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CORK Bibliography: Injury and Accidents

86 citations. January 2007 to present

Prepared: March 2009

Adrian M; Truong MV; Osazuwa T. Measuring levels of co-morbidity in drug user emergency patients treated in Ontario hospitals. Substance Use & Misuse 42(2/3): 199-224, 2007. (59 refs.)

We examined the nature and extent of health problems in drug user patients initially treated in emergency departments and who were subsequently admitted to all hospitals in Ontario, using data from the Hospital Medical Records Institute (HMRI). The modified standardized morbidity ratio (modified SMR) is introduced to improve the measurement and visual display of reduced morbidity as well as excess morbidity. During 1985-86, about 75% of drug user patients entered hospital through the emergency department. There were 5077 emergency patients with primary drug use-related diagnoses and 9827 with secondary drug use-related diagnoses. Cases with poisoning diagnosis made up over 80% of all drug use cases treated in emergency departments. Cases with non-dependent abuse of drugs accounted for 8-12% of emergency drug user patients, whereas those with drug dependence accounted for about 3% of emergency drug user patients. These patients had more than three times the comorbidity experience of all hospital patients. They had excess comorbidity due to mental disorders, infectious and parasitic disorders, and injury and poisoning diagnoses. However, they had reduced comorbidity due to complications of pregnancy, childbirth, and the puerperium and from congenital anomalies and conditions originating in the perinatal period. Cocaine patients were more likely to have infectious parasitic diseases and diseases of the skin and subcutaneous tissue, while amphetamine patients were more likely to have diseases of the digestive system and of the musculo-skeletal system and connective tissue.

Ahlm K; Bjornstig U; Ostrom M. Alcohol and drugs in fatally and non-fatally injured motor vehicle drivers in northern Sweden. Accident Analysis and Prevention 41(1): 129-136, 2009. (65 refs.)

Alcohol and drugs are important risk factors for traffic injuries, a major health problem worldwide. This prospective study investigated the epidemiology and the presence of alcohol and drugs in fatally and hospitalized non-fatally injured drivers of motor vehicles in northern Sweden. During a 2-year study period, blood from fatally and hospitalized non-fatally injured drivers was tested for alcohol and drugs. The study subjects were recruited from well-defined geographical areas with known demographics. Autopsy reports, medical journals, police reports, and toxicological analyses were evaluated. Of the fatally injured, 38% tested positive for alcohol and of the non-fatally 21% tested positive; 7% and 13%, respectively, tested positive for pharmaceuticals with a warning for impaired driving; 9% and 4%, respectively, tested positive for illicit drugs. The most frequently detected pharmaceuticals were benzodiazepines. opiates, and antidepressants. Tetrahydrocannabiol was the most frequently detected illicit substance. No fatally injured women had illegal blood alcohol concentration. The relative proportion of positively tested drivers has increased and was higher than in a similar study 14 years earlier. This finding indicates that alcohol and drugs merit more attention in future traffic safety work.

Allareddy V; Peek-Asa C; Yang JZ; Zwerling C. Risk factors for rural residential fires. Journal of Rural Health 23(3): 264-269, 2007. (18 refs.)

Context and Purpose: Rural households report high fire-related mortality and injury rates, but few studies have examined the risk factors for fires. This study aims to identify occupant and household characteristics that are associated with residential fires in a rural cohort. Methods: Of 1,005 households contacted in a single rural county, 691 (68.8%) agreed to participate. One household with missing information on a reported fire was excluded from the analysis. We used logistic regression to examine the independent association of occupant and household characteristics with reported fires, controlling for years lived in the residence. We also examined the association between the occurrence of previous fires and the adoption of safety measures. Findings: A total of 78 (11.3%) households reported a residential fire. Occupant characteristics that were associated with significantly higher odds of reported fires included the presence of an occupant with alcohol problems (OR = 1.82, 95% CI = 1.01-3.28) and being married (OR = 2.11, 95% CI = 1.14-3.91). Rural farm households were associated with significantly higher odds (OR = 1.72, 95% CI = 1.01-2.93) of reporting a fire when compared to residences in towns, after controlling for all other occupant and household characteristics. The presence of a fire extinguisher (OR = 2.00, 95% CI = 1.10-3.64) was the only fire safety measure that had a statistically significant association with reported fire. Conclusions: Rural farm households report higher incidences of fire when compared to households located in towns. Experiencing a fire is not associated with an increased likelihood of adopting safety measures to prevent injuries once a fire has started.

Bazargan-Hejazi S; Gaines T; Duan NH; Cherpitel CJ. Correlates of injury among ED visits: Effects of alcohol, risk perception, impulsivity, and sensation seeking behaviors. American Journal of Drug and Alcohol Abuse 33(1): 101-108, 2007. (15 refs.)

This cross-sectional study used a random sample of 412 Emergency Department (ED) patients to test the following hypothesizes: 1) injury would be positively associated with problem drinking and recent drinking; 2) impulsivity and sensation seeking would be positively associated with injury, while risk perception would be negatively associated with injury. Results show recent drinking is associated with 2-fold increase in the odds of injury [OR and 95%; CI=2.34 (1.07-5.10)] while problem drinking and personality factors were unrelated to injury. Other significant predictors were gender and age. Findings suggest a need for alcohol screening for patients who check themselves into the ED due to injury.

Bloom GR; Suhail F; Hopkins-Price P; Sood A. Acute anhydrous ammonia injury from accidents during illicit methamphetamine production. Burns 34(5): 713-718, 2008. (22 refs.)

Background: Anhydrous ammonia (AA), a chemical commonly used in agriculture, is a key component in illicit methamphetamine production. Although injuries associated with AA exposure are well studied, AA injuries associated with incidents during illicit methamphetamine production have not been adequately described in the literature. Objective: This study better characterizes AA injuries occurring in an agricultural region where illicit methamphetamine production is common. Methods: We performed a cross-sectional study based on a chart review of 49 patients who were admitted to a tertiary hospital in Illinois with known or suspected exposures to chemical agents. indices of morbidity were compared between injuries resulting from exposure to AA and injuries from other chemicals, and between AA injuries from incidents during illicit methamphetamine production and AA injuries from other causes. Results: AA was the most common cause of chemical injury (41%; n = 20/49). Incidents during illicit methamphetamine production were the most common cause of AA injury (75%; n = 15/20). AA injury was associated with significantly greater morbidity compared to non-AA chemical injury. in addition, methamphetamine-related AA injury was associated with significantly greater morbidity compared to non - methamphetamine-related AA injury. Conclusion: Chemical burns during illicit methamphetamine production were the most common cause of both chemical and AA-related injury in our agricultural population and these injuries were associated with greater morbidity during hospitalization.

Bracken ME; Medzon R; Rathlev NK; Mower WR; Hoffman JR. Effect of intoxication among blunt trauma patients selected for head computed tomography scanning. Annals of Emergency Medicine 49(1): 45-51, 2007. (18 refs.)

Study objective: We examine the prevalence and types of intracranial injuries sustained by intoxicated blunt trauma patients. Methods: The study was conducted as a secondary analysis of National Emergency X-Radiography Utilization Study II head injury database. Treating physicians prospectively assessed presenting signs and symptoms on all blunt trauma patients who underwent head computed tomography (CT). Intoxication status was determined by the examining physician and was based on a history of intoxication, positive toxicologic screen result, or physical evidence suggesting intoxication. Intracranial injury diagnoses were based on final CT interpretations provided by attending radiologists. Results: Intracranial injury was detected in 1,193 of the 13,728 enrolled patients (8.7%), and intoxication was evident in 3,356 (24.4%) patients. Physicians were unable to assess intoxication status in 620 individuals. Intracranial injury was present in 231 intoxicated patients (231/3,356; 6.9%; 95% confidence interval [CI] 6.0 to 7.8), 789 of 9,752 nonintoxicated patients (8.1%; 95% CI 7.6% to 8.6%), and 173 of the 620 patients who could not be assessed for intoxication (prevalence 27.9%; 95% Cl 24.4% to 31.6%). Intracranial injury was identified in only 5 of 299 intoxicated patients (1.7%) who had normal neurological examination results and no evidence of trauma to the calvarium. Conclusion: The prevalence of intracranial injury among intoxicated blunt trauma patients who are selected for head CT is lower than among nonintoxicated patients selected for imaging, which likely represents heightened concern in the presence of intoxication, even without other findings suggestive of intracranial injury. This conclusion is supported by the fact that few intoxicated patients with normal neurologic findings and no evidence of trauma to the calvarium had positive findings on CT imaging.

Bulat T; Castle SC; Rutledge M; Quigley P. Clinical practice algorithms: Medication management to reduce fall risk in the elderly. Part 3, benzodiazepines, cardiovascular agents, and antidepressants. Journal of the American Academy of Nurse Practitioners 20(2): 55-62, 2008. (55 refs.)

There are associations between falls and the use of sedatives, psychotropics, cardiovascular agents, antidepressants, and polypharmacy. Our third article in the series will review the development of specific subalgorithms for benzodiazepines (BZDs), cardiovascular agents, and antidepressants (algorithms 3–5). We presented the process of development in our first article and the summary algorithm (algorithms 1 and 2) in our second article in this series. There are a number of ways in which drugs might increase the risk of an elderly person falling, most common being sedation, impaired balance and reaction time, orthostatic hypotension, and drug-induced parkinsonism. Medications are a potentially modifiable factor which can reduce fall risk The Guideline for the prevention of falls in older persons (American Geriatrics Society, British Geriatrics Society and American Academy of Orthopaedic Surgeons Panel of Falls Prevention, 2001) states that patients who have fallen should have their medications reviewed and altered or stopped as appropriate in light of their risk of future falls.

Burke BA; Lewis RW; Latenser BA; Chung JY; Willoughby C; Ealey GP et al. Methamphetamine-related burns in the cornbelt. Journal of Burn Care & Research 29(4): 574-579, 2008. (10 refs.)

Methamphetamine (ALN) is a highly addictive drug that is easily manufactured from everyday household products and chemicals found at local farm stores. The proliferation of small MA labs has led to a dramatic increase in patients sustaining thermal injury while making and/or using MA. We hypothesized that these patients have larger injuries with longer hospital stays, and larger, nonreimbursed hospital bills compared with burn patients not manufacturing or using MA. In a retrospective case-control study, all burn patients >= 16 years of age admitted to our burn center from January 2002 to December 2005 were stratified into two groups based on urine MA status. Of the 660 burn patients :16 years of age admitted during this 4 year period, urine drug screens were obtained at admission on 410 patients (62%); 10% of urine drug screens were ALAL (+). MA (+) patients have larger burns compared with ALAL (-) patients (9.3 vs 8.6% body surface area burns), have higher rates of inhalation injuries (20.4 vs 9.3%, P =.015), and more nonthermal trauma (13.0 vs 3.1%, P=.001). When compared with MA (-) patients, MA (+) patients require longer hospital stays (median 9.5 vs 7.0 days, P=.036), accrue greater hospital bills per day ($4292 vs $2797, P=.01), and lack medical insurance (66.7 vs 17.7%, P<.0001). The epidemic of MA use and its manufacture mandates that burn centers monitor patients for MA use and develop and institute protocols to ensure proper care of this increasingly costly population.

Casey BJ; Jones RM; Hare TA. The adolescent brain. Annals of the New York Academy of Sciences. Year in Cognitive Neuroscience 2008 1124: 111-126, 2008. (133 refs.)

Adolescence is a developmental period characterized by suboptimal decisions and actions that are associated with an increased incidence of unintentional injuries, violence, substance abuse, unintended pregnancy, and sexually transmitted diseases. Traditional neurobiological and cognitive explanations for adolescent behavior have failed to account for the nonlinear changes in behavior observed during adolescence, relative to both childhood and adulthood. This review provides a biologically plausible model of the neural mechanisms underlying these nonlinear changes in behavior. We provide evidence from recent human brain imaging and animal studies that there is a heightened responsiveness to incentives and socioemotional. contexts during this time, when impulse control is still relatively immature. These findings suggest differential development of bottom-up limbic systems, implicated in incentive and emotional processing, to top-down control systems during adolescence as compared to childhood and adulthood. This developmental pattern may be exacerbated in those adolescents prone to emotional reactivity, increasing the likelihood of poor outcomes.

Cawthon PM; Harrison SL; Barrett-Connor E; Fink HA; Cauley JA; Lewis CE et al. Alcohol intake and its relationship with bone mineral density, falls, and fracture risk in older men. Journal of the American Geriatrics Society 54(11): 1649-1657, 2006. (41 refs.)

To examine the association between alcohol intake and problem drinking history and bone mineral density (BMD), falls and fracture risk. Cross-sectional and prospective cohort study. Six U.S. clinical centers. Five thousand nine hundred seventy-four men aged 65 and older. Alcohol intake and problem drinking histories were ascertained at baseline. Follow-up time was 1 year for falls and a mean of 3.65 years for fractures. Two thousand one hundred twenty-one participants (35.5%) reported limited alcohol intake (< 12 drinks/y); 3,156 (52.8%) reported light intake (< 14 drinks/wk), and 697 (11.7%) reported moderate to heavy intake (>= 14 drinks/wk) in the year before baseline. One thousand one men (16.8%) had ever had problem drinking. In multivariate models, as alcohol intake increased, so did hip and spine BMD (P for trend <.001). Greater alcohol intake was not associated with greater risk for nonspine or hip fractures. Men with light intake, but not moderate to heavy intake, had a lower risk of two or more incident falls (light intake: relative risk (RR) = 0.77, 95% confidence interval (CI) = 0.65-0.92; moderate to heavy intake: RR = 0.83, 95% CI = 0.63-1.10) than abstainers. Men with problem drinking had higher femoral neck (+1.3%) and spine BMD (+1.4%), and a higher risk of two or more falls (RR = 1.59; 95% CI = 1.30-1.94) than those without a history of problem drinking and similar total hip BMD and risk of fracture. In older men, recent alcohol intake is associated with higher BMD. Alcohol intake and fracture risk is unclear. Light alcohol intake may decrease the risk of falling, but a history of problem drinking increased fall risk.

Chamberlain E; Solomon R. Zero blood alcohol concentration limits for drivers under 21: Lessons from Canada. Injury Prevention 14(2): 123-128, 2008. (63 refs.)

Graduated licensing programs (GLPs) that include zero or low blood alcohol concentration (BAC) restrictions have proven to be a popular and effective measure for improving traffic safety among young people. However, a major drawback of such programs, at least in Canada, is that the BAC restriction is lifted on completion of the GLP, which typically occurs around the age of 18 or 19. This corresponds to the legal drinking age in Canada, a time when alcohol consumption and rates of binge drinking increase. It is not surprising, then, that 18 - 20 year-old drivers are dramatically overrepresented in alcohol-related deaths and injuries. One way to address this problem is to raise the legal drinking age, as has occurred in the United States. In jurisdictions, like Canada, that are unlikely to raise the legal drinking age, other measures are necessary to separate drinking from driving among 18 - 20 year-olds. This article recommends that the zero BAC restrictions be extended beyond the completion of the GLP, until drivers reach the age of 21. The scientific evidence for such a measure is reviewed, and the growing government support for enacting such BAC limits in Canada is described.

Cherpitel CJ. Alcohol and injuries: A review of international emergency room studies since 1995. (review). Drug and Alcohol Review 26(2): 201-214, 2007. (56 refs.)

This paper provides a review of emergency room ( ER) studies on alcohol and injury, using representative probability samples of adult injury patients, and focuses on the scope and burden of the problem as measured by estimated blood alcohol concentration ( BAC) at the time of the ER visit, self- report drinking prior to injury, violence- related injury and alcohol use disorders. A computerized search of the English- language literature on MEDLINE, PsychINFO and the National Institute on Alcohol Abuse and Alcoholism ( NIAAA) Alcohol and Alcohol Problems Science Database (ETOH) was conducted for articles published between 1995 and 2005, using the following key descriptors: (1) emergency room/ emergency department/accident and emergency, (2) alcohol/drinking and (3) injuries ( intentional and unintentional). Findings support prior reviews, with injured patients more likely to be positive for BAC and report drinking prior to injury than non- injured, and with the magnitude of the association substantially increased for violence- related injuries compared to non- violence- related injuries. Indicators of alcohol use disorders did not show a strong association with injury. Findings were not homogeneous across studies, however, and contextual variables, including study- level detrimental drinking pattern, explained some of the variation. This review represents a broader range of ER studies than that reported previously, across both developed and developing countries, and has added to our knowledge base in relation to the influence of contextual variables on the alcohol- injury relationship. Future research on alcohol and injury should focus on obtaining representative samples of ER patients, with special attention to both acute and chronic alcohol use, and to organisational and socio- cultural variables that may influence findings across studies. In-depth patient interviews may also be useful for a better understanding of drinking in the injury event and associated circumstances.

Cherpitel CJ; Ye Y. Alcohol-attributable fraction for injury in the US general population: Data from the 2005 National Alcohol Survey. Journal of Studies on Alcohol and Drugs 69(4): 535-538, 2008. (18 refs.)

Objective: Although studies of patients seen in emergency department (ED) settings have documented a strong association of alcohol with injury, such patients are not necessarily representative of the larger population, and less is known of alcohol's association with risk of injury in patient samples outside the ED. Method: Drinking before injury was analyzed in the 2005 National Alcohol Survey among the 1, 149 respondents (18.5%, weighted) who reported an injury during the past year; analysis was by injury treatment type (ED-treated, 29.2%; other-treated, 47.8%; and nontreated, 22.9%). Results: Based on case-crossover analysis, e relative risk of injury from drinking was 1.85 (p <.01) for those with an ED-treated injury, 1.42 (NS) for those with an other-treated injury, and 1.43 (NS) for those with a nontreated injury. Alcohol-attributable fractions based on these relative risk estimates were 2.96% for an ED-treated injury, 1.59% for an other-treated injury, and 1.89% for a nontreated injury. Comparative attributable fractions based on the person's causal attribution of injury to his or her drinking were 3.06%, 1.61%, and 1.47%, respectively. Although these attributable fractions based on case-crossover analysis and subjective evaluation of causal attribution were not greatly different, all estimates were considerably smaller than those found in studies of ED patients. Conclusions: The data suggest that alcohol plays a larger role in those injuries for which treatment is sought in EDs, and this may be related to the severity of the injury. Additional studies of alcohol and injury in general populations that take into account the intensity of exposure to alcohol before the event, as well as recall bias by eliciting data on the proximity of the event to the time of the respondent inter-view, are necessary for determining unbiased estimates of the attributable fraction of alcohol in injury morbidity.

Ch'ng CW; Fitzgerald M; Gerostamoulos J; Cameron P; Bui D; Drummer OH et al. Drug use in motor vehicle drivers presenting to an Australian, adult major trauma centre. Emergency Medicine of Australasia 19(4): 359-365, 2007. (25 refs.)

Objectives: To determine the drug use in injured Victorian drivers involved in motor vehicle collisions and subsequently transported to a major adult trauma centre in Victoria. Methods: A blood sample was obtained from patients who had been taken to The Alfred Emergency & Trauma Centre (Prahran, Vic., Australia) following a motor vehicle collision. This was performed at the same time and under the same law as compulsory blood screening in Victoria (Section 56 of the Road Safety Act). Four hundred and thirty-six specimens were analysed. Blood stored in vacutainer tubes containing preservative were screened for drugs using enzyme-linked immunosorbent assay and gas chromatography-mass spectometry analysis. Medically administered drugs were excluded from the results. Results: Four hundred and thirty-six specimens were analysed. Metabolites of cannabis were the most commonly found drug (46.7%), the active form of cannabis (Delta 9-tetrahydrocannabinol) was found in 33 specimens (7.6%). The next most prevalent drugs were benzodiazepines (15.6%), opiates (11%), amphetamines (4.1%) and methadone (3%). Cocaine was detected in 1.4% of cases. Of the motor vehicle collisions 66% involved males and females of 15-44 years old and Delta 9-tetrahydrocannabinol was almost exclusively found in this age group. In motor vehicle collisions involving older drivers there was an increasing use of benzodiazepines. In women > 65 years old 30% were positive for benzodiazepines. Conclusions: Drug usage found in this group of injured drivers was disturbingly high. The introduction of further initiatives to decrease the prevalence of drug use in motor vehicle drivers is required.

Claassen CA; Larkin GL; Hodges G; Field C. Criminal correlates of injury-related emergency department recidivism. Journal of Emergency Medicine 32(2): 141-147, 2007. (32 refs.)

To investigate criminal and high-risk lifestyle factors that predict emergency department (ED) recidivism, a longitudinal (8-year) cohort study of ED trauma patients was conducted. Study patients provided risk and lifestyle behavior information via semi-structured interview. ED revisit and reinjury rates for 1995-2003 were acquired through hospital record review. Lifetime criminal arrest data were obtained for each study subject via record linkage from PublicData.com, an internet-based service. The 8-year ED re-visit rate was 47% (75/161), but revisits were more often medical than injury-related (30% vs. 17%, respectively). Over half (58%) of all injured ED patients had a documented arrest history, and arrests were significantly more common in those who came back to the ED for repeat trauma vs. those who did not revisit the ED (70.4% vs. 55.9%, respectively; p < 0.05). In this sample, 21% (34/161) had been convicted of 97 property-related crimes, 26% (42/161) of 109 violence-related crimes, 23% (37/161) of 98 drug-related offenses, and 17.4% (28/161) of 89 other non-traffic-related crimes. ED recidivism for trauma care was associated with multiple substance abuse behaviors and drug-related arrests. Significant risk factors for ED recidivism seem to be high-risk substance-abuse-related behaviors and criminal activity, constituting important targets for effective ED-based intervention, referral, and follow-up.

Clements RM. Reducing psychotropic medications in elderly rehabilitation inpatients with a fall-related admission: How often is it happening? Geriatrics & Gerontology International 8(3): 139-142, 2008. (13 refs.)

Aim: To assess the frequency of psychotropic medication withdrawal in an inpatient geriatric rehabilitation population with a fall-related admission diagnosis. Methods: A retrospective medical record audit. The medical records department randomly selected 100 patients admitted between October 2006 and April 2007 to the geriatric rehabilitation ward of Casey Hospital with a fall-related admission diagnosis. Results: The population was predominantly female (71%) and elderly (average age, 80 years) with the vast majority of patients living at home (88%) prior to admission. Twenty-six of 49 (53%) of patients admitted on psychotropic medication were on a reduced regime by discharge (reduced dose or number of psychotropic medications). Just 7 of 100 patients had an increased psychotropic medication regime by discharge. Benzodiazepines were far more likely to be reduced (20/24, 83%) than other psychotropic medications. Conclusion: This audit does suggest an acceptable awareness in this geriatric rehabilitation setting of the fall risk posed by psychotropic medication. It needs to be further explored why benzodiazepines are so much more likely to be reduced in this population than other psychotropic medications, despite those other types also posing a significant fall risk.

Commission of the European Communities. An EU Strategy to Support Member States in Reducing Alcohol Related Harm. Communication for the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions. Brussels: Commission of the European Communitites, 2006. (0 refs.)

In 2001, the Council requested a comprehensive strategy to reduce alcohol-related harm in Europe. This report represents a response to that request. Following an introduction the report sets forth a mandate for action, followed by a case for action. The process of consultation and assessment used in creating these recommendations is then described. This is followed by a description of the five priority themes and the relevant good practices to underpin the implementation. The first of these is Protection of young people, children and the unborn child. The specific aims for accomplishing this are Aim 1: To curb under-age drinking, reduce hazardous and harmful drinking among young people. Aim 2: To reduce the harm suffered by children in families with alcohol problems. Aim 3: To reduce exposure to alcohol during pregnancy, thereby reducing the number of children born with Foetal Alcohol Disorders. The rationale for action is that young people are often unfairly depicted as the perpetrators of alcohol problems rather than the victims. Alcohol is estimated to be a causal factor in 16% of cases of child abuse and neglect. Harmful alcohol consumption among young people has been shown to have a negative impact not only on health and social wellbeing, but also on educational attainment. . There is an increasing trend of Òbinge-drinkingÓ by young people in many parts of the EU. This is exacerbated by the continued availability of alcoholic beverages to under-age consumers. The Second Theme is to reduce injuries and deaths from alcohol-related road traffic accidents. Aim 4: To contribute to reducing alcohol-related road fatalities and injuries. In setting forth the rationale it is noted that approximately one accident in four can be linked to alcohol consumption, and at least 10,000 people are killed in alcohol-related road accidents in the EU each year. Young people aged 18 to 24 are particularly in danger of having an accident. 35% to 45% of fatalities of this age group are due to traffic accidents. For young people, traffic accidents are the most common cause of death (47% ). For drink-driving accidents, two thirds of the people involved were between 15 and 34 years, and 96% were male. The Third Theme is the prevention of alcohol-related harm among adults and reduce the negative impact on. the workplace. The related aims are Aim 5: To decrease alcohol-related chronic physical and mental disorders; Aim 6: To decrease the number of alcohol related deaths.; Aim 7: To provide information to consumers to make informed choices; Aim 8: To contribute to the reduction of alcohol-related harm at the workplace, and promote workplace related actions. The rationale is that while 85% of adult individuals consume alcohol in a moderate and responsible manner, most of the time, harmful and hazardous alcohol consumption is one of the main causes of premature death and avoidable disease and furthermore has a negative impact on working capacity. While 266 million adults drink alcohol up to 20g (women) or 40g (men) per day, over 58 million adults (15%) consume above this level, with 20 million of these (6%) drinking at over 40g (women) or 60g per day (men). Looking at addiction rather than drinking levels, it is also estimated that 23 million Europeans (5% of men, 1% of women) are dependent on alcohol in any one year. The Fourth Theme is to inform, educate and raise awareness on the impact of harmful and hazardous alcohol consumption, and on appropriate consumption patterns, incorporated in Aim 9. The Fifth Theme is to develop, support and maintain a common evidence base. Aim 10: To obtain comparable information on alcohol consumption, especially on young people; definitions on harmful and hazardous consumption, on drinking patterns, on the social and health effects of alcohol; and information on the impact of alcohol policy measures and of alcohol consumption on productivity and economic development. Aim 11: To evaluate the impact of initiatives taken on the basis of this Communication.

Draus JM; Santos AP; Franklin GA; Foley DS. Drug and alcohol use among adolescent blunt trauma patients: Dying to get high? Journal of Pediatric Surgery 43(1): 208-211, 2008. (10 refs.)

Purpose: We compared injury severity, hospital course, and outcomes between adolescent blunt trauma patients with and without positive toxicology screens. Methods: Trauma registry data were used to identify adolescent blunt trauma victims between 2000 and 2005. Demographics, injury severity, hospital course, and outcomes were evaluated. Patients with and without positive toxicology results were compared. Results: There were 9.3% that had positive toxicology results. The mean age of toxicology-positive patients was 17.2 years. The most commonly detected drugs were cannabinoids (40%), alcohol (30%), and polysubstances (23%). Toxicology-positive patients had significantly lower Glasgow Coma Scale (11.8 +/- 4.6 vs 13.7 +/- 3.3; P < .001), higher Injury Severity Score (16.7 +/- 11.2 vs 10.4 +/- 9.1; P < .001), and required more emergent operations (20.7% vs 12.8%; P < .001). Length of stay was longer (7.3 +/- 8.1 vs 4.8 +/- 7.2 days; P < .001). Functional Independence Measure scores were lower (10.5 +/- 2.2 vs 11.2 +/- 1.7; P < .001); mortality was higher (6.4% vs 2.6%; P < .001). Conclusions: A significant number of adolescents had positive toxicology screens. Our data suggest that toxicology-positive patients were more severely injured, required more hospital care, and had worse outcomes than other adolescent blunt trauma victims.

Faller-Marquardt M; Pollak S; Schmidt U. Cigarette burns in forensic medicine. Forensic Science International 176(2-3): 200-208, 2008. (50 refs.)

Skin lesions suspected to have been caused by a burning cigarette require thorough diagnostic evaluation as to the mode of infliction. Accidental cigarette bums must be differentiated from injuries due to self-infliction or maltreatment. The typical categories are presented on the basis of the literature and exemplary cases from the authors' own study material. An intentional infliction must be taken into consideration when a body region is involved which does not normally come into contact with a cigarette by chance. Full thickness bums from glowing cigarettes require an exposure time of more than 1 s. One should also keep in mind the possibility of confusion with local skin infections or thermal effects by traditional medical practices (e.g. moxibustion). In unclear cases, repeated inspection of the lesion is recommended in order to facilitate its classification as to causation and age. The courses of healing in first- to third-degree cigarette bums are demonstrated by means of continuous photographic documentation. The discussion deals with different kinds of accidental and intentional cigarette bums, e.g. in drug addicts, psychiatric patients, victims of child abuse, maltreatment and torture, but also in persons feigning a criminal offence.

Far AC; Roig DA; Jerez MJ; Franzke NTB. Relationship between alcohol, drug use and traffic accidents related to nightlife among a Spanish youth sample in three Autonomous Communities in 2007. Revista Espanola de Salud Publica (Spanish) 82(3): 323-331, 2008. (23 refs.)

Background: The phenomenon known as binge drinking and other drug abuse frequently occurs among young people in nightlife-related areas. This study analyzes the risk behaviours and the accident rate related to alcohol and other drugs among a sample of young people involved in nightlife. Method: A total of 440 young people from 3 Spanish Autonomous Communities took part. The sample size was estimated by means of Respondent Driven Sampling. The statistical analyses mined frequencies and measurements of the relationship of driving risk-related behaviour in relation to the accident rate, number of cases of drunkenness, frequency of accidents during the past month, influence of gender and age, as well as the predictiveness of these variables as regards the accident rate. Results: A total of 50.2% of these young people bad gotten into a vehicle with a driver who was drunk and/or under the influence of drugs, 23.2% has driven when drunk and 23.5% under the influence of drugs. The greater the degree of involvement in nightlife, the higher the frequency of drunkenness [chi(2) (9)= 112.24; p<.000]; the greater the man her of cases of drunkenness, the higher the frequency of thes behaviors: getting into a vehicle with drivers who are drunk or under the influence of drugs [c(2)=36,442, (3) p<0.001], drunken driving [chi(2) =23,748, (3) p<0.001] and driving while under the influence of drugs [chi(2)=23,816 (3) p<0.001]. The regression analysis highlighted drunken driving (odds-ratio=5.4) as the risk behaviour most related to traffic accidents. Conclusions: There is a high incidence of risk behaviours while driving vehicles. Drunkenness, drug use and involvement in nightlife increase the frequency of these behaviours. Drunken driving was the best accident predictor.

Finkelstein E; Prabhu M; Chen H. Increased prevalence of falls among elderly individuals with mental health and substance abuse conditions. American Journal of Geriatric Psychiatry 15(7): 611-619, 2007. (40 refs.)

Objective: To quantify the increase in the likelihood of a fall injury and medical costs of treating fall injuries among elderly individuals with select mental health (MH), substance abuse ( SA), and cognitive disorders compared with the general elderly population. Methods: The authors used a random sample (N = 601,922) of claimants in the 2001 Medicare fee-for-service 5% Standard Analytic File. Using logistic regressions, the authors estimated the odds of sustaining a medically attended fall injury as a function of each MH, cognitive, and SA condition and select demographic characteristics. The authors also used an ordinary least squares regression model to compare the increase in costs associated with fall injuries for those with MH/SA conditions compared to those without MH/SA conditions. Results: The odds of a fall injury are between 1.5 and 4.5 times greater for those with MH and SA conditions among both elderly men and women. Odds of a fall injury among elderly individuals with Alzheimer disease and other dementias are at least three times greater, and the differential increases with age. The increases in cost resulting from a fall injury are greater among both elderly men and women with MH conditions and Alzheimer disease and other dementias and among elderly women with SA conditions. Conclusion: The substantial burden of fall injuries among the elderly with MH/SA conditions suggests the need to direct fall prevention and mitigation strategies specifically toward this vulnerable population.

Formiga F; Navarro M; Duaso E; Chivite D; Ruiz D; Perez-Castejon JM et al. Factors associated with hip fracture-related falls among patients with a history of recurrent falling. Bone 43(5): 941-944, 2008. (29 refs.)

Background: People who have Suffered falls are at greater risk of falling again. We Study the characteristics of falls leading to hip fracture in people with a history of recurrent falls, comparing them with those of people with a history of sporadic falling. Materials and methods: Analysis of the characteristics of a sample of 1225 patients consecutively admitted to six hospitals because of a hip fracture secondary to a fall (index fall) - index fall characteristics (location, time and the possible cause of the fall: intrinsic, extrinsic or combined risk factors) were also determined. Patients with a history of three or more falls (recurrent fallers) in the year prior to the index fall were identified as high-risk fillers: those with less than three falls were considered to be sporadic fallers. Results: The mean number of fills in the year prior to the index fall was 1.7 +/- 6.5; 227 patients (22%) had experienced three or more falls within that period. Most index falls (880, 71.8%) took place at the patient's home, 232 (18.95%) in the street and 113 (9.2%) elsewhere; most (892, 72.9%) took place during daytime. Multiple stepwise logistic regression analysis showed that recurrent fallers were characterized by poorer baseline independence for activities of the daily living, a prior diagnosis of dementia, greater use of prescription drugs and a greater use of neuroleptics. For frequent fallers, the index fall was more often associated with an intrinsic factor than for sporadic fallers. Conclusions: A significant percentage of patients experiencing a fall followed by hip fracture have a history of recurrent failing in the year prior to a fall-related hip fracture. Poorer functional and cognitive status, polypharmacy and the use of neuroleptics are more prevalent in this subgroup of patients, and intrinsic factors as a cause of the fall are more common in this group. Whether these circumstances associated with recurrent falling are responsible for this higher prevalence of intrinsic, non-accidental falls should be addressed prospectively in order to implement preventive strategies.

Forsyth AJM. Banning glassware from nightclubs in Glasgow (Scotland): Observed impacts, compliance and patrons views. Alcohol and Alcoholism 43(1): 111-117, 2008. (22 refs.)

Aim: To examine the impact of a glassware ban policy on disorder-related harm within licensed premises (nightclubs) and how this action was viewed by their patrons. Methods: Field observations were conducted in a sample of eight nightclubs following the introduction of this policy across all such venues within a city centre. These observations involved both quantitative and qualitative data collection observing violence in a naturalistic setting, and were supplemented by taped in-depth interviews with nightclub patrons. Results: Exemptions to the ban had enabled some premises (three out of eight) to continue to serve alcoholic drinks in glass vessels, and injurious violence resulting from these practices was observed. Disorder in all-plastic venues was observed to incur less injury risk. Patrons also reported feeling safer in these nightclubs than in others. Conclusions: This research demonstrated the potential of such policy to reduce the severity of alcohol-related violence in the night-time economy. It is recommended that future bans of this nature be tailored towards the elimination of all types of glassware from such premises.

Freisthler B; Gruenewald PJ; Ring L; LaScala EA. An ecological assessment of the population and environmental correlates of childhood accident, assault, and child abuse injuries. Alcoholism: Clinical and Experimental Research 32(11): 1969-1975, 2008. (45 refs.)

Background: This study examines the relationships of population and environmental characteristics to hospital discharges for childhood accident, assault, and child abuse injuries among youth from 0 to 17 years of age. Methods: The analysis uses aggregate data on populations and environments in 1,646 California zip code areas that were collected for the year 2000. Zero inflated negative binomial models were used to assess ecological relationships between these characteristics and numbers of hospital discharges for childhood injuries from accidents and assaults; negative binomial models were used to assess these relationships for injuries related to child abuse. Results: A number of different characteristics were related to the different injury outcomes. Childhood accident injuries were related to measures female headed households, adult to child ratio, and nonalcohol retail establishments (e.g., numbers of gas stations). Assault injuries were related to measures of poverty and vacant housing. All 3 outcomes were directly related to percent of female-headed households, percent African American residents, and density of off-premise alcohol outlets. Conclusions: The results demonstrate that both population and environmental characteristics are significantly correlated with rates of childhood injuries. These results suggest that some environmental characteristics, in particular the presence of many off-premise alcohol outlets in neighborhoods, may reduce the overall level of guardianship of children's activities in zip code areas, resulting in harm to their children.

French MT; Maclean JC. Underage alcohol use, delinquency, and criminal activity. Health Economics 15(12): 1261-1281, 2006. (75 refs.)

Since 1988, the minimum legal drinking age (MLDA) has been 21 years for all 50 US states. The increasing prevalence of teenagers driving under the influence (DUI) of alcohol and the resulting traffic accidents were two main reasons for raising the MLDA to 21 years. Following the passage of this legislation, several published studies have found that the higher MLDA is associated with a significant reduction in both fatal and non-fatal accidents. While the relationship between MLDA and DUI events among young adults has been extensively studied, less information is available on other potential consequences of underage drinking. The present study uses data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a recent nationally representative survey, to investigate the effects of underage drinking on a variety of delinquency and criminal activity consequences. After controlling for the endogeneity of alcohol use where appropriate, we find strong evidence that various measures of alcohol consumption are related both to delinquency and to criminal activity. However, the findings are not uniform across gender as we find striking differences between males and females. These results have interesting policy and public health implications regarding underage drinking.

Giesbrecht N. Invited Commentary: Is alcohol a risk factor for trauma and chronic disease mortality? Narrowing the gap between evidence and action. (editorial). American Journal of Epidemiology 168(10): 1126-1129, 2008. (34 refs.)

Alcohol has been linked with over 60 chronic diseases and types of trauma, and in developed countries alcohol consumption is ranked third in terms of disability-adjusted life years (of 26 risk factors considered). In this issue of the Journal, two papers from Finland and Canada provide new evidence of the negative effects of alcohol consumption on trauma and mortality. Herttua et al. (Am J Epidemiol. 2008;168(10):1110-1118) used data from a natural experiment involving an increase in access to alcohol and its links to mortality; they offer provocative findings on differential impacts by gender, age, and socioeconomic level. Taylor et al. (Am J Epidemiol. 2008;168(10):1119-1125) focused on lifetime risk of alcohol-related injury mortality, exploring the implications for high-risk drinking patterns. These authors offer agendas for future research on the differential impacts of policy changes according to demographic dimensions, and they highlight the need for a refined measurement of alcohol intake-since the amount of alcohol in a "standard drink" consumed by heavier drinkers is probably not the same as it is for other consumers. There is still a substantial gap between alcohol's position as a significant contributor to mortality and disability and the implementation of effective interventions.

Gmel G; Givel JC; Yersin B; Daeppen JB. Injury and repeated injury: What is the link with acute consumption, binge drinking and chronic heavy alcohol use? Swiss Medical Weekly 137(45-46): 642-648, 2007. (43 refs.)

Objectivcs: First, to test whether current injury is more closely related to acute intake than to usual consumption patterns, and second, to test whether repeated injury is more closely related to general consumption patterns than to acute intake. Methods: Screening of alcohol consumption of 7,872 patients enrolling between january 1, 2003 and June 30, 2004 in an emergency department (ED) in Lausanne, Switzerland. General consumption patterns were measured as usual volume (in drinks per week) and binge drinking (5+ drinks for men; 4+ drinks for women) at least once monthly. Acute intake was measured through number of drinks in the 24-hour period prior to attending the ED. Separate logistic regression models of current injury and repeated injury on alcohol consumption patterns were estimated. Results: Acute intake and binge drinking dominated the association with current injury, while general consumption patterns were predictive of repeated alcohol-related injury. Conclusions: Acute intake is associated with current injury in a dose-response relationship and with binge drinking. Because acute intake can be found among moderate volume drinkers as well as among chronic heavy drinkers, for current injury usual volume adds little predictive value over the effects of acute intake. Repeated injuries occur more often among chronic heavy drinkers, and thus general consumption patterns are more closely associated with injury "recidivism" than with acute intake. A screening question assessing prior injury may be a useful tool in the ED for distinguishing between chronic heavy drinkers and usually moderate drinkers with heavy drinking episodes, and thus prove helpful when creating preventive efforts tailored to different types of drinker.

Good GE; Schopp LH; Thomson D; Hathaway SL; Mazurek MO; Sanford-Martens TC. Men with serious injuries: Relations among masculinity, age, and alcohol use. Rehabilitation Psychology 53(1): 39-45, 2008. (51 refs.)

Objective: To increase understanding of masculine role attitudes and conflicts associated with alcohol use among men with serious injuries. Participants and Measures: Fifty-two Midwestern adult men with spinal cord injury or traumatic brain injury completed masculine role attitudes and conflicts and alcohol consumption instruments. Age and blood alcohol content at injury were obtained from records. Results: Younger men reported greater pursuit of status, drive for dominance, and risk taking but less self-reliance and overall masculine role conflict. Earlier age of injury was associated with greater pursuit of status and drive for dominance but less self-reliance, restrictive emotionality, and overall masculine role conflict. Endorsement of dominance correlated positively with number of alcoholic drinks per drinking episode (r(s) = .43) and binge drinking (r(s) = .47). Masculine role conflict associated with success, power, and competition correlated with number of drinks per drinking episode (r(s) = .46). Implications: Greater awareness and sensitivity to masculinity-related attitudes and conflicts may (a) reduce psychological barriers to accepting assistance, (b) promote active engagement in rehabilitation activities, (c) avoid counterproductive ambivalence and resistance, and (d) improve the therapeutic working alliance associated with favorable outcomes among men with serious injuries.

Graham DP; Cardon AL. An update on substance use and treatment following traumatic brain injury. Annals of the New York Academy of Sciences 1141(Addiction Reviews 2008): 148-162, 2008. (54 refs.)

Traumatic brain injury (TBI) is a leading cause of mortality and morbidity among young adults. Substance abusers constitute a disproportionate percentage of these patients. A history of substance abuse predicts increased disability, poorer prognosis, and delayed recovery. While consensus in the literature indicates that substance-abuse rates decline following injury, conflicting literature shows a significant history of brain injury in addicts. We reviewed the literature on substance abuse after TBI to explore the state of knowledge on TBI as a risk factor for substance abuse. While recent reviews regarding substance abuse in TBI patients concur that substance-abuse rates decline even after mild TBI, an emerging literature suggests mild TBI may cause subtle impairments in cognitive, executive, and decision-making functions that are often poorly recognized in early diagnosis and treatment. When combined with difficulties in psychosocial adjustment and coping skills, these impairments may increase the risk for chronic substance abuse in a subset of TBI patients. Preliminary results from veterans indicate these patterns hold in a combat-related post-traumatic stress disorder population with TBI. This increasingly prevalent combination presents a specific challenge in rehabilitation. While this comorbidity presents a challenge for the successful treatment and rehabilitation of both disorders, there is sparse evidence to recommend any specific treatment strategy for these individuals. Mild TBI and substance abuse are bidirectionally related both for risks and treatment. Further understanding the neuropsychiatric pathology and different effects of different types of injuries will likely improve the implementation of effective treatments for each of these two conditions.

Guse CE; Cortes LM; Hargarten SW; Hennes HM. Fatal injuries of US citizens abroad. Journal of Travel Medicine 14(5): 279-287, 2007. (42 refs.)

Background. US citizens are increasingly traveling, working, and studying abroad as well as retiring abroad. The objective of this study was to describe the type and scope of injury deaths among US citizens abroad and to compare injury death proportions by region to those in the United States. Methods. A cross-sectional design using reports of US citizen deaths abroad for 1998, 2000, and 2002 on file at the US State Department was employed. The main outcome measures were the frequencies of injury deaths and proportional mortality ratios (PMRs) comparing deaths abroad to deaths in the United States. Results. Two thousand eleven injury deaths were reported in the 3 years, comprising 13% of all deaths. The overall age-adjusted PMR for injury fatalities abroad compared to the United States was 1.6 (95% confidence interval 1.6-1.7). The highest age-adjusted PMRs for motor vehicle crashes were found in Africa (2.7) and Southeast Asia (1.6). The proportion of drowning deaths was elevated in all regions abroad. Conclusions. Injuries occur at a higher proportion abroad than in the United States. Motor vehicle crash and drowning fatalities are of particular concern. Improved data quality and surveillance of deaths would help government agencies create more evidence-based country advisories.

Hendrickson RG; Cloutier R; McConnell KJ. Methamphetamine-related emergency department utilization and cost. Academic Emergency Medicine 15(1): 23-31, 2008. (44 refs.)

Objective: To quantify the frequency, cost, and characteristics associated with emergency department (ED) visits that are related to methamphetamine use. Methods: This was a prospective observational study. The authors performed a training program for ED clinicians on the acute and chronic effects of methamphetamine and the signs of methamphetamine abuse. A standardized two question survey was administered to clinicians concerning the relationship between the ED visit and the patient's methamphetamine use. The survey was embedded in the patient tracking system and was required for all ED patients before disposition. Survey results were merged with administrative data on demographics, diagnosis, disposition, and charges. Univariate analyses were used to determine patient characteristics associated with methamphetamine-related ED visits. Results: The authors examined 15,038 ED visits over a 20-week period from February 2006 to June 2006. There were a total of 353 methamphetamine-related visits, for an average of 17.65 visits per week (2.4% of all visits). Hospital charges for methamphetamine-related ED visits averaged $133,181 per week, for an estimated total of $6.9 M in annual charges. Methamphetamine-related ED patients were more likely to be male (odds ratio [OR] 1.6, 95% confidence interval [CI] = 1.30 to 2.01), white (OR 1.8, 95% CI = 1.38 to 2.29), and uninsured (OR 3.2, 95% CI = 2.21 to 4.69). The top four medical conditions associated with methamphetamine-related visits were mental health (18.7%), trauma (18.4%), skin infections (11.1%), and dental diagnoses (9.6%). Conclusions: Methamphetamine abuse accounts for a modest but substantial proportion of ED utilization and hospital cost. Methamphetamine-related ED visits are most commonly related to mental illness, trauma, skin, and dental-related problems.

Herttua K; Makela P; Martikainen P. Differential trends in alcohol-related mortality: A register-based follow-up study in Finland in 1987-2003. Alcohol and Alcoholism 42(5): 456-464, 2007. (46 refs.)

Aims: To assess to what extent alcohol-related mortality has changed by age, sex and education in Finland in 1987-2003, a period which saw two periods of economic growth, separated by a severe depression (1991-1995). Methods: A register-based follow-up study of all over 15-year-old Finnish men and women. Age, sex and education of the participants were measured at the time of the 1985, 1990, 1995 and 2000 censuses. Follow-up for mortality was for 1987--2003. The outcome measure was alcohol-related mortality, which was defined using information on the underlying and contributory causes of death. Results: Among men and women aged 45 years and over, the trends in alcohol-related mortality were associated with economic cycles. Among those aged less than 45 years, alcohol-related mortality decreased from the early 1990s, but intoxication-related accidents and violence still contributed largely to premature mortality. The unfavourable trend for older men resulted from an increase in mortality due to directly alcohol-attributable diseases, alcohol-related diseases of the circulatory system and accidents and violence, and for older women from an increase due to intoxication-related accidents and violence, and alcohol-attributable diseases. Alcohol-related mortality was higher in lower educational groups, and among women the educational gap widened towards the end of the study period. Conclusion: This study shows that trends in both economic conditions and per capita consumption of alcohol are not associated with trends in alcohol-related mortality in all population subgroups. In health policy more attention should be paid to divergent trends in gender, age and education specific alcohol-related mortality.

Hingson RW; Heeren T; Edwards EM. Age at drinking onset, alcohol dependence, and their relation to drug use and dependence, driving under the influence of drugs, and motor-vehicle crash involvement because of drugs. Journal of Studies on Alcohol and Drugs 69(2): 192-201, 2008. (32 refs.)

Objective: We explored among people who ever consumed alcohol whether early age at drinking onset and alcohol dependence predicted drug use and dependence. We also examined among drinkers who have used drugs whether they also predict driving under the influence of drugs and motor-vehicle crash involvement because of drugs. Method: A US. national sample of 42,867 persons age 18 and older was surveyed in 1991-1992 (response rate = 90%). Logistic regression examined these potential associations among 27,616 respondents who ever drank alcohol, controlling for numerous demographic and personal characteristics. Results: Among "ever" drinkers, 22% used drugs, 10% had driven under the influence of drugs, and nearly 1% was in a motor-vehicle crash because of drug use, the equivalent of 1 million people. The younger the age of respondents when they first began drinking and whether they ever experienced alcohol dependence were independently associated with greater odds of ever using drugs and experiencing drug dependence. Among persons who consumed alcohol and drugs, having ever experienced drug dependence was the strongest predictor of driving under the influence of drugs and motor-vehicle crash involvement because of drug use. After controlling for drug dependence and age at first drug use, having experienced alcohol dependence was also independently associated with both outcomes. Conclusions: Efforts to prevent drug-related crashes should include drug use prevention and treatment, as well as prevention of early alcohol use and treatment of alcohol dependence.

Hostetler VC; Sattar SP. Should alcohol be tolerated in the workplace? (letter). American Journal on Addictions 16(5): 427, 2007. (3 refs.)

Jiang X; Li DG; Boyce W; Pickett W. Alcohol consumption and injury among Canadian adolescents: Variations by urban-rural geographic status. Journal of Rural Health 24(2): 143-147, 2008. (25 refs.)

Context: The impact of alcohol consumption on risks for injury among rural adolescents is an important and understudied public health issue. Little is known about whether relationships between alcohol consumption and injury vary between rural and urban adolescents. Purpose: To examine associations between alcohol and medically attended injuries by urban-rural geographic status using a representative national sample of Canadian adolescents. Methods: The study involved a secondary analysis of a national sample of Canadian adolescents aged 11-15 years (n = 7,031) from the 2001-2002 Health Behavior in School-Aged Children Survey. Respondents were classified into 5 geographic categories of rural-urban status. Multiple logistic regression was used to examine the magnitude and homogeneity of associations between drinking patterns and adolescent injuries across these 5 geographic groupings. Findings: Higher rates of alcohol consumption and adolescent injuries were observed in more rural areas. Alcohol consumption was significantly associated with higher risks for injury occurrence with evidence of a dose-related pattern of risk. Associations between alcohol consumption and injury were consistent by urban-rural geographic status. Conclusions: Misuse of alcohol is an important potential cause of injury. Adolescents whose lifestyle includes alcohol consumption experience higher risks for injury, and this association is observed consistently by urban-rural geographic status. Findings of this study emphasize a need to intervene with high-risk adolescents as a tertiary prevention strategy, irrespective of geographic background.

Kaplan S; Prato CG. Impact of BAC limit reduction on different population segments: A Poisson fixed effect analysis. Accident Analysis and Prevention 39(6): 1146-1154, 2007. (27 refs.)

Over the past few decades, several countries enacted the reduction of the legal blood alcohol concentration (BAC) limit, often alongside the administrative license revocation or suspension, to battle drinking-and-driving behavior. Several researchers investigated the effectiveness of these policies by applying different analysis procedures, while assuming population homogeneity in responding to these laws. The present analysis focuses on the evaluation of the impact of BAC limit reduction on different population segments. Poisson regression models, adapted to account for possible observation dependence over time and state specific effects, are estimated to measure the reduction of the number of alcohol-related accidents and fatalities for single-vehicle accidents in 22 U.S. jurisdictions over a period of 15 years starting in 1990. Model estimates demonstrate that, for alcohol-related single-vehicle crashes, (i) BAC laws are more effective in terms of reduction of number of casualties rather than number of accidents, (ii) women and elderly population exhibit higher law compliance with respect to men and to young adult and adult population, respectively, and (iii) the presence of passengers in the vehicle enhances the sense of responsibility of the driver.

Kim H; Colantonio A. Intentional traumatic brain injury in Ontario, Canada. Journal of Trauma, Injury, Infection and Critical Care 65(6): 1287-1292, 2008. (15 refs.)

Background. Violence and traumatic brain injury (TBI) are two major public health concerns. This violence-related TBI, however, has not been studied in Canada and there is little literature on a profile of risk factors and injury severity regarding TBI because of self-inflicted/ suicidal and assault/homicidal injury compared with unintentional TBI. Methods: Cross-sectional study using the comprehensive data sets of Ontario trauma registry from 1993 to 2001. Selling. Data from a large trauma registry were used to assess demographic and injury-related characteristics, injury severity and incident time associated with Till that were either caused unintentionally, were self-inflicted or resulted from an assault. Results. This Study identified 1,409 (8.0%) intentional TBIs and 16,211 (92.0%) unintentional TBIs. Of the intentional TBIs, 389 (27.6%) was self-inflicted TBI (Si-TBI) and 1,020 (72.4%) was other-inflicted TBI. The most common cause of self-inflected-TBI was "jumping from high places" (32.1%), followed by "firearms" (30.6%). About half of other-inflected TBI was because of "fight and brawl" (48.3%), followed by "struck by objects" (26.1%). Self-inflected-TBI was associated with younger age, female gender, and having more alcohol/drug abuse history. For other-inflected, younger age, male gender, having more alcohol/drug abuse history were independently associated. Conclusion: This research provides the first comprehensive overview of intentional TBI based on Canadian data. The comprehensive data sets of the Trauma Registry provided the ability to identify who is at risk for intentional TBI. Prevention programs and more targeted rehabilitation services should be designed for this vulnerable population.

Koljonen V. Long hair, smoking, and deep facial burns. Journal of Burn Care & Research 29(2): 395-397, 2008. (6 refs.)

The purpose of this article is to describe deep facial burn injuries by cigarette lighters in longhaired adults and to report our experience in their treatment. Eight consecutive cigarette lighter burn victims are treated in the Helsinki Burn Center in the year 2006. Seven of the patients were women; their mean age was 50 years. All were under the influence of alcohol at the time of injury. The mean burnt area was 3.5% TBSA. The burnt areas were primarily forehead, cheek, and ipsilateral ear. After a conservative treatment, all the patients underwent an operation, whereby the nonhealing burns were excised and covered with autologous split thickness skin grafts. Postoperative period was uneventful in all the patients. Besides having severe detrimental effects on general health status and wound healing, smoking is the leading cause of residential and total fire deaths worldwide. The patients in this article suffered deep facial burns because of cigarette lighters.

Kool B; Ameratunga S; Robinson E; Crengle S; Jackson R. The contribution of alcohol to falls at home among working-aged adults. Alcohol 42(5): 383-388, 2008. (40 refs.)

The role of alcohol in the occurrence and burden of fall related injury at home is unclear. We examined the contribution of alcohol to fatal and hospitalized injuries due to unintentional falls at home among working-aged adults. We conducted a population-based case-control study in Auckland, New Zealand between July 2005 and July 2006. Cases were 335 people aged 25-60 years who were admitted to hospital or died as a result of unintentional falls at home. Control subjects were 352 people randomly selected from the electoral roll from the same age band as the cases. The participants or next-of-kin completed a structured interview that ascertained data on socio-demographic, personal, and lifestyle factors including alcohol consumption. After controlling for confounding, the consumption of two or more standard alcoholic drinks in the preceding 6 h relative to none was associated with a significantly increased risk of fall related injury (for two standard drinks: odds ratio: 3.7, 95% confidence interval: 1.2-10.9; for three or more drinks: odds ratio: 12.9, 95% confidence interval: 5.2-31.9). Approximately 20% of unintentional falls at home in this population may be attributable to the consumption of two or more alcoholic drinks in the preceding 6 It. Drinking is strongly associated with unintentional falls at home that result in admission to hospital or death. Moreover, a substantial proportion of falls at home among working-age people can be attributed to alcohol consumption. This largely unrecognized problem should be addressed in falls prevention programs.

Lester PE; Kohen I. Smoking in the nursing home: A case report and literature review. Journal of the American Medical Directors Association 9(3): 201-203, 2008. (13 refs.)

We report a case of second- and third-degree burns in an elderly nursing home resident with dementia who was smoking in her room. This case highlights the risks of smoking by residents in long-term care settings. It also raises awareness to the issues involving smoking cessation and restriction of smoking privileges in the long-term care setting.

Lumenta DB; Hautier A; Desouches C; Gouvernet J; Giorgi R; Manelli JC et al. Mortality and morbidity among elderly people with burns: Evaluation of data on admission. Burns 34(7): 965-974, 2008. (47 refs.)

People aged >= 65 years represent a growing population within burns units in the Western world. In 2001, this group was reported to rise to 20% of such admissions. We reviewed the records of 265 burn cases with complete admission and discharge histories, from January 1990 to December 2003 in an A-level regional burns centre. The predictive value of age, gender, total body surface area burned (TBSA), inhalation trauma (IT), premorbid conditions and currently used burn scores (Baux, ABSI, Ryan) for haemodynamic or respiratory complications, mortality and morbidity were analysed. Additionally a subset of patients with diabetes mellitus and >30% total body surface area burned were reviewed. About 16% of all admissions with burns were >65 years of age, with a mortality rate of 30.6% (81/265). Only gender and premorbid conditions did not influence mortality. Haemodynamic and respiratory complications were significantly related to TBSA, presence of I and any of the three scores (all p < 0.001). Among survivors (184/265), the median duration of hospital stay was 26.0 days. Factors contributing to a significantly increased length of stay were, in decreasing order, total body surface area burned, high levels of burn scores, inhalation trauma, flame injury and certain premorbid conditions (cardiovascular disease, alcoholism). About 77.7% of all patients were discharged either to a rehabilitation centre or back to their previous form of housing. This study showed that among burned people aged >65 years a good outcome as evaluated on discharge can be achieved. Studies pooling different centres' results are needed to improve the significance of conclusions drawn from these data.

Macdonald S; Cherpitel CJ; DeSouza A; Stockwell T; Borges G; Giesbrecht N. Variations of alcohol impairment in different types, causes and contexts of injuries: Results of emergency room studies from 16 countries. Accident Analysis and Prevention 38(6): 1107-1112, 2006. (29 refs.)

Objective: The purpose of this paper is to document alcohol impairment (based on a blood alcohol content (BAC) of at least 80 mg%) for different types, causes and location contexts of injuries. Design and setting: Data from 45 studies with 11,536 injury patients were merged to determine variations in the percent of alcohol impairment among injury patients. In each study, emergency room (ER) injury patients were given a short interview on the circumstances of their injury and BAC was measured. Results: Injury severity, measured by number of body regions injured was significantly associated with BACs over 80 mg%. The highest percentage of injury type to involve alcohol was head injury/concussion. In terms of causes of injuries, patients with alcohol impairment were significantly more likely to be involved in violence than any other cause (i.e., vehicle, failing, poisoning or burns). Finally, injuries occurring at a bar or restaurant were significantly more likely to involve alcohol impairment than any other setting. Conclusions: The results demonstrate considerable variation in the circumstances where alcohol is involved in injuries. These results may be useful for the development of prevention initiatives

Mangold FT; Sommers MS; Kent G; Fargo J. Harmful drinking, depression, and conduct disorder among females involved in alcohol-related motor vehicle crashes: A secondary analysis. Journal of Addictions Nursing 10(1): 9-15, 2008. (35 refs.)

Alcohol is involved in 40% of the deaths that occur from traffic injury in the US. Little is known, however, about factors that are associated with alcohol-related traffic injury in women. The purpose of this study was to analyze the relationships among alcohol consumption and two psychological variables (depression and conduct disorder) in a sample of women with harmful drinking patterns and who were involved in an alcohol-related motor vehicle crash (ARMVC). Wilsnack's theoretical model of causes and consequences of problem drinking among women was used to guide the study. The sample included 43 participants, 18 to 45 years old, with a mean age of 28.84 years (SD = 7.10). Regression analyses were per formed to find the best fit regression model. Results indicated that the best-fit regression model that significantly explained approximately 25% of the variance in the average number of drinks per drinking day included depression over a life time, conduct disorder after age 15, and age. Although more work is needed to understand the relationships among the variables, when young women are injured in alcohol-related vehicular crashes, they should also be screened for depression and may have conduct disorder in their past history.

Mann RE; Adlaf E; Zhao JH; Stoduto G; Ialomiteanu A; Smart RG et al. Cannabis use and self-reported collisions in a representative sample of adult drivers. Journal of Safety Research 38(6): 669-674, 2007. (37 refs.)

Problem: This study examines the relationships between collision involvement and several measures of cannabis use, including driving after using cannabis, among drivers, based on a population survey of Ontario adults in 2002 and 2003. Method: Logistic regression analyses examined self-reported collision involvement in the last 12 months by lifetime use of cannabis, past year use of cannabis, and past year driving after using cannabis, while controlling for demographic characteristics. Results: We found that the odds of reporting collision involvement was significantly higher among cannabis users, and among those who reported driving after cannabis use. Some evidence for a dose-response relationship was seen as well. Discussion: Cannabis users and people who report driving after cannabis use are also more likely to report being involved in a collision in the past year. These observations suggest that collision prevention efforts could be aimed at these groups. Additional work to determine the causal pathways involved in the relationships observed here is needed.

Margolis SA; Ypinazar VA; Muller R. The impact of supply reduction through alcohol management plans on serious injury in remote indigenous communities in remote Australia: A ten-year analysis using data from the Royal Flying Doctor Service. Alcohol and Alcoholism 43(1): 104-110, 2008. (34 refs.)

Aims: To assess the impact of supply reduction through Alcohol Management Plans (AMP) on the rate of serious injuries in four indigenous communities in remote Australia. Methods: An ecological study used the database of the Royal Flying Doctor Service (RFDS) to calculate trauma retrieval rates for 8 years pre- and 2 years post-AMP in four remote communities covering a period from 1 January 1995 to 24 November 2005. All serious injuries in these communities required aero-medical retrieval. Results: Serious injury resulted in a total of 798 retrievals during the observation period. One-sided analysis of variance for repeated measurements over the 10 years demonstrated a significant (P = 0.021) decrease of injury retrieval rates after the introduction of the AMP. Similarly, a comparison of linear trends of injury retrieval rates pre- and post-AMP also resulted in a significant decrease (P = 0.022; one-sided paired t-test). Comparisons of injury retrieval rates of just the 2 years pre- and post-AMP also revealed a significant reduction (P = 0.001; paired t-test), with an averaged 52% decline. Identical comparisons of retrieval rates for causes other than injury revealed no significant changes. Conclusion: This impact evaluation provides evidence that AMP was effective in reducing serious injury in the assessed indigenous communities.

Master D; Piorkowski J; Zani S; Babigian A. Snowblower injuries to the hand epidemiology, patterns of injury, and strategies for prevention. Annals of Plastic Surgery 61(6): 613-617, 2008. (14 refs.)

Snowblowers injure approximately 5000 people a year and can cause devastating hand injuries. Even with added safety measures and warnings on modern snowblowers, hand injuries are still occurring at an alarming rate. We have reviewed our series of snowblower-related hand injuries to elucidate the epidemiology, patterns of injury, and strategies for prevention. Questionnaires and treatment records of 22 individuals with snowblower injuries to the hand between 2002 and 2005 were reviewed. All patients were treated by a single hand surgeon at Hartford Hospital in Hartford, CT. Eleven of the 22 held upper level educational degrees. Averaged results include operator experience of 15.17 years, machine age of 21.38 years, temperature of 29.05 degrees F (-1.51 degrees C), precipitation of 8.60 cm (3.38 in), and duration of use of 20.59 minutes excluding 3 outliers. Three patients consumed 1 alcoholic drink and 1 consumed 2 alcoholic drinks before injury. The majority of patients were aware of safety warnings (77.20%) and injured themselves with the machine running (82.35%) resulting in multiple digit injury (2.0 on average) on the dominant hand (68.18%). Operator inexperience, low operator intelligence, and excessive alcohol consumption do not seem to contribute to injury. Instead, significant experience, older machines, short durations of use before injury, characteristic weather patterns, and underlying misperceptions about snowblower design and function typically set the stage for injury. Injuries may be prevented in the future by improving snowblower design and/or by making brief public service announcements.

Matsumoto T; Imamura F. Self-injury in Japanese junior and senior high-school students: Prevalence and association with substance use. Psychiatry and Clinical Neurosciences 62(1): 123-125, 2008. (13 refs.)

The present study examined the prevalence of self-injury and its association with substance abuse in 2974 junior and senior high-school students, by self-reporting questionnaires. Consequently, 9.9% of students (boys, 7.5%; girls, 12.1%) reported an experience of self-injury at least once. Significant differences were found in substance use-related problems including alcohol abuse, smoking, and illicit drug use (P < 0.001) between students with and without an experience of self-injury. The results also suggest that self-injuring students may more easily gain access to illicit drugs even if they had not yet experienced the use of illicit drugs. Self-injury in adolescence may be associated with substance use and is considered to be a risk factor predicting future illicit drug use.

Miller JW; Naimi TS; Brewer RD; Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 119(1): 76-85, 2007. (61 refs.)

OBJECTIVES. Underage drinking contributes to the 3 leading causes of death (unintentional injury, homicide, and suicide) among persons aged 12 to 20 years. Most adverse health effects from underage drinking stem from acute intoxication resulting from binge drinking. Although binge drinking, typically defined as consuming >= 5 drinks on an occasion, is a common pattern of alcohol consumption among youth, few population-based studies have focused specifically on the characteristics of underage binge drinkers and their associated health risk behaviors. METHODS. We analyzed data on current drinking, binge drinking, and other health risk behaviors from the 2003 National Youth Risk Behavior Survey. Prevalence estimates and 95% confidence intervals were calculated by using SAS and SUDAAN statistical software. Logistic regression was used to examine the associations between different patterns of alcohol consumption and health risk behaviors. RESULTS. Overall, 44.9% of high school students reported drinking alcohol during the past 30 days (28.8% binge drank and 16.1% drank alcohol but did not binge drink). Although girls reported more current drinking with no binge drinking, binge-drinking rates were similar among boys and girls. Binge-drinking rates increased with age and school grade. Students who binge drank were more likely than both nondrinkers and current drinkers who did not binge to report poor school performance and involvement in other health risk behaviors such as riding with a driver who had been drinking, being currently sexually active, smoking cigarettes or cigars, being a victim of dating violence, attempting suicide, and using illicit drugs. A strong dose-response relationship was found between the frequency of binge drinking and the prevalence of other health risk behaviors. CONCLUSIONS. Binge drinking is the most common pattern of alcohol consumption among high school youth who drink alcohol and is strongly associated with a wide range of other health risk behaviors. Effective intervention strategies (eg, enforcement of the minimum legal drinking age, screening and brief intervention, and increasing alcohol taxes) should be implemented to prevent underage alcohol consumption and adverse health and social consequences resulting from this behavior.

Miller TR; Zaloshnja E; Spicer RS. Effectiveness and benefit-cost of peer-based workplace substance abuse prevention coupled with random testing. Accident Analysis and Prevention 39(3): 565-573, 2007. (34 refs.)

Few studies have evaluated the impact of workplace substance abuse prevention programs on occupational injury, despite this being a justification for these programs. This paper estimates the effectiveness and benefit-cost ratio of a peer-based substance abuse prevention program at a U.S. transportation company, implemented in phases from 1988 to 1990. The program focuses on changing workplace attitudes toward on-the-job substance use in addition to training workers to recognize and intervene with coworkers who have a problem. The program was strengthened by federally mandated random drug and alcohol testing (implemented, respectively, in 1990 and 1994). With time-series analysis, we analyzed the association of monthly injury rates and costs with phased program implementation, controlling for industry injury trend. The combination of the peer-based program and testing was associated with an approximate one-third reduction in injury rate, avoiding an estimated $48 million in employer costs in 1999. That year, the peer-based program cost the company $35 and testing cost another $35 per employee. The program avoided an estimated $1850 in employer injury costs per employee in 1999, corresponding to a benefit-cost ratio of 26:1. The findings suggest that peer-based programs buttressed by random testing can be cost-effective ill the workplace.

Mock C; Joshipura M; Quansah R; Arreola-Risa C. Advancing injury prevention and trauma care in North America and globally. Surgical Clinics of North America 87(1): 1-19, 2007. (62 refs.)

Historically, in all societies, infectious diseases were the leading cause of death and disability. This pattern changed in the past two centuries in high-income countries with decreases in infection as a result of improved sanitation and medical care and with consequent increases in life expectancy. Some of these gains were offset by increases by other disease, such as cancer, heart disease, and injury. In most high-income countries today injury is the leading cause of death between age 1 and 44. Similar trends are underway in today's low- and middle-income countries (Laics) with decreases in most infectious diseases, except HIV-AIDS, and also with increases in many injury- related causes of death, especially from road traffic. Because of recent increases in use of motorized transport globally, road traffic crashes have now become a leading cause of death among young, working-aged adults in almost every country. In the age group 15 to 44 years, road traffic deaths are second only to HIV-AIDS as a cause of death. In the United States motor vehicle-related death peaked in the 1930s at 30 deaths per 100,000 per year. They are currently at 15 deaths per 100,000 per year nationwide. Many European countries are even lower, such as Sweden at 8 deaths per 100,000 per year. Using a paradigm developed by the WHO, there is extended discussion of efforts to reduce injury related to alcohol and driving. The remainder of the article deals with developing countries and efforts to reduce injury and improve trauma care in those settings.

Moskalewicz J; Swiatkiewicz G; Cherpitel CJ; Ye Y. Results of two emergency room studies. European Addiction Research 12(4): 69-175, 2006. (29 refs.)

The aim of this paper is to examine to what extent cultural differences in male drinking patterns mediate relationships between alcohol and injury in a Polish context. Male patients admitted to emergency rooms located in two culturally different regions were investigated. Data analysis showed significant differences in patients' sociodemographic characteristics, their drinking patterns as well as their annual alcohol consumption. Logistic regression, however, has not confirmed any impact of site, drinking pattern and their interactions on the risk of injury. The risk of injury tended to decline with age, being more than two times lower for men over 50 years old, and was 2.4 times higher for those with an annual consumption of 12+ liters of pure alcohol.

Murrey GJ; Dallas R; Maki A. History of reported head trauma in a sample of women in substance abuse treatment. American Journal of Drug and Alcohol Abuse 33(2): 327-332, 2007. (14 refs.)

Objectives: To determine the prevalence of history of head trauma, causes of such trauma, and the associated chronic sequelae in a sample of women in chemical dependency treatment programs. Participants: A total of 2,198 females of varied ethnic and racial backgrounds participating in substance abuse treatment programs. Measure: Head trauma questionnaire eliciting information via subject report on history of head trauma, cause of such head trauma, and specific chronic sequelae resulting from the head trauma. Results: Nine hundred thirty (42.3%) of the subjects reported history of at least one head trauma; 754 (34.3%) reported the head trauma having had occurred by another person. Data on reported chronic residual sequelae from the bead trauma as well as breakdown by ethnic/racial group is also provided. Conclusions: The prevalence of history of head trauma along with reported sequelae as a result of such in this sample suggests that head trauma may certainly be a significant factor in persons presenting for substance abuse treatment. Assessing for a history of head trauma and associated sequelae in persons presenting in substance abuse treatment programs may be clinically appropriate as such sequelae have been found to adversely affect treatment progress. Further discussion on implications of the results of this research as well as discussion on further research in the area are provided.

Murrey GJ; Dallas R; Maki A. History of reported head trauma in a sample of women in substance abuse treatment. American Journal of Drug and Alcohol Abuse 33(2): 327-332, 2007. (14 refs.)

Nakata A; Ikeda T; Takahashi M; Haratani T; Hojou M; Fujioka Y et al. Non-fatal occupational injury among active and passive smokers in small- and medium-scale manufacturing enterprises in Japan. Social Science & Medicine 63(9): 2452-2463, 2006. (47 refs.)

Active smoking is a risk factor for occupational injury, whereas its association with passive smoking is unknown. To evaluate the contribution of active and passive smoking to non-fatal occupational injury in manufacturing sectors, 2302 randomly selected workers aged 16-83 years working in 244 small- and medium-scale enterprises in Yashio city, Japan, were surveyed by means of a self-administered questionnaire. Smoking history, exposure to passive smoking, and occupational injury were evaluated by self-report. Exposure levels to passive smoking were assessed separately at work and at home as never, occasional, or regular exposure. Overall, 61.4% of men and 22.3% of women were current smokers. Among never smokers, 62.2% of men and 68.6% of women reported exposure to passive smoking either at work or home. Prevalence of occupational injuries was 36.2% for never, 43.3% for former, and 41.2% for current smokers among men and 19.7% for never, 22.2% for former, and 25.2% for current smokers among women. Among never smoking men, odds ratios (ORs) of occupational injury were 2.11 when regularly exposed to passive smoking at work or at home (p = 0.025), 2.27 at work (p = 0.015), and 3.08 at home (p = 0.106), in comparison to never smoking men who were never exposed to passive smoking either at work or at home (referent group). These associations were attenuated to be non-significant, after controlling for potential confounders. Never smoking men with occasional exposure to passive smoking were not significant ORs (1.11-1.19). In contrast, current and former smoking men had significant increases in adjusted ORs (1.57-2.00). In women exposed to smoking there was a non-significant increase in occupational injury. The present study indicates an expected increase in the risk of, occupational injury for current and former smoking men and suggests that exposure to passive smoking is a possible risk factor for never smoking men.

Njoki E; Frantz J; Mpofu R. Health-promotion needs of youth with a spinal cord injury in South Africa. Disability and Rehabilitation 29(6): 465-472, 2007. (20 refs.)

Purpose. To determine the health promotion needs through an exploration of health-related behaviours and the factors that influence the behaviour of physically disabled youth with spinal cord injury. Methods. A descriptive and exploratory study that utilized a qualitative approach was carried out among ten participants aged between 15 and 29 years who were purposely selected. Information was obtained from individual face-to-face interviews and a focus-group discussion. Results. The participants were involved in risky health behaviours including sedentary lifestyles, use of alcohol, tobacco, and drugs. Various factors that influenced their participation in these behaviours were identified including personal struggles with identity and adjustment issues. Conclusions. The results emphasize that participants were involved in health-risk behaviours, which are associated with development of secondary conditions such as respiratory problems, heart diseases, and stroke. Health-promotion strategies employed for these individuals should address the psychological impact of spinal cord injury (SCI) on the individual as an influence to participation in health risk behaviours.

Nordqvist C; Holmqvist M; Nilsen P; Bendtsen P; Lindqvist K. Usual drinking patterns and non-fatal injury among patients seeking emergency care. Public Health 120(11): 1064-1073, 2006. (49 refs.)

Objectives: To explore the association between drinking patterns, irrespective of whether alcohol was consumed in the event of the injury or not, and different injury variables; and to identify settings and situations in which risky drinkers have an increased likelihood of injury. Study design: The study population consisted of all patients aged 18-70 years registered for an injury according to ICD-10 at a Swedish emergency department during an 18-month period. After informed consent, the injury patients were screened for drinking habits by the AUDIT-C questionnaire. The gender, age and drinking pattern of injury patients were compared with the general population. Methods: A total of 2782 patients aged 18-70 years were registered for an injury during the study period. The number of drop-outs was 631. Drop-outs include those who did not consent to participate, were severely injured, too intoxicated or did not fill out the questionnaire satisfactory. Thus, 77.3% of the target group were included for further analysis (1944 drinkers and 207 abstainers). The patients were categorized into three drinking categories: abstainers, non-risky and risky drinkers. Risky drinkers were defined according to usual weekly consumption of 80 g or more of alcohol for women and 110g or more for men and/or heavy episodic drinking (i.e. having six glasses or more one glass = 12 g alcohol), or both, on one occasion at least once a month, valid for both women and men. To estimate the relationship between drinking patterns and the injury variables (environment, cause of injury, activity and diagnosis), odds ratios (OR) were calculated by Logistic regression. Multiple logistic regression was used in order to control for age and sex differences between the various drinking and injury categories. Results: The proportion of risky drinkers was higher in the study population compared with the general population in the same area. When controlling for age and sex, risky drinkers (OR 6.4(adj) Confidence interval CI 1.9-21.2) and non-risky drinkers (OR.4.5(adj) CI 1.4-14.5) displayed an increased risk for injury compared with abstainers, in amusement locations, parks, by or on takes or seas, especially white engaged in play, hobby or other leisure activities (risky drinkers: OR 2.8(adj) CI 1.3-5.6; non-risky drinkers: OR 2.4(adj) CI 1.2-4.6). All differences between drinking patterns in external cause of injury disappeared when age and sex were considered. During rest, meals and attending to personal hygiene, the non-risky drinkers had a tower probability of injury compared with abstainers (OR 0.3(adj) CI 0.1-0.8). Non-risky drinkers had a higher probability than abstainers of suffering luxation (dislocation) or distortion (OR 1.6(adj) CI 1.1-2.5). Nine per cent of the study population reported that they believed that their injury was related to intake of alcohol. Half of this group were non-risky drinkers (CI for the 13.7% difference was 9.7-17.6). Conclusions: Few significant associations between drinking pattern and injury remained when age and sex were controlled for.

Paek KW; Chun KH; Cho JP. Risk factors influencing the occurrence of injuries in Koreans requiring hospitalization. Yonsei Medical Journal 48(2): 164-170, 2007. (28 refs.)

Purpose: This study focused on local communities and the factors influencing injuries requiring hospital admission that affect the quality of life for Koreans. Materials and Methods: This study used data collected from 4,400 households during the 2001 Korea National Health and Nutrition Examination Survey (KNHANES). A stratified multistage probability sampling method was applied and the final sample included 7,924 subjects over 20 years old who had completed the questionnaire regarding factors influencing injuries requiring hospital admission. Multiple logistic regression analysis was used to estimate the risk factors influencing injuries. Results: The incidence of injuries requiring hospital admission in Koreans was higher in men than in women at 2.3 % (95 % CI: 1.8-2.8) and 1.7% (95% CI: 1.3-2.1), respectively. Statistically significant factors affecting the occurrence of injuries requiring hospital admission were marital status (OR: 2.60, 95% CI: 2.22-5.56), state of health (OR: 0.63, 95% CI: 0.43-0.92), frequency of heavy drinking (OR: 1.96, 95% CI: 1.01-3.79), normal physical activities (OR: 1.68, 95% CI: 1.07-2.65), and sleep (OR: 1.54, 95 % CI: 1.01-2.35). Conclusion: The results of this study can be used to develop measures to prevent fatal injuries and be used as basic data for community health programs.

Pariente A; Dartigues JF; Benichou J; Letenneur L; Moore N; Fourrier-Reglat A. Benzodiazepines and injurious falls in community dwelling elders. Drugs & Aging 25(1): 61-70, 2008. (62 refs.)

Background: Benzodiazepines are frequently used medications in the elderly, in whom they are associated with an increased risk of falling, with sometimes dire consequences. Objective: To estimate the impact of benzodiazepine-associated injurious falls in a population of elderly persons. Method: A nested case-control study was conducted using data collected during 10 years of follow-up of the French PAQUID (Personnel Agees QUID) community-based cohort. The main outcome measure was the occurrence of an injurious fall, which was defined as a fall resulting in hospitalization, fracture, head trauma or death. Controls (3 : 1) were frequency-matched to cases. Benzodiazepine exposure was the use of benzodiazepines over the previous 2 weeks reported at the follow-up visit preceding the fall. Results: Benzodiazepine use was significantly associated with the occurrence of injurious falls, with a significant interaction with age. The adjusted odds ratio for injurious falls in subjects exposed to benzodiazepines was 2.2 (95% CI 1.4, 3.4) in subjects aged >= 80 years and 1.3 (95% CI 0.9, 1.9) in subjects aged <80 years. The population attributable risk for injurious falls in subjects exposed to benzodiazepines was 28.1% (95% CI 16.7, 43.2) for subjects aged >= 80 years. The incidence of injurious falls in subjects aged >= 80 years exposed to benzodiazepines in the PAQUID cohort was 2.8/100 person-years. Over 9% of these falls were fatal. According to these results and to recent population estimates, benzodiazepine use could be held responsible for almost 20 000 injurious falls in subjects aged >= 80 years every year in France, and for nearly 1800 deaths. Conclusion: Given the considerable morbidity and mortality associated with benzodiazepine use and the fact that existing good practice guidelines on benzodiazepines have not been effective in preventing their misuse (possibly because they have not been applied), new methods for limiting use of benzodiazepines in the elderly need to be found.

Paulozzi LJ. Is it safe to walk in the Sunbelt? Geographic variation among pedestrian fatalities in the United States, 1999-2003. Journal of Safety Research 37(5): 453-459, 2006. (34 refs.)

Introduction: Previous work using data from the 1980s showed higher rates of pedestrian mortality in the southern United States. Methods: This study was a descriptive analysis of state-specific mortality information from the National Center for Health Statistics for 1999-2002 and the National Highway Traffic Safety Administration for 2003. Results: Highest rates were in the southern rim ("Sunbelt") states for the U.S. population and for the non-Hispanic white population. Rural rates in the highest quartile were 2.1 (95% CI 1.8 to 2.6) times those in the lowest quartile. Urban rates in the highest quartile were 2.2 (95% CI 1.9 to 2.5) times those in the lowest quartile. Posted speed limits at crash sites were 2.6 (95% CI 2.0 to 3.4) times more likely to be >= 35 mph (48.3 km/h) in the highest quartile than in the lowest quartile. Pedestrians killed in the highest quartile were 1.9 (95% CI 1.2 to 3.1) times more likely to have blood alcohol concentrations >= 0.25 g/dL than pedestrians in the lowest quartile. Conclusions: The highest pedestrian fatality rates concentrate in Sunbelt states experiencing rapid population growth in the past 50 years. This pattern may result from at least three features of these states: (a) a high percentage of urban vehicle miles traveled; (b) urban sprawl; and (c) a high prevalence of alcohol use - especially heavy use - among Sunbelt pedestrians.

Paulozzi LJ; Cox CS; Williams DD; Nolte KB. John and Jane Doe: The epidemiology of unidentified decedents. Journal of Forensic Sciences 53(4): 922-927, 2008. (25 refs.)

The number of people who cannot be identified at the time of death, sometimes referred to as John or Jane Does, is unknown, and little is known about them as a group. The study's objectives were to estimate the number of annual unidentified deaths, to identify demographic characteristics associated with dying unidentified, to determine whether the rates of such deaths vary geographically or over time, and to better characterize the causes of death. This was a population-based surveillance study of data collected from death certificates from 1979 to 2004 in the U.S. Subjects were selected by the absence of name, date of birth, and Social Security Number on their certificates. Main outcome measures were distributions by age, sex, and underlying cause of death and rates by sex, race, year, and state of death. An average of 413 unidentified persons died each year. The peak year was 1987 with 691 deaths, a rate of 28.5 per 10 million people. The rate declined to 9.7 per 10 million in 2004. Most unidentified decedents were male (80.6%). Unidentified death rates were highest among black people and in the Southwest. Among deaths for which the cause was known, 82.7% were due to injuries. Among injury deaths, 31.8% were homicides. Improvement in identification technology may have reduced rates of unidentified death since the 1980s. In addition, variations in rates of unidentified decedents may reflect changes in risk factors such as homelessness and substance abuse.

Peltzer K. Injury and social determinants among in-school adolescents in six African countries. Injury Prevention 14(6): 381-388, 2008. (24 refs.)

Background: There is a lack of data on injury and its social correlates among in-school adolescents in Africa. Objectives: To estimate the prevalence of injury among adolescents in six African countries, and to examine the consistency of associations cross-nationally between sociodemographics, social risk factors, and the occurrence of adolescent injury in Africa. Design: Cross-sectional national data from the Global School-based Health Survey (GSHS) conducted in six African countries between 2003 and 2004. Setting: Surveys administered in classrooms. Subjects: The sample included 20 765 students aged 13-15 years from six African countries (Kenya, Namibia, Swaziland, Uganda, Zambia, Zimbabwe) chosen by a two-stage cluster sample design to represent all students in grades 6, 7, 8, 9, and 10 in each country. Results: The mean percentage over all the countries of adolescents reporting one or more serious injuries within the past 12 months was 68.2%, ranging from 38.6% in Swaziland to 71.5% in Zambia. In multivariate regression analysis, risk behaviors were associated with annual injury prevalence, with the highest odds for loneliness, followed by hunger, truancy, depression, smoking, and drug use. The observed risk for all injuries, as well as injuries related to sports, motor vehicles, fighting, and burns, increased consistently with increasing number of risk behaviors. Conclusions: A high annual injury prevalence was found, and risk-taking played a role in the etiology of injury. There is a need to consider an integrated approach to injury etiology in planning injury prevention and safety promotion activities for schoolchildren, paying particular attention to lifestyle factors that have the potential to influence risk of injury.

Ponsford J; Whelan-Goodinson R; Bahar-Fuchs A. Alcohol and drug use following traumatic brain injury: A prospective study. Brain Injury 21(13-14): 1385-1392, 2007. (30 refs.)

Primary objectives: To establish pre-morbid alcohol and drug use in persons with TBI, relative to controls, investigate how patterns of substance use change over time following TBI and identify factors associated with heavy post-injury substance use. Methods and procedures: The Alcohol Use Disorders Identification test (AUDIT) and Drug Abuse Screening Test (DAST) was completed by 121 hospital inpatients with TBI, documenting pre-injury alcohol and drug use, and 133 demographically similar controls. Participants with TBI completed these measures and the Hospital Anxiety and Depression Scale (HADS) again 1 and 2 years post-injury and 76 also completed them at 3 years. Results: Participants with TBI showed similar levels of drug and alcohol use to controls pre-injury, with 31.4% of the TBI group and 29.3% of controls drinking at hazardous levels. Alcohol and drug use declined in the first year post-injury, but increased by 2 years post-injury, with only 21.4% of participants with TBI reporting abstinence from alcohol and 25.4% drinking at hazardous levels. Only 9% showed a drug problem, but 24% had returned to some drug use. Those showing heavy alcohol use post-injury were young, male and heavy drinkers pre-injury. Drug and alcohol use was similar at 3 years post-injury. Conclusions: More active intervention is needed to reduce alcohol and drug use following TBI.

Prudent M; Drame M; Jolly D; Trenque T; Parjoie R; Mahmoudi R et al. Potentially inappropriate use of psychotropic medications in hospitalized elderly patients in France cross-sectional analysis of the prospective, multicentre SAFEs cohort. Drugs & Aging 25(11): 933-946, 2008. (60 refs.)

Background: In France, there is evidence to suggest that 50% of elderly individuals are prescribed psychotropic medications. However, it is known that use of these agents increases the risk of falls, fractures and delirium in older people. Objective: To study the consumption of 'potentially inappropriate medication' (PIM) among patients aged >= 75 years, paying particular attention to psychotropic drugs and the factors influencing the use of 'potentially inappropriate psychotropics' (PIPs). Method: This was a cross-sectional analysis of a prospective multicentre cohort of 1306 hospitalized French patients aged >= 75 years (the SAFEs [Sujet Age Fragile: Evaluation et suivi (Frail Elderly Subjects: Evaluation and follow-up)] cohort). The present analysis involved the 1176 patients for whom there was information on the usual treatments being taken in the 2 weeks before hospitalization. The drugs were coded according to the Anatomical Therapeutic Chemical classification; the Beers list as updated in 2003 defined which medications were considered PIPs. Standardized geriatric assessment variables were recorded on inclusion in the study. Logistic regression analysis was performed to identify factors linked to use of psychotropics and PIPs. Results: The mean number of drugs taken was 5.7 +/- 2.9 per patient. Twenty-eight percent of patients took at least one PIM. The number of patients who had taken at least one psychotropic drug in the 2 weeks before hospitalization (mean 1.6 +/- 0.9 psychotropics per patient) was 589 (50.1%). More than half of both the 510 patients with a depressive syndrome and the 543 patients affected by dementia were treated with psychotropics. Multivariate analysis showed that prescription of psychotropics was linked to the presence of a dementia syndrome (odds ratio [OR] = 1.4; 95% CI 1.1, 1.9; p = 0.03), the presence of a depressive syndrome (OR = 1.7; 95% CI 1.3, 2.1; p < 0.001), living in an institution (OR = 2.2; 95% CI 1.5, 3.4; p < 0.001), use of more than five drugs (OR = 3.2; 95% CI 2.5, 4.2; p < 0.001) and Charlson's co-morbidity score >1 (OR = 0.6; 95% Cl 0.5, 0.8; p = 0.001). Nineteen percent of all psychotropics prescribed were PIPs. Of these PIPs, 66.5% were anxiolytics, 28.4% were antidepressants and 5.1% were antipsychotics. Use of PIPs in the multivariate analysis was associated only with consumption of more than five drugs (OR = 1.7; 95% CI 1.1, 2.5; p = 0.01). Conclusion: PIM use is common among hospitalized older adults in France. The most important determinant of risk of receiving a psychotropic medication or a PIP was the number of drugs being taken. The elderly, who have multiple co-morbidities, complex chronic conditions and are usually receiving polypharmacy, are at increased risk for adverse drug events. These adverse events are often linked to problems that could be preventable such as delirium, depression and falls. Regular review of prescriptions would help optimize prescription of psychotropics in the elderly. The Beers list is a good tool for evaluating PIMs but is too restrictive with respect to psychotropics; in the latter respect, the list could usefully be widened.

Puljula J; Savola O; Tuomivaara V; Pribula J; Hillbom M. Weekday distribution of head traumas in patients admitted to the emergency department of a city hospital: Effects of age, gender and drinking pattern. Alcohol and Alcoholism 42(5): 474-479, 2007. (36 refs.)

Aims: To define the alcohol-related risk for head traumas and to compare the weekly and monthly variations in alcohol consumption, and the occurrence of head traumas in a population with heavy episodic drinking as the prevailing drinking pattern. Methods: All consecutive admissions due to head trauma into a Finnish city hospital during 1 year (1999) were recorded. 832 consecutive patients with data on alcohol consumption were covered. We compared the number of final diagnoses of head traumas per day and month to the anticipated frequency in the absence of any weekly or monthly variation. Official statistics on alcohol consumption in Finland are presented as reference. Results: Alcohol-related head traumas were most common in young adults and people of working age. The occurrence of head traumas in sober subjects showed no temporal variations. By contrast, alcohol-related cases peaked on weekends and in the most popular vacation month (July). The alcohol-related risk from Friday to Sunday was 27.3% in women and 20.3% in men. The additional risk related to alcohol consumption in July was 16.1% in women and 5.3% in men. Conclusions: We found an excess of head traumas during weekends and the primary vacation month, and this excess was associated with heavy episodic drinking. Active measures are needed to prevent head traumas caused by this type of behaviour.

Raman SR; Boyce WF; Pickett W. Associations between adolescent risk behaviors and injury: The modifying role of disability. Journal of School Health 79(1): 8-16, 2009. (46 refs.)

Adolescents with disabilities are at risk for poor health outcomes including injury. The objective of this study was to examine if disability status modifies the association between risk behavior and injury among adolescents. The cross-sectional Health Behavior in School-Aged Children Survey was administered to a representative sample of 7235 Canadian students (grades 6-10) in 2002. Students who reported at least 1 functional difficulty due to a health condition were classified as having a disability. Engagement in up to 6 individual risk behaviors and a summative multiple risk behavior score were considered the primary exposures. Primary outcomes included medically attended injury experienced during a 12-month period. Sixteen percent of students reported a disability. Almost all risk behaviors and all injury outcomes were more common among students with disabilities than in those without disabilities (eg, older age group's smoking: 17.5% vs 8.9%, p = <.01; medically attended injury: 67.4% vs 51.4%, p = <.01). Clear risk gradients were observed between engagement in multiple risk behavior and all injury outcomes. The association between multiple risk behavior and injury was accentuated by disability status among older students, particularly for students with disabilities who engaged in frequent multiple risk behavior (adjusted risk ratio 1.8, 95% CI: 1.6-1.9). Canadian students with disabilities who engage in risk behaviors experience higher risks for medically attended injury than their nondisabled peers who engage in those same risk behaviors. Injury prevention programs that focus on risk-taking behavior should integrate the needs of this high-risk group of adolescents in order to prevent additional disability.

Rodriguez-Martos A; Castellano Y; Salmeron JM; Domingo G. Simple advice for injured hazardous drinkers: An implementation study. Alcohol and Alcoholism 42(5): 430-435, 2007. (24 refs.)

Aim: To evaluate the implementation of a screening and intervention procedure for hazardous drinkers in the routine praxis of an emergency service, without increasing the ED (emergency department) staff. Methods: Four stages of the implementation process were undertaken: exploration and adoption, programme installation, and initial implementation. Two hospitals participated, with a coordinator, four trainers and all the emergency nursing staff. Eligible patients were males over age 15 presenting at the weekend with a traffic injury. Screening was performed with five questions (the three items of alcohol use disorders identification test (AUDIT-C) plus two questions about drinking within 6 h before the crash). Hazardous drinkers and drivers who had driven while intoxicated were offered simple advice. The programme implementation was evaluated by reviewing the patients forms and by interviews and surveys of the nursing staff. Results: The study lasted for 27 weeks. Knowledge and compliance with the programme were good. However, only 25% of the eligible patients were identified. Simple advice was accomplished by 94.7% of those in need of it. Although the majority of nurses felt at ease performing the intervention, 75% considered the programme as a work overload and only 21% reckoned that it was feasible for the emergency service. Conclusion: The emergency setting poses important barriers to the implementation of brief interventions.

Rootman DB; Mustard R; Kalia V; Ahmed N. Increased incidence of complications in trauma patients cointoxicated with alcohol and other drugs. Journal of Trauma 62(3): 755-758, 2007. (23 refs.)

Background: Alcohol and drug intoxication is prevalent in trauma patients. Although intoxication and cointoxication can have a range of physiologic effects, their implications for clinical management are unclear. The current investigation aims to assess the effects of alcohol and substance use as well as the interaction between these two states on outcomes and in-hospital complications. Methods: All trauma patients with an Injury Severity Score (ISS) >= 12 during a 5-year period who were tested for both alcohol and other drugs were included. Alcohol-positive, drug-positive, and both-positive patients were compared with patients who tested negative. Logistic regression analysis was performed controlling for age and ISS to assess the relative contribution of intoxication or cointoxication in determining clinical outcomes and in-hospital complications. Results: For alcohol-positive and drug-positive patients, intoxication status did not appear to influence outcomes. However, cointoxicated individuals were found to have an increased incidence of complications overall (odds ratio [OR] = 2.06), an increased incidence of pneumonia specifically (OR = 3.34) and an increased incidence of the requirement for mechanical ventilation (OR = 2.37). Conclusions: Cointoxication with alcohol and other drugs is a risk factor for increased in-hospital complications.

Schermer CR; Omi EC; Ton-That H; Grimley K; Van Auken P; Santaniello J et al. A clustering of injury behaviors. Journal of Trauma, Injury, Infection and Critical Care 65(5): 1000-1004, 2008. (23 refs.)

Background: Alcohol is a well-known risk factor for injury. A number of other behaviors are also associated with injury risk. We hypothesized that risky drinking would be associated with other high risk behaviors, thereby delineating a need for behavioral interventions in addition to alcohol. Methods: A consecutive sample of trauma patients was interviewed for drinking and risky behaviors including seat belt use, helmet use, and driving behaviors. The Alcohol Use Disorders Identification Test was used to screen for risky drinking and risky behavior questions were taken from validated questionnaires. Behaviors were ranked on a Likert scale ranging from a low to a high likelihood of the behavior or assessed the frequency of behavior in the past 30 days. An Alcohol Use Disorders Identification Test score of 8 or more was considered risky drinking for adults age 21 to 64, and 4 or more for ages 16 to 20 and over 65. Risky and non-risky drinkers were compared on behavior risk items. A p value of less than 0.05 was considered significant. Results: One hundred sixty patients (mean age, 36.8 years, 72% men,) were interviewed. Risky drinkers were more likely to drive after consuming alcohol, ride with drinking drivers, tailgate, weave in and out of traffic, and make angry gestures at other drivers (all p < 0.05). Risky drinkers were less likely to wear motorcycle helmets. However, risky drinkers were no more or less likely to talk on the cell phone while driving, to use seatbelts, or use turn signals. Although number of lifetime vehicle crashes were similar, risky drinkers were more likely to have been the party at fault for the crash (mean 1.09 vs. 0.64, p = 0.03). Conclusions: Factors other than alcohol increase injury risk in problem drinkers. Injury prevention programs performing alcohol interventions should consider including behavioral interventions along with alcohol reduction strategies. New screening and intervention programs should be developed for injury behaviors that increase risk but are not alcohol related.

Sexton RL; Carlson RG; Leukefeld CG; Booth BM. Patterns of illicit methamphetamine production ("cooking") and associated risks in the rural south: An ethnographic exploration. Journal of Drug Issues 36(4): 853-876, 2006. (47 refs.)

This article describes rural methamphetamine (MA) production ("cooking") and associated risks in Kentucky and Arkansas. It is based on qualitative interviews with 36 active MA users and one former user, a population that included 10 MA "cookers." Participants reported that various forms of the Birch cooking method have become widespread locally over the past decade. There is an underground market in MA ingredients like pseudoephedrine pills and anhydrous ammonia and innovative methods to overcome restrictions on obtaining them. MA production is hazardous. Explosions, chemical spills, and injuries are associated with acquiring anhydrous ammonia. MA cooking is often undertaken by the inexperienced, those "high" on MA, or people who rush production because of fear of discovery or craving for the drug. Consequently, accidents and injuries sometimes occur. Lab waste is also a potential danger. Our preliminary findings can inform future research and the development of educational programs that address MA cooking and associated problems.

Smink BE; Movig KLL; Lusthof KJ; De Gier JJ; Uges DRA; Egberts ACG. The relation between the use of psychoactive substances and the severity of the injury in a group of crash-involved drivers admitted to a regional trauma center. Traffic Injury Prevention 9(2): 105-108, 2008. (15 refs.)

Objective. There is much evidence that driving under the influence of alcohol and/or drugs of abuse is related to an increased accident risk. A remaining question is whether the use of psychoactive substances is also related to clinically more severe accidents. The aim of this study is to explore the relationship between the use of psychoactive substances and the injury severity in a group of crash-involved drivers. Methods. The study group included all injured car drivers, admitted to the regional trauma center, in the period from May 2000 until August 2001. The outcome of interest was the severity of injury, measured by using the Injury Severity Score (ISS). The determinant was the presence of psychoactive substances in blood and urine samples. Psychoactive substances tested for were alcohol, amphetamines, barbiturates, benzodiazepines, cannabis, methadone, opiates, and tricyclic antidepressants in blood and urine. Results. The number of injured car drivers included in this study was 106. Overall, 43% (46/106) of the drivers tested positive for at least one psychoactive substance. Comparison of the means of the log ISS suggests that there is no significant difference between drivers who tested positive for alcohol and/or drugs, compared to drivers tested negative. Conclusion. The results of this study support the hypothesis that there is no clear association between use of psychoactive substances and the severity of crash-related injury.

Smyth B; Hoffman V; Fan J; Hser YI. Years of potential life lost among heroin addicts 33 years after treatment. Preventive Medicine 44(4): 369-374, 2007. (52 refs.)

Objective. To examine premature mortality in terms of years of potential life lost (YPLL) among a cohort of long-term heroin addicts. Method. This longitudinal, prospective study followed a cohort of 581 male heroin addicts in California for more than 33 years. In the latest follow-up conducted in 1996/97, 282 subjects (48.5%) were confirmed as deceased by death certificates. YPLL before age 65 years was calculated by causes of death. Ethnic differences in YPLL were assessed among Whites, Hispanics, and African Americans. Results. On average, addicts in this cohort lost 18.3 years (SD= 10.7) of potential life before age 65. Of the total YPLL for the cohort, 22.3% of the years lost was due to heroin overdose, 14.0% due to chronic liver disease, and 10.2% to accidents. The total YPLL and YPLL by death cause in addict cohort were significantly higher than that of US population. The YPLL among African Americans was significantly lower than that among Whites or Hispanics. Conclusion. The YPLL among addicts was much higher than that in the national population; within the cohort, premature mortality was higher among Whites and Hispanics compared to African American addicts.

Soderstrom CA; DiClemente CC; Dischinger PC; Hebel JR; McDuff DR; Auman KM; Kufera JA. A controlled trial of brief intervention versus brief advice for at-risk drinking trauma center patients. Journal of Trauma, Injury, Infection and Critical Care 62(5): 1102-1111, 2007. (41 refs.)

Background: Numerous reports document that preinjury alcohol use is associated with all modes of injury requiring treatment in a trauma center, with 25% to 50% or more of patients testing positive for alcohol at the time of admission. There is evidence that in trauma patients unaddressed alcohol use problems result in recurrent injury requiring readmission to a trauma center and/or death. Methods: A randomized clinical trial was conducted to assess the effectiveness of two types of brief interventions to reduce drinking and the consequences of drinking. Trauma patients defined as at-risk alcohol users (n = 497) were randomized into two treatment options: a brief personalized motivational intervention (PMI), or brief information and advice (BIA). After a brief assessment, PMI subjects received a motivational session, feedback letter, and two postdischarge telephone contacts, whereas the BIA group received a brochure and one postdischarge telephone contact. Both groups were reassessed at 6 and 12 months postinjury. Results: Both the PMI and BIA groups had statistically significant reductions in drinking, binge episodes, and consequences related to drinking that persisted from the 6- to the 12-month follow-up. However, although not statistically significant, for those classified as lower-level drinkers (<= 1 drink per day), there was a consistent pattern of maintaining reductions for the PMI group at 12 months compared with the BIA group. Conclusion: our results suggest that brief interventions (PMI and BIA) that link alcohol consumption with trauma injury and consequences of drinking can be effective in reducing drinking and consequences related to drinking in a significant portion of at-risk nondependent drinkers.

Sorock GS; Chen LH; Gonzalgo SR; Baker SP. Alcohol-drinking history and fatal injury in older adults. Alcohol 40(3): 193-199, 2006. (40 refs.)

Although most clinical guidelines for older adults allow for one drink a day in persons without a history of alcoholism, diabetes, or cardiovascular disease, alcohol may contribute to fatal injury in the elderly. Using two national surveys, this case-control study determined the associations between drinking history and fatal injuries from falls, motor vehicle crashes and suicides. We performed a case-control study using 1,735 cases who died of falls, motor vehicle crashes, or suicides selected from the 1993 National Mortality Follow-Back Survey; controls (n = 13,381) were a representative sample of the U.S. population from the 1992 National Longitudinal Alcohol Epidemiologic Survey. Cases and controls were restricted to ages 55 years and older. Having 12 or more drinks in the year before death or interview for the controls was used to assess alcohol-drinking history. The unadjusted relative odds for drinkers versus nondrinkers for falls, motor vehicle crashes, and suicides were 1.7, 1.7, and 1.6, respectively. Adjustment for age, gender, marital status, education, and working in the last year did not change these effect estimates, which all excluded the null value. Drinking increased the risk of suicide more for women than for men. Drinking history in older adults is associated about equally with an increased risk of fatal injury from falls, motor vehicle crashes, and suicides.

Sterke CS; Verhagen AP; Van Beeck EF; van der Cammen TJM. The influence of drug use on fall incidents among nursing home residents: A systematic review. (review). International Psychogeriatrics 20(5): 890-910, 2008. (39 refs.)

Background: Falls are a major health problem among the elderly, particularly in nursing homes. Abnormalities of balance and gait, psychoactive drug use, and dementia have been shown to contribute to fall risk. Methods: We conducted a systematic review of the literature to investigate which psychoactive drugs increase fall risk and what is known about the influence of these drugs on gait in nursing home residents with dementia. We included studies with a prospective cohort design on psychoactive drug use in nursing homes with dementia residents and with falls as an outcome measure. Results: Seventeen studies were included in the review. Pooled risk estimates were not calculated because there was no homogeneity across studies. We assessed the strength of evidence for psychoactive drugs as a prognostic factor for falls by defining four levels of evidence: strong, moderate, limited or inconclusive. Strong evidence was defined as consistent findings (>= 80%) in at least two high quality cohorts. We found strong evidence that the use of multiple drugs (3/3 cohorts, effect sizes 1.30-10.30), antidepressants (10/12 cohorts, effect sizes 1.10-7.60), and anti-anxiety drugs (2/2 cohorts, effect sizes 1.22-1.32) is associated with increased fall risk. The evidence for the association of other psychoactive drug classes with fall risk was limited or inconclusive. Conclusions: Research on the contribution of psychoactive drugs to fall risk in nursing home residents with dementia is limited. The scarce evidence shows, however, that multiple drugs, antidepressants and anti-anxiety drugs increase fall risk in nursing home populations with residents with dementia.

Taylor B; Rehm J; Room R; Patra J; Bondy S. Determination of lifetime injury mortality risk in Canada in 2002 by drinking amount per occasion and number of occasions. American Journal of Epidemiology 168(10): 1119-1125, 2008. (43 refs.)

Injury is the leading cause of alcohol-attributable mortality in Canada. Risk is determined by amount consumed per occasion and accumulates across drinking episodes. The authors estimated alcohol-attributable injury mortality in Canada for 2002 by combining the absolute risk of injury unrelated to alcohol with relative risks that were specific to gender and consumption per occasion, while taking into account lifetime number of drinking occasions. The absolute risk increased as number of drinking occasions and number of drinks per occasion increased. The absolute risk remained relatively low at fewer than 2 drinking occasions per month, regardless of number of drinks. Absolute risk levels reached 1 in 1,000 at 5 or more drinks once per month for men and at 5-7 drinks once per month for women. The probability of mortality was 1 in 100 for all levels of consumption above 3 drinks 3 times per week for men and above 5 drinks 3 times per week for women. No safe level of consumption is recommended based on these results, although risk is much lower for consuming 3 standard drinks or less fewer than 3 times per week. Absolute risk reflects long-term effects of drinking patterns and is important for risk-communication and alcohol-control policy.

Valencia-Martin JL; Galan I; Rodriguez-Artalejo F. The joint association of average volume of alcohol and binge drinking with hazardous driving behaviour and traffic crashes. Addiction 103(5): 749-757, 2008. (62 refs.)

Background Previous studies on alcohol-related road safety have not assessed the joint impact of average volume of alcohol and binge drinking. Aim To examine the joint and separate association of average volume of alcohol and binge drinking with hazardous driving behaviour and traffic crashes. Methods Data were drawn from telephone interviews conducted in the period 2000-2005, with 12 037 individuals representative of the population aged 18-64 years in the Madrid region, Spain. The threshold between average moderate and heavy volumes was 40 g of alcohol/day in men and 24 g/day in women. Binge drinking was defined as intake of >= 80 g of alcohol in men and >= 60 g in women, during any drinking occasion in the preceding 30 days. Individuals were classified into the following categories: (i) non-drinkers; (ii) moderate drinkers with no binge drinking (MDNB); (iii) moderate drinkers with binge drinking (MDB); (iv) heavy drinkers with no binge drinking (HDNB); and (v) heavy drinkers with binge drinking (HDB). Analyses were performed using logistic regression, with adjustment for sex, age and educational level. Findings: Frequency of inadequate seat-belt use increased progressively across categories of alcohol consumption, with odds ratio (OR) 1 in non-drinkers, 1.19 [95% confidence interval (CI) 1.06-1.33] in MDNB, 1.69 (1.41-2.03) in MDB, 1.68 (1.24-2.29) in HDNB and 2.41 (1.83-3.18) in HDB (P for trend < 0.001). Compared with MDNB, alcohol-impaired driving was also more frequent in MDB (OR 7.43; 95% CI: 5.52-10.00), HDNB (OR 7.31; 95% CI: 4.37-12.25) and in HDB (OR 15.50; 95% CI: 10.62-22.61). Lastly, compared with non-drinkers, frequency of traffic crashes increased progressively across categories of alcohol consumption (P for trend = 0.028), although it only reached statistical significance in HDB (OR 2.01; 95% CI: 1.00-4.09). Conclusions: Self-reported average volume of alcohol and binge drinking are both associated with self-reported hazardous driving behaviour and traffic crashes. The strength of the association is greater when average heavy consumption and binge drinking occur jointly.

van der Hooft CS; Schoofs MWCJ; Ziere G; Hofman A; Pols HAP; Sturkenboom MCJM et al. Inappropriate benzodiazepine use in older adults and the risk of fracture. British Journal of Clinical Pharmacology 66(2): 276-282, 2008. (15 refs.)

AIMS: The Beers criteria for prescribing in elderly are well known and used for many drug utilization studies. We investigated the clinical value of the Beers criteria for benzodiazepine use, notably the association between inappropriate use and risk of fracture. METHODS We performed a nested case-control study within the Rotterdam Study, a population-based cohort study in 7983 elderly. The proportion of 'inappropriate' benzodiazepine use according to the Beers criteria was compared between fracture patients and controls. 'Inappropriate' use for elderly implies use of some long-acting benzodiazepines and some intermediate/short-acting ones exceeding a suggested maximum daily dose. Also, alternative criteria were applied to compare the risk of fracture. Cases were defined as persons with incident fracture between 1991 and 2002 who were current benzodiazepine users on the fracture date. Controls were matched on fracture date and were also current benzodiazepine users. RESULTS: The risk of fracture in 'inappropriate' benzodiazepine users according to the Beers criteria was not significantly different from 'appropriate' users [odds ratio (OR) 1.07, 95% confidence interval (CI) 0.72, 1.60]. However, a significantly higher risk of fracture was found in 'high dose' users and a longer duration of use (14-90 days), irrespective of the type of benzodiazepine (OR 3.45, 95% CI 1.38, 8.59). CONCLUSIONS: These findings suggest that inappropriate benzodiazepine use according to the Beers criteria is not associated with increased risk of fracture. Daily dose and longer duration of use (> 14 days) is associated with higher risk of fracture, irrespective of the type of benzodiazepine prescribed.

Vestergaard P; Rejnmark L; Mosekilde L. Anxiolytics and sedatives and risk of fractures: Effects of half-life. Calcified Tissue International 82(1): 34-43, 2008. (25 refs.)

To study the risk of fractures associated with anxiolytics, sedatives, and hypnotics, we conducted a case-control study. Cases were all subjects with any fracture during the year 2000 (n = 124,655). For each case, three controls (n = 373,962) matched on age and gender were randomly drawn from the background population. The exposure was use of any anxiolytic, sedative, or hypnotics. Adjustments were made for a number of potential confounders. Most anxiolytics, sedatives, and hypnotics were associated with a limited increase in the risk of fractures. There was a dose-response relationship, and drugs with a half-life longer than 24 h were associated with a trend toward a higher relative risk of fractures than drugs with a shorter half-life. Both current use (last use < 1 year ago) and past use (last use more than one year ago) were associated with an increased risk of fractures. We conclude that anxiolytics, sedatives, and hypnotics are associated with a limited increase in the risk of fractures. For most drugs a dose-response relationship was present, and drugs with a half-life > 24 h tended to be associated with a higher risk of fractures than drugs with a shorter half-life. This points to a dose-dependent risk of, for example, falls leading to fractures. However, the increased risk of fractures with past use may suggest an effect of the condition for which the drug was prescribed rather than the drug per se (confounding by indication).

Vickery CD; Sherer M; Nick TG; Nakase-Richardson R; Corrigan JD; Hammond F et al. Relationships among premorbid alcohol use, acute intoxication, and early functional status after traumatic brain injury. Archives of Physical Medicine and Rehabilitation 89(1): 48-55, 2008. (41 refs.)

Objective: To investigate the relationships among intoxication at time of injury, preinjury history of problem drinking, and early functional status in patient's with traumatic brain injury (TBI). Design: Prospective cohort study. Setting: Acute inpatient TBI rehabilitation. Participants: Participants were 1748 persons with TBI. Interventions: Not applicable. Main Outcome Measures: Blood alcohol levels (BALs) were obtained at admission to the emergency department, and a history of problem drinking was obtained through interview. Study outcomes, Disability Rating Scale (DRS), and FIM instrument scores were gathered at admission to inpatient rehabilitation. Results: Multivariate regression analysis revealed that BAL and a history of binge drinking were predictive of DRS, but not FIM, scores. A higher BAL was associated with poorer functional status on the DRS. Paradoxically, a history of binge drinking was associated with more intact functional status on the DRS. Conclusions: The relationships among intoxication at time of injury, history of problem drinking, and early outcome after TBI were modest. Injury severity had a more significant association with TBI functional status.

Vingilis E; McLeod AI; Stoduto G; Seeley J; Mann RE. Impact of extended drinking hours in Ontario on motor-vehicle collision and non-motor-vehicle collision injuries. Journal of Studies on Alcohol and Drugs 68(6): 905-911, 2007. (30 refs.)

Objective: On May 1, 1996, Ontario, Canada, amended the Liquor Licence Act to extend the hours of alcohol sales and service in licensed establishments from I AM to 2 AM. The purpose of this study was to evaluate the impact of extended drinking hours in Ontario on motor-vehicle collision (MVC) and other injuries admitted to regional trauma units based on Ontario Trauma Registry data. Method: A quasiexperimental design using interrupted time series was used to assess changes in admissions to Ontario trauma units. The analyzed data sets were monthly data on number of admissions from MVC and other causes of injury during the 11 Pm- 12 AM, 12-1 AM, 1-2 AM, and 2-3 AM time windows for 4 years before and 3 years after the policy change (May 1992-April 1999). Results: For MVC injuries, no significant pre-post increases were found for the 2-3 AM period commensurate with the introduction of the extended drinking hours, but decreases were found for the 11 Pm- 12 Am and 1-2 AM periods. For non-MVC injuries, a significant increase was found for the 2-3 AM period. Conclusions: The data sets suggest that increased availability of alcohol as a result of extension of closing hours had an impact on non-MVC injuries presenting to Ontario trauma units, but road safety initiatives may have mediated the effects of the extension on MVC injuries. These observations are consistent with those of other studies of small changes in alcohol availability.

Vungkhanching M; Heinemann AW; Langley MJ; Ridgely M; Kramer KM. Feasibility of a skills-based substance abuse prevention program following traumatic brain injury. Journal of Health Trauma Rehabilitation 22(3): 167-176, 2007. (31 refs.)

Objective: To demonstrate the feasibility of a skills-based substance abuse prevention counseling program in a community setting for adults who sustained traumatic brain injury. Participants: Convenience sample of 117 participants (mean age = 35 years) with preinjury history of alcohol or other drug use. Intervention group participants (n = 36) from 3 vocational rehabilitation programs; a no-intervention comparison group (n = 81) from an outpatient rehabilitation service. Intervention: 12 individual counseling sessions featuring skills-based intervention. Main Outcome Measures: Changes in self-reported alcohol and other drug use, coping skillfulness, affect, and employment status from baseline to 9 months postintervention. Results: Significant differences were noted at baseline for the intervention and comparison groups on ethnicity, time postinjury, marital status, and employment (P < .05). At the 9-month follow-up, the intervention group participants achieved a statistically significant decrease in alcohol and drug use (P < .05), increase in coping skillfulness (P < .01), and increased likelihood of maintaining employment (P < .01) relative to the comparison group. Controlling for baseline-adjusted means for the intervention and comparison groups, a statistically significant group difference in adjusted change was noted; the intervention group participants reported lower negative affect at the 9-month follow-up assessment (P < .05). Conclusions: A skills-based intervention provides a promising approach to promoting abstinence from all substances and increasing readiness for employment for adults with traumatic brain injuries in outpatient settings.

Walker R; Cole JE; Logan TK; Corrigan JD. Screening substance abuse treatment clients for traumatic brain injury: Prevalence and characteristics. Journal of Head Trauma Rehabilitation 22(6): 360-367, 2007. (23 refs.)

Objectives: To examine clinical characteristics of clients in state-funded substance abuse treatment who report traumatic brain injury with loss of consciousness (TBI-LOC). Participants: Adult clients (N = 7784) entering state-funded substance abuse treatment in a rural state during a 12-month period. Measurement tools: Substance use and mental health problems were measured using the federal Substance Abuse and Mental Health Services Administration (SAMHSA) adaptation of the Addiction Severity index (ASI). A brain injury screening question was used to determine the number of TBI-LOCs in a client's lifetime. Design: Cross-sectional study of intake characteristics as part of a state-mandated treatment outcome study. Results: Almost one-third (31.7%) of substance abuse treatment clients reported 1 or more TBI-LOCs. The clients reporting 2 or more TBI-LOCs were more likely than clients with none or 1 TBI-LOC to have serious mental health problems (ie, depression, anxiety, hallucinations, and suicidal thoughts and attempts), trouble controlling violent behavior, trouble concentrating or remembering, and more months of use of most substances. When depression and anxiety were held constant, and controlling for race and gender, clients with TBI-LOC had more months of marijuana and tranquilizer use. Conclusions: Findings suggest that treatment providers may need to be attentive to the complex conditions that co-occur with TBI-LOC. Future research should examine whether there are differences in treatment outcome for clients reporting TBI-LOC.

Wells S; Thompson JM; Cherpitel C; Macdonald S; Marais S; Borges G. Gender differences in the relationship between alcohol and violent injury: An analysis of cross-national emergency department data. Journal of Studies on Alcohol and Drugs 68(6): 824-833, 2007. (42 refs.)

Objective: The objectives of the present study were twofold: (1) to determine whether gender differences exist in the roles of drinking in the event (i.e., self-reported drinking before the injury and estimated blood alcohol concentration [BAC] captured after injury) and drinking pattern (i.e., heavy episodic drinking) in explaining violent versus nonviolent injuries and (2) to assess whether these gender differences vary by country. Method: Emergency department data were analyzed from 30 hospitals in 15 countries, as part of the Emergency Room Collaborative Alcohol Analysis Project and the World Health Organization Collaborative Study of Alcohol and Injuries. Interaction effects between gender and alcohol were tested in the prediction of violent versus nonviolent injury for each country. Results: The bivariate analyses revealed significantly larger effects of drinking-in-the-event variables for men than for women in three countries (i.e., 6 hours before the injury in Argentina and having a positive BAC in Belarus and Spain). In the multivariate analyses, restricted to countries with sufficient sample sizes (i.e., Mexico, South Africa, and the United States), no significant gender differences were found between the drinking-in-the-event variables and violent injury In the bivariate and multivariate analyses, a significant interaction effect between gender and heavy episodic drinking was found in the United States, indicating that heavy episodic drinking predicted violent injury for women but not for men. Conclusions: Although the results are preliminary, treatment and prevention programs may need to target both genders equally or perhaps even focus more on heavy-drinking women, particularly in the United States.

Winqvist S; Lehtilahti M; Jokelainen J; Luukinen H; Hillbom M. Traumatic brain injuries in children and young adults: A birth cohort study from northern Finland. (editorial). Neuroepidemiology 29(1/2): 136-142, 2007. (34 refs.)

Aims: Incidence and mortality rates of traumatic brain injury (TBI) were investigated by using the Northern Finland Birth Cohort. This cohort provides a valuable source of data from the population born in 1966 (n = 12,058) in the 2 northernmost provinces of Finland. Methods: The cohort was followed for 34 years, and data were gathered from the Finnish Hospital Discharge Register and the Registry for Causes of Death by Statistics Finland. Results: The annual incidence of and mortality from TBI were 118 and 14/100,000, respectively. Case fatality was 12%. An estimated prevalence of TBI at the age of 34 years was 269 /100,000. Peak occurrences were observed at the age of 6 - 7 years in both genders and at the age of 18 - 23 years in men. The proportion of TBI mortality out of total mortality was 12%. Young men aged 16 - 34 years had 10-fold proportionate mortality from TBI compared to boys aged <= 15 years. Alcohol drinking was associated with a particularly prominent number of intentional injuries in young men. Conclusion: Incidence and mortality rates of TBI vary according to age and gender. Peaks occur in children at the age of school entry and in men at the age of 18 - 23 years. Children have mild injuries, whereas the injuries of young men are frequently intentional and fatal and associated with alcohol drinking.

Young J; Beech D; Offodile R. Foreign body ingestion and management: "I swallowed a crack pipe". American Surgeon 73(11): 1144-1146, 2007. (10 refs.)

There is a wide variety of objects that find their way into the human gastrointestinal tract, either accidentally or deliberately. In this case a crack pipe was ingested in its entirety. Despite the seemingly rare and random nature that this scenario presents, this patient's care serves to reinforce what should be done to successfully manage a patient with an ingested foreign body, as well as the important issues related to crack cocaine abuse.

Zhu BL; Ishikawa T; Michiue T; Li DR; Zhao D; Quan L et al. Postmortem serum catecholamine levels in relation to the cause of death. Forensic Science International 173(2/3): 122-129, 2007. (42 refs.)

Catecholatnines are major humoral factors and neurotransmitters that contribute to various stress responses. However, they have been considered unstable due to agony, terminal medical care and postmortem interference. The present study was a comprehensive investigation of postmortem serum levels of adrenaline (Adr), noradrenaline (Nad) and dopamine (DA) with regard to the cause of death in serial medicolegal autopsy cases (n = 542) including fatalities from various traumas and diseases. There was a slight tendency toward postmortem increases of Nad and DA in cardiac blood as well as Adr and Nad in peripheral blood, a slight age-dependent decrease in Adr and DA in right heart blood, and a marked increase in serum DA due to administration during critical medical care. When these factors were taken into consideration, significantly higher cardiac blood levels were observed for Adr and Nad in injury and asphyxiation cases and for Adr in fatal methamphetarnine (MA) abuse and other poisoning cases, whereas those levels were lower in fatal hypothermia. Drowning, fire fatality, acute cardiac death and cerebrovascular disease showed intermediate Adr and Nad levels. The DA level was elevated in cases of injury, hyperthermia, MA fatality and other poisoning. Topographical analyses suggested that the major sources of increased serum catecholamines in cases of injury was abdominal viscera including adrenal glands, and that in cases of asphyxiation, drowning, fire fatality, hyperthermia, MA fatality, other poisoning, acute cardiac death and cerebrovascular disease was the extremities in addition to abdominal viscera. However, there was in part a large case-to-case difference in each marker related to individual causes of death. These findings differed markedly from clinical observations and suggest that the postmortem serum catecholarnine levels may reflect the magnitude of physical stress responses during the process of death in individual cases.