Alcohol in home and leisure injuries

Type and Context of Alcohol-Related Injury among Patients Presenting to Emergency Departments in a Caribbean Country

There is an association between alcohol consumption and injuries in Latin America and the Caribbean. This cross-sectional study explores the socio-contextual factors of alcohol-related injuries in Trinidad and Tobago. Data on drinking patterns, injury type, drinking context prior to injury, and demographics were collected from patients presenting with injuries to the Emergency Departments (ED) of four hospitals. Findings show that 20.6% of patients had consumed alcohol, mainly beer, in the 6 h before injury. More than half were drinking at home (27%), or someone else’s home (27%). Injury most commonly occurred outdoors (36%) while in transit. Alcohol-related injuries occurred mainly because of falling or tripping (31.7%); these patients recorded the highest mean alcohol consumption prior to injury. Most persons who fell (50%) did so at home. Findings highlight the previously unreported significant risk of non-drivers sustaining injures through falling and tripping because of heavy alcohol use. Current interventions to reduce alcohol-related injury have focused on drink driving but there is a need for interventions targeting pedestrians and those who drink at home. A comprehensive multi-component approach including secondary prevention interventions in the medical setting, community educational interventions, enforcement of current legislative policies concerning the sale of alcohol, and policy initiatives surrounding road safety and alcohol outlet density should be implemented.

Theory of mind deficits following acute alcohol intoxication

Acute alcohol consumption is associated with socially inappropriate behaviour. Such behaviour could in part reflect the potential of alcohol to interfere with social cognition. In this experiment we tested the hypothesis that acute alcohol consumption by regular heavy social drinking young adults would compromise an aspect of social cognition, namely theory of mind (understanding intentions, emotions and beliefs). Participants who had consumed 6-8 units of alcohol showed specific impairments on two theory of mind tests: identification of faux pas and emotion recognition. This result suggests that alcohol consumption could lead to social problems secondary to difficulties in interpreting the behaviour of others due to theory of mind impairments.

Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disorders

AIMS

To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD.

SETTING

Department of Veterans Affairs, Veterans Health Administration (VHA).

PARTICIPANTS

A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 (n = 3,944,778), followed from the beginning of FY02 through the end of FY06.

MEASUREMENTS

Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index.

FINDINGS

Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality.

CONCLUSIONS

In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death.

ALCOHOL AND VIOLENCE-RELATED INJURIES AMONG EMERGENCY ROOM PATIENTS IN AN INTERNATIONAL PERSPECTIVE

While alcohol has been found to be more closely associated with violence-related injury than with injury from other causes, little data is available which documents heterogeneity in this association across countries or cultures, taking into consideration usual drinking patterns and other socio-cultural variables. Data are reported from 15 countries comprising the Emergency Room Collaborative Alcohol Analysis Project and the WHO Collaborative Study on Alcohol and Injury. Case-crossover analysis was used to analyze the risk of injury (among current drinkers) from drinking six hours prior to the event, based on frequency of usual drinking, for violence-related injuries and separately for non-violence related injuries. Relative risk (RR) for a violence-related injury was significantly greater than for injuries from other causes across all countries (pooled RR=22.22 vs. 4.33), but the magnitude of risk varied considerably (ranging from 4.68 in Spain to 942 in Canada). Pooled effect size was found to be heterogeneous across countries, and was explained, in part, by the level of detrimental drinking pattern in a country. Risk for a violence-related injury was not significantly different by age (<30 and 30+), reporting 5 or more drinks on at least one occasion during the last year, or reporting symptoms of alcohol dependence. A number of methodological concerns suggest that risk of a violence-related injury compared to injuries from other causes may be inflated, and such variables as context of drinking should be taken into consideration in establishing relative risk and alcohol attributable fraction of violence-related injury across countries and cultures.

Associating leisure with drinking: current research and future directions

This paper has two components: (1) a survey of current research relating drinking with leisure, and (2) suggestions for future studies in the area. A total of 43 relevant journal articles published between 1980 and 1994 were located via an on-line search. Results of these studies generally fall under one of the following themes: (1) alcohol is an integral part of leisure experience, (2) drinking is an impediment to leisure, (3) participation in active leisure reduces alcohol use/abuse, and (4) drinking and leisure have no relations. Overall, it was found that current research suffered an overdependence on special populations and a lack of robust instruments measuring either drinking or leisure. Suggestions for future research were provided, such as better research design and greater integration of leisure into alcohol research.

Risk factors and geographical heterogeneity in unintentional home injuries incidence rate: new evidence based on Multiscopo Survey in Italy

Home injuries together, with road traffic accidents, are estimated to be the third cause of death in Italy (Arokiasamy and Krishnan 1994). However, as in most other countries, in Italy there is a lack of information on home injuries and on how differences in geographical patterns may influence the scope and magnitude of this phenomenon. By analysing a multipurpose large survey (Multiscopo) carried out annually, geographical heterogeneity in home injuries incidence rate can be investigated. The aim of this study is the assessment of possible differences in geographical patterns among the Italian regions making use of a re-analysis of Multiscopo home injury data. The study results show that Italian regions differ greatly in the number of home injuries. The geographical heterogeneity may be due to the unemployment rate and the incidence of poverty that is greater in the Southern and Insular regions than in other zones. Other socio-economic variables such as alcohol consumption can increase the risk of injury in the home. To prevent them it could be useful to organize campaigns aimed at increasing the awareness among people about this problem.

Frequency of heavy episodic drinking among nonfatal injury patients attending an emergency room

This study investigated the relationship between frequency of heavy episodic drinking and nonfatal injury in four categories: environment, external cause, diagnosis, and activity at the time of injury. Data were collected over 18 months at the emergency room facility of a Swedish hospital. Injury patients aged 18-70 years answered an alcohol screening questionnaire. Heavy episodic drinking was measured as drinking six glasses (72 g alcohol) or more per occasion, for both males and females. A total of 2211 patients were enrolled in the study (79.5% completion rate). Demographic and drinking characteristics for the patients were compared to those of the general population, data for which were derived from a population-based survey. The proportion of people who reported heavy episodic drinking once a month or more was nearly twice as large among the injury patients as in the general population. However, age and sex outweighed heavy episodic drinking as risk factors for most injury types. There were 11 significant associations between frequency of heavy episodic drinking and injury types in the four injury categories, yet no linear trends of increased likelihood of injury with increased frequency of heavy episodic drinking could be discerned.

Effect of hypothermia on blood-brain barrier permeability following traumatic brain injury in chronically ethanol-treated rats

The objective of this study was to investigate the effect of hypothermia on the blood-brain barrier (BBB) disruption caused by traumatic brain injury (TBI) in chronically ethanol-treated rats. BBB permeability was measured using Evans blue (EB) dye. Arterial blood pressure levels of animals in hypothermic groups decreased significantly. The EB dye extravasation into the brain significantly increased in hypothermia and at 6 and 24 h after TBI. In ethanol-treated rats that were subjected to TBI, hypothermia led to a significant decrease in EB dye content in the brain at 24 h but not at 6 h after TBI when compared with TBI alone.

Injury severity: role of alcohol, substance use and risk-taking

OBJECTIVE

The objective of the present study was to quantify the relationship between acute alcohol consumption and injury severity.

METHODS

A cross-sectional study was conducted at the Gold Coast Hospital, Gold Coast, Queensland, Australia between October 2000 and October 2001. Data were collected from a systematic sample of patients greater than 15 years of age who presented to the ED for treatment of an injury sustained less than 24 h prior to presentation. Study participants were interviewed face to face on-site. Information obtained included: demographics details; situational variables relative to time of injury (i.e. location, activity and companions at time of injury); self-reported alcohol consumption in the 6 and 24 h prior to time of injury; usual alcohol consumption patterns; self-reported substance use in the 6 and 24 h prior to time of injury; and risk-taking behaviour. Injury severity was coded from patient medical records using the New Injury Severity Score.

RESULTS

Of 789 eligible patients presenting during the study periods, 593 were interviewed (75.2%). Patients who reported drinking above low-risk levels (odds ratio [OR] = 3.35; 95% confidence interval [CI] 1.2-9.6) or who drank beer (OR = 3.54; 95% CI 1.1-11.1) in 6 h prior to injury were significantly more likely to sustain serious than minor injury. Drinking setting and usual drinking patterns were not significantly associated with injury severity, either in crude analyses, or after adjusting for relevant variables.

CONCLUSION

The results of the present study support the conclusion that among injured patients who presented for treatment at a large metropolitan ED, although acute alcohol consumption does not appear to be associated with minor or moderate injury, there is some evidence to suggest that acute alcohol consumption is associated with serious injury.

Acute alcohol use and the risk of non-fatal injury in sixteen countries

AIMS

To determine the relative risk (RR) of non-fatal injury associated with alcohol consumption in a series of emergency departments (EDs), possible effect modifiers and the impact of contextual variables on differences across sites.

DESIGN

The case-crossover method was used to obtain RR estimates of the effect of alcohol on non-fatal injuries. Meta-analysis was used to evaluate the consistency and magnitude of RR across sites, and the extent to which contextual variables explain differences in effect sizes.

PARTICIPANTS

Probability samples of 11,536 injured patients attending 28 EDs studies in 16 countries (1984-2002). The majority of the sample was male (65%) and > 30 years old (53%).

MEASUREMENTS

Exposed cases where those that consumed alcohol 6 hours prior to the injury. Usual alcohol consumption served as the control period.

FINDINGS

Drinking within 6 hours prior to the injury was reported by 21% of the sample. The estimated (random) pooled relative risk for patients who reported alcohol use within 6 hours prior to injury was 5.69 (95% confidence interval = 4.04-8.00), ranging from 1.05 in Canada to 35.00 in South Africa. Effect size was not homogeneous across studies, as societies with riskier consumption patterns had a higher relative risk for injury. Heavier drinkers also showed lower RR.

CONCLUSIONS

Acute alcohol was a risk factor for non-fatal injuries in most sites. Policy measures addressed to the general population are recommended, especially in societies with riskier consumption patterns.

The annual societal cost of alcohol misuse in Scotland

OBJECTIVE

To estimate the annual socioeconomic burden imposed by alcohol misuse on Scottish society.

DESIGN AND SETTING

Resource use attributable to alcohol misuse was obtained from appropriate databases, published literature and a Working Party on Social Work Caseload and Alcohol Misuse. Unit resource costs at 2001/2002 prices were applied to the resource use estimates to determine the annual direct cost attributable to alcohol misuse. Indirect costs arising from excess unemployment, absenteeism from work and premature mortality were also estimated as was the human cost of alcohol misuse arising from premature mortality among the non-working population.

MAIN OUTCOME MEASURES AND RESULTS

The annual healthcare cost of managing alcohol misuse was estimated to be pounds sterling 95.6 million. Hospital admissions (57%) and accident and emergency attendances (10%) accounted for the greatest health service costs. Social work services including the Children's Hearing System were estimated to cost pounds sterling 85.9 million whilst the criminal justice system was estimated to cost pounds sterling 267.9 million. Indirect costs were estimated to account for pounds sterling 404.5 million. The human cost of premature mortality among the non-working population was estimated to be pounds sterling 216.7 million.

CONCLUSIONS

Alcohol misuse imposes a substantial burden on Scottish society, costing pounds sterling 1,071 million per year at 2001/2002 prices, which is greater than many prevalent illnesses such as stroke, depression and diabetes mellitus. In terms of the statutory agencies, alcohol misuse imposes a greater burden on the criminal justice system than both the health service and social work services. However, the greatest burden is on the individual and society as a whole arising from lost productivity.

Alcohol and the health of aging men

Alcohol drinking, alcohol abuse, and alcoholism are more common among men than women at all ages. This article reviews the epidemiology and clinical effects of alcohol use in aging men. Alcoholism demands aggressive intervention when encountered in cognitively impaired people.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

Fatal falls down stairs

Fatal falls down stairs in south-east Scotland were studied using prospectively collected data between 1992 and 1997. 51 individuals, comprising 27 men and 24 women with mean age 68.9 years, died following falls down stairs, 30 (59%) of which were unwitnessed. 43 (84%) individuals died following falls within their own homes. Overall, 27 (53%) fatal falls resulted in death at the scene of the accident. Analysis of injuries according to the Abbreviated Injury Scale yielded injury severity scores (ISS) of between 5 and 75, but only four individuals had injuries recognised to be unsurvivable (ISS = 75). Injury to the brain and/or spinal cord was responsible for the vast majority of most severe injuries. The results demonstrate that stairs represent a significant hazard for the elderly. Most of the deaths in the pre-hospital setting appeared to be more the result of the fact that the victim was alone and unable to summon assistance, rather than as a result of unsurvivable injuries. Consideration needs to be given to both how the safety of stairs can be improved and whether a particular elderly person can safely cope with stairs.

Alcohol and injuries in elderly people

Injuries are a common cause of morbidity and mortality among elderly people. Falls are the most common type of accident, accounting for around 40% of injuries. There is substantial evidence that heavy alcohol use is an important risk factor for injuries in younger people, but results of the few studies of alcohol and injuries among elderly people have been inconsistent. In this paper, we review the literature on the effects of alcohol on gait and balance and present reasons that a causal relationship between alcohol and injuries is biologically plausible. We review the epidemiological studies of the relationship between alcohol and falls, hip fractures and other injuries in the elderly population and discuss sources of error in these studies. Selection bias, small sample sizes, measurement error and potential confounders such as age, gender, health status and medications may have played a substantial role in negative results from several studies. Further research that will help clarify the relationship between alcohol and injuries in elderly people is sorely needed.

Baseball and beer: an analysis of alcohol consumption patterns among male spectators at major-league sporting events

STUDY OBJECTIVE

Examination of alcohol consumption patterns of male spectators at two major-league baseball stadiums.

METHODS

A prospective observational study was conducted at two stadiums over the course of three games at each venue. We approached 1,084 male spectators of drinking age in a consecutive fashion at two junctures: at the entrance gate and during the fifth inning inside the stadium's concourse. Of those approached, 747 (68.9%) participated. After verbal consent, participants completed a questionnaire and blew into a breath analyzer. The results were blinded and later analyzed.

RESULTS

Forty-one percent of all participants tested positive for alcohol. The highest consumption occurred in the 20- to 35-year-old age group. In this age group, 50.8% had consumed some alcohol, and 10.8% had a blood alcohol level of .08% (intoxicated) or higher. Almost 5% of all participants tested during the fifth inning collection were intoxicated and claimed to be driving.

CONCLUSION

Of the spectators tested, those in the 20- to 35-year-old age group were most likely to have consumed alcohol and to be legally intoxicated. A disturbing number of spectators who had blood alcohol levels of .08% or higher late in the game claimed to be driving home.

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

The purpose of this study was to examine whether risk factors vary for injuries that occur at work, at home, at recreational events and at multiple settings. Three major types of factors were investigated: lifestyle factors such as sleep, stress and exercise; substance use; and demographic characteristics. Data were obtained from a household survey of 882 Ontario adults. In order to determine whether different factors were related to different kinds of accidental injuries, chi 2 tests were conducted among five injury groups: no injuries; work; home; recreational; and multiple injury episodes (i.e. at least two separate injury episodes in two different settings). The first set of comparisons were conducted between those with zero injuries and each of the aforementioned four injury groups. Those with multiple injury episodes were significantly more likely than those with no injuries to be single, under the age of 30, and have lifestyle problems (i.e. sleep problems, financial problems and a desire for counselling) and substance use/problems (i.e. cigarettes, alcohol, licit and illicit drugs). For comparisons between each of the work, home and recreational injury groups and no injury group, eight factors were significant altogether, but no single factor was significantly related to more than one injury group. Contrasts between all combinations of injury group pairs (i.e. excluding the no injury group) indicated that risk factors for those with multiple injury episodes differed significantly from those with home and recreational injuries for several characteristics. This exploratory study provides some support that risk factors may vary, depending on the injury group.

Dose-related effect of alcohol on mismatch negativity and reaction time performance

In a recent study, the mismatch negativity (MMN) component of auditory event-related potential, elicited by occasional frequency changes in a repetitive tone, was strongly attenuated by a low dosage of alcohol. We investigated the phenomenon in nine subjects with two different dosages of ethanol (0.35 and 0.55 g/kg), and with two magnitudes of frequency changes (5% and 10%), in a single-blind, placebo-controlled paradigm. Ethanol had no observable effect on the N1 and P2 deflections, nor on the reaction time to frequency changes measured in a separate session. However, the MMN was attenuated after administration of the larger dosage of alcohol, suggesting impaired preconscious processing of stimulus features outside the scope of attention. The results support the view according to which the automatic functions of human information processing are more sensitive than the controlled functions to the detrimental effects of alcohol. The fact that the MMN suppression was stronger when stimulus deviation was smaller indicates that at relatively low blood alcohol concentrations the detection of small deviations is especially hampered.

Low dose of ethanol suppresses mismatch negativity of auditory event-related potentials

The acute effect of a low dose of ethanol (0.5 g/kg) on attention and auditory event-related potentials (ERPs) was investigated in 10 social drinkers using a single-blind, placebo-controlled cross-over design. A dichotic listening task, in which the subjects were instructed to attend selectively to stimuli to one ear while ignoring stimuli to the other, was used. The amplitudes of N1, P2, and the mismatch negativity (MMN) were significantly diminished by alcohol. The latencies of the MMN and N2b were also significantly increased after alcohol ingestion. The novel finding of the significant (> 60% reduction in amplitude) suppression of the MMN can be interpreted as indicating disturbed preconscious detection of acoustic changes outside the scope of attention. Because this is a prerequisite to an attentional shift, the MMN suppression may be related to increased risk for accidents after alcohol ingestion. The same dose of alcohol that suppressed the MMN left intact selective attention and conscious "target" detection, as reflected by the processing negativity and P3 deflections, thus suggesting that the automatic functions of human information processing are more sensitive to alcohol than the controlled, attentional functions.