Browsing by Author "MacDonald, S."

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A case-crossover study of acute alcohol use and suicide attempt
(ALCOHOL RES DOCUMENTATION INC CENT ALCOHOL STUD RUTGERS UNIV, C/O DEIRDRE ENGLISH, 607 ALLISON RD, PISCATAWAY, NJ 08854-8001 USA, 2004) Borges, G.; Cherpitel, C.J.; MacDonald, S.; Giesbrecht, N.; Stockwell, T.; Wilcox, H.C.; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mx
Objective: Several studies have shown that acute alcohol use is associated with suicidal behavior, but the magnitude and nature of the relationship remain unclear. We report a study on the impact of acute alcohol use on suicide attempts treated in the emergency room (ER) using the case-crossover design. Method: Seven ER studies carried out in the United States, Canada, Mexico and Australia from 1984 to 1996 with probability samples and similar methodology were merged yielding a total of 102 suicide attempters (overall 52% were male and 59% under 30 years of age). Results: Thirty-six patients reported alcohol use within 6 hours prior to the suicide attempt. When usual alcohol consumption during the past 12 months served as the control value, the estimated relative risk (RR) for patients who reported alcohol use within 6 hours prior to the suicide attempt was 9.6 (95% confidence interval: 5.7-16.3). Although the prevalence of alcohol use differed by sex, there was no statistically significant difference in the estimated RRs (RR = 13.6 men and RR = 5.3 women, p = 0.11 for the heterogeneity test). Conclusions: A positive association was found between alcohol use 6 hours prior and suicide attempts in 102 ER cases in four countries. The case-crossover methodology is well suited to studies for which an external control group is not easily obtainable.
A cross-national meta-analysis of alcohol and injury: data from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP)
(2003) Cherpitel, C.J.; Bond, J.; Ye, Y.; Borges, G.; MacDonald, S.; Giesbrecht, N.; Public Health Institute Alcohol Research Group 2000 Hearst Avenue Berkeley, CA 94709 USA; ccherpitel@arg.org
Acute alcohol use and the risk of non-fatal injury in sixteen countries
(WILEY-BLACKWELL, COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA, 2006) Borges, G.; Cherpitel, C.J.; Orozco, R.; Bond, J.; Ye, Y.; MacDonald, S.; Giesbrecht, N.; Stockwell, T.; Cremonte, M.; Moskalewicz, J.; Swiatkiewicz, G.; Poznyak, V.; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mx
Aims To determine the relative risk (RR) of non-fatal injury associated with alcohol consumption in a series of emergency departments (EDs), possible effect modifiers and the impact of contextual variables on differences across sites. Design The case-crossover method was used to obtain RR estimates of the effect of alcohol on non-fatal injuries. Meta-analysis was used to evaluate the consistency and magnitude of RR across sites, and the extent to which contextual variables explain differences in effect sizes. Participants Probability samples of 11 536 injured patients attending 28 EDs studies in 16 countries (1984-2002). The majority of the sample was male (65%) and > 30 years old (53%). Measurements Exposed cases where those that consumed alcohol 6 hours prior to the injury. Usual alcohol consumption served as the control period. Findings Drinking within 6 hours prior to the injury was reported by 21% of the sample. The estimated (random) pooled relative risk for patients who reported alcohol use within 6 hours prior to injury was 5.69 (95% confidence interval = 4.04-8.00), ranging from 1.05 in Canada to 35.00 in South Africa. Effect size was not homogeneous across studies, as societies with riskier consumption patterns had a higher relative risk for injury. Heavier drinkers also showed lower RR. Conclusions Acute alcohol was a risk factor for non-fatal injuries in most sites. Policy measures addressed to the general population are recommended, especially in societies with riskier consumption patterns.
Emergency room injury presentations as an indicator of alcohol-related problems in the community: A multilevel analysis of an international study
(ALCOHOL RES DOCUMENTATION INC CENT ALCOHOL STUD RUTGERS UNIV, C/O DEIRDRE ENGLISH, 607 ALLISON RD, PISCATAWAY, NJ 08854-8001 USA, 2004) Young, D.J.; Stockwell, T.; Cherpitel, C.J.; Ye, Y.; MacDonald, S.; Borges, G.; Giesbrecht, N.; Curtin Univ Technol, Nat Drug Res Inst, Perth, WA 6001, Australia; timstock@uvic.ca
Objective: This study describes and examines the development of surrogate measures of acute alcohol-related injury for use in the evaluation of community-based prevention initiatives. Method: An international collaborative study of alcohol and injury, the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP), provided a subset of data on 8,580 emergency room (ER) presentations from five countries and 28 ER facilities. Results: Presentations most likely to be alcohol related were those made between 12:00 AM and 4:59 AM (56%), on Fridays, Saturdays or Sundays (26%); and those among injured persons who were male (28%), who were aged between 18 and 45 years (24%) or who were unmarried (24%). Multilevel logistic regression models confirmed the significance of the above variables as predictors of alcohol involvement prior to the injury event. The strongest predictor variable was presentation between 12 midnight and 4:59 AM with an odds ratio of 4.92 (Wald Test chi(2) = 397.6 p <.001). Being male had an odds ratio of 3.01 (Wald Test chi(2) = 247.25,p <.001), and presenting on a Friday, Saturday or Sunday night had an odds ratio of 1.50 (Wald Test chi(2) = 49.6, p <.001), whereas being under 45 (odds ratio [OR] = 1.20, p <.05) and being unmarried (OR = 1.2, p <.01) were less strong predictors. Combining all these values for variables raised the probability of prior alcohol involvement in such injury presentations to 0.65, although only 3.37% of all cases met these criteria, limiting applicability of this combined variable as a surrogate measure for intervention studies. Probabilities of prior alcohol involvement are presented with other combinations of values for the predictor variables. Conclusions: Frequency of night-time injury presentations to ER facilities, particularly by men, can be used as a reliable surrogate measure of alcohol-related injuries for various epidemiological and evaluation purposes.
Multicentre study of acute alcohol use and non-fatal injuries: data from the WHO collaborative study on alcohol and injuries
(WORLD HEALTH ORGANIZATION, MARKETING AND DISSEMINATION, CH-1211 GENEVA 27, SWITZERLAND, 2006) Borges, G.; Cherpitel, C.; Orozco, R.; Bond, J.; Ye, Y.; MacDonald, S.; Rehm, J.; Poznyak, V.; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mx
Objectives To study the risk of non-fatal injury at low levels and moderate levels of alcohol consumption as well as the differences in risk across modes of injury and differences among alcoholics. Methods Data are from patients aged 18 years and older collected in 2001-02 by the WHO collaborative study on alcohol and injuries from 10 emergency departments around the world (n = 4320). We used a case-crossover method to compare the use of alcohol during the 6 hours prior to the injury with the use of alcohol during same day of the week in the previous week. Findings The risk of injury increased, with consumption of a single drink (odds ratio (OR) = 3.3; 95% confidence interval = 1.9-5.7), and there was a 10-fold increase for participants who had consumed six or more drinks duribng the previous six hours. Participants who had sustained intentional injuries were at a higher risk than participants who had sustained unintentional injuries. Patients who had no symptoms of alcohol dependence had a higher OR. Conclusion Since low levels of drinking were associated with an increased risk of sustaining a non-fatal injury, and patients who are not dependent on alcohol may be at higher risk of becoming injured, comprehensive strategies for reducing harm should be implemented for all drinkers seen in emergency departments.
The criteria for causation of alcohol in violent injuries based on emergency room data from six countries
(PERGAMON-ELSEVIER SCIENCE LTD, THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND, 2005) MacDonald, S.; Cherpitel, C.J.; Borges, G.; DeSouza, A.; Giesbrecht, N.; Stockwell, T.; Univ Western Ontario, Ctr Addict & Mental Hlth, London, ON N6G 4X8, Canada; scotm@uwo.ca
This paper is based on data using similar methods collected from patients at 30 emergency rooms (ERs) in six countries. These data were analyzed with the goal of determining whether alcohol is a likely cause of violence through an application of criteria outlined by Bradford Hill [Proc. R. Soc. Med. 58 (1966) 295]. Analyses were conducted by comparing various measures of alcohol involvement in violent versus accidental injuries. The results supported temporal sequence of events and specificity. The odds ratios of violent versus accidental injury for a blood alcohol concentration (BAC) over 80 mg% were significant for each country, ranging from 2.77 for Mexico to 9.45 for Canada, which supports both the strength of associations and the consistency of findings. No third variables were found from the logistic regression analysis that better explain the relationships between alcohol and violence. A significant dose-response relationship between BAC level and violence was also found. All analyses conducted point to a causal role of alcohol in injuries related to violence. (C) 2004 Elsevier Ltd. All rights reserved.