Comparison of lifestyle and substance use factors related to accidental injuries at work, home and recreational events

Sleep problems and work injuries: a systematic review and meta-analysis

OBJECTIVES

Sleep problems are a potential risk factor for work injuries but the extent of the risk is unclear. We conducted a systematic review and meta-analysis to quantify the effect of sleep problems on work injuries.

METHODS

A systematic literature search using several databases was performed. Sleep problems of any duration or frequency as well as work injuries of any severity were of interest. The effect estimates of the individual studies were pooled and relative risks (RR) and 95% confidence intervals (CI) were calculated through random effects models. Additionally, the population attributable risk was estimated.

RESULTS

In total, 27 observational studies (n = 268,332 participants) that provided 54 relative risk estimates were included. The findings of the meta-analysis suggested that workers with sleep problems had a 1.62 times higher risk of being injured than workers without sleep problems (RR: 1.62, 95% CI: 1.43-1.84). Approximately 13% of work injuries could be attributed to sleep problems.

CONCLUSION

This systematic review confirmed the association between sleep problems and work injuries and, for the first time, quantified its magnitude. As sleep problems are of growing concern in the population, these findings are of interest for both sleep researchers and occupational physicians.

Early predictors of injury mortality among Swedish conscripts: a 35-year cohort study

Injuries represent an important cause of mortality among young adults. We studied the associations between adolescents' family, psychological, behavioural and drug-related risk factors in relation to unintentional injury death. A population-based cohort of 49,411 Swedish conscripts aged 18-20 years was followed for 35 years. The end-point of study was injury death up to 2004. The relationship between two family, four psychological and eight behavioural risk factors and injury death were analysed with Cox proportional hazards analyses and χ(2) tests. Among 485 unintentional injury deaths, 40% occurred in subjects aged 25 years or under. The incidence per 1000 person years was 0.29 (95% CI, 0.26-0.31) and the mean age of death was 33 years. Problem drinking at both adolescent and adulthood was more strongly associated with injury death (HR=5.40) than illicit drug use (HR=2.70) even after adjusted for behavioural risk factors: (HR=3.43) and (HR=1.75), respectively. Adolescent risk factors such as contact with police and juvenile authorities, low emotional control, conduct problems at school and low social maturity were significant predictors of injury death in multivariate analyses. Young adults with social, behavioural and psychological problems and especially alcohol and drug use at both adolescent and adulthood have a high mortality rate due to road traffic injuries and all kind of injuries. Early identification of vulnerable groups of adolescents with psychological and behavioural problems including alcohol and drug use at local levels could make a difference.

Variations of alcohol impairment in different types, causes and contexts of injuries: results of emergency room studies from 16 countries

OBJECTIVE

The purpose of this paper is to document alcohol impairment (based on a blood alcohol content (BAC) of at least 80 mg%) for different types, causes and location contexts of injuries.

DESIGN AND SETTING

Data from 45 studies with 11,536 injury patients were merged to determine variations in the percent of alcohol impairment among injury patients. In each study, emergency room (ER) injury patients were given a short interview on the circumstances of their injury and BAC was measured.

RESULTS

Injury severity, measured by number of body regions injured was significantly associated with BACs over 80 mg%. The highest percentage of injury type to involve alcohol was head injury/concussion. In terms of causes of injuries, patients with alcohol impairment were significantly more likely to be involved in violence than any other cause (i.e., vehicle, falling, poisoning or burns). Finally, injuries occurring at a bar or restaurant were significantly more likely to involve alcohol impairment than any other setting.

CONCLUSIONS

The results demonstrate considerable variation in the circumstances where alcohol is involved in injuries. These results may be useful for the development of prevention initiatives.

Illicit drug use and injuries: A review of emergency room studies

The reviewed emergency room studies (n = 11) show overall prevalence rates of illicit drug use of 35-40% in studies using blood and urine toxicology and 1-5% in self-report studies. Cannabis and cocaine are the substances most prevalent in these studies, with a higher prevalence of cocaine in emergency rooms in the USA than in other countries where cannabis is the most common substance. Illicit drugs and alcohol are often used in combination. No relationship was found between injury severity and illicit drug use. Less clear associations emerged concerning patient and injury characteristics and illicit drug use. However, illicit drug use seems to be more common in men aged 20-40 years and is strongly associated with violence-related injuries. Variations in the prevalence rates and patient characteristics can partly be explained by locale and/or country of research. Moreover, because methodological differences influence the study outcomes, methodological aspects of emergency room studies should be taken into consideration when interpreting the results.

Alcohol and/or benzodiazepine use: different accidents--different impacts?

1611 patients were included in this investigation. 16.7% of the patients were involved in traffic accidents, 38.2% were injured by a sudden fall, 3.5% were involved in an act of violence, 22.8% were injured by a sports related accident and 18.9% were hurt within a work-related accident. 19.5% of the patients tested positive for alcohol, 5.2% tested positive for benzodiazepines and 1.4% tested positive for both substances. Blood samples were positive for alcohol in 27% males and 7.7% females and for benzodiazepines in 6.3% males and in 3.5% females. The mean blood alcohol concentration (BAC) as well as the mean benzodiazepine plasma level were higher in patients injured in violent accidents compared to the other injury groups. This study provides epidemiologic information about the relationship between specific kinds of accidents and alcohol and/or benzodiazepine use in a large probability sample of emergency room patients. We found a high number of patients using alcohol, and a lower but still relavant number of benzodiazepine users in this large and unselected traumatology ER sample. This study adds evidence to the existing literature about the co-occurance of alcohol and/or benzodiazepine consumption and accident-related injuries.

Sleep-related risk of occupational injuries in Japanese small and medium-scale enterprises

A cross-sectional study evaluated the contribution of daily sleep habits to occupational injuries. A self-administered questionnaire solicited answers about sleep, symptoms of depression, occupational injury, demographics, presence of diseases and lifestyle factors from 2,903 workers between the ages of 16-83 (mean 45) yr in small and medium-scale enterprises. Eight sleep habits were queried and dichotomized: 1) less or more than 6 hr of daily sleep, 2) taking more or less than 30 min to fall asleep (Difficulty initiating sleep; DIS), 3) awakening during sleep more or less than 3 times/wk (Difficulty maintaining sleep; DMS), 4) early morning awakening more or less than 3 times/wk (EMA), 5) definitely/somewhat difficulty waking up or not, 6) sleeping very poorly/not so well at night or not, 7) definitely/somewhat insufficient nightly sleep or not, and 8) difficulty in breathing during sleep more than once/week or less. Occupational injury was assessed by asking subjects 'Have you ever been injured during your work, including minor scratches and cuts (Yes/No)?' Both sleep and injury were assessed over the previous one year period. One-third of workers answered that they had experienced injury. Workers with sleep features of DIS, sleeping poorly at night, insufficient sleep, and insomnia had a significantly higher prevalence for injury after adjusting for multiple confounders. The findings suggest that poor nocturnal sleep habits are associated with self-reported occupational injury.

Progression of a general substance use pattern among adolescents in Switzerland? Investigating the relationship between alcohol, tobacco, and cannabis use over a 12-year period

Many studies have shown that different risk or problem behaviors in adolescence are interrelated. Given the increased use of various substances among adolescents in the United States and in most European countries, the question emerges whether there are more substance use "specialists" or a progression of a general substance use pattern. If the latter is the case, the interrelatedness of the different substances should remain stable over time in a representative sample and among subgroups characterized by gender and language. Data from 4,146 15-year-olds in Switzerland surveyed in 1986, 1994 and 1998 were analyzed, using confirmatory factor analyses based on polychoric correlations. Smoking, drunkenness and cannabis use greatly increased over the 12-year period. However, in the different survey years, the factor structure did not differ for all 15-year-olds in general or for subgroups. This progression of a general pattern refers to an increased normalization of recreational substance use in general, not only of cannabis use. Favorable attitudes towards general substance use are a challenge to substance use prevention in adolescence, and reveal a need for more research on such a progression in other countries.

The relationship between alcohol consumption patterns and car, work, sports and home accidents for different age groups

The purpose of this study was to examine the relationship between alcohol consumption patterns and car, work, sports and home accidents for different age groups. A secondary analysis of data from a randomized household survey of 10385 Canadians was conducted. Overall, alcohol consumption patterns were significantly associated with car collisions, work and sports accidents for younger age groups (i.e. 15-24 and 25-34), but this relationship was not significant for the older age groups.

Demographic and substance use factors related to violent and accidental injuries: results from an emergency room study

OBJECTIVE

The primary goal of this study was to identify demographic and substance use factors associated with violent injuries, accidental injuries, and medical conditions or illnesses (non-injured).

METHOD

Data were examined from a sample of 1701 admissions to emergency rooms at two Canadian hospitals. These patients were interviewed and provided urine samples to detect the presence of drug metabolites for alcohol, THC, benzodiazepines, barbiturates, morphine, and codeine.

RESULTS

Those with violent injuries were significantly (P<0.0001) more likely to be male and have lower incomes compared with both the accidental injury and non-injury groups. About 37% of violent injuries occurred at a bar or restaurant, which was significantly more than 3% for accidental injuries and 2% for non-injuries (P<0.00001). The violent injury group was significantly more likely than the other two groups to report feeling the effects of alcohol at the time of the injury and to report negative consequences of alcohol use (P<0.00001). Furthermore, about 42% of those with violent injuries had a blood alcohol level (BAL) over 80 mg% compared to only 4% with accidental injuries (P<0.00001) and 2% of non-injuries (P<0.00001). In terms of drug tests for other substances, the violent injury group was significantly more likely to test positive for benzodiazepines than the accidental injury group (P<0.01) while all between group comparisons for other drugs were not significant.