DRINKING IN THE INJURY EVENT: A COMPARISON OF MEXICAN-AMERICAN MALE ER PATIENTS IN THE UNITED STATES AND IN MEXICO

Probability samples of 66 Mexican-American injured male emergency room (ER) patients in Santa Clara County, CA, and 457 injured male ER patients in Pachuca, Mexico are compared on a number of drinking-in-the-event variables. While those in Pachuca were more likely to be positive on the breathalyzer than those in Santa Clara, they were less likely to attribute a causal association of their drinking with the event. Site (Santa Clara) was found to be a significant (positive) predictor of drinking prior to injury.     

Violence related injuries in the emergency room: alcohol, depression, and conduct problems

OBJECTIVE: The aim of this study was to obtain epidemiological measures of the association between alcohol consumption and emergency room (ER) attendance due to violence, compared to the general population in the city of Pachuca, Mexico, during October-November, 1996 and June-July, 1997. METHOD: The study was a population-based case-control design. Intervention and Measurements: Data consisted of an interviewer-administered questionnaire, collected on a 24-h basis, during the entire week. Setting and Participants: Cases were 127 patients (78% male) admitted to the ER because of an injury that was the result of violence (being in a fight or being attacked by someone). A sample of residents from Pachuca (n = 920) was the comparison group. RESULTS: Patients reporting drinking within 6h compared to nondrinkers were more likely to suffer a violence-related injury [34.0 (17.5-66.2)] and alcohol dependent patients were more likely to be involved in a violence-related injury [7.4 (3.5-15.6)] compared to noncurrent drinkers. When both alcohol prior and alcohol dependence were considered simultaneously in multiple models among current drinkers, patients with violence-related injuries were more likely to report alcohol prior but not to be positive for alcohol dependence. Depressive symptoms, but not conduct problem behavior, were also associated with violent injury in simultaneous regressions that included alcohol variables. CONCLUSIONS: In the city of Pachuca, Mexico, a large relationship between drinking prior to the event and violence-related injury, regardless of alcohol dependence, was found. Depression was also related to violence, suggesting the need for more comprehensive intervention with these patients.     

Violence Related Injuries in the Emergency Room: Alcohol,Depression, and Conduct Problems

Objective.?The aim of this study was to obtain epidemiological measures of the association between alcohol consumption and emergency room (ER) attendance due to violence, compared to the general population in the city of Pachuca, Mexico, during October–November, 1996 and June–July, 1997. Method.?The study was a population-based case-control design. Intervention and Measurements: Data consisted of an interviewer-administered questionnaire, collected on a 24-h basis, during the entire week. Setting and Participants: Cases were 127 patients (78% male) admitted to the ER because of an injury that was the result of violence (being in a fight or being attacked by someone). A sample of residents from Pachuca (n = 920) was the comparison group. Results.?Patients reporting drinking within 6 h compared to nondrinkers were more likely to suffer a violence-related injury [34.0 (17.5–66.2)] and alcohol dependent patients were more likely to be involved in a violence-related injury [7.4 (3.5–15.6)] compared to noncurrent drinkers. When both alcohol prior and alcohol dependence were considered simultaneously in multiple models among current drinkers, patients with violence-related injuries were more likely to report alcohol prior but not to be positive for alcohol dependence. Depressive symptoms, but not conduct problem behavior, were also associated with violent injury in simultaneous regressions that included alcohol variables. Conclusions.?In the city of Pachuca, Mexico, a large relationship between drinking prior to the event and violence-related injury, regardless of alcohol dependence, was found. Depression was also related to violence, suggesting the need for more comprehensive intervention with these patients.     

Validity of self-reported alcohol consumption in the emergency room: data from the United States, Mexico and Spain.

The validity of self-reported alcohol consumption within 6 hours prior to injury based on breath-analyzer readings obtained at the time of emergency room (ER) admission is compared among probability samples of ER patients in Contra Costa County, California (n = 450), Mexico City (n = 500) and Barcelona, Spain (n = 864). The same questionnaire, study design and methods were used in all three countries to maintain comparability for comparative analyses. The analysis was restricted to those breath analyzed within 6 hours of injury occurrence who reported no drinking following the event. Validity of self-reports was high in all three samples. The proportion of those reporting not drinking prior to injury who had positive breath-analyzer readings was .5% in the U.S., 1.5% in Spain and 3.3% in Mexico. Validity of self-reports was not associated with cause of injury in the United States. In Mexico those injured in motor vehicle accidents or by violence were most likely to deny drinking, while in Spain those injured in violent situations were most likely to report not drinking. Validity of self-reports in these studies is much higher than that found in other U.S. studies, but this may be partly due to the fact that self-reports were obtained after the patient had been breath analyzed.     

Drug use and problem drinking associated with primary care and emergency room utilization in the US general population: data from the 2005 national alcohol survey

BACKGROUND: Substance use problems are overrepresented in probability samples of patients in primary care settings including the emergency room (ER) compared to the general population. While large proportions of those with alcohol or drug use disorders are most likely to obtain services for these problems outside the mental health or substance abuse treatment system, accounting, in part, for this overrepresentation, little is known about the association of alcohol misuse or drug use with health services utilization in the general population. METHODS: The prevalence and predictive value of alcohol misuse and drug use on ER and primary care use was analyzed on 6919 respondents from the 2005 National Alcohol Survey (NAS). RESULTS: Among those reporting an ER visit during the last year, 24% were positive for risky drinking (14+ drinks weekly for men and 7+ for females and/or 5+/4+ in a day in the last 12 months), 8% for problem drinking, 3% for alcohol dependence, and 7% for illicit drug use greater than monthly. Figures for primary care users were, respectively: 24%, 5%, 3%, and 3%. ER users were more likely to be positive for problem drinking and greater than monthly illicit drug use compared to non-ER users, while no significant differences were found in substance use for users and non-users of primary care. In logistic regression controlling for gender, age, and health insurance, problem drinkers were twice as likely as non-problem drinkers (Odds ratio, OR=1.99) (p<0.01), and those reporting greater than monthly drug use were almost twice as likely as those using drugs less frequently or not at all (OR=1.92; p=0.01) to report ER use, while those reporting alcohol dependence were 1.63 times more likely to report primary care use (p<0.05). CONCLUSION: These data support the belief that both the ER and other primary care settings are important sites for identifying those with substance use problems and for initiating a brief intervention.     

Selection of screening items for alcohol abuse and alcohol dependence among Mexicans and Mexican Americans in the emergency department.

OBJECTIVE: This article reports on the selection of screening items to detect Mexican or Mexican-American patients in the emergency department (ED) who have alcohol problems and could benefit from an intervention or a referral for treatment. Items are tested against the Rapid Alcohol Problems Screen (RAPS), which has been optimized from standard screening instruments and has outperformed these instruments. METHOD: The performance of individual items from standard screening instruments (CAGE, TWEAK, AUDIT, TRAUMA and BMAST) against International Classification of Diseases, Tenth Revision and Diagnostic and Statistical Manual, Fourth Revision criteria for alcohol abuse and dependence was evaluated in a merged probability sample (N = 869; 72% men) of 537 ED patients from three hospitals in Pachuca, Mexico, and 332 Mexican-American ED patients in Santa Clara County, CA. Logistic regression and tree-classification models were used for item selection. RESULTS: We found a prevalence of 15% for alcohol dependence and a prevalence of 28% for alcohol abuse or dependence in the merged sample. The RAPS items did not perform as well in terms of sensitivity (93%) as the optimal five items identified in these analyses (sensitivity = 98%) for alcohol dependence, but did demonstrate better specificity (79%) than the optimal five items (65%), which is an important consideration in a time of cost containment. Both sets of items showed better sensitivity and positive predictive value but similar Receiver Operating Characteristic values for respondents in the high acculturation group compared to those at other levels of acculturation. Differences in positive predictive value across all subgroups tended to increase at increased cutpoints, especially for the RAPS. CONCLUSIONS: These analyses suggest that the RAPS performs favorably compared to those items optimized, in this sample of Hispanic ED patients. Based on comparative item performance in these analyses, the RAPS may hold promise as a useful tool for screening for alcohol dependence, but requires further evaluation as a stand-alone instrument in comparison with other standard screening instruments.     

Psychometric properties of alcohol screening tests in the emergency department in Argentina,Mexico and the United States

The objective of this article is to report psychometric characteristics of the AUDIT, CAGE, RAPS4, and TWEAK and to compare them across three countries: Argentina, Mexico, and the United States which used a similar protocol and methodology. Probability samples of patients 18 years and older were drawn from emergency departments in Mar del Plata, Argentina (n = 780), Pachuca, Mexico (n = 1624) and Santa Clara, U.S. (n = 1220). Concurrent validity was assessed by comparing their performance against a diagnosis of alcohol dependence (DSM-IV) obtained through the Composite International Diagnostic Interview, and for the briefer measures, also by their correlation with the AUDIT. The internal consistency of the CAGE, RAPS4, and TWEAK scores was estimated by the KR-20 formula and by Cronbach's Alpha for the AUDIT. Corrected item-total correlation and D-values were used as item discrimination measures.     

Alcohol-related expectancies and assaults among injured drinkers in the emergency department setting.

This study examined the extent to which alcohol-related expectancies were associated with assaults among 278 injured drinkers in the emergency department setting. Results of logistic regression analyses indicated that patients who were male, had high blood alcohol levels and who expected alcohol to make them more careless were more likely to report being assaulted. Conversely, among males, patients who expected to become more powerful and aggressive when drinking were less likely to be assaulted. These findings suggest that helping patients understand how expectancies surrounding alcohol use shape drinking and its behavioral concomitants may circumvent their risk for future assaults.     

Drinking patterns and problems, drug use and health services utilization: a comparison of two regions in the US general population

While substance abuse has been found to be over-represented in some primary care settings, we do not know under what circumstances this association may vary, and whether it may be linked to differences in attitudes regarding alcohol use as reflected in regional rates of abstention and heavy or problem drinking. Data are reported from the Southern and Western regions of the 1995 National Alcohol Survey. Alcohol consumption variables were not found to be predictive of primary care utilization. Main effects were found for heavier drinking on emergency room (ER) use for an injury, and interactive effects of region were found for consequences of drinking, with those in the South who reported consequences more likely to have used the ER for either an injury or illness than those in the West. These data suggest that ER utilization may be related to regional differences in drinking patterns, while primary care utilization may not be.     

Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department

OBJECTIVE: The study aim was to test whether a brief motivational intervention, with or without a booster session, would improve drinking-related outcomes more than standard Emergency Department (ED) treatment. METHOD: The study population consisted of 539 (78% male) injured patients treated in the ED and discharged to the community following their treatment. Injured patients met inclusion criteria if they were assessed as hazardous or harmful drinkers by scoring eight or more on the AUDIT and/or having alcohol in their system at the time of their injury or ED visit. Patients were randomly assigned to either standard care (SC), brief intervention (BI) or brief intervention plus a booster session (BIB). At 1-year follow-up, 447 patients (83% of the sample) were re-interviewed to measure alcohol-related negative consequences, injuries and drinking. RESULTS: Patients receiving BIB, but not B1 patients, reduced alcohol-related negative consequences and alcohol-related injuries more than did those in the SC group. All three groups reduced their days of heavy drinking. Patients with histories of hazardous drinking responded to BIB, whether or not they had consumed alcohol prior to their injury. CONCLUSIONS: Together, these results indicate that the effects of a booster session that is added to a brief intervention in the ED can be helpful to injured patients with a history of hazardous or harmful drinking, irrespective of whether they have consumed alcohol prior to their injury.     

Multi-level analysis of causal attribution of injury to alcohol and modifying effects: Data from two international emergency room projects

Although alcohol consumption and injury has received a great deal of attention in the literature, less is known about patient's causal attribution of the injury event to their drinking or factors which modify attribution. Hierarchical linear modeling is used to analyze the relationships of the volume of alcohol consumed prior to injury and feeling drunk at the time of the event with causal attribution, as well as the association of aggregate individual-level and socio-cultural variables on these relationships. Data analyzed are from 1955 ER patients who reported drinking prior to injury included in 35 ERs from 24 studies covering 15 countries from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the WHO Collaborative Study on Alcohol and Injuries. Half of those patients drinking prior to injury attributed a causal association of their injury with alcohol consumption, but the rate of causal attribution varied significantly across studies. When controlling for gender and age, the volume of alcohol consumed and feeling drunk (controlling for volume) were both significantly predictive of attribution and this did not vary across studies. Those who drink at least weekly were less likely to attribute causality at a low volume level, but more likely at high volume levels than less frequent drinkers. Attribution of causality was also less likely at low volume levels in those societies with low detrimental drinking patterns, but more likely at high volume levels or when feeling drunk compared to societies with high detrimental drinking patterns. These findings have important implications for brief intervention in the ER if motivation to change drinking behavior is greater among those attributing a causal association of their drinking with injury.     

Alcohol consumption and casualties; drinking in the event

The data reported are from a 20% probability sample (n = 2516) of all adult patients seeking care in the emergency room at San Francisco General Hospital during a 60-day period. Thirty-five percent (35%) of the injured and 18% of the non-injured reported drinking prior to the event. This paper compares the following variables related to drinking-in-the-event for injured and non-injured: drinking places, drinking companions, amount consumed, time lapsed between drinking and the event, effects of drinking and causality attributed by the patient to drinking and the event. When these variables were entered into a logistic regression to evaluate their predictive value on injury status, only time lapsed since the last drink and drug use prior to the event were predictive of injury with both being negatively associated with admission to the emergency room for an injury. Injuries were more likely than non-injuries to occur in close proximity to drinking (44% of injuries occurred in less than 1 h of the last drink), and close to a third of the injured attributed a causal association of drinking with the event, with 60% of these feeling they were drunk at the time of injury.     

Variation in length of time to development of alcoholism by family history of problem drinking

Patients hospitalized for treatment of alcoholism were asked to provide information on family history of drinking problems, age at onset of drinking, and timing of the occurrence of problems due to use of alcohol in their lives, using a time scale. Analysis of data from 256 male patients indicated a strong association between a family history of problem drinking and development of alcoholism at a young age. Mean age at the time the patients could be defined as alcoholic, based on the chronological history of the time of occurrence of symptoms, ranged from 27.2 years for bilineal family history positive patients to 38.5 years for those with negative family history, and the difference could not be explained by differences in age at onset of drinking. The results indicate that the increased risk of alcoholism among individuals with family history of problem drinking, which has been postulated on the basis of many cross-sectional studies, is likely to be overestimated.     

Prevalence and correlates of alcohol use disorders during antiretroviral treatment in injection-driven HIV epidemics in Vietnam

BackgroundAlcohol use disorders (AUD) negatively affects adherence to and outcomes of antiretroviral treatment (ART) for HIV/AIDS patients. This study determined the prevalence of AUD and identified correlates of alcohol consumption and drinking problems during ART in large injection-driven HIV epidemics in Vietnam.MethodsWe conducted a cross-sectional study of 1016 patients (36.2% women, mean age = 35.4) in 7 hospitals in Hanoi, Hai Phong, and Ho Chi Minh City. Alcohol use problems were assessed using the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C). Step-wise multivariate regression analyses determined the correlates of alcohol consumption, hazardous drinking, and binge drinking in HIV/AIDS patients.ResultsThere were 55.0% patients reported ever drinking, 30.1% had positive hazardous drinking and 22.3% had binge drinking. Patients who were male, drug users, working as free-lancers, asymptomatic stage, and poorer immune status were more likely to have severe alcohol consumption, hazardous drinking and binge drinking. Drug users taking both ART and Methadone Maintenance Treatment (MMT), were less likely to report AUD. In non-drug users, the longer duration of ART was also associated with lower alcohol consumption and likelihood of drinking problems. In drug users, those in the 1st year ART were more likely to be at-risk drinking than other patient groups.ConclusionAUD is highly prevalent in HIV/AIDS patients taking ART in large injection-driven HIV epidemics. ART guidelines should include AUD screening and interventions. Expanding the coverage of current services for drug users, including MMT and ART, might contribute to the reduction of AUD.     

Breath analysis and self-reports as measures of alcohol-related emergency room admissions

This study reports breath-analyzer readings and self-reports as measures of alcohol-related admission to the emergency room of San Francisco General Hospital. A 20% probability sample of patients admitted during a 60-day period was breath analyzed and interviewed. Interviews and breath samples were obtained on 75% of the sample of 2,516 patients. Twice the proportion of injury patients compared to noninjury patients had positive admission breath samples and reported drinking prior to the event. Alcohol involvement reached 41% for self-reports among injured men and over half of both men and women injured in fights or assaults reported drinking prior to the event. Self-reported alcohol use was found to be a valid measure of alcohol consumption when compared to breath-analyzer readings for the same individuals. Emergency room patients may be more likely than others to provide accurate reports of alcohol consumption if they feel that disclosure of amount and timing of drinking prior to an injury or illness could be important in their care. The data suggest that self-reports when used in conjunction with a quantifiable estimate of blood alcohol may be an appropriate method of ascertaining alcohol's involvement in emergency room cases.     

The Role of Ineffective Emotion Regulation in Problem Drinking Varies by Emotional Disposition,Delinquency, and Gender of South Korean Adolescents

This study examined the role of emotion regulation (ER) strategies and emotional disposition in problem drinking of adolescent offenders (n = 303) and non-offending peers (n = 287) from South Korea. The participants completed a questionnaire assessing problem drinking, positive and negative emotion, emotional intensity, and use of problem solving, support seeking, and avoidant ER strategies. Problem drinking was positively associated with negative emotion, emotional intensity, and support-seeking ER in both groups, and avoidant ER among offenders only. Support-seeking ER accounted for the association between positive emotion and drinking in both groups, and avoidant ER further accounted for the association between positive emotion and drinking among offenders. Only among female offenders was the association between emotional intensity and drinking explained by support-seeking ER. The results imply that intervention to improve ER effectiveness, taking into account emotional disposition, delinquency differences, and gender, may help lessen problem drinking among adolescents.     

热休克蛋白70与雌孕激素受体在男性乳腺良恶性病变中的表达

目的　为探讨热休克蛋白 70与雌、孕激素受体在男性乳腺增生和男性乳癌增殖中的作用及意义。方法　用免疫组织化学方法对 2 8例男性乳腺发育异常和 2例男性乳癌进行检测。结果　在 2 8例男性乳腺增生病变中 ,热休克蛋白 70阳性率为 70 .1% (2 0 / 2 8) ,雌、孕激素受体阳性率分别为 6 4.3%和 6 0 .7% (18/ 2 8和 17/ 2 8) ;2例男性乳癌三种染色均为阳性。结论　结果提示 ,热休克蛋白可作为导管上皮增生及癌细胞增殖的一个指标。雌、孕激素受体失衡与男性乳腺增生及男性乳癌的发生有关。     

The effect of alcohol consumption on emergency department services use among injured patients: A cross-national emergency room study

OBJECTIVE: Although injured patients in the emergency department (ED) report more frequent use of the ED compared with the general population, and alcohol-related admissions and chronic alcohol misuse have been found to be predictive of future ED admissions, these data are based on only a few U.S. studies. The purpose of this article was to explore the association of alcohol use and ED services use among injured patients cross-nationally. METHOD: Binary and multinomial logistic regression were used to analyze the association of alcohol consumption with prior ED visits among 9,743 injured patients surveyed in 37 EDs in 14 countries and reported in 23 studies from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and World Health Organization Collaborative Study of Alcohol and Injuries. RESULTS: Drinking within 6 hours before injury was associated with prior ED visits during the last 12 months (odds ratio = 1.25, p < .05), with a positive dose-response relationship. Heavy drinkers and those drinkers who were alcohol-dependent were also significantly more likely to report multiple prior ED visits, reflecting an elevated burden of services use. At the ED level, stigmatization of alcohol use was the only significant contextual variable that consistently predicted cross-ED variation in the relationship between drinking and ED use, in which the association was weaker in areas where alcohol use is less accepted. CONCLUSIONS: This study lends additional support to the potential effectiveness of screening for acute and chronic alcohol use among ED injured patients to reduce ED services use and associated costs.     

Alcohol-related injury in the ER: a cross-national meta-analysis from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP)

OBJECTIVE: To examine the impact of usual drinking patterns and related problems on the acute use of alcohol in injury. METHOD: The impact of quantity and frequency of drinking, alcohol problems and dependence symptoms on admission to the emergency room (ER) for an alcohol-related injury (based, separately, on a positive blood alcohol concentration [BAC] and self-reported drinking within 6 hours prior to injury), compared with a nonalcohol related injury, was examined using meta-analysis, across 15 ER studies covering seven countries. RESULTS: Pooled effect size for consuming five or more drinks on an occasion at least monthly was significant but not homogeneous, with odds ratios (ORs) of 4.16 for BAC and 3.92 for self-report. Frequency of drinking among nonheavy drinkers was found to have the largest effect size (5.93 for BAC and 4.93 for self-report). Heavy drinking, controlling for frequency, was also significant (ORs of 2.08 for BAC and 1.86 for self-report), but effect size was homogeneous only for self-report. Effect sizes for consequences of drinking and dependence symptoms were also significant and homogeneous, with ORs of 4.29 and 3.55, respectively, for BAC, and 3.84 and 3.94, respectively, for self-report. In meta-regression analysis, among contextual variables the level to which alcohol use is stigmatized in the culture was most consistently predictive of heavy-drinking effect size on an alcohol-related injury, with larger effect sizes found in those studies reporting a lower level of stigmatization. CONCLUSIONS: Whereas quantity and frequency of drinking were both found to be highly predictive of an alcohol-related injury, sociocultural variables may affect observed associations of heavy drinking with an alcohol-related injury.