Brief intervention in alcohol-positive traffic casualties: is it worth the effort?

AIMS: This study aimed at testing the effectiveness of a brief motivational intervention (BI) compared with a minimal intervention (MI) for reducing alcohol consumption in adult, alcohol-positive traffic casualties. METHODS: Patients were recruited at the emergency room of a trauma hospital and screened for alcohol by a qualitative saliva test (positive from a blood alcohol concentration of 0.02 g/l). Positive patients (13.3%) who accepted entering the study were randomly allocated into BI and MI. Baseline assessment was the same for all patients. Blind telephone follow-ups were performed at months 3, 6, and 12, and results were analysed by protocol and by intention-to-treat analysis. RESULTS: After 1 year of follow-up, 67% of the patients had reduced their consumption, the percentage of heavy drinkers had dropped by 47%, and 62% of baseline AUDIT-C positive patients (hazardous drinkers) had become negative. Binge drinking dropped significantly (P < 0.05). Results at month 12 were in line with the previous ones. CONCLUSIONS: The effectiveness of BI compared with MI has not been verified, but a significant reduction in consumption has been observed in the whole sample, without significant differences by type of intervention. The persistence and dimension of changes suggest a real effect of both interventions, although the lack of a pure control group does not allow definitive conclusions. Traffic casualties are in a teachable moments to benefit from easy and cheap interventions.     

Intention-to-treat analysis: who is in? Who is out?

To assess whether the term "intention to treat" (ITT) predicts inclusion of all randomized subjects in the analysis, we reviewed 100 randomly selected reports of randomized trials that mentioned analysis by ITT. Only 42 of 100 reports included all randomized subjects in the ITT analysis. We could not determine which categories of participants were excluded from the ITT analysis in 13 trials. The most common categories of excluded subjects were patients who, after randomization, received no follow-up (16/100), received no treatment (14/100), or were found not to meet study entry criteria (12/100). We could determine the number of participants in the ITT analysis for 92 studies. Nineteen of the 92 studies excluded more than 5% of randomized participants, and 10 excluded more than 10%. There is considerable variation in how researchers define and apply the principle of intention to treat.     

Who is at risk of death in an earthquake?

Although, theoretically, the impacts of a disaster are not randomly distributed across health and socioeconomic classes, empirical evidence of this claim is scarce. In a population-based cohort study, the authors identified risk factors for mortality from the September 21, 1999, Taiwan earthquake, which occurred in the middle of the night. Among 297,047 earthquake victims in central Taiwan who experienced partial or complete dwelling damage, 295,437 (noncases) survived the earthquake and 1,610 (cases) died between September 21 and October 31, 1999. Odds ratios were adjusted for both micro-level individual variables and macro-level neighborhood variables. People with mental disorders (odds ratio (OR) = 2.0, 95% confidence interval (CI): 1.1, 3.5), people with moderate physical disabilities (OR = 1.7, 95% CI: 1.2, 2.3), and people who had been hospitalized just prior to the earthquake (OR = 1.4, 95% CI: 1.2, 1.7) were the most vulnerable. The degree of vulnerability increased with decreasing monthly wage (measured in New Taiwanese dollars (NT$)) (NT$20,000 approximately NT$39,999: OR = 1.5, 95% CI: 1.1, 2.1; 相似文献   

Brief alcohol interventions: do counsellors' and patients' communication characteristics predict change?

AIMS: To identify communication characteristics of patients and counsellors during brief alcohol intervention (BAI) which predict changes in alcohol consumption 12 months later. METHODS: Tape-recordings of 97 BAI sessions with hazardous drinkers were analysed using the Motivational Interviewing Skill Code (MISC). Outcome measures were (i) baseline to a 12-month difference in the weekly drinking quantity, and (ii) baseline to a 12-month difference in heavy drinking episodes per month. Bivariate analyses were conducted for all MISC measures, and significant variables were included in multiple linear regression models. RESULTS: Patient communication characteristics (ability to change) during BAI significantly predicted the weekly drinking quantity in the multiple linear regression model. There were significant differences for some of the counsellor skills in bivariate analyses but not in the multiple regression model adjusting for patients' talk characteristics. Changes in heavy drinking showed no significant association with patient or counsellor skills in the multiple linear regression model. CONCLUSION: Findings indicate that the more the patient expresses ability to change during the intervention, the more weekly alcohol use decreases. The role of the counsellor during the interaction, and influence on the outcomes was not clearly established. Implications for BAI and related research are discussed.     

Who is a generalist? An analysis of whether physicians trained as generalists practice as generalists

Accurate data on the number of generalist physicians are needed to monitor the physician workforce and to plan for future requirements in the changing health care system. This study assessed the relationship between two frequently used definitions of a generalist physician: completion of graduate medical education (GME) in only a generalist discipline and physician's self-report of practicing as a generalist. Data for 4,808 physician graduates from six Pennsylvania medical schools from 1986 to 1991 were analyzed using information from the GME tracking census of the Association of American Medical Colleges and the Physician Masterfile of the American Medical Association. Of 1,291 physicians trained in a generalist discipline, 1,205 (93%) reported practicing as generalists. Conversely, of the 3,517 not trained in a generalist discipline, 3,358 (95%) were not practicing as generalists. These results indicate GME training is a valid predictor of self-reported practice and provide baseline data to monitor future changes.     

Who is working for whom?

A recent trend in many medical groups toward management aiding in "employee self-fulfillment" leads to the question, "Who is working for whom?" The author of this article firmly believes that a manager's expectations, encouragement, and support of his employees must be used to balance his own personal intelligence, knowledge, and skills if he is to be successful in his job. A manager's strong desire and commitment to becoming involved in his employees' lives will bring many benefits to all involved--management, employees, and most importantly, the patients.     

Who is the NHS for?

The immediate, common sense answer to the question, "Who is the NHS for?" would obviously be, "The patients who use it". This may well be the fundamental purpose of the NHS, yet it would appear that differing views of how this is to be achieved contribute to a misreading between stakeholders of each others' remit. The different positions taken by the two most important NHS stakeholders, the professional clinicians and the administrative managers, affect their definitions of, and therefore their attitudes to their own contribution to the purpose of the NHS. Suggests that before priorities in health care can be considered and discussed, let along be set, consensual agreement needs to be reached concerning the views of professional clinicians and managers of ways of achieving their vision of who the NHS is for.     

Who needs an implantable defibrillator?

Ventricular arrhythmias account for 80% of sudden cardiac deaths. The implantable defibrillator (ICD) is an effective means of preventing these deaths. This article discusses which patients may benefit from ICD implantation and addresses the cost-effectiveness of their use.     

Who is hurt by procyclical mortality?

There is renewed interest in understanding how fluctuations in mortality and in health are related to fluctuations in economic conditions. The traditional perspective that economic recessions lower health and raise mortality has been challenged by recent findings that reveal mortality is actually procyclical. The epidemiology of the phenomenon - traffic accidents, cardiovascular disease, and smoking and drinking - suggests that socioeconomically vulnerable populations might be disproportionately at risk of "working themselves to death" during periods of heightened economic activity. In this paper, I examine mortality by individual characteristic during the 1980s and 1990s using the U.S. National Longitudinal Mortality Study. I find scant evidence that disadvantaged groups are significantly more exposed to procyclical mortality. Rather, working-age men with more education appear to bear a heavier burden, while those with little education experience countercyclical mortality.