Drinking in the Injury Event: A Comparison of Emergency Room Populations in the United States,Mexico, and Spain

Variables related to drinking in the injury event were compared among probability samples of emergency room patients in Contra Costa County, California (N = 1,001), Mexico City (N = 1,688) and Barcelona, Spain (N = 1,684). Drinking companions and places of drinking prior to injury, place of injury associated with drinking, amount of alcohol consumed, proximity of drinking with the injury event, perceived drunkenness at the time, and causal attribution of drinking with the event were all found to vary among the samples. The data suggest that the context in which alcohol is involved in the injury event is affected by the context in which alcohol is typically consumed in a culture and is important in analyzing alcohol's role in injury occurrence and situations which may be considered high-risk for alcohol-related injuries.     

Acculturation,Alcohol Consumption,and Casualties among United States Hispanics in the Emergency Room

The association of alcohol consumption and casualties was analyzed among Hispanic emergency room patients to determine whether level of acculturation and accompanying changes in drinking patterns influence risk of alcohol-related injuries. A sample of patients admitted to a county hospital emergency room during a 1-year period was breathalyzed and interviewed (N = 1,102). Of these, 112 identified themselves as Hispanic. Hispanic males were more likely than non-Hispanics to have positive breathalyzer readings, to report drinking prior to the event, and to attribute a causal association of drinking with the event. These findings were most pronounced among those in the moderate and high acculturation groups.     

Measurements,Instruments, Scales,and Tests: Use of AUDIT for Alcohol Screening among Emergency Room Patients in Thailand

This study evaluated the Alcohol Use Disorders Identification Test (AUDIT) against blood alcohol levels and medical diagnoses. The population under study included 695 current drinkers admitted to emergency rooms of four regional Thailand hospitals. The AUDIT positivity rate was 61% among 343 patients who drank prior to admission and 32% among 352 patients who did not drink alcohol before admission. Breath alcohol levels were positively associated with AUDIT scores. The sensitivity against a previous or current alcohol-related medical diagnosis was 89%. We concluded that the AUDIT is a satisfactory instrument for alcohol screening in this population.     

Alcohol, violence, and the Alcohol Myopia Model: preliminary findings and implications for prevention

This experiment provided a preliminary test of whether the Alcohol Myopia Model (AMM; Steele & Josephs, 1990) would provide a guiding framework for the prevention of alcohol-related violence. The model contends that alcohol has a "myopic" effect on attentional capacity that presumably facilitates violence by focusing attention onto more salient provocative, rather than less salient inhibitory, cues in hostile situations. Participants were 16 intoxicated male social drinkers who completed a laboratory task in which electric shocks were received from, and administered to, a fictitious opponent under the guise of a competitive reaction-time task while they were exposed to either violence-promoting (n=8) or violence-inhibiting (n=8) cues. Aggression was operationalized as the intensity and duration of shocks administered by the participant to his "opponent." Despite being equally intoxicated, participants exposed to violence-inhibiting cues were dramatically less aggressive (d=1.65) than those exposed to the violence-promoting cues. Our data suggest that the AMM holds a great deal of promise to help develop effective prevention interventions for alcohol-related violence.     

阜阳市城乡普通人群饮酒情况及相关问题调查

目的：了解目前阜阳市城乡普通人群的饮酒情况及相关问题。方法：采用整群抽样调查，使用定式问卷向5178名城乡普通人群调查饮酒情况及与饮酒相关的社会、心理、躯体疾病。结果：普通人群男、女及整体饮酒率分别为40．7％、5．3％和24．0％。城镇饮酒率高于农村，高文化人群(高中及大学以上)高于低文化人群(初中及以下)。重度饮酒者占13．8％，男性(15．1％)高于女性(2．3％)。酒精所致的精神障碍发生率为3．3％，男性酒依赖时点患病率为6．469％，是女性的40．5倍。男性出现各种社会心理损害的比例高于女性，而在躯体损害方面女性多于男性。结论：随着内地经济进一步发展，本市酒消耗量将迅速上升，与饮酒相关的问题将会愈加突出。     

Drinking Patterns and Problems: A Comparison of Primary Care with the Emergency Room

A comparison is made of drinking patterns and problems of probability samples of noninjured patients drawn from the emergency room (ER) (n = 974) versus primary care clinics (n = 767) in the same metropolitan community. Those in the primary care sample were significantly less likely to report heavier drinking, consequences of drinking, alcohol dependence, and ever having treatment for an alcohol problem, controlling for demographic differences between the two sites. The data suggest that while primary care settings remain an important site for early identification and intervention for problem drinking, the ER may hold more potential for targeting prevention efforts in an era of reduced resources.     

Alcohol and Casualties in the Emergency Room: A Us-Italy Comparison of Weekdays and Weekend Evenings

This paper examines similarities and differences in associations of alcohol and casualties with time of arrival in the emergency room (weekdays vs weekend evenings) in probability samples of patients from two cultures where typical patterns of alcohol use vary greatly-Trieste, Italy (N=475) and Contra Costa County, California (USA) (N=l 482). In Contra Costa, but not in Trieste, those sampled on weekend evenings were more likely to have positive breathalyzer readings and to report drinking prior to the event than those sampled on weekdays. Rates for both positive breathalyzer readings and self-reported drinking prior to the event were lower in Contra Costa than in Trieste. These and other findings reported here point to differences in the relationship of alcohol and casualties in a culture where alcohol consumption is a routine part of life's daily activities as compared to the U.S. pattern of drinking primarily during leisure times.

Presented at the Alcohol Epidemiology Symposium, sponsored by the Kettil Bruun Society for Social and Epidemiological Research on Alcohol, Krakow, Poland, June 7-11,1993.     

手术室护士在急诊清创缝合术中易被感染血源性疾病的危险因素及防护

目的手术室护士对易被感染血源性疾病的防护。方法培养护士优秀的协调能力、加强自我防护的能力、提高自身专业技术水平的能力、进行血源性传播疾病知识的学习培训、加强手卫生的管理和完善报告制度。结果我院手术室护士发生职业暴露的次数由2009年6月至2010年5月的17例,下降到现在的3例(2010年6月至2011年5月)。结论在严格执行感染管理制度和操作规程的同时,充分利用各种防护用具和屏障,减少各种危险行为,加强医务人员的环保意识和自我防护意识,定期检查,监督,发现问题及时解决,并加强医疗废物危害性的认识,抓好每个环节的管理,切实作好职业防护,采取积极有效的措施,最大限度地保护医务人员和患者,使职业损伤的危害性降低到最低,从而更好地为患者服务。     

Violence and Illegal Drug Use among Adolescents: Evidence from the U.S. National Adolescent Student Health Survey

The relationships between violence, drug use, and victimization were examined in a representative sample of American adolescents. The commonly used illegal drugs (marijuana, amyl/butyl nitrites, psychedelics, amphetamines, and cocaine) and alcohol were considered. Drug users, compared to nonusers, fought more, took more risks which predisposed them to assault, and were assaulted more both at school and outside school supervision. Adolescents who were victims at school were also more likely to be victimized outside of school supervision. This study clearly demonstrates that the aggressor may also be the victim, and that illegal drug/alcohol use is related to victimization.     

Responsible disinhibition: Alcohol,men and violence to women

Theories about alcohol's role in stranger violence abound. Theories about alcohol's role in ‘domestic violence’1 do not. The targets of such violence differ as does the nature of the violence towards them. Theory needs to reflect this. This article reviews key theories linking alcohol and violence. Further, it reports on research with 20 women that resulted in an alternative theory on the role of alcohol in their partner's violence. The results of the research are summarised and placed within the theoretical model, ‘Responsible Disinhibition’. The model is grounded in the women's views and highlights individual responsibility for violence regardless of the level of intoxication. Finally, this article argues that theory needs to reflect the socio-cultural context in which it was constructed – a context that combines two culturally male and culturally tolerated behaviours – heavy drinking and violent behaviour.     

The association between partner and non-partner aggression and suicidal ideation in patients seeking substance use disorder treatment

Objective

The present study was designed to examine the relationship between prior partner and non-partner aggression and suicidal ideation in patients seeking drug and alcohol treatment.

Method

Patients entering drug and alcohol treatment (n = 488) were screened for prior partner and non-partner aggression as well as recent suicidal thoughts. We examined the association between aggression and suicidal ideation in bivariate and multivariate models.

Results

Within the past two weeks, 33% (159/488) of the sample reported suicidal ideation. In bivariate analyses, neither psychological nor physical aggression towards a non-partner was related to suicidal ideation. Partner psychological aggression was related to suicidal ideation in bivariate but not multivariate analyses. Physical aggression towards a partner was consistently related to higher rates of suicidal ideation even after controlling for other known risk factors (OR = 1.8; CI = 1.1–2.7). Mediational analyses indicate that this relationship was no longer significant after accounting for current negative affect.

Conclusion

Suicidal ideation is common in patients seeking drug and alcohol treatment and particularly likely in those who report prior aggression towards a partner.     

Alcohol Use,Depressive Symptoms,and Cultural Characteristics in Two Mexican-American Samples

We modeled associations of quantity and frequency of alcohol use with depressive symptoms (negative affect, lack of positive affect, somatic disturbance, interpersonal problems) in two household surveys of Mexican-Americans (Ns = 1,313 and 3,577). Multivariate analyses controlled cultural (immigration, acculturation) and demographic (age, income, household size, marital status, employment status) characteristics, and assessed interactions of these two classes of predictors. Alcohol use was inconsistently related to depression. In some analyses, cultural characteristics accounted for associations of alcohol use with depression. In others, associations of alcohol use with depression depended on cultural characteristics. Associations of drinking with depression tended not to be robust across samples     

Alcohol Use,Depression, and High-Risk Occupations Among Young Adults in the Ukraine

This study examined alcohol consumption in relation to anxiety, depression, and involvement with high risk occupations (HRO; e.g., coal miners), among young adults in the Ukraine (aged 18–25) (N = 192; 60.9% male; 100% Caucasian). Participants were grouped on the basis of drinking status: (1) current drinkers (CDs; n = 132) or (2) nondrinkers (NDs; n = 60). Questionnaires assessed frequency of alcohol use, motives for drinking, problem identification, as well as anxiety and depression (i.e., Hamilton scales). Bivariate analyses showed that CDs were more likely than NDs to be single, have a HRO, and have greater anxiety and depression; for example, 91.7% of CDs had a HRO as compared to 56.7% of NDs. Drinking status was not significantly related to age or gender. Among CDs, common motives for use included: to reduce anxiety and fears (60.6%), because my friends use alcohol (75.0%), to fight stress (78.8%), and to increase self-esteem (64.4%). Among CDs, past month drinking days were: 25% 1–2 days, 37.9% 3–7 days, 25% 8–21 days, and 12.1% 22–30 days. Regarding problem identification, 29.5% reported not having a problem, 34.8% reported possibly having a problem, 21.9% reported having a problem but not needing help, and 13.6% reported having a problem/needing help. Young adults involved in HRO may be a particularly high risk population given increased likelihood of alcohol use, anxiety, and depression. Early intervention strategies that incorporate motivational interviewing approaches to address coping and social motives for use may be beneficial to address substance use and mental health problems.     

Perceived Cognitive Competence,Depressive Symptoms and the Incidence of Alcohol-Related Problems in Urban School Children

ABSTRACT

Objective: This study is to test the hypothesis that poor perceived cognitive competence might signal an increased risk of subsequent alcohol-related problems in children. Method: A prospective epidemiologic study of elementary school students aged 9–13 years in Baltimore, Maryland, was undertaken. Perceived cognitive competence, peer use of alcohol, and other suspected risk characteristics for alcohol-related problems were assessed in 1990, among 1232 children with no prior history of problems associated with drinking alcohol. Occurrences of alcohol-related problems were assessed in subsequent annual interviews through 1994. Results: Four years later, 17.6% of these children are found to have developed one or more alcohol-related problems for the first time during the follow-up. Having depressive symptoms is associated with higher risk of developing alcohol-related problems while perceived cognitive competence is not (estimated Relative Risk (RR) = 1.6, 95% Confidence Interval (CI) 1.1–2.1 for depressive symptoms). The evidence from exploratory analyses suggests a possible interaction between depressive symptoms and perceived cognitive competence. Alcohol-related problems develop earlier for youths reporting both lower perceived cognitive competence and depressive symptoms relative to those with no depressive symptoms and high perceived cognitive competence. Furthermore, among children with at least one depressive symptom, having low or moderate perceived cognitive competence is associated with doubling the risk of developing alcohol-related problems relative to those with high cognitive competence (RR = 2.3, 95%CI 1.1–4.7 for low competence; RR = 2.1, 95%CI 1.2–3.9 for moderate competence). Conclusions: The evidence does not support a strong association between perceived cognitive competence and later alcohol-related problems. However, the exploratory search for interactions disclosed a possibility that depressive symptoms and poor perceived cognitive competence might combine to foster subsequent development of alcohol-related problems.     

Drugs,Violence, and Federal Funding: A Research Odyssey

Two decades of research activity focusing on drugs/violence relationships are described. Initial interest in this area was kindled by field experiences. Literature review revealed a dearth of concepts and data. A tripartite conceptual framework was formulated to define drug-related violence. A series of empirical studies were undertaken to verify and elaborate the conceptual framework. Findings from these studies debunked prevailing mythology about drugs/violence relationships. Findings also demonstrated the usefulness of a public health perspective and the critical importance of collecting qualitative data in order to achieve a deeper understanding of these phenomena. [Translations are provided in the International Abstracts Section of this issue.]     

Alcohol Misuse Among Female Veterans: Exploring Associations With Interpersonal Violence and Mental Health

Background: The correlates of alcohol misuse among female Veterans are not well understood. The present study explored associations among alcohol misuse, demographic/military-related characteristics, interpersonal violence exposure, and posttraumatic stress disorder (PTSD) and depression symptom severity. Method: Participants were 369 female Veteran patients of the VA New England Healthcare System. Participants completed a paper-and-pencil mail survey that included validated assessments of alcohol misuse, interpersonal violence, and psychological distress. Results: Younger age, adulthood physical abuse, military sexual trauma, past-year psychological aggression by an intimate partner, and PTSD and depression symptom severity showed significant univariate associations with alcohol misuse (as indicated by unsafe drinking levels, presence or incipience of an alcohol use disorder, intrapersonal alcohol-related concerns, and/or interpersonal alcohol-related concerns). A couple of these associations remained significant when examined in logistic regression models. Conclusions: Findings suggest that female Veterans who are at risk for alcohol use disorders and/or are experiencing alcohol-related problems may benefit from screening and intervention efforts that take into account interpersonal violence exposures and mental health symptoms on a case-by-case basis. Results also suggest the importance of future research examining correlates and risk factors for substance misuse among female Veterans.     

Six-Month Follow-Up of Computerized Alcohol Screening,Brief Intervention,and Referral to Treatment in the Emergency Department

ABSTRACT

The goal of this observational study was to measure change in alcohol consumption at 6 months following emergency department computerized alcohol screening brief intervention (CASI) and referral to treatment (ED-SBIRT) with integrated brief negotiated interview (BNI) and computer-generated personal alcohol reduction plans. At-risk patients received a BNI by CASI, including personalized feedback, assessment of readiness to change, reasons for cutting down, goal setting, and a printed personal alcohol reduction plan. Alcohol use was assessed by telephone interview 6 months after CASI. Factors associated with lower alcohol consumption were examined. Of the 385 participants who completed the BNI, were consented, and enrolled, 221 subjects completed the 6-month follow-up interview. Forty-seven percent of the study sample of at-risk patients were no longer drinking over the National Institute on Alcohol Abuse and Alcoholism (NIAAA)-recommended limits. Reductions were greater for patients with Alcohol Use Disorders Identification Test (AUDIT) scores of 1 to 7. Readiness to change was a good predictor of drinking below the recommended limits. The use of computerized ED-SBIRT with integrated personalized messaging and BNI holds promise as a viable screening and intervention modality for a wide range of emergency department patients.     

Screening Instruments for Alcohol Problems: A Comparison of Cut Points between Mexican American and Mexican Patients in the Emergency Room

The performance of alcohol use disorder screening instruments (CAGE, BMAST, AUDIT, TWEAK) at various cut points were compared between a Mexican American emergency room (ER) sample (n = 586) and a sample of ER patients in Mexico (n = 1,417) using ICD-10 and DSM-IV criteria for alcohol dependence and harmful drinking/abuse by gender and injury status. Lowering cut points improved instrument performance substantially for females in both samples. Further research is needed to explore instrument performance by gender and level of acculturation.     

Depression and heavy drinking occasions: a cross-sectional general population study

The purpose of this study was to assess the association between depression and heavy drinking occasions in the Finnish general population. A subsample (2086/4020, response rate 51.9%) of the National FINRISK 2007 Study was used. Depression was assessed with a modified Beck Depression Inventory (short form) and alcohol problems with the Alcohol Use Disorders Identification Test. Total alcohol intake and number of heavy drinking occasions (≥7 drinks for men, ≥5 drinks for women) were evaluated using the Timeline Followback. Of the sample, 13.0% (123/946) of men and 17.4% (198/1140) of women were classified as being depressed. Further, 7.5% (71/946) of men and 3.5% (40/1140) of women reported having at least four heavy drinking occasions in the previous 28days. In an adjusted logistic regression model, these men had a 2.6-fold risk (95% C.I. 1.2-5.3) of depression, as compared to men with less than four heavy drinking occasions. The association was found irrespective of total alcohol consumption and alcohol problems. This association was not found in women.     

Gender Differences in Alcohol Use and Alcohol Problems: Mediation by Social Roles and Gender-Role Attitudes

This study assesses the causal place of Traditional Gender Role Attitudes (TGRA) in models for men and women, which also include social roles by explanatory variables for alcohol use and alcohol problems. Mediation of gender differences by TGRA occurs mainly in abstinence. Interaction effect is weak for alcohol consumption and frequency of “heavy drinking.” The most important explanatory variables are the status factors age and education, which are mediated by TGRA in a small way. Specific aspects of alcohol-related problems are analyzed separately for the problem drinking category. Differences in results with other studies are discussed, and further study is proposed.