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.     

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.     

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.     

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.     

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 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。     

Alcohol-Attributable Calories Consumed as a Result of Binge Drinking: A National Survey of Drinkers in the United States

Aims: Estimate the alcohol-attributed calories associated with respondents' (a) most recent binge drinking episode, and (b) binge drinking across a thirty-day period. Methods: Examined responses to a module of the 2008 Behavioral Risk Factor Surveillance System (BRFSS), completed by a 10-state sample in the United States (n = 7,375), in order to estimate the alcohol-attributed calories consumed among binge drinkers. Alcohol-attributed calories were estimated by multiplying number of drinks consumed for each category (beer, wine, liquor drinks, and pre-mixed flavored drinks) collected in the BRFSS by caloric averages based on two data sources. Results: In the past 30 days, respondents averaged 4.13 (SD = 5.84) binge drinking episodes, and consumed an average of 4.15 (SD = 3.55) beers, .67 (SD = 1.56) glasses of wine, 1.49 (SD = 2.53) shots of liquor, and .15 (SD = .79) pre-mixed flavored beverages during their most recent binge drinking episode. The average amount of alcohol-attributed calories consumed during this binge drinking episode was 991.76 (SD = 578.71), with men consuming significantly more calories than females. Conclusions: Dietary guidelines suggest the calories associated with alcoholic beverages should be considered as part of one's limited allotment of calories associated with solid fats and sugars, yet our results highlight alcohol as a major contributor (approximately 1,000 calories) to the proposed daily caloric needs on binge drinking days.     

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.     

Drinking patterns and problems: a comparison of emergency room populations in the United States and Spain.

The association of alcohol consumption and casualties is compared in probability samples of two culturally diverse emergency room populations: Barcelona, Spain (N = 2972) and Contra Costa County, California (N = 3609). Similar methods and data collection instruments were used to breathalyze and interview patients regarding self-reported alcohol consumption 6 h prior to the injury, usual drinking patterns and alcohol-related problems. Breathalyzer reading was positively associated with injury in both Contra Costa and Barcelona, but at the legal level only in Barcelona. Self-reported alcohol intake within 6 h prior to the event was positively associated with injury only among females in Contra Costa. Frequent light drinking was associated with injuries in Barcelona while heavier drinking was associated with injuries in Contra Costa. Little association was found between social consequences of drinking and injuries in either sample, however, the Contra Costa sample reported significantly higher rates of these problems than Barcelona, among moderate and high quantity drinkers. Although few differences were found between the two samples, findings suggest that usual drinking patterns within a culture may influence the association of alcohol and casualties, and future studies should explore these differences by type and cause of injury.     

Legal Ages for Purchase and Consumption of Alcohol and Heavy Drinking Among College Students in Canada,Europe, and the United States

ABSTRACT

Heavy drinking and associated negative consequences remain a serious problem among college students. In a secondary analysis of data from two published study, the authors examine the correlation between minimum legal age to purchase and/or consume alcohol and rates of heavy drinking among college students in 22 countries. The published studies use identical definitions of heavy drinking and similar methodologies. In the study of 20 European countries and the United States, there is a positive correlation between prevalence of heavy drinking and both minimum legal purchase age (r =.34) and minimum legal drinking age (r =.19); in the study of Canada and the United States, there is a perfect positive correlation (r = 1.0). Examination of this evidence does not support the conclusion that a lower minimum legal age for purchase and/or consumption of alcoholic beverages is a protective factor for decreasing heavy drinking among college students.     

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.     

Self-change among Spanish speakers with alcohol and drug use disorders in Spain and the United States

Objective

Few cross-cultural studies have investigated the self-change process with substance abusers. This study examined commonalities and differences related to the self-change process with Spanish speaking self-changers in Spain and the United States (U.S.) who reported recovering from an alcohol or drug problem on their own (i.e., without formal help or treatment) for ≥ 1 year.

Method

Advertisements were primarily used to recruit participants. There were 56 participants in the final sample (Spain, n = 29; US; n = 27). Participants provided demographic and substance use history information and completed the Drug Use History Questionnaire, Reasons for Change Scale, the Life Events Checklist, and a checklist for maintenance factors after recovery.

Results

Significantly more self-changers from the U.S. met DSM IV-TR criteria for alcohol dependence, reported significantly more life events in the year prior to recovery and significantly more maintenance/support events in the year after their recovery than their counterparts in Spain. The majority of participants' recoveries involved abstinence. Some alcohol abusers, however, report successfully engaging in low-risk drinking with no consequences (50% Spain; 22% U.S.), and some drug abusers in Spain (23%) reported a few days per year of very little drug use.

Conclusions

The two groups of Spanish speakers represented very different cultures, and those from the U.S. came from several countries in the Southern hemisphere. The results of this study suggest that even though people speak the same language that does not mitigate against cultural differences. Additional studies of the process of self-change with larger participant samples are needed to better inform the development and provision of interventions for Spanish speakers with alcohol and drug use disorders across different cultures and countries.     

Obstacles to the adoption of low risk drinking goals in the treatment of alcohol problems in the United States: A commentary

Although moderation and harm reduction approaches to the treatment of alcohol problems are accepted in many parts of the world, they continue to be rare in the US. A major reason for this state of affairs has to do with the way alcohol treatment services in the US developed, and in particular the creation of a group of paraprofessional counselors many of whom attributed their recovery to the 12-step philosophy. While it is unlikely that these counselors will offer moderation services, the provision of services to problem drinkers in primary care medical settings presents a promising alternative.     

Cannabis cultivation in Spain: A profile of plantations,growers and production systems

BackgroundThe European market for cannabis derivatives is being transformed. The cultivation of cannabis within the EU and the shift of demand from hashish to domestic marihuana are key aspects of this transformation. Spain, formerly central to the trade of Moroccan hashish, is becoming a marihuana-producing country. The emergence of “import-substitution” has been researched in other EU countries, but thus far the Spanish case remains undocumented.MethodsThis paper is based on analysis of data of 748 cannabis plantations seized by Spanish police in 2013. The sample comprises reports of seizures identified through a survey of online news and police reports. “Event-analysis” methods were applied to these sources.ResultsThe analysis offers a typology of plantations, a profile of participants and the different production systems, and a model of regional distribution. Half of the plantations were small (less than 42 plants) and half contained between 100 and 1000 plants, with an average size of 261 plants. About three-quarters of plants were cultivated indoors using stolen electricity. 86% of all plants seized were from large-scale plantations (more than 220 plants). Most plantations were located along the Mediterranean coast, where population and tourism are concentrated. Over three-quarters of those indicted by police were Spanish (85%). Among the foreign owners of big plantations, Dutch nationals predominated. The number of seized plants by province was directly associated with the number of grow shops (β = 0.962, p < 0.001).ConclusionThe rise of large-scale cannabis plantations in the Spanish Mediterranean coast is increasingly replacing import of Moroccan hashish. Indoor cultivation supported by grow shops, that provide the technology and know-how, seem to be the dominant form of organization in this emerging industry. Large-scale plantations may have met most of the demand for marihuana in 2013.     

Vulnerabilities and Cultural Change: Drug Use among Puerto Rican Adolescents in the United States

The investigations examined drug usage-based and culture-based differences in young Puerto Ricans living in New York (100 nonusers and 192 drug users), Americans living in New York (100 nonusers and 99 drug users), and Puerto Ricans living in Puerto Rico (100 nonusers and 98 drug users). The Associative Group Analysis method was used to measure cultural change in three dimensions: dominant perceptions, priorities, and evaluations. The findings show that the Puerto Rican drug user and nonuser groups in New York differed significantly in their paths of acculturation. The nonusers were shown to progress successfully in learning American meanings and adopting American perspectives and cultural norms. The drug users were attracted to dominant American priorities (e.g., wealth and freedom) but showed little progress in adopting deeper American cultural meanings necessary for effective coping     

Health Warnings,Smoking Rules,and Smoking Status: A Cross-National Comparison of Turkey and the United States

Objectives: This study aimed to compare the prevalence of smoking status (i.e., current, former and never) between the United States and Turkey in terms of age and gender, and examine how smoking rules and health warnings are associated with smoking status within and between the two countries. Methods: The study used data from the 2012–2013 National Adult Tobacco Survey (U.S. sample, N = 60,196) and the 2012 Global Adult Tobacco Survey (Turkey sample, N = 9,581). SAS PROC SURVEYLOGISTIC with a weighted variable was used to examine the associations between demographics (age, gender and education), smoking rules, health warnings, and smoking status within and between the two countries. Results: There was an 18% current smoking prevalence among U.S. sample, compared to 27% of the Turkey sample. The U.S. sample had a higher rate of former smoking compared to the Turkey sample (25% vs. 22%). In both countries, being older and male gender predicted former smoking while being younger and female gender predicted never smoking. Having seen a health warning, and not allowing smoking in the vehicle and home positively predicted former and never smoking status. Higher education predicted both smoking statuses in the U.S. only. Conclusions: It is important to work with partners particularly in low- and middle-income countries (e.g., Turkey) to combat the global tobacco epidemic. In both counties, cessation endeavors should emphasize a comprehensive understanding of smoking status in terms of smoking rules in personal spaces and health warnings.     

Heroin Use among Soldiers in the United States and Vietnam: A Comparison in Retrospect

A “unique” heroin epidemic was claimed to exist among American soldiers in Vietnam in the early 1970s. To assess this claim, in 1972 we simultaneously evaluated heroin use in two similar military populations in the United States and Vietnam and compared findings with previous Vietnam studies. The total percentage ever reporting use of heroin was comparable in both locations. Recent use, however, was significantly higher in Vietnam. Heroin users, regardless of location, were demographically and psychosocially more similar than different. Any conclusion that the heroin epidemic in Vietnam was grossly “unique” seems unwarranted.     

Initiation and persistence of alcohol use in United States Black, Hispanic, and White male and female youth

Background

The relation between early and frequent alcohol use and later difficulties is quite strong. However, the degree that alcohol use persists, which is often a necessary cause for developing alcohol-related problems or an alcohol use disorder, is not well studied, particularly with attention to race and gender. A novel statistical approach, the Multi-facet Longitudinal Model, enables the concurrent study of age of initiation and persistence.

Methods

The models were applied to longitudinal data on youth alcohol use from ages 12 through 19, collected in the (U.S.) National Longitudinal Survey of Youth 1997 cohort (N = 8984).

Results

Results confirmed that Black adolescents initiate alcohol use at later ages than do White youth. Further, after initiation, White adolescents were substantially more likely than Black adolescents to continue reporting alcohol use in subsequent years. Hispanic teens showed an intermediate pattern. Gender differences were more ambiguous, with a tendency for boys to be less likely to continue drinking after initiation than were girls.

Conclusions

Novel findings from the new analytic models suggest differential implications of early alcohol use by race and gender. Early use of alcohol might be less consequential for males who initiate alcohol use early, Black, and Hispanic youth than for their female and White counterparts.