Alcohol use and injury risk in Thailand: A case-crossover emergency department study

Alcohol Screening and Brief Intervention in Primary Health Care in Kazakhstan—Results of a Cluster Randomised Pilot Study

Objective: The aim of this pilot trial was to assess the feasibility of ASBI in primary health care units (PHCUs) in Kazakhstan.

Methods: A two-arm cluster randomised trial in five PHCUs based on the RE-AIM framework for implementation studies was carried out. Patients with AUDIT-C scores ≥4 for females and ≥5 for males received a brief face-to-face intervention delivered by a trained physician plus information leaflet (intervention group, IG) or simple feedback including a leaflet (control group, CG).

Results: Among 7327 patients eligible for alcohol screening according to the inclusion criteria 1148 patients were screened (15.7%, IG: 11.5%, CG: 27.3%). 12.3% (N = 141) were tested AUDIT-C positive (IG: 9.9%, CG: 15.1%). Out of 112 physicians invited, 48 took part in the ASBI training, 31 finally participated in the study, 21 in the IG (2 PHCUs), 10 in the CG (3 PHCUs). The majority of physicians did not have difficulties in performing the intervention.

Conclusion: ASBI is feasible and can be implemented into PHC settings in Kazakhstan. However, the implementation depends on the willingness and interest of the PHCU and the physicians.

Expected Years Of Life Lost Due To Alcohol Consumption In Thai Adults: A 16-Year Follow-Up Cohort Of National Health Examination Survey 2004-2019

AIMS

Evidence of premature death attributable to alcohol, a modifiable risk factor, is crucial for guiding public health policy for alcohol control. The aim of this study was to estimate alcohol-related mortality and potential years of life lost (PYLL) in Thailand in 2004-2019.

METHODS

We analysed data of the third National Health Examination Survey in 2004 linked to National Death Registry data of 2004-2019. Causes of death were based on International Classification of Diseases version 10. PYLL was calculated by cause of death, age group and sex. All analyses were weighted to take into account the probabilities for the multi-stage sampling of the 2004 Thai population aged ≥15 years.

RESULTS

There were 10,704 deaths with a follow-up time of 507,771.7 person-years. The crude mortality rate of the initial sample was 868.6 per 100,000 population. The mortality rate attributable to alcohol was 18.6 per 100,000 population (30.7 per 100,000 population in males and 6.8 per 100,000 population in females). The top leading cause of alcohol-attributable deaths was unspecified liver diseases in both males and females (6.1 and 3.1 per 100,000 population, respectively). The total years of life lost (YLL) at baseline were 9.4 million years or 49.5 years per person on average, with significantly more years in males. Mortality rate and expected YLL were highest in ages of 30-44 years, followed by 15-29 years.

CONCLUSION

Males were 4-fold more likely to die from all alcohol-attributable causes compared with females. Young adults had a greater loss of life years than older adults.

The association between the time of alcohol drinking and injury risk in Thailand: a cross-sectional emergency department study

BACKGROUND

Although the relationship between acute alcohol consumption and injuries is well recognized, studies exploring how the time of day the drinking commences affects alcohol-related injuries have been scarce. This contribution examines the associations between the time at which the drinking began and the duration of the drinking, the volume of alcohol consumed, the injury type, and the blood alcohol concentration (BAC) level.

METHOD

This study employed a cross-sectional survey, which was conducted in two hospital emergency departments (ED) in Chiangmai Province, Thailand. The sample was composed of 519 injured patients aged 18 years and older. Outcome measures included the BAC and type of injury. Exposures included the quantity of alcohol consumed, the time the drinking commenced, and the pattern of drinking involved.

RESULTS

The injured patients who drank alcohol within six hours prior to sustaining their injury were more likely to get injured and present themselves at the ED at night (20:00-04:00) compared to those who sustained an injury but did not drink in the hours prior. However, this relationship was only true for unintentional injuries, not intentional ones. The majority of participants consumed their first drink between 16:00 and 20:00. On average, among the 104 patients who drank prior to sustaining an injury, the total amount of alcohol consumed was 6.9 drinks, the duration of drinking was 2.6 h, the rate of drinking was 6.0 drinks/hour, and the BAC was 0.119 gm%. Every drink increased the BAC by 0.012 gm% and each year of increasing age increased the BAC by 0.003 gm%. People who were older, less educated, and drank more frequently tended to have their first drink earlier than other drinkers. An earlier start to their drinking resulted in a faster pace of drinking and a higher BAC.

CONCLUSIONS

BAC increased with the total amount of alcohol consumed and the age of the drinker. Different groups of people had their first drink at different times of the day, resulting in differences in the rate of drinking, the BAC, the time of injury, and the time they presented to the ED after injury.

Contribution of Substance Use in Acute Injuries With Regards to the Intent, Nature and Context of Injury: A CHIRPP Database Study

Introduction

Using the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) sentinel surveillance system, the objective of this study was to compare intent, circumstances, injury type and patient demographics in patients who used a substance prior to the injury versus those who did not use any substances.

Methods

Data were retrospectively collected from November 1^st 2016 to October 31^st 2017. All patients presenting to the Hôpital de l’Enfant-Jésus ED following trauma were included, aside from those who left without seeing a physician or had no physical injury (e.g., overdose without any trauma was excluded). Patients voluntarily completed a standardised form or agreed to be contacted later. Medical charts of all attendances were reviewed by the CHIRPP’s program coordinator. Substance use included illicit drugs, medications for recreational purposes, alcohol or other used either by the patient or another person involved.

Results

A total of 12,857 patients were included. Substance use was involved in 701 (5.5%) cases and was associated with injuries sustained by males (p < .001). The mean age of patients injured while using substances was 42.8 years, compared to 45.5 years in those who did not use substances (p < .001). Substance use was involved in 3.6% of unintentional injuries, compared to 26.2% of injuries intentionally inflicted by other and 38.9% for self-inflicted injuries (p < 0.0001). When substances were used, the odds of intentional injuries were 7.5 times greater compared to non-intentional injuries (95% CI 6.7, 8.5). Burns, head injuries and polytraumas were more prevalent when drugs or alcohol were involved.

Conclusion

This study outlines the significant contribution of substance use in intentional injuries, suggesting that it could potentially be beneficial to specifically target patients who present with deliberate physical injuries in preventive and therapeutic interventions offered in the ED.