (Canada), diagnosed with at least one chronic condition, and without dementia were included. Patients living in remote areas and who died in the year following their index date were excluded. We used latent class analysis, a probability-based model to establish profiles of frequent emergency department users. Frequent use was defined as having five visits or more during 1 year. Patient characteristics included sociodemographic characteristics, physical and mental comorbidities and prior healthcare utilisation. RESULTS Out of 4 51 775 patients who visited emergency departments at least once in 2012-2013, 13 676 (3.03%) were frequent users. Four groups were identified: (1) 'low morbidity' (n=5501, 40.2%), (2) 'high physical comorbidity' (n=3202, 23.4%), (3) 'injury or chronic non-cancer pain' (n=2313, 19.5%) and (4) 'mental health or alcohol/substance abuse' (n=2660, 16.9%). CONCLUSIONS The four profiles have distinct medical and socioeconomic characteristics. These profiles provide useful information for developing tailored interventions that would address the specific needs of each type of frequent emergency department users.
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Affiliation(s)
- Yohann Moanahere Chiu
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Isabelle Dufour
- École des sciences infirmières, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Josiane Courteau
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Vanasse
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nicole Dubuc
- École des sciences infirmières, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de Recherche sur le Vieillissement, Sherbrooke, Quebec, Canada
| | - Nicolas Elazhary
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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[Substance-related disorders and transition psychiatry]. DER NERVENARZT 2022; 93:341-350. [PMID: 35267052 DOI: 10.1007/s00115-022-01266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Addictive disorders are typically manifested during adolescence and have a high transmission rate into adulthood. When adulthood is reached the responsibility by the child and adolescent psychiatric care system ends and patients transition to adult psychiatry. A lack of supportive concepts and approaches to this transition can have detrimental effects on the long-term health of affected individuals. OBJECTIVE Addiction treatment requirements of young adults transitioning between the systems of care are presented. Developmental psychopathological concepts are presented and treatment recommendations are provided. MATERIAL AND METHODS The scientific literature on development-related approaches to addiction treatment was evaluated. Care conditions relevant to transitional psychiatry are discussed and a description of needs is carried out. RESULTS Adolescents and young adults are very frequently affected by addictive disorders. The need for disorder-specific and age-specific transition-related concepts and services for these patients is high. During the transition from child and adolescent psychiatry to the psychiatric care system for adults, patients with substance-related disorders require treatment-related educational and age-appropriate psychosocial support services that address the high comorbidity and developmental delays. CONCLUSION Age-specific and disorder-specific treatment services should be broadly expanded and the interfaces to youth welfare, addiction counseling and adult psychiatry should be better coordinated.
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GUNN RACHELL, STEINGRIMSSON JONA, MERRILL JENNIFERE, SOUZA TIMOTHY, BARNETT NANCY. Characterising patterns of alcohol use among heavy drinkers: A cluster analysis utilising alcohol biosensor data. Drug Alcohol Rev 2021; 40:1155-1164. [PMID: 33987927 PMCID: PMC9972297 DOI: 10.1111/dar.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Previous research has predominately relied on person-level or single characteristics of drinking episodes to characterise patterns of drinking that may confer risk. This research often relies on self-report measures. Advancements in wearable alcohol biosensors provide a multi-faceted objective measure of drinking. The current study aimed to characterise drinking episodes using data derived from a wearable alcohol biosensor. METHODS Participants (n = 45) were adult heavy drinkers who wore the Secure Continuous Remote Alcohol Monitoring (SCRAM) bracelet and reported on their drinking behaviours. Cluster analysis was used to evaluate unique combinations of alcohol episode characteristics. Associations between clusters and self-reported person and event-level factors were also examined in univariable and multivariable models. RESULTS Results suggested three unique clusters: Cluster 1 (most common, slowest rate of rise to and decline from peak), Cluster 2 (highest peak transdermal alcohol concentration and area under the curve) and Cluster 3 (fastest rate of decline from peak). Univariable analyses distinguished Cluster 1 as having fewer self-reported drinks and fewer episodes that occurred on weekends relative to Cluster 2. The effect for number of drinks remained in multivariable analyses. DISCUSSION AND CONCLUSIONS This is the first study to characterise drinking patterns at the event-level using objective data. Results suggest that it is possible to distinguish drinking episodes based on several characteristics derived from wearable alcohol biosensors. This examination lays the groundwork for future studies to characterise patterns of drinking and their association with consequences of drinking behaviour.
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Affiliation(s)
- RACHEL L. GUNN
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
| | - JON A. STEINGRIMSSON
- Biostatistics, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
| | - JENNIFER E. MERRILL
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
| | - TIMOTHY SOUZA
- Data Management Systems, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
| | - NANCY BARNETT
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, USA
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Liu Y, Vaddiparti K, Cheong J, Cottler LB. Identification of Typologies of Cocaine Use Based on Quantity, Frequency, and Duration of Use: A Latent Profile Analysis. J Addict Med 2020; 15:211-218. [PMID: 33009168 DOI: 10.1097/adm.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We identified the patterns of cocaine use during individuals' heaviest use period by considering quantity, frequency, and duration simultaneously and examined the correlates and risk profile for these patterns. METHODS Latent profile analysis was conducted among the 3117 individuals who reported lifetime use of cocaine in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) with quantity, frequency, and duration used as indicators. Logistic regression analyses examined factors associated with subtype membership based on patterns of cocaine use and the relationships between these patterns and cocaine use disorder (CocUD) and its severity. RESULTS Four patterns were identified: a "low use" class (72.6%), a "moderate use" class (8.2%), a "daily use" class (17.9%), and a "very high quantity use" class (1.3%). Relative to non-Hispanic White and the "low use" class, non-Hispanic Black was associated with increased odds to be in the "moderate use" and "daily use" classes. Higher prevalence of smoking crack cocaine and poly-route use was observed among the "very high quantity use" class relative to other classes; increased risk of using other substances was associated with the "daily use" class. Higher levels of cocaine use were associated with higher risks of CocUD and worse severity compared to the "low use" class. CONCLUSIONS People who use cocaine are heterogeneous with different patterns of use and risks of CocUD. Reducing cocaine smoking and poly-route of use should be placed as the same priority as decreasing very high quantity of use in interventions.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL (YL, KV, LBC); Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL (JWC)
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Croese EM, Hoof JJV. Alcohol Intoxication and Psychological Problems Among Adolescents. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2020. [DOI: 10.1080/1067828x.2020.1789524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Demarque KC, Dutra-Tavares AC, Nunes-Freitas AL, Araújo UC, Manhães AC, Abreu-Villaça Y, Filgueiras CC, Ribeiro-Carvalho A. Ethanol exposure during the brain growth spurt affects social behavior and increases susceptibility to acute ethanol effects during adolescence in male mice. Int J Dev Neurosci 2020; 80:197-207. [PMID: 32077124 DOI: 10.1002/jdn.10017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/02/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023] Open
Abstract
The brain is particularly vulnerable to ethanol effects during its growth spurt. Outcomes of early ethanol exposure such as hyperactivity have been extensively investigated; however, persons with fetal alcohol spectrum disorder frequently have social impairments and are heavy drinkers. Despite that, scant information is available regarding the neurobiological basis of these latter behavioral issues. Here, Swiss mice exposed to ethanol (Etoh, 5 g/kg i.p., alternate days) or saline during the brain growth spurt [postnatal day (PN) 2 to 8] were used to assess social behavior after an ethanol challenging during adolescence. At PN39, animals were administered with a single ethanol dose (1 g/Kg) or water by gavage and were then evaluated in the three-chamber sociability test. We also evaluated corticosterone serum levels and the frontal cerebral cortex serotoninergic system. Etoh males showed reductions in sociability. Ethanol challenging reverted these alterations in social behavior, reduced corticosterone levels, and increased the 5-HT2 receptor binding of male Etoh mice. No alterations were observed in 5-HT and 5-HIAA contents. These data support the idea that ethanol exposure during the brain growth spurt impacts social abilities during adolescence, alters ethanol reexposure effects, and suggests that stress response and serotoninergic system play roles in this phenomenon.
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Affiliation(s)
- Kelly C Demarque
- Laboratório de Biologia Celular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ana C Dutra-Tavares
- Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - André L Nunes-Freitas
- Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ulisses C Araújo
- Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alex C Manhães
- Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yael Abreu-Villaça
- Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudio C Filgueiras
- Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anderson Ribeiro-Carvalho
- Departamento de Ciências, Faculdade de Formação de Professores da Universidade do Estado do Rio de Janeiro, São Gonçalo, Brazil
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Acker A, Norris ML, Coo H, Santos A, Allain D, Dow K. Severe alcohol intoxication among Canadian Youth: A 2-year surveillance study. Paediatr Child Health 2019; 26:e82-e88. [PMID: 33747315 DOI: 10.1093/pch/pxz152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/23/2019] [Indexed: 11/14/2022] Open
Abstract
Purpose To obtain data on Canadian youth, aged 11 to 15 years, presenting to paediatric emergency departments, with severe alcohol intoxication and to describe demographics, presentations to hospital, concurrent substance use, comorbidities, and short-term outcomes of admission to emergency departments. Methods Between March 2013 and February 2015, through the established methodology of the Canadian Paediatric Surveillance Program, Canadian paediatricians and paediatric subspecialists were surveyed monthly to identify cases of young adolescents presenting to paediatric emergency departments across Canada with severe alcohol intoxication. Those that identified cases were subsequently sent a detailed questionnaire. The detailed questionnaires were then screened to ensure the reported cases met the study's inclusion criteria. Results A total of 39 cases (18 females and 21 males) were included in the final analysis. Overall, results indicate over 90% of presenting youth had consumed spirits, 39% had concurrent substance use and 46% experienced serious medical morbidity. Almost two-thirds of youth were admitted to hospital for a period ranging from 10 hours to 5 days; 12 youth required intubation. Follow-up referrals were provided to two-thirds of youth, with variable supports given. No statistically significant differences between sexes were noted for blood alcohol level or concurrent substance use. Conclusion Although rates of alcohol use in adolescents have been steadily decreasing, results from this surveillance study suggest that severe intoxication arising from the use of alcohol alone, and with concurrent substance use, results in significant immediate health consequences in young adolescents. Results from this study also highlight characteristics of patients, initial treatments and initial referrals across Canadian paediatric healthcare facilities, the results of which highlight variability and may aid in the guidance of a future longitudinal study, prevention strategies, and public health messaging.
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Affiliation(s)
- Amy Acker
- Department of Pediatrics, Queen's University, Kingston, Ontario
| | - Mark L Norris
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Helen Coo
- Department of Pediatrics, Queen's University, Kingston, Ontario
| | - Alexandre Santos
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Dominic Allain
- Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta
| | - Kimberly Dow
- Department of Pediatrics, Queen's University, Kingston, Ontario
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Pavarin RM, Domenicali M, Marani S, Caputo F, Mazzoni M. Visits of adolescents for acute alcohol intoxication to emergency departments in Northern Italy: natives and non-natives. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1664665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Raimondo Maria Pavarin
- Epidemiological Monitoring Center on Addiction, Mental Health DSM-DP, Ausl Bologna, Bologna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences G. Fontana, Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, University of Bologna, Bologna, Italy
| | - Silvia Marani
- Epidemiological Monitoring Center on Addiction, Mental Health DSM-DP, Azienda USL Bologna, Bologna, Italy
| | - Fabio Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento (Ferrara), Italy
| | - Monica Mazzoni
- Department of statistics, Città Metropolitana of Bologna, Italy
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Sanvisens A, Sanjeevan I, Zuluaga P, Túnez A, de Francisco A, Papaseit E, García-Eroles L, Muga R. Five-Year Incidence of Hospital-Based Emergencies Related to Acute Recreational Intoxication in Minors. Alcohol Clin Exp Res 2019; 43:2179-2186. [PMID: 31454093 DOI: 10.1111/acer.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol or other drug (AOD) intoxication in minors is a public health challenge. We characterized underage patients admitted to an emergency department (ED) with acute, recreational AOD intoxication. METHODS We conducted a 5-year (2012 to 2016) analysis of minors admitted to the only hospital-based pediatric ED in an urban area. Episodes of AOD intoxication were selected using ICD-9-CM diagnostic codes. Sociodemographics, substance use and clinical characteristics, laboratory parameters, and discharge dispositions were collected through the revision of clinical charts. RESULTS A total of 266 admissions related to recreational AOD intoxication in 258 patients occurred during the study period. Among the 258 patients, 127 (49.2%) were men, median age 16 years [IQR: 15 to 17 years], and 234 (90.7%) of episodes were alcohol-related. At admission, 202/256 (78.9%) patients had a Glasgow Coma Scale ≥ 13 points, the median systolic and diastolic blood pressure was 109 mmHg (IQR: 101 to 118 mmHg) and 67 mmHg (IQR: 60 to 73 mmHg), respectively, and the median blood glucose level was 112 mg/dl (IQR: 99 to 127 mg/dl). Only 72/258 (27.9%) patients underwent urine screening (22/72 (30.5%) were positive for cannabis), and only 30/258 (11.6%) were tested for blood ethanol (median: 185 mg/dl, IQR: 163 to 240 mg/dl). There was a trend in admissions occurring early in the morning of weekend days, and 249 (96.5%) patients were discharged home the day of admission. CONCLUSIONS Though the severity of AOD intoxication seems to be mild to moderate, assessment of substance exposure is low and may underestimate polydrug use in underage populations.
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Affiliation(s)
- Arantza Sanvisens
- From the, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Institut Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Irina Sanjeevan
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Paola Zuluaga
- From the, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Institut Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Adrià Túnez
- From the, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Institut Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Antonio de Francisco
- Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Esther Papaseit
- Department of Pharmacology, Hospital Universitari Germans Trias i Pujol, Institut Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Luis García-Eroles
- Department of Health Information Systems, Generalitat de Catalunya, Barcelona, Spain
| | - Robert Muga
- From the, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Institut Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
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Trefan L, Gartner A, Alcock A, Farewell D, Morgan J, Fone D, Paranjothy S. Epidemiology of alcohol-related emergency hospital admissions in children and adolescents: An e-cohort analysis in Wales in 2006-2011. PLoS One 2019; 14:e0217598. [PMID: 31163052 PMCID: PMC6548373 DOI: 10.1371/journal.pone.0217598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/14/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Harmful levels of alcohol consumption in young people are prevalent and of increasing public concern in the western world. Rates of alcohol-related emergency hospital admissions in children and young people between 10 to 17 years were described, and the reasons for these admissions and their association with socio-demographic factors were examined. METHODS E-cohort data were extracted from the Secure Anonymised Information Linkage Databank, which contained alcohol-related emergency hospital admissions (N = 2968) from 2006 to 2011 in children and adolescents aged 10 to 17 years in Wales. A generalised linear mixed model was fitted using a log-link with a population offset to the data to calculate incident rate ratios (IRRSs). RESULTS There was a general decreasing trend from 2006 to 2011 in the number and rate of alcohol-related emergency hospital admissions; the mean age of admission was 15.4 (standard deviation 1.4) years. In each of the four youngest age groups (10-13,14,15,16 years), females had higher IRRs than males. Males had slightly higher IRR compared to females only in the oldest age group (17 years). IRRs increased with increasing deprivation. The majority (92%) of the admissions lasted one day and most of the admissions (70%) occured during the last three days of the week with a peak on Saturday. The length of stay in hospital was longer in cases when self-harm were present. Multiple admissions showed high prevalance of serious self-harm cases in females. The number of admissions with injuries and falls were higher for males than females. CONCLUSION Female children and adolescents were more likely to be admitted to hospital for alcohol-related reasons. These data illustrate the significant burden of alcohol-related harm in young people and highlight the need for interventions and policies that promote safe drinking practices among young people to prevent future alcohol-related harm during the life-course.
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Affiliation(s)
- Laszlo Trefan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Andrea Gartner
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Amy Alcock
- Royal Gwent Hospital, Newport, United Kingdom
| | - Daniel Farewell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | - David Fone
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Shantini Paranjothy
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Van Hoof JJ, Klerk FA, Van der Lely N. Acute Alcohol Intoxication: Differences in School Levels and Effects on Educational Performance. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017. [DOI: 10.1080/1067828x.2017.1396515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Arnaud N, Diestelkamp S, Wartberg L, Sack P, Daubmann A, Thomasius R. Short- to Midterm Effectiveness of a Brief Motivational Intervention to Reduce Alcohol Use and Related Problems for Alcohol Intoxicated Children and Adolescents in Pediatric Emergency Departments: A Randomized Controlled Trial. Acad Emerg Med 2017; 24:186-200. [PMID: 27801991 DOI: 10.1111/acem.13126] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/29/2016] [Accepted: 10/19/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The proportion of children and adolescents receiving emergency care for acute alcohol intoxication (AAI) in Germany has sharply increased over the past years. Despite this, no randomized controlled trials (RCTs) have studied guideline- and evidence-based interventions to prevent future alcohol misuse within this population. The objective of our investigation was to evaluate the effectiveness of a brief motivational intervention (b-MI) to reduce drinking and associated problems within pediatric emergency departments (PED) in Hamburg, Germany. METHODS This stratified cluster-RCT compared a widely established but modified targeted b-MI and treatment as usual (TAU) for patients recruited and treated on Fridays, Saturdays, or Sundays from July 2011 to January 2014 for AAI in EDs of six pediatric hospitals in Hamburg, Germany. Patients under the age of 18 years and their caregivers were included in the study. Intervention was delivered by trained hospital-external staff. The intervention group (n = 141) received a single-session b-MI with a telephone booster after 6 weeks and a brief consultation for caregivers. All intervention material was manual-based. The TAU control group (n = 175) received youth-specific written information on alcohol use and contact information for community resources. Primary outcomes were changes in binge drinking frequency, number of alcoholic drinks on a typical occasion, and alcohol-related problems using the brief Rutgers Alcohol Problem Index. Outcomes were measured by research assistants not involved in intervention delivery. Baseline data were collected in person at the PED, and follow-up data were collected via telephone 3 and 6 months after baseline. Secondary outcome was postenrollment health service utilization. Analyses were based on linear mixed models and intent to treat. RESULTS A total of 86.1% (87.5%) of patients in the b-MI group and 82.4% (86.9%) in the TAU group provided valid outcome data after 3 (6) months, respectively. The differences between groups for all outcomes were statistically nonsignificant at both follow-ups (p > 0.05). After 3 months the mean change in binge drinking frequency was -1.36 (95% confidence interval [CI] = -1.81 to -0.91), a reduction of 62.1% in the b-MI group, and -1.29 (95% CI = -1.77 to -0.95), a reduction of 49.0% in the TAU group. The mean change in number of alcoholic drinks on a typical occasion was -2.24 (95% CI = -3.18 to -1.29), a reduction of 37.5% in the b-MI group, and -1.34 (95% CI = -2.54 to -0.14), a reduction of 26.4% in the TAU group. The mean change of alcohol-related problems was -6.72 (95% CI = -7.68 to -5.76), a reduction of 60.5% in the b-MI group, and -6.43 (95% CI = -7.37 to -5.49), a reduction of 58.3% in the TAU group. The differences in mean changes between groups were similar after 6 months for all outcomes. CONCLUSION This study provides new information on the effectiveness of b-MIs delivered at discharge of young AAI patients in emergency care. Both trial groups reduced alcohol use and related problems but the b-MI was not associated with significant effects. Although the intervention approach appears feasible, further considerations of improving the outcomes for this relevant target group are required.
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Affiliation(s)
- Nicolas Arnaud
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Silke Diestelkamp
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Lutz Wartberg
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Peter‐Michael Sack
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Rainer Thomasius
- German Centre for Addiction Research in Childhood and Adolescence (DZSKJ) University Medical Centre Hamburg‐Eppendorf Hamburg Germany
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A latent profile analysis of drinking patterns among nonstudent emerging adults. Addict Behav 2016; 62:14-9. [PMID: 27305099 DOI: 10.1016/j.addbeh.2016.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 11/22/2022]
Abstract
Research indicates that nonstudent emerging adults, as compared to their college-attending peers, are at higher risk for experiencing alcohol-related problems, including alcohol use disorders. The present study sought to extend the limited research on nonstudent drinking by (1) identifying sub-groups of nonstudent drinkers based on their drinking patterns and (2) determining the extent to which social-cognitive between-person factors related to drinking (i.e., social expectancies, perceived drinking norms, social drinking motivations) distinguish these sub-groups. Participants were 195 (65.1% men) nonstudent emerging adult heavy episodic drinkers recruited from the community. Mean age was 21.88 (SD=2.08) years and 45.4% were unemployed. Latent profile analysis identified two classes based on drinking across 30days. The "moderate drinkers" group (n=143; 73.3%) reported consuming 10-11 drinks weekly and drinking two to three times per week, on average. The "heavy drinkers" class (n=52; 26.7%) reported consuming 42-43 drinks weekly and drinking six to seven days per week. Both groups exhibited a cyclic pattern of drinking whereby weekday drinking was lower, with increases on the weekend; the heavy drinkers class had stronger weekend increases starting earlier. Heavy drinkers reported greater volume, frequency, and problematic drinking behaviors, as compared to the moderate drinkers. The heavy drinkers class also endorsed stronger social motives and perceived their peers to drink more. The present study offered unique insights into nonstudent emerging adult drinking patterns by identifying sub-populations of drinkers based on their past 30-day use. Knowledge gained from this study could aide in tailoring existing alcohol interventions to nonstudents to reduce alcohol-related harms.
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Newton AS, Shave K, Rosychuk RJ. Does Emergency Department Use for Alcohol and Other Drug Use Cluster Geographically? A Population-Based Retrospective Cohort Study. Subst Use Misuse 2016; 51:1239-44. [PMID: 27192544 DOI: 10.3109/10826084.2016.1160122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To identify geographic areas in Alberta, Canada with higher numbers of adolescents with an emergency department (ED) presentation for a mental or behavioral disorder secondary to alcohol and other drug use. METHODS A population-based cohort analysis of ED visits (n = 7787) by adolescents aged 15-17 years (n = 7238) during 2002-2011. We calculated sex-adjusted directly standardized rates (DSRs) and identified space-time clusters in health zones (North, Edmonton, Calgary, Central, and South). RESULTS The North zone had higher DSRs compared to other areas. Clusters were identified in: (1) North, Edmonton, and northwest Central zones [relative risk (RR: 1.54; from 2004 to 2008); (2) western South and southern Calgary zones (RR: 1.58; from 2007 to 2011); and (3) northern South zone (RR: 2.38; from 2006 to 2007). CONCLUSIONS The spatial scan can identify geographic areas of high health care use for specific health conditions. These results, in turn, can be used to inform health resource planning.
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Affiliation(s)
- Amanda S Newton
- a Department of Pediatrics , University of Alberta , Edmonton , Canada
| | - Kassi Shave
- b Department of Pediatrics Graduate Program , University of Alberta , Edmonton , Canada
| | - Rhonda J Rosychuk
- a Department of Pediatrics , University of Alberta , Edmonton , Canada
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Kuttler H, Schwendemann H, Reis O, Bitzer EM. Developmental Hazards Among Young Alcohol Intoxicated Patients. J Adolesc Health 2016; 59:87-95. [PMID: 27185620 DOI: 10.1016/j.jadohealth.2016.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/12/2016] [Accepted: 03/10/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The rising numbers of alcohol intoxicated adolescents (AIA) treated in emergency care units in several European countries have drawn attention to this target group for prevention. To our knowledge, this is the first study to assess a broad array of developmental hazards and their stability in AIA and to compare their distribution with representative samples (RS). METHODS A multisite cohort study of AIA aged 13-17 years assessed, in the hospital (t0) and 6 months later (t1), (family) violence, cannabis and alcohol use, school problems, delinquency, homelessness, depression, and suicidality, using items from representative German surveys: Children and Adolescent Health Survey (KiGGS), Childhood Trauma Questionnaire and Communities That Care Youth Survey. We calculated the differences between AIA and RS and corresponding 95% confidence intervals. For AIA respondents who completed t0 and t1 information, we calculated prevalence/persistence/incidence of developmental hazards and corresponding 95% confidence interval. RESULTS A total of 342 AIA participated at t0, 228 at t1 (67%). AIA had a significantly higher burden of concomitant risks regarding physical and emotional family abuse, (sexual) victimization, cannabis use, binge drinking, school expulsion, police arrest, gang membership, and being violent. Six months after hospitalization, emotional family abuse (34.1%), cannabis use (23.5%), depression (14.8%), and being violent (13.2%) were especially prevalent. CONCLUSIONS Developmental hazards are up to six times more prevalent in AIA than in RS. Therefore, when assessing the risk profile of AIA, it is important to consider developmental hazards as well as detrimental alcohol use.
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Affiliation(s)
- Heidi Kuttler
- Public Health & Health Education, Freiburg University of Education, Freiburg, Germany.
| | - Hanna Schwendemann
- Public Health & Health Education, Freiburg University of Education, Freiburg, Germany
| | - Olaf Reis
- Clinic for Child and Adolescent Neuropsychiatry, Rostock University of Medicine, Rostock, Germany
| | - Eva Maria Bitzer
- Public Health & Health Education, Freiburg University of Education, Freiburg, Germany
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