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

The impact of late-night alcohol restrictions on ambulance call-outs in entertainment precincts

INTRODUCTION

In July 2016, the Queensland Government introduced the Tackling Alcohol-Fuelled Violence (TAFV) policy to address alcohol-related harm in entertainment precincts [safe night precincts (SNP)]. Additional measures were introduced in February and July 2017. We aim to examine the impact of the policy on Queensland Ambulance Service call-outs in Fortitude Valley, Surfers Paradise, all 15 SNP suburbs combined and statewide.

METHODS

Auto-regressive integrated moving average (ARIMA) models and seasonal ARIMA (SARIMA) models were developed to test the impact of TAFV policy stages on monthly number of ambulance call-outs during high alcohol hours (HAH; Friday and Saturday nights, 20:00-05:59) over an 8-year period (July 2011-June 2019).

RESULTS

The average number of monthly call-outs in HAH reduced by 26.2% in Fortitude Valley, 21.1% in Surfers Paradise and 4.3% in all 15 SNP suburbs combined. In Fortitude Valley, there was a significant decline in the monthly number of call-outs between 00:00 and 02:59 and across all HAH combined when examining the cumulative effect of the policy stages; and significant declines between 03:00 and 05:59 after each stage and cumulatively. Across the 15 SNP suburbs combined, there was a significant decline in call-outs between 03:00 and 05:59 after the third policy stage (July 2017). There were no significant declines in Surfers Paradise or statewide.

DISCUSSION AND CONCLUSIONS

Overall, the introduction of the TAFV policy stages in Queensland had a limited effect on ambulance call-outs during HAH. However, there were some notable declines in HAH ambulance call-outs in some of the state's key nightlife suburbs.

The impact of changes to alcohol policy on patron drinking behaviours in Queensland

INTRODUCTION

On 1 July 2016, stage 1 of the Tackling Alcohol-Fuelled Violence (TAFV) policy was introduced in Queensland, Australia and included restricted alcohol service to 03:00 in dedicated entertainment precincts (safe night precincts or SNPs). During stage 2 (from 1 February 2017), the number of extended trading permits (i.e. trading until 05:00) per venue were reduced; and during stage 3 (from 1 July 2017), networked identification scanners were mandated for late-night venues. We aim to examine whether patron drinking behaviours in two key SNPs changed significantly following stages 2 and 3.

METHODS

The study design was repeated cross-sectional, with three data collection (policy) stages. Patrons street surveys were conducted in Fortitude Valley (n = 2066) and Cairns (n = 1021) SNPs between July 2016 and November 2018. Linear or negative binomial regressions were conducted to examine changes in three key outcomes: blood alcohol concentration (BAC) reading, proportion of pre-drinkers and number of pre-drinks.

RESULTS

We found no significant difference in BAC reading, proportion of pre-drinkers or number of pre-drinks at stages 2 and 3 of the policy compared to baseline in Fortitude Valley. In Cairns, we found significant reductions in patron BAC at stage 3 of the policy, and female BAC at stages 2 and 3 compared to baseline; while the proportion of females pre-drinking significantly reduced by half in stage 2.

DISCUSSION AND CONCLUSIONS

Despite evidence of some reductions in alcohol consumption, high levels of intoxication remain, suggesting harm reduction may be more difficult to achieve in these drinkers.

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

INTRODUCTION AND AIMS

While injuries and alcohol contribute to a large proportion of the disease burden in Thailand, no well-designed underlying study has yet been published. This study aims to evaluate the relationship between acute alcohol consumption and injury risk in Thailand.

DESIGN AND METHODS

Using the case-crossover design, this study examined 520 injured patients aged 18 years and older from two emergency departments in Meuang District, Chiang-Mai Province, Thailand, from June to August of 2016. The case period was defined as 6 h prior to injury, the two control periods as the same 6-h period at 1 day and 7 days prior to injury. Alcohol exposure and the amount consumed were measured for these periods.

RESULTS

Twenty percent of injured patients consumed alcohol within the 6 h prior to injury, averaging 6.9 drinks during that time. The odds of injury for those individuals consuming alcoholic beverages was 5.0 (95% confidence interval 3.0, 8.2) times greater compared to non-exposure individuals; every additional drink consumed increased the odds of injury by 1.3 (95% confidence interval 1.2, 1.4). Alcohol use significantly increased the odds of sustaining an unintentional injury, intentional injury inflicted by someone else or experiencing a road traffic injury (among drivers). The dose-response analysis indicated alcohol use significantly increased the risks of unintentional injury and road traffic injuries (among drivers).

DISCUSSION AND CONCLUSIONS

Exposure to alcohol increased the odds of injury in a dose-dependent fashion; hence, comprehensive, cost-effective strategies should be implemented in Thailand to reduce alcohol exposure, binge drinking and drunk driving.

Alcohol Consumption and Violent Deaths in the City of Sao Paulo in 2015

Background: Excessive alcohol consumption is a serious public health issue, because drunkenness affects critical judgment and self-control, making people more vulnerable to violence and accidents, with thus a potential association between alcohol consumption and violent deaths. Objective: To assess the association between alcohol consumption and violent deaths in the city of Sao Paulo, Brazil, in 2015, and its relationship with gender, age, cause of death and blood alcohol concentration (BAC) of victims. Methods: A cross-sectional retrospective study was conducted by collection of data from 2,882 victims of violent deaths subjected to examination of BAC from the archives of the Institute of Legal Medicine of the State of Sao Paulo, Brazil. Results: Alcohol was detected in blood samples of 27.06% of the victims and mean BAC levels were 1.92 ± 1.24 g/L. The mean age of the victims was 33.49 ± 15.19 years. The majority of the victims were male (84.14%) and the prevalence of positive BAC was higher amongst men (28.74%) than women (18.16%). Homicide was the most prevalent cause of death in the sample (36.57%), but there were a higher proportion of traffic accidents victims with positive BAC (32.01%), as well as higher BAC levels in these victims (46.77% in the range of 1.6-2.5 g/L). Conclusions: The results obtained in this study support a potential association between alcohol consumption and violent deaths in the city of Sao Paulo, mainly in traffic accidents victims.

The Relationship Between the U.S. State Alcohol Policy Environment and Individuals' Experience of Secondhand Effects: Alcohol Harms Due to Others' Drinking

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.

Boozy Nights and Violent Fights: Perceptions of Environmental Cues to Violence and Crime in Licensed Venues

This article examines perceptions of environmental cues to crime, violence, and injuries in barroom settings, and how they differ between bar fight participants and non-participants. Bouncer friendliness, patron sex composition, and room temperature were chosen as experimental variables based on three criteria: (a) emerged as a theme in bar user focus groups, (b) unclear effects in the literature, and (c) policy relevant and easy to modify. These experimental variables were manipulated in written vignettes set in a bar. A three-part online questionnaire recorded 681 male university students' responses to questions on demographics, the experiment, drinking and clubbing habits, and the Snell Masculinity Scale. A 2 × 2 × 2 randomized independent groups factorial design with covariates was embedded in the questionnaire, measuring the effects of the experimental variables on bar users' perceived fear of victimization, likelihood and frequency of crime, venue preference, and perceived severity of injuries after accounting for prior bar fight participation and masculinity. Participants generally rated perceived fear of victimization, likelihood and frequency of crime, and severity of injuries to be highest when the bouncer was unfriendly, the temperature was hot, and patrons were majority male. Only main effects were significant ( p < .01). Masculinity scale responses were not related to participant perceptions. While fight participants (9.8% of the sample) and non-participants had similar perceptions of the risk associated with certain environmental cues, fight participants were significantly (a) less fearful of victimization in settings they perceived as dangerous and (b) more willing to drink in any hypothetical venue.

Risk factors for violence-related injuries in emergency departments: a Danish linkage study

Background: Interpersonal violence is a pervasive global public health problem associated with myriad health, social and economic consequences. In recent years the rates of interpersonal violence have decreased, however, high numbers of individuals continue to present to emergency departments for non-fatal violence-related injuries. Objective: This study aimed to examine a range of risk factors associated with violence-related injuries in an emergency department in Denmark. Method: A case-control study was conducted on a sample of 3,940 victims of violence collected by the Accident Analysis Center for Aarhus County Municipality. Using the Danish Civil Registry System, controls were matched 10:1 on age, gender and municipality. Risk factors were rendered from Danish health and social registers five years prior to the violent assault. These included marital status, educational qualification, employment status, national origin, involvement with child protective services (CPS), prior convictions, and a diagnosis of adjustment disorder and alcohol and/or substance use disorders. Results: Multivariate logistic regression identified that being male, divorced, unmarried, non-Danish origin, attending compulsory education, being outside the labour force, students, involvement with CPS, prior criminal conviction and a diagnosis of alcohol and/or substance use disorders were associated with an increased likelihood of being exposed to violence. The dominant risk factors were alcohol and/or substance use disorders (OR = 3.62) and prior criminal conviction (OR = 3.54). Attainment of tertiary education was associated with a reduced likelihood of being a victim of violence. Conclusion: These findings highlight that research into effective interventions offered in emergency departments may help the public health effort to reduce the health, social and economic burden of interpersonal violence.

Prevalence and predictors of injuries in Kenya: findings from the national STEPs survey

BACKGROUND

Injuries are becoming an increasingly important public health challenge globally, and are responsible for 9% of deaths. Beyond their impact on health and well-being, fatal and non-fatal injuries also affect social and economic development for individuals concerned. Kenya has limited data on the magnitude and factors associated with injuries. This study sought to determine the magnitude and risk factors for injuries in Kenya and to identify where the largest burden lies.

METHODS

A national population-based household survey was conducted from April-June 2015 among adults age 18-69 years. A three-stage cluster sample design was used to select clusters, households and eligible individuals based on WHO guidelines. We estimated the prevalence of injuries, identified factors associated with injuries and the use of protective devices/practices among road users. Multivariate logistic regression was used to identify potential factors associated with injuries.

RESULTS

A total of 4484 adults were included in the study. Approximately 15% had injuries from the past 12 months, 60.3% were males. Four percent of the respondents had been injured in a road traffic crash, 10.9% had experienced unintentional injuries other than road traffic injuries while 3.7% had been injured in violent incidents. Among drivers and passengers 12.5% reported always using a seatbelt and 8.1% of the drivers reported driving while drunk. The leading causes of injuries other than road traffic crashes were falls (47.6%) and cuts (34.0%). Males (p = 0.001), age 18-29 (p < 0.05) and smokers (p = 0.001) were significantly more likely to be injured in a road traffic crash. A higher social economic status (p = 0.001) was protective against other unintentional injuries while students had higher odds for such types of injuries. Heavy episodic drinking (p = 0.001) and smoking (p < 0.05) were associated with increased likelihood of occurrence of a violent injury.

CONCLUSIONS

Our study found that male, heavy episodic drinkers, current smokers and students were associated with various injury types. Our study findings highlight the need to scale up interventions for injury prevention for specific injury mechanisms and target groups. There is need for sustained road safety mass media campaigns and strengthened enforcement on helmet wearing, seatbelt use and drink driving.

Non-Fatal Injury in Thailand From 2005 to 2013: Incidence Trends and Links to Alcohol Consumption Patterns in the Thai Cohort Study

Background

We analyzed population-based injury trends and the association between injury and alcohol consumption patterns in Thailand, a middle-income country undergoing rapid social change.

Methods

A nationwide cohort of 42 785 Thai adult Open University students, who were aged 15 to 87 years at enrolment, participated in cross-sectional assessments at baseline (2005) and 8 years later (2013). Incident non-fatal traffic and non-traffic injuries were recorded. Alcohol consumption patterns were categorized as follows: non-drinkers, occasional light drinkers, occasional heavy drinkers, regular drinkers, and ex-drinkers. Logistic regression was used to assess associations in 2005 and 2013 between injuries and alcohol consumption. We adjusted odds ratios (ORs) for socio-demographic factors, stress, health behaviors, and risk-taking behaviors.

Results

Incidence estimates in 2013 were standardized to the age structure of 2005: the standardized rates were 10% (95% confidence interval [CI], 9.32–9.89) for participants with at least one non-traffic injury and 5% (95% CI, 4.86–5.29) for those with at least one traffic injury. Both standardized incidences for non-traffic and traffic injuries were significantly lower than corresponding rates in 2005 (20% and 6%, respectively). Alcohol consumption was significantly associated with non-traffic injury in 2005, but the association disappeared in 2013. For example, non-traffic injury was associated with regular drinking (adjusted OR 1.17; 95% CI, 1.01–1.40) in 2005, but not in 2013 (adjusted OR 0.89; 95% CI, 0.73–1.10). In both survey years, traffic injury was not associated with occasional heavy drinking when adjusted for health and risk-taking behavior.

Conclusions

We examined non-fatal injury and the health-risk transition in Thailand in 2005 and 2013. Our data revealed decreases in alcohol consumption and non-fatal injury in the Thai Cohort between 2005 and 2013. Alcohol-related injury in Thailand today could be amenable to preventive intervention.

Impact of Trauma, Massive Blood Loss and Administration of Resuscitation Fluids on a Person's Blood-Alcohol Concentration and Rate of Ethanol Metabolism

Excessive drinking and drunkenness are tightly linked to many types of intentional and unintentional injuries involving trauma and blood loss, which often necessitate emergency medical intervention. This article considers the impact of trauma, massive blood loss, and the administration of life-saving replacement fluids on a person's blood alcohol concentration (BAC) and rate of ethanol metabolism. Both German and English language journals were reviewed and results from animal experiments, human studies, and actual victims of trauma undergoing life-saving treatment were considered. If trauma-related bleeding occurs when some ingested alcohol remains unabsorbed in the stomach, then under these circumstances continued absorption into portal venous blood is delayed, owing to altered splanchnic circulation. Hemodilution caused by administration of replacement fluids has only minimal effects on a preexisting BAC, because ethanol distributes into the total body water (TBW) compartment, which represents 50-60% of body weight. After hypovolemia there is a transfer of fluids from tissue compartments into the blood, which becomes more like plasma in composition with lower hematocrit and hemoglobin content. Unless the trauma or emergency treatment impedes hepatic blood flow, the rate of ethanol metabolism is not expected to differ from normal values, namely 0.10-0.25 g/L/h (0.01-0.025 g% per h). If ethanol is fully absorbed and distributed in all body fluids and tissues, neither massive blood loss nor administration of resuscitating fluids is expected to have any significant effect on a preexisting BAC or the rate of ethanol metabolism.

Trends in violence in England and Wales 2010-2014

BACKGROUND

The National Violence Surveillance Network (NVSN) of emergency departments (ED), minor injuries units and walk-in-centres in England and Wales has brought clarity to contradictory violence trends derived from crime survey and police data. Gender, age-specific and regional trends in violence-related injury in England and Wales since 2010 have not been studied.

METHODS

Data on violence-related injury were collected from a structured sample of 151 EDs in England and Wales. ED attendance date and age and gender of patients who reported injury in violence from 1 January 2010 to 31 December 2014 were identified from attendance codes, specified at the local level. Time series statistical methods were used to detect both regional and national trends.

RESULTS

In total, 247 016 (178 709 males: 72.3%) violence-related attendances were identified. Estimated annual injury rate across England and Wales was 4.4/1000 population (95% CI 3.9 to 4.9); males 6.5/1000 (95% CI 5.6 to 7.2) and females 2.4/1000 (95% CI 2.1 to 2.6). On average, overall attendances decreased by 13.8% per year over the 5 years (95% CI -14.8 to -12.1). Attendances decreased significantly for both genders and all age groups (0-10, 11-17, 18-30, 31-50, 51+ years); declines were greatest among children and adolescents. Significant decreases in violence-related injury were found in all but two regions. Violence peaked in May and July.

CONCLUSIONS

From an ED perspective, violence in England and Wales decreased substantially between 2010 and 2014, especially among children and adolescents. Violence prevention efforts should focus on regions with the highest injury rates and during the period May-July.

Alcohol misuse, firearm violence perpetration, and public policy in the United States

OBJECTIVE

Firearm violence is a significant public health problem in the United States, and alcohol is frequently involved. This article reviews existing research on the relationships between alcohol misuse; ownership, access to, and use of firearms; and the commission of firearm violence, and discusses the policy implications of these findings.

METHOD

Narrative review augmented by new tabulations of publicly-available data.

RESULTS

Acute and chronic alcohol misuse is positively associated with firearm ownership, risk behaviors involving firearms, and risk for perpetrating both interpersonal and self-directed firearm violence. In an average month, an estimated 8.9 to 11.7 million firearm owners binge drink. For men, deaths from alcohol-related firearm violence equal those from alcohol-related motor vehicle crashes. Enforceable policies restricting access to firearms for persons who misuse alcohol are uncommon. Policies that restrict access on the basis of other risk factors have been shown to reduce risk for subsequent violence.

CONCLUSION

The evidence suggests that restricting access to firearms for persons with a documented history of alcohol misuse would be an effective violence prevention measure. Restrictions should rely on unambiguous definitions of alcohol misuse to facilitate enforcement and should be rigorously evaluated.

Violence and non-violence-related injuries and alcohol in women from developed and developing countries: a multi-site emergency room study

This study sought to analyze the association between alcohol consumption and the occurrence of injuries in women attending the emergency room (ER) from developing and developed countries. The sample consisted of ER data from women in 15 countries that were collected as part of two multi-site studies using similar methodologies: the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP), and World Health Organization Collaborative Study on Alcohol and Injuries (WHO Study). Women ranged in age from 18 to 98years. Those from developed countries had higher levels of education (43% completed high-school) than women from developing countries (37%). Over half of the women from developing countries reported they had not consumed alcohol in the last 12months (abstentious), while 2% reported drinking every day. In addition, current drinking women from developing countries reported more binge drinking episodes (33% reported 5 to 11 drinks and 15% reported 12 or more drinks on an occasion) compared to those from developed countries (28% and 11%, respectively). Violence-related injury was more prevalent in developing countries (18%) compared to developed countries (9%). An association between injury and the frequency of alcohol consumption in the last 12months was observed in both developing and developed countries. Although women from developing countries who suffered violence-related injuries were more likely to demonstrate alcohol abstinence or have lower rates of daily alcohol consumption, these women drank in a more dangerous way, and violence-related injuries were more likely to occur in these women than in those living in developed countries.

Focus on: the burden of alcohol use--trauma and emergency outcomes

Hospital emergency departments (EDs) see many patients with alcohol-related injuries and therefore frequently are used to assess the relationship between alcohol consumption and injury risk. These studies typically use either case-control or case-crossover designs. Case-control studies, which compare injured ED patients with either medical ED patients or the general population, found an increased risk of injury after alcohol consumption, but differences between the case and control subjects partly may account for this effect. Case-crossover designs, which avoid this potential confounding factor by using the injured patients as their own control subjects, also found elevated rates of injury risk after alcohol consumption. However, the degree to which risk is increased can vary depending on the study design used. Other factors influencing injury risk include concurrent use of other drugs and drinking patterns. Additional studies have evaluated cross-country variation in injury risk as well as the risk by type (i.e., intentional vs. unintentional) and cause of the injury. Finally, ED studies have helped determine the alcohol-attributable fraction of injuries, the causal attribution of injuries to drinking, and the impact of others' drinking. Although these studies have some limitations, they have provided valuable insight into the association between drinking and injury risk.

Alcohol and drug use as predictors of intentional injuries in two emergency departments in British Columbia

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.

Alcohol-related violence presenting to the emergency department: is 'glassing' the big issue?

OBJECTIVE

The study aims to describe the characteristics of patients presenting to EDs within Queensland, Australia with injuries because of assault with a glass implement ('glassing') and to set this within the broader context of presentations because of alcohol-related violence.

METHODS

This is an analysis of prospectively collected ED injury surveillance data collated by the Queensland Injury Surveillance Unit between 1999 and 2011. Cases of injury because of alcohol-related violence were identified and analysed using coded fields supplemented with qualitative data contained within the injury description text. Descriptive statistics were used to assess the characteristics of injury presentations because of alcohol-related violence. Violence included interpersonal violence and aggression (verbal aggression and object violence).

RESULTS

A total of 4629 cases were studied. The study population was predominantly men (72%) and aged 18 to 24 (36%), with men in this age group comprising more than a quarter of the study population (28%). Nine per cent of alcohol-related assault injuries were a consequence of 'glassing'. The home was the most common location for alcohol-related violence (31%) and alcohol-related 'glassings' (33%). Overall, the most common glass object involved was a bottle (75%); however, within licensed venues an even mix of a drinking glass (44%) and glass bottle (45%) was identified.

CONCLUSIONS

Contrary to public perception generated by media, 'glassing' incidents, particularly at licensed venues, constitute a relatively small proportion of all alcohol-related violence. The current study highlights the predominance of young men injured following alcohol-related violence, demonstrating a key focus area within the population for aiming prevention strategies.

Alcohol and violence in the emergency room: a review and perspectives from psychological and social sciences

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.

Alcohol, Health, and Injuries

Although alcohol has existed almost as long as human existence, its consumption and abuse can have many detrimental effects. Alcohol has been associated with a wide variety of injuries, both intentional and unintentional, and can lead to physical, verbal, and sexual violence as well as family dysfunction. The role of alcohol advertising and media plays a role in alcohol’s contribution to society, and youth may be more heavily influenced than adults. Moreover, alcohol has psychological, social, and physical consequences in addition to a direct impact on health. A number of methods may be advantageous for lifestyle medicine practitioners targeting this issue, including prevention strategies for alcohol misuse, increased legal reinforcement, screening and brief intervention, public campaigns, and media advocacy.

D, de Bradshaw AM. Risk of injury after alcohol consumption from case-crossover studies in five countries from the Americas

AIMS

This study aimed to: (i) provide relative risk (RR) estimates between acute alcohol use and injuries from emergency departments (EDs) in the Dominican Republic, Guatemala, Guyana, Nicaragua and Panama, and (ii) test whether the RR differs if two control periods for the estimates were used.

DESIGN

Case-crossover methodology was used to obtain estimates of the RR of having an injury within 6 hours after drinking alcohol, using a pair-matching design with control periods of the same time of day on the day prior to injury, and the same time of day and day of week during the week prior to injury.

SETTING

EDs.

PARTICIPANTS

A total of 2503 injured patients from EDs were interviewed between 2010 and 2011, with a response rate of 92.6%.

MEASUREMENTS

Number of drinks consumed within 6 hours prior to the injury and in the two control periods.

FINDINGS

The RR of injury after drinking alcohol was 4.38 [95% confidence interval (CI): 3.29-5.84] using the prior week as the control period, and 5.35 (CI: 3.50-8.17) using the prior day as a control period. The RR was 5.08 (CI: 4.15-6.23) in multiple matching. Those drinking one to two drinks had a RR of 4.85 (CI: 3.12-7.54); those drinking three to five drinks an RR of 5.00 (CI: 3.47-7.18); those drinking six to 15 drinks an RR of 4.54 (CI: 3.36-6.14); and those drinking 16 or more drinks an RR of 10.42 (CI: 4.38-24.79).

CONCLUSIONS

As in other countries, drinking alcohol is an important trigger for an injury in the Dominican Republic, Guatemala, Guyana, Nicaragua and Panama.

The association of alcohol drinking pattern and self-inflicted intentional injury in Korea: a cross-sectional WHO collaborative emergency room study

OBJECTIVES

Self-inflicted intentional injuries are increasing at an alarming rate in the Republic of Korea, yet few reports describe their relationship with alcohol consumption. The aim of this study was to characterise the association of alcohol drinking patterns and self-inflicted intentional injury in Korean emergency departments (EDs) using WHO collaborative study protocol.

DESIGN

Cross-sectional study.

SETTING

Data were collected from four general hospital EDs in four geographically diverse regions of Korea: Seoul, Suwon, Chuncheon and Gwangju.

PARTICIPANTS

Information was collected on 1989 patients aged 18 and above. A representative probability sample was drawn from patients admitted to each ED for the first time within 6 h of injury.

PRIMARY AND SECONDARY OUTCOME MEASURES

Alcohol-related non-fatal injuries.

RESULTS

Among 467 persons with alcohol-related injuries, 33 (7.1%), were self-inflicted intentional injuries and 137 (29.3%) were intentional injuries caused by someone else. The adjusted odds of self-inflicted intentional injury verses unintentional injury were calculated for heavy (OR 1.764; 95% CI 0.783 to 3.976), binge (OR 2.125; 95% CI 0.930 to 4.858) and moderate drinking (OR 3.039; 95% CI 1.129 to 8.178) after controlling for demographic variables. Similar odds were reported for pooled intentional injury data (self-inflicted and caused by someone else) and drinking patterns.

CONCLUSIONS

These data show a strong association between all patterns of acute alcohol consumption and self-inflicted intentional injury in the Republic of Korea.

Overview of the fast alcohol screening test and some patient characteristics from a regional maxillofacial trauma clinic based in Glasgow, United Kingdom

A huge body of evidence exists as to the efficacy of alcohol screening and alcohol brief interventions in a range of settings including maxillofacial trauma clinics. An overview of the Fast Alcohol Screening Test (FAST) and some patient characteristics were gathered from those attending a regional maxillofacial trauma clinic in Glasgow, United Kingdom. A 3-month study was undertaken from March 2011 using the FAST as a means of detecting hazardous or harmful alcohol use. Gender, age, and deprivation were examined from patient records. Descriptive statistics were obtained, and gender, deprivation, and alcohol consumption were analyzed using Spearman's rho to ascertain potential correlations between these variables. Two hundred and eighteen patients (157 men and 61 women) participated in the study. A total of 120 participants were deemed to be FAST positive, with a score of 3 or more. The mean age of all patients was 34 years. Forty-six participants (21.3%) fell into the most deprived category. There was no significant correlation between deprivation and age, and deprivation and alcohol intake, but a significant negative correlation between age and alcohol intake was underscored (r = -.183, n = 218, p = .007, two-tailed). Alcohol screening and alcohol brief interventions appear to be a worthwhile contribution to the service studied. Screening could be utilized more effectively through targeting the young male population. Moreover, additional research needs to be carried out to further ascertain if relationships are present between deprivation and age, deprivation and alcohol intake, and age and alcohol intake.

Attribution of alcohol to violence-related injury: self and other's drinking in the event

OBJECTIVE

Alcohol can result in harm (including injury) not only to the drinker but also to others; however, little research exists on the additional proportion of violence-related injuries that can be attributed to the perpetrator.

METHOD

Data are reported from emergency department studies in 14 countries on the prevalence of patients' self-report of drinking within the 6 hours before the violence-related injury event, patients' belief that the event would not have happened if they had not been drinking at the time, and patients' perception that the perpetrator had been drinking. Alcohol-attributable fraction was calculated based on the patients' perception that their own drinking was causally related to the event and on their perception that the perpetrator had been drinking.

RESULTS

Across all countries, 62.9% of the violence-related injuries involved alcohol use on the part of the victim, the perpetrator, or both. Rates of others definitely drinking, as perceived by the victim, ranged from 14% to 73% across countries and was positively associated with patients' own drinking in the event and with attributing a causal association between their drinking and the event. Estimates of alcohol-attributable fraction were 38.8% when the victim and perpetrator were considered together compared with 23.9% when only the patient was considered and varied by country-level drinking pattern.

CONCLUSIONS

These findings suggest adjustments that could be made to global burden of disease estimates because of violence-related injury morbidity to better reflect alcohol-attributable fraction when drinking by others and country-level drinking patterns are taken into account.