Associations between alcohol outlets and emergency department injury presentations: effects of distance from the central business district

Objective : To examine the effects of licensed outlets and sales on levels of alcohol‐related injuries presenting to emergency departments (EDs) in the Inner, Middle and Outer postcode zones of Perth, Australia. Methods : Using panel data (2002–2010), a surrogate measure (based on day of week and time of day of presentation) was used to identify alcohol‐related injuries presenting at EDs. Postcodes were grouped according to their distance from the central business district (CBD). Numbers of alcohol outlets and their sales were the primary explanatory variables. Data were analysed using negative binomial regression with random effects. Results : In the Inner and Outer postcode zones, counts of on‐site outlets were positively associated with alcohol‐related injury (IRR: 1.008; 95%CI 1.003–1.013 and IRR: 1.021; 95%CI 1.013–1.030 respectively). An additional off‐site outlet was associated with 6.8% fewer alcohol‐related injuries (95%CI 0.887–0.980). In the Middle postcode zone, mean off‐site sales were positively associated with injury (IRR: 1.024; 95%CI 1.003–1.044). Conclusions : Associations between alcohol availability variables and injury differed by outlet type and distance from the CBD. Implications : These findings provide further evidence to support stronger controls on liquor licensing, and indicate the need for different controls according to the location and type of licence.     

Neighborhood Alcohol Outlets and the Association with Violent Crime in One Mid-Atlantic City: The Implications for Zoning Policy

Violent crime such as homicide causes significant excess morbidity and mortality in US urban areas. A health impact assessment (HIA) identified zoning policy related to alcohol outlets as one way to decrease violent crime. The objectives were to determine the relationship between alcohol outlets including off-premise alcohol outlets and violent crime in one urban area to provide local public health evidence to inform a zoning code rewrite. An ecologic analysis of census tracts in Baltimore City was conducted from 2011 to 2012. The data included violent crimes (n = 51,942) from 2006 to 2010, licensed alcohol outlets establishments (n = 1,327) from 2005 to 2006, and data on neighborhood disadvantage, percent minority, percent occupancy, and drug arrests from 2005 to 2009. Negative binomial regression models were used to determine the relationship between the counts of alcohol outlets and violent crimes controlling for other factors. Spatial correlation was assessed and regression inference adjusted accordingly. Each one-unit increase in the number of alcohol outlets was associated with a 2.2 % increase in the count of violent crimes adjusting for neighborhood disadvantage, percent minority, percent occupancy, drug arrests, and spatial dependence (IRR = 1.022, 95 % CI = 1.015, 1.028). Off-premise alcohol outlets were significantly associated with violent crime in the adjusted model (IRR = 1.048, 95 % CI = 1.035, 1.061). Generating Baltimore-specific estimates of the relationship between alcohol outlets and violent crime has been central to supporting the incorporation of alcohol outlet policies in the zoning code rewrite being conducted in Baltimore City.     

The social gradient of alcohol availability in Victoria, Australia

Objectives: To explore the socioeconomic gradient of alcohol availability in Victoria, Australia. Methods: Using data for the smallest geographic units available, per‐capita and area‐based measures of alcohol outlet density were calculated for four types of alcohol outlet (broadly: restaurants, hotels, packaged liquor outlets and licensed clubs). These densities were aggregated across deciles of socioeconomic disadvantage, to compare the average density of alcohol outlets across ten levels of socioeconomic status. In addition, negative binomial regression models were developed, assessing the relationship between density and socioeconomic status while controlling for relevant covariates. Results: In urban areas, both takeaway liquor outlets and licensed clubs were significantly more likely to be located in areas of socioeconomic disadvantage, while hotel and restaurant licences were more prevalent in advantaged areas. In rural and regional Victoria, all types of outlet types were more prevalent in areas of socioeconomic disadvantage. Conclusions: The findings suggest that disparities in exposure to alcohol outlets in Victoria may play a role in explaining socioeconomic disparities in health outcomes, with Victorians living in disadvantaged areas generally faced with higher levels of alcohol availability.     

Density of tobacco retail outlets near schools and smoking behaviour among secondary school students

Objective: To investigate whether the density of tobacco retail outlets near schools in Victoria, Australia, is associated with adolescent smoking behaviour. Methods: Cross‐sectional survey data of 2,044 secondary school students aged 12–17 years was combined with tobacco outlet audit data. Associations between students' self‐reported tobacco use and the density of tobacco outlets near schools was examined using multilevel logistic and negative binomial regression models, with cigarette price at local milk bars and key socio‐demographic and school‐related variables included as covariates. Results: Increased tobacco retail outlet density was associated with a significant increase in the number of cigarettes smoked in the previous seven days among students who smoked in the past month (IRR=1.13; 95% CI 1.02–1.26), but not the odds of smoking in the past month in the larger sample (OR=1.06; 95% CI 0.90–1.24), after controlling for local mean price of cigarettes and socio‐demographic and school‐related variables. Conclusions and implications: This study suggests there is a positive association between tobacco retail outlet density and cigarette consumption among adolescent smokers, but not smoking prevalence, in the Australian context. There is value in considering policy measures that restrict the supply of tobacco retail outlets in school neighbourhoods as a means of reducing youth cigarette consumption.     

Alcohol outlet density is related to police events and motor vehicle accidents in Manukau City,New Zealand

Objectives: To explore the cross‐sectional association between alcohol outlet density and police events in Manukau City, New Zealand. Methods: Using data for the Census Area Unit (suburb) level, per‐capita measures of alcohol outlet density for January 2009 were calculated for off‐licence outlets, clubs and bars, and restaurants and cafés. Data on police events and motor vehicle accidents were obtained for the period 1 July 2008 to 30 June 2009, and also converted into per capita measures. A spatial seemingly unrelated regression model was developed, which simultaneously assessed the relationship between densities and all nine categories of police events, and motor vehicle accidents, while controlling for relevant covariates. Results: All three outlet density measures were significantly associated with a range of police events, but only off‐licence density was significantly associated with motor vehicle accidents. An additional off‐licence outlet in a given area was associated with 85.4 additional police events and 10.3 additional motor vehicle accidents; an additional club or bar was associated with 34.7 additional police events and 0.5 additional motor vehicle accidents; and an additional restaurant or cafe was associated with 13.2 additional police events and 2.1 additional motor vehicle accidents. Conclusions: The results do not imply causality. However, they are broadly consistent with availability theory, and imply that local alcohol policy should account for the effects of additional outlets when new licences are granted. While the methodological approach described here is easily transferable to investigate the relationships elsewhere, we suggest some areas for improvement of future studies.     

The Geography of Violence,Alcohol Outlets,and Drug Arrests in Boston

Objectives. We examined the relationship between alcohol outlets, drug markets (approximated by arrests for possession and trafficking), and violence in Boston, Massachusetts, in 2006. We analyzed geographic and environmental versus individual factors related to violence and identified areas high in violent crime.Methods. We used data from the Boston Police Department, US Census, and Massachusetts State Alcohol Beverage Control Commission. Spatial modeling was employed at the block group level, and violent crime, alcohol outlets, and drug markets were mapped.Results. Relative to other block groups, block groups in the highest decile of violent crime (n = 55) were found to be poorer (e.g., lower incomes, higher percentages of vacant homes), and they had greater numbers of alcohol outlets and higher drug arrest rates. Alcohol outlets and drug possession and trafficking arrests were predictive of violent crime. Also, spatial effects resulting from neighboring block groups were related to violent crime. Both alcohol outlet density and type were associated with violent crime in a differentiated and complex way.Conclusions. With drug possession and trafficking arrests as a proxy for drug markets, spatial relationships between alcohol outlets and violence were found in addition to typical sociodemographic predictors.Understanding the environmental and social contexts in which violence occurs has been an increasingly important area of research, one that has broad applicability to public policies on violence mitigation far beyond purely research issues. Increased theoretical understanding of the spatial and environmental contexts of violence, such as theories relating alcohol outlets to violence, have gone hand in hand with improvements in spatial techniques and computing power, transforming this area of research. Furthermore, although there have been studies on violence related to types and densities of alcohol outlets,1–5 there has been less research attempting to include measures of drug arrests and to more fully incorporate spatial features such as characteristics of adjacent geographic areas.Locations of alcohol outlets are frequently related to occurrence of violence. The incidence of interpersonal violence appears to increase in and around locations with alcohol outlets, particularly bars and liquor stores.1,3–5 There are several possible mechanisms. First, bars and liquor stores often attract individuals likely to be involved in violent interactions, such as young males (alcohol availability theory).6 Second, these retail alcohol outlets are often located in areas with less guardianship than others (social disorganization theory).1,3,7 Third, these types of outlets provide opportunities for social interactions that may lead to violence (alcohol availability and niche theory).Finally, establishments serving alcohol can foster increased expressions of aggression.6 Empirical studies have shown a correlation between higher rates of violence and increased proximity to bars and liquor stores1,8–10 as well as sales through alcohol outlets.11 Similar arguments have been suggested to support empirically observed cross-sectional relationships between rates of violence and locations of off-premise establishments.9,12Establishment effects, however, may be related to other crime-related aspects of the environments of off-premise outlets, such as illegal drug activity and prostitution.13 Questions remain as to whether effects related to alcohol outlets are due to the outlets themselves or the general characteristics of the areas in which they are located. Recent criminological research on bars and taverns suggests that managers of these establishments create environments that suppress or facilitate violence through business-related choices such as types of activities and entertainment, staff and training, and property characteristics.14Two theoretical concerns have guided much of the empirical work over the past 2 decades. First, alcohol outlets might serve as markers for other population or environmental features that are related to violence. These markers could consist of specific population characteristics related to greater levels of violence (e.g., poverty, female-headed households)10 or place-based characteristics related to lower levels of police enforcement and surveillance (e.g., vacant retail establishments).15 Second, violence and alcohol outlets are part of the continuous spatial fabric of communities, and thus standard statistical analyses of data, which assume independence of observations, are complicated by spatial autocorrelation between observations.16 Spatial models have been applied to help correct for bias or increased sampling variation of effect estimates arising from a lack of spatial independence in modeling violence outcomes.17We examined the relationship between alcohol outlets and violent crime in an analytical framework that treats alcohol outlets as potentially both “producers” of violent behavior and markers or attractors of violence. Our initial assessments of the effects of typical sociodemographic measures demonstrated that there remained effects of alcohol outlet presence not accounted for by these features. Subsequently, to capture more spatial and environmental characteristics and to illustrate the presence of spatial effects that were distinct from the 2 types of effects just mentioned, we assessed how adjacent area characteristics relate to violent crime in the target area. To deal with the different ways in which outlets are posited to be related to violence, we accounted for outlet density and type and whether a violent crime occurred on a weekend or weekday.In addition, we included information on drug arrests for trafficking and possession (as estimators of drug markets) to properly account for the relationship between violence and drug markets when assessing the effects of alcohol outlets. Although Martinez et al.18 found a significant relationship between drug markets and violence when accounting for social disorganization, our analysis is the first, to our knowledge, to also include alcohol outlet type and density.     

From Medical to Recreational Marijuana Sales: Marijuana Outlets and Crime in an Era of Changing Marijuana Legislation

A movement from medical to recreational marijuana use allows for a larger base of potential users who have easier access to marijuana, because they do not have to visit a physician before using marijuana. This study examines whether changes in the density of marijuana outlets were related to violent, property, and marijuana-specific crimes in Denver, CO during a time in which marijuana outlets began selling marijuana for recreational, and not just medical, use. We collected data on locations of crimes, marijuana outlets and covariates for 481 Census block groups over 34 months (N = 16,354 space–time units). A Bayesian Poisson space–time model assessed statistical relationships between independent measures and crime counts within “local” Census block groups. We examined spatial “lag” effects to assess whether crimes in Census block groups adjacent to locations of outlets were also affected. Independent of the effects of covariates, densities of marijuana outlets were unrelated to property and violent crimes in local areas. However, the density of marijuana outlets in spatially adjacent areas was positively related to property crime in spatially adjacent areas over time. Further, the density of marijuana outlets in local and spatially adjacent blocks groups was related to higher rates of marijuana-specific crime. This study suggests that the effects of the availability of marijuana outlets on crime do not necessarily occur within the specific areas within which these outlets are located, but may occur in adjacent areas. Thus studies assessing the effects of these outlets in local areas alone may risk underestimating their true effects.     

Is access to alcohol associated with alcohol/substance abuse among people diagnosed with anxiety/mood disorder?

ObjectivesTo investigate the relationship between access to off-license alcohol outlets and areas with dual treatment for alcohol/drug abuse and anxiety/mood disorder compared to areas with anxiety/mood disorder only in an urban setting in New Zealand.Study designEcologic study.MethodsWithin small areas (2840 meshblocks, mean size 0.05 km²) in the city of Auckland, New Zealand, counts of adults receiving anxiety/mood disorder treatment (2008–9) were identified and the proportions of these individuals also receiving treatment for alcohol/drug abuse were generated. Access to off-license alcohol outlets were defined as: 1) shortest road distance from the population-weighted centroid of each small area to an outlet; 2) count of outlets within a 3 km road network buffer; and 3) relative density of outlets across Auckland (determined through kernel density estimates). To test for the relationship between access to alcohol outlets and dual diagnosis, meshblocks without any cases of anxiety/mood disorder were excluded from analyses. Remaining meshblocks were dichotomized into any or no dual diagnosis. Logistic regression was used to estimate the association between access to alcohol outlets and treatment for the dual conditions.ResultsNeighbourhoods with dual diagnosis were generally similar to those with anxiety/mood disorder only, in terms of ethnic and gender/age composition. Regression analyses indicated statistically significant decreased risk of dual diagnosis for those areas with the lowest density (using a buffer) of alcohol outlets (OR = 0.75, P-value = 0.027) compared with areas with the highest density, after adjustment for deprivation and population density. All access measures also indicated significant linear trends where dual diagnosis was more likely in areas with greater access.ConclusionsGenerally, decreased access to alcohol outlets was associated with decreased odds of dual diagnosis of alcohol/drug abuse and anxiety/mood disorder. Measures to control access to alcohol outlets may be an important area for alcohol/substance abuse intervention, particularly for vulnerable sub-populations.     

Alcohol Outlets,Neighborhood Characteristics,and Intimate Partner Violence: Ecological Analysis of a California City

Neighborhood indicators of social disadvantage, such as poverty and unemployment, are associated with intimate partner violence (IPV). Despite the well-established link between heavy drinking and IPV, few studies have analyzed the contribution of alcohol outlet density to the occurrence of IPV. Greater numbers of alcohol outlets in a community may be a sign of loosened normative constraints against violence, promote problem drinking among at-risk couples, and provide environments where groups of persons at risk for IPV may form and mutually reinforce IPV-related attitudes, norms, and problem behaviors. This study used ecological data to determine if alcohol outlet density (number of bars, restaurants serving alcohol, and off-premise outlets per unit area) is related to rates of IPV-related police calls and IPV-related crime reports in Sacramento, California. Separate analyses for IPV calls and crime reports were conducted using Bayesian space–time models adjusted for area characteristics (poverty rate, unemployment rate, racial/ethnic composition). The results showed that each additional off-premise alcohol outlet is associated with an approximate 4% increase in IPV-related police calls and an approximate 3% increase in IPV-related crime reports. Bars and restaurants were not associated with either outcome. The findings suggest that alcohol outlet density, especially off-premise outlets, appear to be related to IPV events. Further research is needed to understand the mechanisms by which neighborhood factors, such as alcohol outlet density, affect IPV behaviors. Understanding these mechanisms is of public health importance for developing environmental IPV prevention strategies, such as changes in zoning, community action, education, and enforcement activities.     

Alcohol outlet density and violence: a geospatial analysis

AIMS: To examine the relationship between alcohol outlet density and violent crime controlling for neighbourhood sociostructural characteristics and the effects of spatially autocorrelated error. DESIGN: The sample for this ecologic study comprised 188 census tracts from the City of Austin, Texas and 263 tracts from the City of San Antonio, Texas. Data pertaining to neighbourhood social structure, alcohol density and violent crime were collected from archival sources, and analysed using bivariate, multivariate and geospatial analyses. RESULTS: Using ordinary least squares analysis, the neighbourhood sociostructural covariates explained close to 59% of the variability in violent crime rates in Austin and close to 39% in San Antonio. Adding alcohol outlet density in the target and adjacent census tracts improved the explanatory power of both models. Alcohol outlet density in the target census tract remained a significant predictor of violent crime rates in both cities when the effects of autocorrelated error were controlled for. In Austin, the effects of alcohol outlet density in the adjacent census tracts also remained significant. The final model explains 71% of the variance in violent crime in Austin and 56% in San Antonio. CONCLUSIONS: The findings show a clear association between alcohol outlet density and violence, and suggest that the issues of alcohol availability and access are fundamental to the prevention of alcohol-related problems within communities.     

At Surgeons' Sessions: A Focus on Adjunctive Immunotherapy

Abstract

Background: Antimuscarinic drug prescribing scoring systems might better identify patients at risk of adverse drug reactions. The recently developed Anticholinergic Risk Scale (ARS) score is significantly associated with the number of antimuscarinic side effects in older outpatients. We sought to identify the clinical and demographic patient-level correlates of the ARS, including a modified version adjusted for daily dose, in elderly hospitalized patients. Methods: Clinical and demographic patient characteristics known to be associated with antimuscarinic prescribing, ARS and dose-adjusted ARS scores, and full medication exposure on admission were recorded in 362 consecutive patients (aged 83.6 ± 6.6 years) admitted to 2 geriatric units (NHS Grampian, Aberdeen, Scotland, UK) between February 1, 2010 and June 30, 2010. Results: Each year of increasing age was associated with reduced number of antimuscarinic drugs (incidence rate ratio [IRR], 0.963; 95% confidence interval [CI], 0.948–0.980; P < 0.001), non-antimuscarinic drugs (IRR, 0.991; 95% CI, 0.985–0.997; P = 0.006), and total number of drugs (IRR, 0.988; 95% CI, 0.983–0.994; P < 0.001). Multivariate Poisson regression showed that increasing age and history of dementia were negatively associated with the ARS score (IRR, 0.97; 95% CI, 0.94–0.99; P = 0.001 and IRR, 0.62; 95% CI, 0.41–0.92; P = 0.019, respectively). By contrast, institutionalization (IRR, 1.32; 95% CI, 1.00–1.74; P = 0.050), Charlson comorbidity index (IRR, 1.06; 95% CI, 1.01–1.11; P = 0.015), and total number of non-antimuscarinic drugs (IRR, 1.13; 95% CI, 1.08–1.18; P < 0.001) were all positively associated with the ARS score. Similar results were observed for the dose-adjusted ARS score. Conclusion: Institutionalization, comorbidities, and non-antimuscarinic polypharmacy show independent positive associations with the ARS and dose-adjusted ARS scores in older hospitalized patients. Increasing age and dementia are negatively associated with the ARS score.     

Evaluation of alcohol outlet density and its relation with violence

OBJECTIVES: The current study set out to investigate alcohol availability in a densely populated, residential area of suburban S?o Paulo associated with high levels of social deprivation and violence. Gun-related deaths and a heavy concentration of alcohol outlets are notable features of the area surveyed. Given the strong evidence for a link between alcohol availability and a number of alcohol-related problems, including violent crime, measures designed to reduce accessibility have become a favored choice for alcohol prevention programs in recent years. METHODS: The interviewers were 24 residents of the area who were trained for the study. It was selected an area of nineteen streets, covering a total distance of 3.7 km. A profile of each alcohol outlet available on the area was recorded. RESULTS: One hundred and seven alcohol outlets were recorded. The number of other properties in the same area was counted at 1,202. Two measures of outlet density may thus be calculated: the number of outlets per kilometer of roadway (29 outlets/km); and the proportion of all properties that sold alcohol (1 in 12). CONCLUSIONS: The results of this study is compared with others which are mainly from developed countries and shown that the area studied have the highest density of alcohol outlet density ever recorded in the medical literature. The implication of this data related to the violence of the region is discussed. By generating a profile of alcohol sales and selling points, it was hoped to gain a better understanding of alcohol access issues within the sample area. Future alcohol prevention policy would be well served by such knowledge.     

Racial differences in post‐neonatal mortality in Chicago: What risk factors explain the black infant's disadvantage?

Objectives. To investigate the extent to which the place of residence affects the black to white differential in post‐neonatal (28–365 days) mortality, we performed a univariate analysis and multivariate logistic regression of the 1982–1983 Illinois vital records, Chicago Police violent crime information and 1980 US Census income data.

Methods. Four environmental predictors of post‐neonatal death were examined: a median family income of < $10 000 per year, a poverty prevalence of > 50%, violent crime rates of > 11/1000 and limited community access to primary medical care based on physician supply ratios.

Results. The post‐neonatal mortality rate of black (n = 50 765) infants was three times that of white (n = 50 690) infants: 10/1000 versus 3/1000, respectively. Thirty‐six percent of the white infants had none of the environmental risk factors, whereas only 13% of the black infants had none of the risk factors. For black infants, the presence of any one factor was associated with a slightly increased risk of post‐neonatal mortality (9/1000 as compared to 7/1000 with no risk factors), whereas the presence of two or more risk factors was associated with a higher risk (11/1000). When the number of these environmental risk factors were taken into account, the OR for black infants declined from 3.0 (95% CI 2.5–3.6) to 1.7 (95% Cl 1.5–1.9). When the differences in maternal age, education, marital status and infant birth weight were also taken into account the odds ratio of post‐neonatal death for blacks was 1.5 (95% CI 1.3–1.7).

Conclusions. We conclude that a substantial proportion of the black to white difference in post‐neonatal mortality is associated with specific environmental conditions.     

Longitudinal Associations between Change in Neighborhood Social Disorder and Change in Food Swamps in an Urban Setting

Few studies have examined how neighborhood contextual features may influence the food outlet mix. We evaluated the relationship between changes in neighborhood crime and changes in the food environment, namely the relative density of unhealthy (or intermediate) food outlets out of total food outlets, or food swamp score, in Baltimore City from 2000 to 2012, using neighborhood fixed-effects linear regression models. Comparing neighborhoods to themselves over time, each unit increase in crime rate was associated with an increase in the food swamp score (b?=?0.13; 95% CI, ?0.00017 to 0.25). The association with food swamp score was in the same direction for violent crime and in the inverse direction for arrests related to juvenile crimes (proxy of reduced crime), but did not reach statistical significance when examined separately. Unfavorable conditions, such as crime, may deter a critical consumer base, diminishing the capacity of a community to attract businesses that are perceived to be neighborhood enhancing. Addressing these more distal drivers may be important for policies and programs to improve these food environments.     

ALCOHOL-RELATED CRIME: THE GOOD PRACTICE OF THE MAGISTRATES' COURTS

Alcohol-related crime is an ongoing problem in the court systemof England and Wales. The Magistrates' Association believesthat the system could be improved by: (1) the introduction ofa new Licensing Act; (2) better control over licensed premises;(3) increased training for licensees; (4) more informative trainingfor magistrates on the availability and role of alcohol programmes;(5) improved enforcement of licensing laws by the police.     

Does Alcohol Outlet Density Affect Youth Access to Alcohol?

PurposeTo investigate how community alcohol outlet density may be associated with alcohol access among adolescents.MethodsData were collected through a three-wave panel study with youth aged 14–16 at baseline using computer-assisted telephone interviews. Study participants were recruited from 50 zip codes with varying alcohol outlet density and median household income in California. Data analyses were conducted using multilevel, linear growth models and data from 1028 youth (52% male, 51% white).ResultsAfter taking into account individual-level factors and zip code median household income, zip code alcohol outlet density was significantly and positively related to the initial levels of the likelihood and frequency of getting alcohol through various sources including commercial outlets, shoulder tapping, home or family members, and underage acquaintances.ConclusionsHigh levels of alcohol outlets in the community enable youth access to alcohol through commercial outlets, family, and social networks.     

Differences in licensee, police and public opinions regarding interventions to reduce alcohol-related harm associated with licensed premises

Objectives: To determine the level of support by licensees, police and the general public for interventions to reduce alcohol-related harm associated with licensed premises and to identify differences between the three groups.
Methods: Participants were 108 licensees of premises licensed to sell alcohol; 132 police officers; 200 members of the public. Questionnaires were administered either through work settings or by mail. Respondents' levels of agreement with interventions to reduce alcohol-related harm associated with licensed premises: responsible service of alcohol; security and crowd control; policing; patron transport; and linking of alcohol-related harm to licensed premises and communication.
Results: Police and members of the public were significantly more likely than licensees to agree with strategies under licensee control, such as subsidising patron transport and training staff to deal with intoxicated patrons. Police were more likely than licensees and members of the public to agree with strategies requiring community action and changes to liquor licensing laws. Licensees had significantly lower levels of agreement than the other groups about licensees' responsibility to reduce alcohol-related harm as a consequence of drinking at their premises.
Conclusions: While there was good agreement between police officers and members of the public about strategies for reducing alcohol-related harm at licensed premises, licensees held divergent views about strategies within their control. Licensees were less likely than police and members of the public to agree they were responsible for reducing alcohol-related harm resulting from drinking at their premises.     

Care Coordination to Enhance Management of Long‐Term Enteral Tube Feeding

Background: A systematic review and meta‐analysis was completed to summarize care delivery models that used care coordination and/or team approach methods in the management of patients requiring long‐term enteral tube feeding. Our aim was to evaluate team composition, implementation strategies, and the effectiveness of these methods. Methods: We conducted a broad search of 7 databases from inception to May 2012, cross‐referenced clinical reviews and medical guidelines, and consulted clinical experts. Independent reviewers screened eligible studies, extracted data, and assessed study quality. Results: Fifteen studies enrolling 2145 patients were included in this review. The studies described multidisciplinary teams composed of primary care physicians, specialists, nurses, dietitians, and language or speech specialists. Patients and their families/caregivers were also an important part of the care team. The interventions were multifaceted and employed multiple simultaneous strategies that particularly included patient and family education, staff education, and continuous auditing and feedback methods. Meta‐analysis suggested no significant reductions in complications (incidence rate ratio [IRR], 0.53; 95% confidence interval [CI], 0.27–1.05), infections (IRR, 0.77; 95% CI, 0.48–1.24), and overall hospital admissions (IRR, 0.36; 95% CI, 0.13–1.00) most likely due to lack of statistical power. We found significant reduction of total hospital costs (estimates in US dollars: ?623.08; 95% CI, ?745.64 to ?500.53; P < .01) after the interventions. Conclusion: Studies suggested a positive association of care coordination by a multidisciplinary team approach and improved patient outcomes for long‐term enteral feeding patients. However, the available evidence does not allow estimating the effectiveness of a particular intervention or team composition.     

Sexual Offending in Women and Psychiatric Disorder: A National Case–Control Study

Women commit 4–5% of all sexual crimes, but there is considerable uncertainty about associations with psychosis and substance abuse. We examined the prevalence of psychiatric hospitalization, psychotic disorders, and substance abuse in a nationwide sample of female sexual offenders. We obtained data from Swedish national registers for criminal convictions, hospital discharge diagnoses, and demographic and socioeconomic factors between 1988 and 2000, and merged them using unique identifiers. Convicted female sexual offenders (n = 93) were compared with all females convicted of non-sexual violent offences (n = 13,452) and a random sample of general population women (n = 20,597). Over 13 years, 36.6% of female sexual offenders had been admitted to psychiatric hospital and 7.5% been discharged with a diagnosis of a psychotic disorder. Compared to non-sexual violent offenders, there were no significant differences in the proportion diagnosed with psychosis or substance abuse. Compared to women in the general population, however, there was a significantly increased risk in sex offenders of psychiatric hospitalization (age-adjusted odds ratio [AOR] = 15.4; 95% CI: 10.0–23.7), being diagnosed with a psychotic disorder (AOR = 16.2; 95% CI: 7.2–36.4), and with substance use disorders (AOR = 22.6; 95% CI: 13.0–39.1). We conclude that the prevalence of psychotic and substance use disorders was not different between sexual offenders and other violent offenders, suggesting non-specificity of sexual offending in women. Nevertheless, substantially increased prevalences of psychiatric disorder, underline the importance of screening and assessment of female sexual and other violent offenders.