1
|
Abstract
BACKGROUND The Coronavirus Disease 2019 (COVID-19) pandemic has had a dramatic impact on individual and societal behaviors, as well as on health care systems. It confers a unique opportunity to examine the relationship among disease, policies, and patterns of activity, as well as their impacts on surgical unit functionality. This study aims to compare the distribution and patterns of injury at a tertiary hand surgery trauma center before and during the COVID-19 pandemic. METHODS A retrospective analysis of all patients presenting to the Royal North Shore Hospital hand surgery service in the 5-week period from March 16 to April 21 in 2019 and 2020 was undertaken, forming 2 cohorts for comparison. Demographic, injury, and operative data were collected and compared descriptively using comparative statistics. RESULTS There were 114 primary operative presentations during the 5-week period in 2020, representing a 27.4% decrease from the 157 presentations during the equivalent period in 2019. There was an increase in the proportion of emergency presentations from 73.9% in 2019 to 85.1% in 2020 (P = .03), with a corresponding decrease in elective presentations during 2020. The incidence of sporting injuries and motor vehicle accidents decreased in 2020, whereas falls and accidents involving knives and tools remained relatively constant. Operating times decreased in 2020, whereas the length of hospital stay remained constant. CONCLUSIONS The COVID-19 pandemic and consequent restrictions of activity have had substantial impacts on the patterns of hand trauma and its management. These insights have implications for staff and resource management during times of social disruption in the future.
Collapse
Affiliation(s)
- Serag Saleh
- University of New South Wales, Sydney, Australia
| | | | | | - David J Graham
- Australian Research Collaboration on the Hand, Mudgeeraba, QLD, Australia
- Gold Coast University Hospital, Southport, QLD, Australia
| | | | - Michael J Symes
- University of New South Wales, Sydney, Australia
- Royal North Shore Hospital, St Leonards, NSW, Australia
- St George Hospital, Kogarah, NSW, Australia
| | - Brahman S Sivakumar
- Australian Research Collaboration on the Hand, Mudgeeraba, QLD, Australia
- Royal North Shore Hospital, St Leonards, NSW, Australia
- Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia
- Nepean Hospital, Kingswood, NSW, Australia
| |
Collapse
|
2
|
Roemer A, Stockwell T, Zhao J, Chow C, Vallance K, Cherpitel C. Gender differences in the consumption of alcohol mixed with caffeine and risk of injury. Drug Alcohol Rev 2019; 38:750-757. [PMID: 31599075 PMCID: PMC6907685 DOI: 10.1111/dar.12997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS There is increasing evidence suggesting the consumption of caffeinated alcoholic beverages is associated with risks over and above alcohol use on its own; however, research in this area remains limited. We examined whether gender differences existed in the relationship between the combined use of alcohol and caffeine (Alc + Caff) and risk for injury. DESIGN AND METHODS This emergency department study utilised case-control and case-crossover analyses to examine in situ session specific Alc + Caff use and injury risk for men and women, while controlling for socio-demographic variables, dose of alcohol and caffeine, other substance use, risk-taking propensity and context. The sample comprised 2804 individuals aged 18-years or older who presented to three hospital emergency departments in British Columbia. RESULTS A relationship between Alc + Caff use and increased risk of injury was confirmed. Further, gender differences were found in the risk relationship between Alc + Caff use and injury. Women were found to have a higher risk injury propensity following Alc + Caff use in both the case-control (OR = 3.10, 95% CI = 1.78, 5.84) and case-crossover analyses (OR = 3.21, 95% CI = 1.69, 6.12), relative to men (OR = 1.69, 95% CI = 1.30, 2.30; OR = 1.38, 95% CI = 1.08, 1.86). These results remained even after controlling for demographic factors, risk-taking, context and other substance use. DISCUSSION AND CONCLUSIONS Women may be at higher risk of injury than men following the consumption of alcohol mixed with caffeine. The findings offer support for differential low-risk drinking guidelines for men and women and the restriction and regulation of the sale and availability of caffeinated alcoholic beverages.
Collapse
Affiliation(s)
- Audra Roemer
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Jinhui Zhao
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Clifton Chow
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
- Vancouver Coastal Health Authority, Vancouver, Canada
| | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | | |
Collapse
|
3
|
Greenfield TK, Cook WK, Karriker-Jaffe KJ, Patterson D, Kerr WC, Xuan Z, Naimi TS. The Relationship Between the U.S. State Alcohol Policy Environment and Individuals' Experience of Secondhand Effects: Alcohol Harms Due to Others' Drinking. Alcohol Clin Exp Res 2019; 43:1234-1243. [PMID: 31166048 PMCID: PMC6553486 DOI: 10.1111/acer.14054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 04/05/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although restrictive state alcohol policy environments are protective for individuals' binge drinking, research is sparse on the effect of alcohol policies on alcohol's harms to others (AHTO). We examined the lagged associations between efficacy of U.S. state alcohol policies and number of harms from others' drinking 1 year later. METHODS Individuals with AHTO data in a nationally representative sample of U.S. adults (analytic sample n = 26,744) that pooled the 2000, 2005, 2010, and 2015 National Alcohol Surveys and a 2015 National Alcohol's Harm to Others Survey were linked with prior-year state policy measures. We used 2 measures from the Alcohol Policy Scale (APS)-effectiveness in reducing (i) binge drinking and (ii) impaired driving, based on experts' efficacy judgments regarding 29 state alcohol policies. Three 12-month AHTO measures (due to another drinker) were experiencing: (i) either family/marriage difficulties or financial troubles; (ii) being assaulted or vandalized; and (iii) passenger with drunk driver or traffic accident. Multilevel models accounting for clustering within states and stratified by age-groups (<40 vs. ≥40) examined associations between the APS and AHTO measures, controlling for individual covariates (gender, race, education, employment and marital status, family problem-drinking history) of the victim. RESULTS Only for those aged <40, the lagged APS-Binge drinking and APS-Impaired driving scores were each inversely associated with aggression-related harms and, separately, with drunk driving-related harm from someone else's drinking (ps < 0.05 to < 0.01). Family/financial harms were not associated with APS scores for either age-group. Composite AHTO measures (any of 3 harm-types) also were inversely associated with stronger state alcohol policy environments (ps < 0.05 to <0.01). CONCLUSIONS State alcohol policies may be effective in reducing, to a meaningful degree, aggression-related harms and vehicular hazards due to other drinkers, but mainly in those under 40.
Collapse
Affiliation(s)
| | - Won K. Cook
- Public Health Institute, Alcohol Research Group, Emeryville California USA
| | | | - Deidre Patterson
- Public Health Institute, Alcohol Research Group, Emeryville California USA
| | - William C. Kerr
- Public Health Institute, Alcohol Research Group, Emeryville California USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy S. Naimi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Clinical Addiction Research & Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Jang BJ, Schuler MS, Evans-Polce RJ, Patrick ME. Marital Status as a Partial Mediator of the Associations Between Young Adult Substance Use and Subsequent Substance Use Disorder: Application of Causal Inference Methods. J Stud Alcohol Drugs 2018. [PMID: 30079872 DOI: 10.15288/jsad.2018.79.567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Young adult substance use is linked with the risk of substance use disorders (SUDs) later in adulthood. Marriage may be part of this pathway because of both selection effects (early substance use reducing marriage) and socialization effects (marriage reducing later substance use and disorder). We examine whether marital status mediates the association between young adult substance use and subsequent SUDs, using causal mediation methods to strengthen inferences. METHOD Using panel data from high school seniors in 1990-1998, we examined whether the effects of two exposures (level of alcohol/marijuana use at age 19/20) on the outcomes (alcohol use disorder [AUD]/ marijuana use disorder [MUD], nondisordered use, or abstinence at age 35) were mediated by marital status at age 29/30. Propensity score weights adjusted for potential confounding regarding both the exposures and the mediator. RESULTS Moderate and heavy alcohol/marijuana use at age 19/20 were associated with higher odds of AUD/MUD and lower odds of abstinence, each relative to nondisordered use, at age 35. The association between heavy alcohol use at age 19/20 and subsequent AUD was partially mediated by being unmarried at age 29/30; the associations between moderate and heavy marijuana use at age 19/20 and subsequent marijuana abstinence were partially mediated by being unmarried at age 29/30. CONCLUSIONS Both selection and socialization effects related to marriage explain the perpetuation of substance use behaviors across adulthood. Selection effects on marriage seem to occur at different thresholds for young adult alcohol and marijuana use.
Collapse
Affiliation(s)
- Bohyun Joy Jang
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | | | | | - Megan E Patrick
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
5
|
Variance in the Efficacy of Brief Interventions to Reduce Hazardous and Harmful Alcohol Consumption Between Injury and Noninjury Patients in Emergency Departments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Ann Emerg Med 2017; 70:714-723.e13. [DOI: 10.1016/j.annemergmed.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/19/2017] [Accepted: 05/02/2017] [Indexed: 01/03/2023]
|
6
|
Nordfjaern T. Violence involvement among nightlife patrons: The relative role of demographics and substance use. Aggress Behav 2017; 43:398-407. [PMID: 28078788 DOI: 10.1002/ab.21698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 02/03/2023]
Abstract
The nightlife setting is a risk context for violence involvement that ultimately may cause severe injuries and fatalities. Few studies have examined associations between alcohol and illicit substance use with physical violence involvement among nightlife patrons. The aim of the current study was to investigate the relative role of demographics and substance use characteristics for nightlife violence involvement among Norwegian nightlife patrons. A cross-sectional self-completion survey was conducted outside 12 licensed premises in Oslo (n = 1099, response rate = 76%) and each respondent's BAC level was measured by a breathalyzer and registered on the questionnaire. A total of 103 individuals (10%) reported that they had been involved in physical violence when they were consuming alcohol in the nightlife setting during the last 12 months. Uni-variate results showed that patrons who had been involved in violence were more likely to present a BAC level above 1.00‰ than those who had not been involved. The prevalence of last year illicit substance use was overall high, especially in the violence-involved group. The most important factors associated with violence involvement in multivariate analysis were a high frequency of last year alcohol intoxication and last year illicit substance use. Women and those with high education had a lower risk of violence involvement. The implications for preventive initiatives are that these need to focus on factors additional to alcohol restrictions. Preventive efforts targeted to specific patron groups and measures targeting patrons who are more likely to use illicit substances may hold promise. Aggr. Behav. 43:398-407, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Trond Nordfjaern
- Norwegian Institute of Public Health, Department of Drug Policy; Oslo Norway
| |
Collapse
|
7
|
Bunker N, Woods C, Conway J, Usher K. Patterns of ‘at home’ alcohol-related injury presentations to emergency departments – An integrative literature review. Collegian 2017. [DOI: 10.1016/j.colegn.2016.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
8
|
Gavine A, MacGillivray S, Williams DJ. Universal community-based social development interventions for preventing community violence by young people 12 to 18 years of age. Hippokratia 2017. [DOI: 10.1002/14651858.cd011258.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anna Gavine
- University of Dundee; evidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research; 11 Airlie Place Dundee UK DD1 4HJ
| | - Stephen MacGillivray
- University of Dundee; evidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Science, Dundee Centre for Health and Related Research; Airlie Place Dundee Tayside UK DD1 4HN
| | - Damien J Williams
- University of St Andrews; School of Medicine; Medical and Biological Sciences Building, North Haugh St Andrews Fife UK KY16 9TF
| |
Collapse
|
9
|
Mattila VM, Parkkari J, Lintonen T, Kannus P, Rimpelä A. Occurrence of violence and violence-related injuries among 12—18 year-old Finns. Scand J Public Health 2016; 33:307-13. [PMID: 16087493 DOI: 10.1080/14034940510005851] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: The aim of this study was to investigate the occurrence, nature, and severity of violence and violence-related injuries, and the occurrence of alcohol-related violence among Finnish adolescents. Methods: A 12-page questionnaire was mailed to a nationwide representative sample of 12-, 14-, 16-, and 18-year-olds (n=10,883). The response rate was 75%. Results: Of the 8,135 respondents, 7.9% (646) reported violence occurrence and 1.7% violence-related injury during the past month. The male—female ratio for violence occurrence was 1.9 (95% CI 1.6—2.2) and for violence-related injury occurrence 0.8 (95% CI 0.6—1.2). Sixteen-year-old girls reported the highest injury rate (23/1,000). Most typically, the violent persons were individuals known by the victim before the incident. Girls were significantly ( p<0.001) more often (43%) in a fight with, or assailed by, a family member than boys (8%). Although boys' violent actions were related to leisure-time activities (64%), violence rarely took place during sports activities. Alcohol-related violence increased with age. Some 13% of 14-year-olds reported being under the influence of alcohol at the time of violence. The corresponding figures for 16- and 18-year-olds were 41% and 62%, respectively. Moreover, alcohol was closely associated with violence-related injuries. Conclusions: Violence is common among Finnish adolescents. While violence does not always lead to injury, related injuries are an important cause of adolescent morbidity. Alcohol seems to be strongly associated with adolescent violence and related injuries.
Collapse
Affiliation(s)
- Ville M Mattila
- School of Public Health, University of Tampere, Finland, University Hospital of Tampere, Tampere, Finland.
| | | | | | | | | |
Collapse
|
10
|
French MT, Zavala SK. The Health Benefits of Moderate Drinking Revisited: Alcohol Use and Self-Reported Health Status. Am J Health Promot 2016; 21:484-91. [PMID: 17674634 DOI: 10.4278/0890-1171-21.6.484] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To examine the association between alcohol use and self-reported health status. In particular, we sought to determine whether moderate drinkers are more likely to self-report above-average health status compared with other current drinkers, former drinkers, and lifetime abstainers. Design. Cross-sectional survey. Setting. Continental United States. Subjects. The sample adult component of the 2002 U.S. National Health Interview Survey (n = 31,044), representative of the U.S. noninstitutionalized civilian household population. Measures. Dichotomous measure of above-average self-reported health status relative to all other health states. Several measures characterized alcohol use patterns (i.e., continuous and categorical measure of alcohol use, a proxy measure of problem drinking, former drinking, lifetime abstaining). Chronic health conditions and various demographic and lifestyle factors were included as covariates in all regression models. Results. For both men and women, current moderate drinkers had the highest odds (OR = 1.27 for men, p < .01; OR = 2.03 for women, p < .01) of reporting above-average health status compared with other current drinkers, former drinkers, and lifetime abstainers. The odds dropped to 1.12 and 1.34, respectively, when all past-year drinkers were collapsed into a single group. Conclusion. Moderate alcohol consumption was associated with the highest odds of reporting above-average health status, even after controlling for chronic health conditions and demographic and lifestyle factors associated with health.
Collapse
Affiliation(s)
- Michael T French
- University of Miami, Department of Sociology, 5202 University Drive, Merrick Building, Room 121F, P O Box 248162, Coral Gables, FL 33124-2030, USA.
| | | |
Collapse
|
11
|
An overview of injuries to adolescents and young adults related to substance use: data from Canadian emergency departments. CAN J EMERG MED 2015; 11:330-6. [DOI: 10.1017/s1481803500011374] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:Alcohol is a significant risk factor for injury, and is one of the leading causes of death, disability and premature mortality among young Canadians. This paper provides an overview of alcohol-related injury among adolescents and young adults presenting to Canadian emergency departments (EDs).Methods:We reviewed records from the Canadian Hospitals Injury Reporting and Prevention Program database during the 4-year period between 2000 and 2003. We included individuals younger than 25 years who presented to EDs in 11 pediatric and general hospitals with injuries for which alcohol, either alone or in conjunction with drugs, was recorded as a contributing factor. We examined key socio-demographic and injury-related factors associated with alcohol and drug-related injuries, including intent and disposition.Results:Alcohol was identified as a factor in 2389 injuries during this 4-year period; 408 (17%) of these cases also involved drug use. Approximately 55% of these patients were male and the majority was between 15 and 19 years of age. Unintentional injuries were the most common presentation, self-harm injuries were more common among female patients and violence-related injuries were more common among male patients. Most patients received treatment for their injuries. However, as age increased, outcome differences were observed between sexes.Conclusion:Alcohol-related injuries are increasing among Canadian youth. These findings highlight the importance of obtaining thorough drug and alcohol histories and measurement, when appropriate, for adolescents and young adults presenting to EDs with injuries.
Collapse
|
12
|
Carter J, Sharon E, Stern TA. The management of alcohol use disorders: the impact of pharmacologic, affective, behavioral, and cognitive approaches. Prim Care Companion CNS Disord 2015; 16:14f01683. [PMID: 25664205 DOI: 10.4088/pcc.14f01683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/25/2014] [Indexed: 12/11/2022] Open
|
13
|
Mathias JL, Harman-Smith Y, Bowden SC, Rosenfeld JV, Bigler ED. Contribution of psychological trauma to outcomes after traumatic brain injury: assaults versus sporting injuries. J Neurotrauma 2014; 31:658-69. [PMID: 24228916 DOI: 10.1089/neu.2013.3160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Clinical research into outcomes after traumatic brain injury (TBI) frequently combines injuries that have been sustained through different causes (e.g., car accidents, assaults, and falls), the effect of which is not well understood. This study examined the contribution of injury-related psychological trauma—which is more commonly associated with specific types of injuries—to outcomes after nonpenetrating TBI in order to determine whether it may be having a differential effect in samples containing mixed injuries. Data from three groups that were prospectively recruited for two larger studies were compared: one that sustained a TBI as a result of physical assaults (i.e., psychologically traumatizing) and another as a result of sporting injuries (i.e., nonpsychologically traumatizing), as well as an orthopedic control group (OC). Psychosocial and emotional (postconcussion symptoms, injury-related stress, and depression), cognitive (memory, abstract reasoning, problem solving, and verbal fluency), and functional (general outcome; resumption of home, social, and work roles) outcomes were all assessed. The TBI(assault) group reported significantly poorer psychosocial and emotional outcomes and higher rates of litigation (criminal rather than civil) than both the TBI(sport) and OC groups approximately 6 months postinjury, but there were no differences in the cognitive or functional outcomes of the three groups. The findings suggest that the cause of a TBI may assist in explaining some of the differences in outcomes of people who have seemingly comparable injuries. Involvement in litigation and the cause of an injury may also be confounded, which may lead to the erroneous conclusion that litigants have poorer outcomes.
Collapse
|
14
|
Gavine A, MacGillivray S, Williams DJ. Universal community-based social development interventions for preventing community violence by young people 12 to 18 years of age. Cochrane Database Syst Rev 2014. [DOI: 10.1002/14651858.cd011258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
15
|
Cherpitel CJ, Martin G, Macdonald S, Brubacher JR, Stenstrom R. Alcohol and drug use as predictors of intentional injuries in two emergency departments in British Columbia. Am J Addict 2013; 22:87-92. [PMID: 23414491 DOI: 10.1111/j.1521-0391.2013.00316.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 08/10/2011] [Accepted: 08/15/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND While a substantial literature exists demonstrating a strong association of alcohol and intentional injury, less is known about the association of intentional injury with recreational drug use, either alone, or in combination with alcohol. OBJECTIVES The risk of intentional injury due to alcohol and other drug use prior to injury is analyzed in a sample of emergency department (ED) patients. METHODS Logistic regression was used to examine the predictive value of alcohol and drug use on intentional versus non-intentional injury in a probability sample of ED patients in Vancouver, BC (n = 436). RESULTS Those reporting only alcohol use were close to four times more likely (OR = 3.73) to report an intentional injury, and those reporting alcohol combined with other drug(s) almost 18 times more likely (OR = 17.75) than those reporting no substance use. Those reporting both alcohol and drug use reported drinking significantly more alcohol (15.7 drinks) than those reporting alcohol use alone (5 drinks). CONCLUSIONS These data suggest that alcohol in combination with other drugs may be more strongly associated with intentional injury than alcohol alone. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE The strong association of alcohol combined with other drug use on injury may be due to the increased amount of alcohol consumed by those using both substances, and is an area requiring more research with larger samples of intentional injury patients.
Collapse
|
16
|
Korcha RA, Cherpitel CJ, Witbrodt J, Borges G, Hejazi-Bazargan S, Bond JC, Ye Y, Gmel G. Violence-related injury and gender: the role of alcohol and alcohol combined with illicit drugs. Drug Alcohol Rev 2013; 33:43-50. [PMID: 24261437 DOI: 10.1111/dar.12087] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 10/08/2004] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIMS The positive relationship between alcohol use, gender and violence-related injury is well established. However, less is known about injuries when alcohol is used in combination with other drugs. DESIGN AND METHODS Self-report information was collected on alcohol and illicit drug use in the 6 h before a violence-related injury in probability samples of patients presenting to emergency departments (n=9686). RESULTS Patients with violence-related injuries reported the highest rates of alcohol use (49% of men; 23% of women) and alcohol use combined with illicit drugs (8% of men; 4% of women) whereas non-violent injury patients reported lower rates of alcohol use (17% of men; 8% of women) and alcohol use combined with drugs (2% for men; 1% for women). Marijuana/hashish was the most commonly reported drug. The odds of a violent injury were increased when alcohol was used [men: odds ratio (OR)=5.4, 95% confidence interval (CI) 4.6-6.3; women: OR=4.0, 95% CI 3.0-5.5] or when alcohol was combined with illicit drug use before the injury (men: OR=6.6, 95% CI 4.7-9.3; women: OR=5.7, 95% CI=2.7-12.2) compared with non-users. No significant change in the odds of a violent injury was observed for men or women when alcohol users were compared with alcohol and drug users. DISCUSSION AND CONCLUSIONS The positive association between alcohol and violent injury does not appear to be altered by the added use of drugs. Additional work is needed to understand the interpersonal, contextual and cultural factors related to substance use to identify best prevention practices and develop appropriate policies.
Collapse
Affiliation(s)
- Rachael A Korcha
- Alcohol Research Group, Public Health Institute, Emeryville, USA
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Zerhouni O, Bègue L, Brousse G, Carpentier F, Dematteis M, Pennel L, Swendsen J, Cherpitel C. Alcohol and violence in the emergency room: a review and perspectives from psychological and social sciences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4584-606. [PMID: 24084671 PMCID: PMC3823306 DOI: 10.3390/ijerph10104584] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 11/17/2022]
Abstract
Our objective is to present a focused review of the scientific literature on the effect of alcohol consumption on violence related-injuries assessed in the emergency room (ER) and to show how psychological and behavioral sciences could lead to a better understanding of the factors contributing to alcohol-related injuries in the ER. We retrieved published literature through a detailed search in Academic Search Premier, MEDLINE with Full Text PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO, PUBMed and SocINDEX with Full Text for articles related to emergency rooms, medical problems and sociocognitive models addressing alcohol intoxication articles. The first search was conducted in June 2011 and updated until August 2013. Literature shows that compared to uninjured patients; injured ones have a higher probability of: (i) having an elevated blood-alcohol concentration upon arrival at the ER; (ii) reporting having drunk alcohol during the six hours preceding the event; and (iii) suffering from drinking-related consequences that adversely affect their social life. The main neurocognitive and sociocognitive models on alcohol and aggression are also discussed in order to understand the aetiology of violence-related injuries in emergency rooms. Suggestions are made for future research and prevention.
Collapse
Affiliation(s)
- Oulmann Zerhouni
- Laboratoire Interuniversitaire de Psychologie, Personnalité, Cognition, Changement Social, UFR SHS, 1251 avenue Centrale, BP 47, 38040 Grenoble Cedex 9, France; E-Mail:
| | - Laurent Bègue
- Laboratoire Interuniversitaire de Psychologie, Personnalité, Cognition, Changement Social, UFR SHS, 1251 avenue Centrale, BP 47, 38040 Grenoble Cedex 9, France; E-Mail:
| | - Georges Brousse
- CHU Clermont Ferrand, Urgences Adultes, 28 Place Henri Dunant BP 69, 63003 Clermont-Ferrand Cedex 01, France; E-Mail:
- UFR Médecine, Université Clermont 1, Place Henri Dunant, Clermont-Ferrand F-63001, France
- UFR Médecine, Université Clermont 1, EA 7280, Clermont-Ferrand F63001, France
| | - Françoise Carpentier
- Centre hospitalier universitaire de Grenoble, CHU de Grenoble BP 217 38043 Grenoble cedex 09, France; E-Mail:
| | - Maurice Dematteis
- INSERM U1042, Grenoble F-38042, France; E-Mail:
- Faculté de Médecine, Université Joseph Fourier, Grenoble F-38042, France; E-Mail:
- CHU, Hôpital Michallon, Addictologie, Grenoble F-38043, France
| | - Lucie Pennel
- Faculté de Médecine, Université Joseph Fourier, Grenoble F-38042, France; E-Mail:
- CHU, Hôpital Michallon, Addictologie, Grenoble F-38043, France
- INSERM U836, Equipe 10, Grenoble F-38042, France
| | - Joel Swendsen
- CNRS UMR 5287, INCIA, Institut de Neurosciences cognitives et intégratives d’Aquitaine, Université Victor Segalen, Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux cedex, France; E-Mail:
| | - Cheryl Cherpitel
- Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA; E-Mail:
| |
Collapse
|
18
|
Kork F, Kleinwächter R, Weiss-Gerlach E, Broecker S, Pragst F, Wernecke KD, Spies C. Oral fluid testing for illicit substance use in preanaesthetic care. J Int Med Res 2012; 40:194-203. [PMID: 22429359 DOI: 10.1177/147323001204000120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Due to specific risks associated with illicit drug use, the preanaesthetic detection of illicit substances is essential. This prospective observational study evaluated oral fluid testing and self reporting of illicit drug use compared with confirmatory blood testing. METHODS Consecutively enrolled preanaesthetic and emergency room patients (n=939) completed a paper-based lifestyle questionnaire. An oral fluid sample was obtained and analysed for illicit substance use by a point-of-care testing device (Dräger Drugtest® 5000). Patients who tested positive by self reporting or oral fluid testing underwent confirmatory blood testing (n=117). RESULTS Self reporting revealed more overall illicit substance use and more users of cannabinoids, amphetamines, opioids, cocaine and benzodiazepines than oral fluid testing. Self reporting was more sensitive than blood testing for the detection of overall illicit substance use, and for use of cannabinoids and benzodiazepines. CONCLUSIONS Self reporting revealed higher rates of illicit substance use than oral fluid testing in preanaesthetic patients, and may lead to more interventions and more appropriately tailored treatment and anaesthesia compared with oral fluid testing.
Collapse
Affiliation(s)
- F Kork
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow Clinic and Campus Charité Mitte, Charité-University Medicine Berlin, Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
19
|
Barrio G, Jiménez-Mejías E, Pulido J, Lardelli-Claret P, Bravo MJ, de la Fuente L. Association between cannabis use and non-traffic injuries. ACCIDENT; ANALYSIS AND PREVENTION 2012; 47:172-176. [PMID: 22405246 DOI: 10.1016/j.aap.2012.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 11/28/2011] [Accepted: 01/04/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND This study aimed to assess the association between cannabis use and unintended non-fatal injuries other than those caused by road crashes. METHODS Cross-sectional data were collected from a nationwide sample of 27,934 subjects surveyed in 2005 in Spain: 14,699 persons aged 15-34 years and 13,235 aged 35-64 years. Logistic regression was used to obtain odds ratios (OR) between patterns of cannabis use and frequency of non-traffic injuries, adjusted for sociodemographic factors and for the use of alcohol, tobacco and other drugs. RESULTS Cannabis use in the last 12 months was associated with a higher frequency of injuries (OR=1.4; 95% CI: 1.2-1.7). The OR in older adults (35-64 year age group) was 1.8 and 1.3 in younger people (15-34 year age group). The strongest associations found were between weekly use of cannabis and injuries from knocks and bumps (OR=5.1; 95% CI 2.9-8.9) and those occurring outside work (OR=3.0; 95% CI 1.8-4.9) in the older adult population. CONCLUSION Although our analysis did not control for behavioural factors, cannabis use is independently associated with an increased frequency of non-traffic injuries, especially in the older adult population. These associations emphasise the need to carry out longitudinal studies addressing the causal links between cannabis use and unintended injuries.
Collapse
Affiliation(s)
- Gregorio Barrio
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Monforte de Lemos, 5, 28029 Madrid, Spain
| | | | | | | | | | | |
Collapse
|
20
|
Hutchison C, Morrison R. Oral and maxillofacial trauma and the use of telemedicine in the grampian region of Scotland: a retrospective study. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2012; 3:e2. [PMID: 24422014 PMCID: PMC3886085 DOI: 10.5037/jomr.2012.3302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 09/26/2012] [Indexed: 11/16/2022]
Abstract
Objectives To evaluate the amount and nature of adult facial trauma in Aberdeen, Scotland's third largest city, that requires referral to Aberdeen Royal Infirmary oral and maxillofacial surgery department by the Emergency Department and Grampian's telemedicine service over a six month period. Material and Methods A retrospective audit using oral and maxillofacial surgery trauma clinic and theatre records to identify Emergency Department (ED) notes for those patients presenting with facial trauma. ED notes were examined to extract demographic data on each patient as well as information on the nature and outcomes of the facial trauma. This data was compared with previously published national and international statistics. Results 137 patients were identified with a mean age of 33.7 years with a standard deviation of 16.7. 83.2% of facial trauma victims were male and 62% of facial injuries were caused by alleged assault. Only 1 patient was referred to Aberdeen Royal Infirmary by telemedicine. Conclusions Aberdeen has a high number of injuries caused by interpersonal violence. Telemedicine is an underused resource in the referral and review of facial trauma at Aberdeen Royal Infirmary.
Collapse
Affiliation(s)
| | - Roderick Morrison
- Department of Oral and Maxillofacial Surgery, Aberdeen Royal Infirmary Scotland
| |
Collapse
|
21
|
Dzik WH, Blajchman MA, Fergusson D, Hameed M, Henry B, Kirkpatrick AW, Korogyi T, Logsetty S, Skeate RC, Stanworth S, MacAdams C, Muirhead B. Clinical review: Canadian National Advisory Committee on Blood and Blood Products--Massive transfusion consensus conference 2011: report of the panel. Crit Care 2011; 15:242. [PMID: 22188866 PMCID: PMC3388668 DOI: 10.1186/cc10498] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In June 2011 the Canadian National Advisory Committee on Blood and Blood Products sponsored an international consensus conference on transfusion and trauma. A panel of 10 experts and two external advisors reviewed the current medical literature and information presented at the conference by invited international speakers and attendees. The Consensus Panel addressed six specific questions on the topic of blood transfusion in trauma. The questions focused on: ratio-based blood resuscitation in trauma patients; the impact of survivorship bias in current research conclusions; the value of nonplasma coagulation products; the role of protocols for delivery of urgent transfusion; the merits of traditional laboratory monitoring compared with measures of clot viscoelasticity; and opportunities for future research. Key findings include a lack of evidence to support the use of 1:1:1 blood component ratios as the standard of care, the importance of early use of tranexamic acid, the expected value of an organized response plan, and the recommendation for an integrated approach that includes antifibrinolytics, rapid release of red blood cells, and a foundation ratio of blood components adjusted by results from either traditional coagulation tests or clot viscoelasticity or both. The present report is intended to provide guidance to practitioners, hospitals, and policy-makers.
Collapse
Affiliation(s)
- Walter H Dzik
- Blood Transfusion Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Morris A Blajchman
- Canadian Blood Services, Southern Ontario Region, Departments of Pathology and Medicine, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5
- NHLBI TMH Clinical Trials Network, Bethesda, MD, USA
| | - Dean Fergusson
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Clinical Epidemiology Program, Faculty of Medicine, University of Ottawa, 6th Floor Critical Care Wing, Office W6119, 501 Smyth Road, Box 201, Ottawa, Ontario, Canada K1H 8L6
| | - Morad Hameed
- General Surgery Residency Program, Department of Surgery and Critical Care Medicine, University of British Columbia, Trauma Services, Vancouver General Hospital, 855 W 12 Avenue, Vancouver, British Columbia, Canada V5Z 1M9
| | - Blair Henry
- Sunnybrook Health Sciences Centre, Joint Centre for Bioethics, Department of Family and Community Medicine, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room H2-39, Toronto, Ontario, Canada M4N 3M5
| | - Andrew W Kirkpatrick
- Department of Critical Care Medicine and Surgery, University of Calgary, Regional Trauma Services, Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta, Canada T2N 2T9
| | - Teresa Korogyi
- Emergency Department, Sunnybrook Health Sciences Center, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5
| | - Sarvesh Logsetty
- Manitoba Firefighters' Burn Unit, University of Manitoba, GC401A, 820 Sherbrook Avenue, Winnipeg, Manitoba, Canada R3A1R9
| | - Robert C Skeate
- Canadian Blood Services Central Ontario Region, Department of Laboratory Medicine and Pathobiology, University of Toronto, 67 College Street, Toronto, Ontario, Canada M5G 2M1
| | - Simon Stanworth
- Department of Haematology, John Radcliffe Hospital, University of Oxford, UK
| | - Charles MacAdams
- Perioperative Blood Conservation Program Calgary Zone, Department of Anesthesia, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta, Canada T2N 2T9
| | - Brian Muirhead
- Transfusion Practices Committee, Blood Conservation Servcies, Winnipeg Regional Health Authority, Department of Anesthesiology, University of Manitoba, 347 Cambridge Street, Winnipeg, Manitoba, Canada R3M 3E8
| |
Collapse
|
22
|
Stenbacka M, Leifman A, Dalal K, Jansson B. Early predictors of injury mortality among Swedish conscripts: a 35-year cohort study. ACCIDENT; ANALYSIS AND PREVENTION 2011; 43:228-234. [PMID: 21094318 DOI: 10.1016/j.aap.2010.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 08/13/2010] [Indexed: 05/30/2023]
Abstract
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.
Collapse
Affiliation(s)
- Marlene Stenbacka
- Karolinska Institutet. Department of Public Health Sciences, Division of Social Medicine and Karolinska University Hospital Solna, Addiction Center, Building Z8. 171 76 Stockholm, Sweden.
| | | | | | | |
Collapse
|
23
|
Coghlan M, Macdonald S. The role of substance use and psychosocial characteristics in explaining unintentional injuries. ACCIDENT; ANALYSIS AND PREVENTION 2010; 42:476-479. [PMID: 20159069 DOI: 10.1016/j.aap.2009.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 07/01/2009] [Accepted: 09/09/2009] [Indexed: 05/28/2023]
Abstract
The objective of this study was to examine the relationship between the use of various substances and selected psychosocial characteristics with unintentional injury. Cross-sectional data was collected from groups of subjects in treatment for a primary problem with cocaine (n=300), cannabis (n=128), alcohol (n=110), other drugs (n=35), tobacco (n=249), or gambling (n=199). Subjects completed a self-administered questionnaire that included questions on various psychosocial scales (i.e., risk-taking/impulsivity, chronic stress, coping, and social supports), frequency of drug and alcohol use, and unintentional injuries in the year prior to treatment. For the univariate analyses, both frequency of cocaine and cannabis use, risk-taking/impulsivity, stress, and coping were significantly related to injuries. For the multivariate analyses, only risk-taking/impulsivity, stress, age, and sex were significantly related to injuries. The results provide important information regarding factors associated with reported injuries among individuals in addiction treatment.
Collapse
Affiliation(s)
- Michelle Coghlan
- Centre for Addictions Research of British Columbia, University of Victoria, PO Box 1700, Stn CSC, Victoria, Canada V8W 2Y2.
| | | |
Collapse
|
24
|
Charbonney E, McFarlan A, Haas B, Gentilello L, Ahmed N. Alcohol, drugs and trauma: consequences, screening and intervention in 2009. TRAUMA-ENGLAND 2009. [DOI: 10.1177/1460408609349888] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alcohol use is a preventable cause of injury as it doubles the risk of re-injury and increases mortality. For this reason, the American College of Surgeons, Committee on Trauma had mandated a screening and subsequent intervention strategy for all Level I centres, and there is good evidence to support the efficacy of such programmes. Clinicians can play a key role in reducing injury related to alcohol use through their participation in these programmes. Although validated screening tools and evidence to support brief interventions for alcohol use exist, the benefit of these experiences for other recreational drugs awaits further research in this area. In the meantime, the implementation of alcohol screening and brief intervention programmes across all trauma programmes and emergency departments should become a global healthcare priority.
Collapse
Affiliation(s)
- Emmanuel Charbonney
- Critical Care Department, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada,
| | - Amanda McFarlan
- Trauma Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Haas
- Trauma Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Larry Gentilello
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Najma Ahmed
- Trauma Program, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada, Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Ferrier-Auerbach AG, Kehle SM, Erbes CR, Arbisi PA, Thuras P, Polusny MA. Predictors of alcohol use prior to deployment in National Guard Soldiers. Addict Behav 2009; 34:625-31. [PMID: 19375239 DOI: 10.1016/j.addbeh.2009.03.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 02/26/2009] [Accepted: 03/25/2009] [Indexed: 11/16/2022]
Abstract
Frequent and heavy alcohol use is associated with negative mental and physical health consequences. Previous research has suggested that alcohol misuse is associated with demographic, personality, and mental health variables. This study examined the relative contribution of these factors in predicting drinking among National Guard soldiers prior to deployment to a combat zone. Members of a National Guard Brigade Combat Team (N=515) completed questionnaires assessing drinking behaviors in the past year (frequency, quantity, binge, and total drinking), as well as demographic, personality, and mental health variables. As a group, demographic and personality variables significantly predicted all drinking outcomes. Negative emotionality and disconstraint were independent predictors of all drinking variables. Younger age predicted higher quantity of drinking, while being unmarried predicted greater total drinking and higher frequency of binge drinking. Once the influence of personality variables were accounted for, mental health was not associated with any drinking variable. The results of this study illustrate the role of factors associated with problematic drinking in a sample of high-risk individuals.
Collapse
|
26
|
|
27
|
Balsa AI, French MT, Maclean JC, Norton EC. From pubs to scrubs: alcohol misuse and health care use. Health Serv Res 2009; 44:1480-503. [PMID: 19500163 DOI: 10.1111/j.1475-6773.2009.00987.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To analyze the relationships between alcohol misuse and two types of acute health care use-hospital admissions and emergency room (ER) episodes. DATA SOURCES/STUDY SETTING The first (2001/2002) and second (2004/2005) waves of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC). STUDY DESIGN Longitudinal study using a group of adults (18-60 years in Wave 1, N=23,079). Gender-stratified regression analysis adjusted for a range of covariates associated with health care use. First-difference methods corrected for potential omitted variable bias. DATA COLLECTION The target population of the NESARC was the civilian noninstitutionalized population aged 18 and older residing in the United States and the District of Columbia. The survey response rate was 81 percent in Wave 1 (N=43,093) and 65 percent in Wave 2 (N=34,653). PRINCIPAL FINDINGS Frequent drinking to intoxication was positively associated with hospital admissions for both men and women and increased the likelihood of using ER services for women. Alcohol dependence and/or abuse was related to higher use of ER services for both genders and increased hospitalizations for men. CONCLUSIONS These findings provide updated and nationally representative estimates of the relationships between alcohol misuse and health care use, and they underscore the potential implications of alcohol misuse on health care expenditures.
Collapse
Affiliation(s)
- Ana I Balsa
- Department of Sociology, Sociology Research Center, University of Miami, Coral Gables, FL, USA
| | | | | | | |
Collapse
|
28
|
MACDONALD SCOTT, WELLS SAMANTHA. Factors related to self-reported violent and accidental injuries. Drug Alcohol Rev 2009. [DOI: 10.1080/09595230120079611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
29
|
Abstract
This paper provides a review of emergency room (ER) studies on alcohol and injury, using representative probability samples of adult injury patients, and focuses on the scope and burden of the problem as measured by estimated blood alcohol concentration (BAC) at the time of the ER visit, self-report drinking prior to injury, violence-related injury and alcohol use disorders. A computerized search of the English-language literature on MEDLINE, PsychINFO and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol and Alcohol Problems Science Database (ETOH) was conducted for articles published between 1995 and 2005, using the following key descriptors: (1) emergency room/emergency department/accident and emergency, (2) alcohol/drinking and (3) injuries (intentional and unintentional). Findings support prior reviews, with injured patients more likely to be positive for BAC and report drinking prior to injury than non-injured, and with the magnitude of the association substantially increased for violence-related injuries compared to non-violence-related injuries. Indicators of alcohol use disorders did not show a strong association with injury. Findings were not homogeneous across studies, however, and contextual variables, including study-level detrimental drinking pattern, explained some of the variation. This review represents a broader range of ER studies than that reported previously, across both developed and developing countries, and has added to our knowledge base in relation to the influence of contextual variables on the alcohol-injury relationship. Future research on alcohol and injury should focus on obtaining representative samples of ER patients, with special attention to both acute and chronic alcohol use, and to organisational and socio-cultural variables that may influence findings across studies. In-depth patient interviews may also be useful for a better understanding of drinking in the injury event and associated circumstances.
Collapse
Affiliation(s)
- Cheryl J Cherpitel
- Public Health Institute, Alcohol Research Group, Emeryville, CA 94608, USA.
| |
Collapse
|
30
|
Veldhuizen S, Wade TJ, Cairney J. Alcohol consumption among Canadians taking benzodiazepines and related drugs. Pharmacoepidemiol Drug Saf 2009; 18:203-10. [PMID: 19115421 DOI: 10.1002/pds.1702] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Benzodiazepines and related drugs (BZDs) are widely used for the treatment of anxiety, insomnia and other conditions. The combination of BZDs with alcohol increases risk for oversedation, abuse, dependence and accidents. This study examines drinking behaviour among Canadians taking BZDs. METHODS We use data from cycle 1.2 of the Canadian Community Health Survey, a large (n = 36,984) population survey conducted in 2002 by Statistics Canada. We use bivariate methods and logistic regression to test the independent association between BZD use and 2 levels of recent drinking in the general population, and then examine associations between drinking and sociodemographic factors within the group of BZD users. RESULTS Any drinking and heavy drinking are less common among users of BZDs than among other respondents, but these differences are small (any drinking, OR = 0.77, p = 0.02; heavy drinking, OR = 0.81, p = 0.13) when differences in respondent characteristics are controlled statistically. Among BZD users, any drinking is associated with male sex, younger age and not meeting criteria for a past-year anxiety disorder. Heavy drinking is associated only with younger age. CONCLUSIONS Heavy alcohol use is uncommon among users of BZDs, and the combination of alcohol and BZD use is rare in the general population. Differences between BZD users and others are not large when other factors are taken into account, however, which may call into question the effectiveness of physician and pharmacist warnings against this combination. People treated for an anxiety disorder with BZDs may be less likely to use alcohol than those taking them for other indications.
Collapse
Affiliation(s)
- Scott Veldhuizen
- Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | | | | |
Collapse
|
31
|
Predictors of violence following Emergency Department visit for cocaine-related chest pain. Drug Alcohol Depend 2009; 99:79-88. [PMID: 18722724 PMCID: PMC2656683 DOI: 10.1016/j.drugalcdep.2008.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 06/12/2008] [Accepted: 07/01/2008] [Indexed: 11/22/2022]
Abstract
This study examined 1-year violence outcomes among non-injured patients treated in the Emergency Department (ED) for cocaine-related chest pain. An urban Level I ED required patients with chest pain (age 60 and younger) provide a urine sample for cocaine testing. Cocaine-positive consenting patients (n=219) were interviewed in the ED; 80% completed follow-up interviews over 12-months (n=174; 59% male, 79% African-American, mean age=38.8, standard deviation 9.06; range=19-60). Baseline rates of past year violent victimization and perpetration history were: 38% and 30%, respectively. During the 12-month follow-up, rates of victimization and perpetration outcomes were 35% and 30%, respectively. Predictors of violence outcomes (either victimization or perpetration) in the year post-ED visit based on characteristics were measured at baseline or during the follow-up period (i.e., gender, age, psychological distress, binge drinking days, cocaine use days, marijuana use days, substance abuse/dependence diagnosis, victimization/perpetration history). Victimization during the follow-up was related to younger age, more frequent binge drinking and marijuana use at baseline, and victimization history, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Specifically, participants who reported victimization at baseline were approximately 3 times more likely to report victimization at 12-month follow-up. Perpetration during the follow-up was related to younger age and more frequent binge drinking at baseline, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Overall, no significant gender differences were observed in violence; however, women were more likely than men to report injury during the most severe partner violence incident. Violence is a common problem among patients presenting to an inner-city ED for cocaine-related chest pain, with younger age and frequency of binge drinking being a consistent marker of continued violence involvement. Intervention approaches to link these not-in-treatment cocaine users to services and reduce cocaine use must take into account concomitant alcohol misuse and violence.
Collapse
|
32
|
Abstract
This study investigates the association between alcohol use and emergency-department (ED) utilization in the United States using nationally representative data from the 2001 National Health Interview Survey (N = 33,326). Estimates from our probit models indicate that among men, current drinkers are less likely to have visited the ED in the past year than former drinkers. Among women, lifetime abstainers are less likely than current drinkers to have had an ED episode. Finally, frequency of binge drinking significantly increases the likelihood of ED visits for men. The results suggest that focusing solely on problem drinking provides a limited perspective.
Collapse
Affiliation(s)
- Michael T French
- Department of Sociology, University of Miami, Coral Gables, Florida 33124-2030, USA.
| | | | | |
Collapse
|
33
|
Walton MA, Goldstein AL, Chermack ST, McCammon RJ, Cunningham RM, Barry KL, Blow FC. Brief alcohol intervention in the emergency department: moderators of effectiveness. J Stud Alcohol Drugs 2008; 69:550-60. [PMID: 18612571 DOI: 10.15288/jsad.2008.69.550] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Prior research supports the effectiveness of brief interventions for reducing alcohol misuse among patients in the emergency department (ED). However, limited information is available regarding the mechanisms of change, which could assist clinicians in streamlining or amplifying these interventions. This article examines moderators of outcomes among ED patients, ages 19 and older, who participated in a randomized controlled trial of a brief intervention for alcohol misuse. METHOD Injured patients (N= 4,476) completed a computerized survey; 575 at-risk drinkers were randomly assigned to one of four brief intervention conditions, and 85% were interviewed again at 3-month and 12-month follow-ups. RESULTS Regression models using the generalized estimating equations approach examined interaction effects between intervention condition (advice/no advice) and hypothesized moderator variables (stage of change, self-efficacy, acute alcohol use, attribution of injury to alcohol) on alcohol outcomes over time. Overall, participants who reported higher levels of self-efficacy had lower weekly consumption and consequences, whereas those with higher readiness to change had greater weekly consumption and consequences. Furthermore, individuals who attributed their injury to alcohol and received advice had significantly lower levels of average weekly alcohol consumption and less frequent heavy drinking from baseline to 12-month follow-up compared with those who attributed their injury to alcohol but did not receive advice. CONCLUSIONS This study provides novel data regarding attribution for alcohol-related injury as an important moderator of change and suggests that highlighting the alcohol/injury connection in brief, ED-based alcohol interventions can augment their effectiveness.
Collapse
Affiliation(s)
- Maureen A Walton
- Department of Psychiatry, Rachel Upjohn Building, University of Michigan, 4250 Plymouth Road, Ann Arbor, Michigan 48109, USA.
| | | | | | | | | | | | | |
Collapse
|
34
|
Bacaner N, Kinney TA, Biros M, Bochert S, Casuto N. The Relationship among Depressive and Alcoholic Symptoms and Aggressive Behavior in Adult Male Emergency Department Patients. Acad Emerg Med 2008. [DOI: 10.1197/aemj.9.2.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Nina Bacaner
- Community University Health Care Center, Hennepin County Medical Center, Minneapolis, MN
| | - Terry A. Kinney
- Department of Speech‐Communication, Hennepin County Medical Center, Minneapolis, MN
| | - Michelle Biros
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Shelli Bochert
- School of Public Health, Hennepin County Medical Center, Minneapolis, MN
| | - Nadov Casuto
- Department of Educational Psychology, University of Minnesota, Hennepin County Medical Center, Minneapolis, MN
| |
Collapse
|
35
|
Modulation of human risky decision making by flunitrazepam. Psychopharmacology (Berl) 2008; 196:177-88. [PMID: 17917718 DOI: 10.1007/s00213-007-0951-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
Abstract
RATIONALE GABA-modulating drugs produce disinhibitory effects that increase the probability of risk-taking behavior. Previous reports suggest that the misuse of the benzodiazepine flunitrazepam is associated with several forms of harmful risky behavior, including theft, violence, and intoxication-related auto accidents. OBJECTIVES The present study examined the dose-response relationships between acute flunitrazepam administration and human decision making under conditions of risk. The analyses also examined flunitrazepam-mediated changes in decision-making processes using a computational modeling approach, the expectancy valence model (EVM). MATERIALS AND METHODS Using a laboratory measure of risky decision making designed to address acute drug effects, 12 adults were administered placebo, 0.5, 1.0, and 2.0 mg/70 kg flunitrazepam in a within-subject, repeated measures counterbalanced design. Flunitrazepam was compounded and doses were administered in an 8-oz liquid solution. Primary data analyses examined subjective effects, response rates, distribution of choices between the risky and nonrisky option, and personality correlates related to peak drug effects. Individual-subject data were submitted to a computational modeling analysis (EVM) that provided parameter estimates corresponding to components of valence; updating expectancies about alternatives (learning/memory); and consistency between choices and expected outcomes (sensitivity to learned outcomes). RESULTS Flunitrazepam produced dose-related changes in subjective effects and response rates, and increased selection of the risky response option. High doses significantly changed decision-making processes related to the learning/memory and consistency parameters. CONCLUSIONS At sufficiently high doses, flunitrazepam can engender increases in risky decision making. Globally, these changes appear similar to previous effects we have observed after acute administration of alcohol and alprazolam. As suggested by the EVM outcomes, the mechanisms underlying the changes in risky decision making are more similar to alprazolam than alcohol.
Collapse
|
36
|
Correlates of Violence History Among Injured Patients in an Urban Emergency Department. J Addict Dis 2007; 26:61-75. [DOI: 10.1300/j069v26n03_07] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
37
|
Segatto ML, Pinsky I, Laranjeira R, Rezende FF, dos Reis Vilela T. [Screening and brief intervention for alcoholic patients treated at emergency rooms: prospects and challenges]. CAD SAUDE PUBLICA 2007; 23:1753-62. [PMID: 17653393 DOI: 10.1590/s0102-311x2007000800002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 02/15/2007] [Indexed: 11/22/2022] Open
Abstract
The purpose of this article was to present the general principles, concepts, and main elements of brief intervention, with a literature review on its use for alcoholic patients treated at emergency rooms. It also presents the applicability of screening as a first step to the brief intervention process and the use of validated standard instruments that allow useful information for consistent feedback. Finally, it highlights the challenges associated with screening in emergency rooms due to insufficient time, inadequate professional training, fear of annoying the patient, and common beliefs that alcoholics do not respond to such interventions. Meanwhile, it emphasizes the relevancy of brief emergency intervention, which is both feasible and efficient, and the need for research to define the relevant adjustments by professionals and the health care system.
Collapse
Affiliation(s)
- Maria Luiza Segatto
- Programa de Atenção à Pessoa com Dependência Química, Universidade Federal de Uberlândia, Uberlândia, Brasil.
| | | | | | | | | |
Collapse
|
38
|
Chen WJ, Fang CC, Shyu RS, Lin KC. Underreporting of illicit drug use by patients at emergency departments as revealed by two-tiered urinalysis. Addict Behav 2006; 31:2304-8. [PMID: 16564643 DOI: 10.1016/j.addbeh.2006.02.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 01/23/2006] [Accepted: 02/17/2006] [Indexed: 11/18/2022]
Abstract
This study investigates the validity of questionnaire-based self-reports of illicit drug use by comparing with a two-tiered urinalysis among patients at emergency departments. Questions on the use of alcohol and drugs were administered to patients recruited on a continual basis for 2weeks at the emergency department of two hospitals in northern Taiwan. Positive tests of initial urinalysis using fluorescence polarization immunoassay were further confirmed by gas chromatography/mass spectrometry. In a total of 1502 patients interviewed, 632 (42%) also provided a urine sample. Among those with urine samples, the positive rate of urinalysis was 1.4% for amphetamine-type drugs and 1.6% for opiates. Among those with positive urinalysis, a false-negative rate ranged from 66.6% for amphetamines to 70.0% for opiates. Meanwhile, all the self-reported current uses of either amphetamines or opiates were confirmed by urinalysis. The results indicate that the false-negative rates of questionnaire-based, self-reported current use of illicit drug are around two thirds and the false-positive rates are negligible, which might be useful for the calibration of estimates from epidemiological surveys.
Collapse
Affiliation(s)
- Wei J Chen
- Institute of Epidemiology, College of Public Health, National Taiwan University, 1 Jen-Ai Road, Sec. 1, Taipei 100, Taiwan.
| | | | | | | |
Collapse
|
39
|
Vitale SG, van de Mheen H, van de Wiel A, Garretsen HFL. Substance use among emergency room patients: Is self-report preferable to biochemical markers? Addict Behav 2006; 31:1661-9. [PMID: 16446045 DOI: 10.1016/j.addbeh.2005.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 11/18/2005] [Accepted: 12/19/2005] [Indexed: 11/26/2022]
Abstract
AIM OF STUDY To explore the validity of self-reported substance use among emergency room populations and the processes of sample selection bias, to establish their influence on the prevalence rates found. METHODS Self-reported alcohol and illicit drug use of patients in the emergency room is compared with results from an alcohol breath analyser and urine toxicology. RESULTS Variations in reported substance use occur when comparing self-report measures with alcohol breath analyser results and urine toxicology. Self-reported alcohol use was found among 7.5% of the patients compared with 4.7% based on alcohol breath analysers. Illicit drug use was reported by 9.0% of the patients whereas urine toxicology resulted in 30% patients positive for illicit drug use. Patients that voluntarily participate in the study differ from those that do not participate. Patients who refuse an alcohol breath analyser report slightly more alcohol use prior to the injury (difference not significant), and patients who provide a urine sample report more illicit drug use prior to the injury compared to those that refuse. DISCUSSION Differences in prevalence rates can be explained partly by the measurements used and partly by sample selection bias. Self-reported alcohol use and self-reported illicit drug use are preferable to the "gold standard" when used among emergency room patients, because both measures provide more accurate information on the actual use. Sample selection bias also influences the prevalence rates.
Collapse
Affiliation(s)
- S G Vitale
- Addiction Research Institute (IVO), Heemraadssingel 194, 3021 DM Rotterdam, The Netherlands
| | | | | | | |
Collapse
|
40
|
Violle N, Messaoudi M, Lefranc-Millot C, Desor D, Nejdi A, Demagny B, Schroeder H. Ethological comparison of the effects of a bovine αs1-casein tryptic hydrolysate and diazepam on the behaviour of rats in two models of anxiety. Pharmacol Biochem Behav 2006; 84:517-23. [PMID: 16899284 DOI: 10.1016/j.pbb.2006.06.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 06/26/2006] [Accepted: 06/28/2006] [Indexed: 11/26/2022]
Abstract
A bovine alpha s1-casein tryptic hydrolysate was previously demonstrated to display an anxiolytic-like activity in the conditioned defensive burying and in the elevated plus-maze models when i.p. injected. The present study assessed the anxiolytic-like effects of this tryptic hydrolysate after an oral administration in rats faced to the same behavioural situations using diazepam as a reference. In a first experiment, the behavioural effects of the hydrolysate in the conditioned defensive burying test were investigated at doses ranging 5-50 mg/kg. The results showed that the minimal dose required to elicit an anxiolytic-like activity is 15 mg/kg. In a second experiment, the alpha s1-casein tryptic hydrolysate (15 mg/kg, p.o.) was demonstrated to display an anxiolytic-like activity similar to diazepam (3 mg/kg, p.o.) in the conditioned defensive burying test and the elevated plus-maze. However, the ethological analysis of behaviour indicated that this hydrolysate has a different activity compared to diazepam. While diazepam induced a disinhibition state in rats, possibly related to the risk-taking behaviour observed after a benzodiazepine ingestion in humans, the tryptic hydrolysate did not display such a side effect. These results suggest that the mechanism of action of the bovine alpha s1-casein tryptic hydrolysate may differ from that of diazepam.
Collapse
Affiliation(s)
- Nicolas Violle
- Neurosciences Comportementales, URAFPA, INRA UC12340, INPL-UHP, 54500 Vandoeuvre-lès-Nancy, France
| | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
This study examines hypotheses and builds models to help clarify the causal connections between drugs and violence outcomes among Mexican-American male gang members. The study uses cross-sectional data of 160 male gang members sampled from 26 gangs in a Southwestern city. A life-history /intensive interview using closed and open-ended questions and a violence risk psychometric test (PFAV) also employed 10 scenario questions to elicit self-produced accounts of the participant's last fight. Gang member participant's ages ranged from 14 to 25 years with a mean age of 18.5 years. The study concludes that drug use interacts with an individual gang member's risk for violence to affect violent behavior outcomes. Furthermore, an important situational variable explaining violent outcomes among respondents scoring high on the violence risk measure was whether the rival was using drugs that resulted in high intoxication levels. The study concludes that drugs have a modulating and mediating influence on violence that is conditioned by situational and individual level variables among members of these adolescent street gangs.
Collapse
Affiliation(s)
- Avelardo Valdez
- Office for Drug and Social Policy Research, Graduate School of Social Work, University of Houston, 237 Social Work Building, Houston, TX 77204-4013, USA
| | | | | |
Collapse
|
42
|
Cherpitel CJ, Ye Y, Moskalewicz J, Swiatkiewicz G. Risk of injury: a case-crossover analysis of injured emergency service patients in poland. Alcohol Clin Exp Res 2006; 29:2181-7. [PMID: 16385188 DOI: 10.1097/01.alc.0000191771.44999.a1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over the last 15 years large changes in both alcohol consumption and the health care system have occurred in Poland. Substantial fluctuations in alcohol-related mortality followed and burden on health services increased, but data on risk of injury from alcohol consumption are relatively scarce METHODS Estimates for risk of injury from drinking within six hours prior to the event are reported in samples of emergency services patients from Warsaw (n=508) and Sosnowiec (n=432), using case-crossover analysis based on usual frequency of drinking RESULTS A four-fold risk of injury was found for those reporting drinking prior to injury compared to those not drinking, and this was significantly greater for those positive for alcohol use disorders compared to those negative. Relative risk of injury was marginally greater in Sosnowiec (5.2) compared to Warsaw (3.4) (p=0.06), and was significantly greater for those under 30. A 17-fold increase in risk for violence-related injury was found, and was significantly greater for females than males. Risk was substantially greater in Sosnowiec compared to Warsaw across all subgroups, but differences were not significant, possibly due to the small numbers of those sustaining injuries from violence in Warsaw. DISCUSSION Injury risk related to drinking was expected to be significantly greater in Sosnowiec, due to more traditional drinking styles of infrequent intake of large quantities of spirits, than in Warsaw, but this was only partially borne out by these data. Risk estimates for all injuries were similar to those found in other case-crossover studies in emergency departments. Given the high relative risk estimates for injury related to drinking prior to the event, among both problem and non-problem drinkers, hospital-based emergency services in Poland may be an important site for identification of those who could benefit from a brief intervention or referral for a reduction in alcohol-related injuries.
Collapse
Affiliation(s)
- Cheryl J Cherpitel
- Public Health Institute, Alcohol Research Group, Berkeley, CA 94709, USA.
| | | | | | | |
Collapse
|
43
|
Vitale S, van de Mheen D. Illicit drug use and injuries: A review of emergency room studies. Drug Alcohol Depend 2006; 82:1-9. [PMID: 16183213 DOI: 10.1016/j.drugalcdep.2005.08.017] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2004] [Revised: 08/23/2005] [Accepted: 08/28/2005] [Indexed: 10/25/2022]
Abstract
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.
Collapse
Affiliation(s)
- Salvatore Vitale
- Addiction Research Institute (IVO), Heemraadssingel 194, 3021 DM Rotterdam, The Netherlands.
| | | |
Collapse
|
44
|
Wadsworth EJK, Moss SC, Simpson SA, Smith AP. A community based investigation of the association between cannabis use, injuries and accidents. J Psychopharmacol 2006; 20:5-13. [PMID: 16204330 DOI: 10.1177/0269881105056642] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are well documented acute and chronic effects of cannabis use. However, less is known about any effects on safety within the context of work and everyday life. The aim of the study was to examine any association between cannabis use and injuries and accidents. A postal questionnaire survey was conducted among people selected at random from the electoral registers of Cardiff and Merthyr Tydfil. Cannabis use was associated with both minor injuries and accidents, particularly among those with high levels of other associated risk factors. Cannabis use was associated with a significant detrimental impact on safety. It is possible that this is linked to an amplification of other risk factors associated with accidents and injuries. This has potentially wide reaching implications particularly in the context of other work and lifestyle characteristics.
Collapse
Affiliation(s)
- E J K Wadsworth
- Centre for Occupational and Health Psychology, Cardiff University, 63 Park Place, Cardiff, CF10 3AS, UK.
| | | | | | | |
Collapse
|
45
|
Dauer ARM, Rubio ES, Coris ME, Valls JM. BRIEF INTERVENTION IN ALCOHOL-POSITIVE TRAFFIC CASUALTIES: IS IT WORTH THE EFFORT? Alcohol Alcohol 2005; 41:76-83. [PMID: 16303790 DOI: 10.1093/alcalc/agh241] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS This study aimed at testing the effectiveness of a brief motivational intervention (BI) compared with a minimal intervention (MI) for reducing alcohol consumption in adult, alcohol-positive traffic casualties. METHODS Patients were recruited at the emergency room of a trauma hospital and screened for alcohol by a qualitative saliva test (positive from a blood alcohol concentration of 0.02 g/l). Positive patients (13.3%) who accepted entering the study were randomly allocated into BI and MI. Baseline assessment was the same for all patients. Blind telephone follow-ups were performed at months 3, 6, and 12, and results were analysed by protocol and by intention-to-treat analysis. RESULTS After 1 year of follow-up, 67% of the patients had reduced their consumption, the percentage of heavy drinkers had dropped by 47%, and 62% of baseline AUDIT-C positive patients (hazardous drinkers) had become negative. Binge drinking dropped significantly (P < 0.05). Results at month 12 were in line with the previous ones. CONCLUSIONS The effectiveness of BI compared with MI has not been verified, but a significant reduction in consumption has been observed in the whole sample, without significant differences by type of intervention. The persistence and dimension of changes suggest a real effect of both interventions, although the lack of a pure control group does not allow definitive conclusions. Traffic casualties are in a teachable moments to benefit from easy and cheap interventions.
Collapse
|
46
|
Lane SD, Tcheremissine OV, Lieving LM, Nouvion S, Cherek DR. Acute effects of alprazolam on risky decision making in humans. Psychopharmacology (Berl) 2005; 181:364-73. [PMID: 15830221 DOI: 10.1007/s00213-005-2265-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2004] [Accepted: 03/06/2005] [Indexed: 10/25/2022]
Abstract
RATIONALE GABA-A receptor ligands, including benzodiapines, may induce disinhibitory effects that increase the probability of risky decision making. To date, few laboratory studies have examined the acute, dose-related effects of benzodiazepines on human risk-taking behavior. Recent data indicate that in the United States alprazolam is the benzodiazepine most frequently misused for recreational purposes. OBJECTIVES The present study was designed to demonstrate a dose-response relationship between acute alprazolam administration and human risk taking. Furthermore, this investigation sought to examine: (1) the behavioral mechanisms that may be involved in changes in the probability of risky decision making related to alprazolam administration and (2) risk seeking-related personality variables that may predict drug effects on risk taking. METHODS Using a laboratory measure of risk taking designed to address acute drug effects, 16 adults were administered placebo, 0.5, 1.0, and 2.0 mg alprazolam in a within-subject repeated-measures design. The risk-taking task presented subjects with a choice between two response options operationally defined as risky and nonrisky. Data analyses examined subjective effects, response rates, distribution of choices between the risky and nonrisky option, trial-by-trial response probabilities, and personality correlates related to drug effects at the 2.0-mg dose. RESULTS Alprazolam administration produced dose-related changes in subjective effects, response rates, and, most importantly, dose-dependently increased selection of the risky response option. The 2.0-mg dose increased the probability of making consecutive risky responses following a gain on the risky response option. Increases at 2.0 mg were related to a combination of personality scales that included high venturesomeness and novelty seeking and low harm avoidance. CONCLUSIONS Alprazolam administration produced increases in human risk taking under laboratory conditions. In union with previous studies, the observed shift in trial-by-trial response probabilities suggests that sensitivity to consequences (e.g., oversensitivity to recent rewards) may be an important mechanism in the psychopharmacology of risky decision making. Additionally, risk-seeking personality traits may be predictive of acute drug effects on risk-taking behavior.
Collapse
Affiliation(s)
- Scott D Lane
- Department of Psychiatry and Behavioral Sciences, UTHSC-Houston, TX 77030, USA.
| | | | | | | | | |
Collapse
|
47
|
Borges G, Mondragón L, Medina-Mora ME, Orozco R, Zambrano J, Cherpitel C. A CASE-CONTROL STUDY OF ALCOHOL AND SUBSTANCE USE DISORDERS AS RISK FACTORS FOR NON-FATAL INJURY. Alcohol Alcohol 2005; 40:257-62. [PMID: 15851400 DOI: 10.1093/alcalc/agh160] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS While alcohol use is thought to be a major risk factor for both fatal and non-fatal injuries, the association of substance use disorders (alcohol use disorders, AUD and substance use disorders, SUD) with occurrence of injury has not received the same attention. To report the association of AUD and SUD, according to diagnostic and statistics manual of mental disorders-IV (DSM-IV) and international classification of diseases 10 (ICD-10) criteria, and the risk of non-fatal injuries. METHODS A case-control study: Cases included 653 injured patients, 18-65-years-old, who attended one emergency department (ED). Controls included 1131 subjects from a representative sample of residents of Mexico City, of the same age group. Information on drug and alcohol use was obtained by interview using the world mental health version of the composite international diagnostic interview (WMH-CIDI). RESULTS Among injured patients, the prevalence of substance abuse or dependence within the last 12 months was 12.3% for alcohol and 2.5% for other substances (marijuana, cocaine, tranquilizers, amphetamines, others). Among residents of Mexico City, these prevalences were 1.8 and 0.3%, respectively. Adjusted odds ratios (OR) of injury according to alcohol and substance use were 4.95 (95% confidence interval (CI): 2.87-8.52) for alcohol and 2.58 (0.73-9.17) for other substances. An important level of comorbid alcohol and substance use disorders was also found. CONCLUSIONS Efforts in the ED should be carried out to treat and/or refer patients with alcohol and substance use disorders, and special care should be taken to address comorbid cases.
Collapse
Affiliation(s)
- Guilherme Borges
- Metropolitan Autonomous University-Xochimilco, Mexico City, Mexico.
| | | | | | | | | | | |
Collapse
|
48
|
Pedersen-Bjergaard U, Reubsaet JLE, Nielsen SL, Pedersen-Bjergaard S, Perrild H, Pramming S, Thorsteinsson B. Psychoactive drugs, alcohol, and severe hypoglycemia in insulin-treated diabetes: analysis of 141 cases. Am J Med 2005; 118:307-10. [PMID: 15745730 DOI: 10.1016/j.amjmed.2004.07.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2003] [Accepted: 07/26/2004] [Indexed: 10/25/2022]
|
49
|
Macdonald S, Cherpitel CJ, Borges G, Desouza A, Giesbrecht N, Stockwell T. The criteria for causation of alcohol in violent injuries based on emergency room data from six countries. Addict Behav 2005; 30:103-13. [PMID: 15561452 DOI: 10.1016/j.addbeh.2004.04.016] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This paper is based on data using similar methods collected from patients at 30 emergency rooms (ERs) in six countries. These data were analyzed with the goal of determining whether alcohol is a likely cause of violence through an application of criteria outlined by Bradford Hill. Analyses were conducted by comparing various measures of alcohol involvement in violent versus accidental injuries. The results supported temporal sequence of events and specificity. The odds ratios of violent versus accidental injury for a blood alcohol concentration (BAC) over 80 mg% were significant for each country, ranging from 2.77 for Mexico to 9.45 for Canada, which supports both the strength of associations and the consistency of findings. No third variables were found from the logistic regression analysis that better explain the relationships between alcohol and violence. A significant dose-response relationship between BAC level and violence was also found. All analyses conducted point to a causal role of alcohol in injuries related to violence.
Collapse
Affiliation(s)
- Scott Macdonald
- Centre for Addiction and Mental Health, University of Western Ontario, Suite 200, 100 Collip Circle, London, ON, Canada N6G 4X8.
| | | | | | | | | | | |
Collapse
|
50
|
Leonard KE, Quigley BM, Collins RL. Drinking, personality, and bar environmental characteristics as predictors of involvement in barroom aggression. Addict Behav 2003; 28:1681-700. [PMID: 14656553 DOI: 10.1016/j.addbeh.2003.08.042] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Theoretical approaches to alcohol and violence have emphasized three interrelated domains of influence: the situational context, aggression-facilitating characteristics of individuals, and the impact of alcohol consumption. We examined these three domains as predictors of experiencing violence in the barroom setting. Participants were recruited through one of two phone surveys or through newspaper advertisements and classified into one of three groups: Experienced Bar Violence (EBV), Observed Bar Violence (OBV), and No Bar Violence (NBV). They completed questionnaires assessing individual difference and alcohol use variables, and an interview that assessed characteristics of their usual bar. The results suggested that individual difference and alcohol variables distinguished men in the EBV group from men in the OBV and NBV groups. However, women in the EBV group were distinguished from women in the NBV group by the characteristics of their usual bar and by the alcohol variables, but were distinguished from the OBV group only in terms of individual difference variables. The implications of these findings with respect to the influence of alcohol on barroom violence are discussed.
Collapse
Affiliation(s)
- Kenneth E Leonard
- Research Institute on Addictions, University at Buffalo, State University of New York, 1021 Main Street, Buffalo, NY 14203, USA.
| | | | | |
Collapse
|