Male drinking and violence-related injury in the emergency room.

AIMS: To present epidemiological measures of associations between violence-related injuries (assaults and fights), alcohol consumption prior to the event, and drinking patterns among males attending hospital emergency rooms (ERs) in Mexico City. DESIGN: All patients were interviewed and breath tested for alcohol consumption. The data were analyzed using a case-control design. SETTING: Eight ERs in Mexico City that were representative of the types of emergency care systems available in that city (from public, private and social security systems hospitals). PARTICIPANTS: Cases were males patients (n = 445) admitted to the ER because of a fight or an assault. The control group was comprised of patients (n = 320) admitted to the ER because of accidents that are less frequently reported a alcohol-related (i.e. work-place accidents, animal bites or recreational accidents excluding near drowning). MEASUREMENTS: A breath sample to estimate BAG, as well as an interviewer-administered questionnaire were used. FINDINGS: Alcohol consumption prior to injury was found to be a more important risk factor than usual drinking for injuries resulting from violence, while quantity of usual alcohol consumption was more predictive of violence-related injuries than frequency of drinking. CONCLUSIONS: These data suggest the importance of using more appropriate control groups when estimating associations of alcohol and violence-related injuries so that associations will not be underestimated. More research is needed to establish unbiased estimates of alcohol-related violence.

Alcohol intake and severity of injuries on highways in Mexico: a comparative analysis.

AIMS: To analyze the association between alcohol intake and the severity of injuries sustained from traffic accidents on a Mexican highway. DESIGN: An observational unit evaluated drivers involved in auto accidents. SETTING: Mexico-Cuernavaca Highway, Mexico. A 60 km-long road with many altitude variations and sharp curves. PARTICIPANTS: Three hundred and eighty-six drivers involved in traffic accidents between March and September, 1994. MEASUREMENTS: A questionnaire was applied to the driver, an occupant or witness at the site of the accident to collect information about the driver, vehicle characteristics, type of accident, day-night occurrence, road section (Mexico-Cuernavaca or Cuernavaca-Mexico) and weather conditions. A physical examination was carried out to determine the presence and severity of injuries. FINDINGS: There were 177 injured people, including 12 deaths, with rates of 67.5 injuries and 4.58 deaths per 10,000 km driven. Variables associated with alcohol intake (p < 0.05) included: severity of injuries, non-use of seat belt, vehicle size and occurrence at night. Risk factors for severe injuries were: alcohol intake (adjusted OR 6.1 CI 95% 1.6-24.0); non-use of seat belt (OR 4.9 CI 2.2-10.8), age < 25 years (OR 3.6 CI 1.0-12.7), age > 54 years (OR 6.0 CI 1.4-25.0), speed > 90 km/h (OR 2.6 CI 1.1-6.3) and occurrence at night (OR 2.6 CI 1.3-5.3). CONCLUSIONS: Alcohol intake is a major risk factor for severe injuries from highway traffic accidents. Its association with other risk factors such as non-use of seat belt and excessive speed suggests the importance of designing interventions aimed at reducing alcohol intake among automobile drivers.

Suicide attempts and alcohol consumption in an emergency room sample.

OBJECTIVE: The aim of this study was to obtain an epidemiologic measure of association between suicide attempts and alcohol consumption in eight emergency room (ER) hospitals. METHOD: All patients were interviewed and breath tested for alcohol consumption. The data were analyzed using the case-control methodology. Cases were patients (N = 40; 21 male) admitted to ER because of a suicide attempt. The control group comprised patients (N = 372) admitted to ER because of accidents that are less frequently reported as alcohol related (i.e., workplace accidents, animal bites, and recreational accidents, except drowning). RESULTS: The proportion of suicide attempts under the effects of alcohol was significantly higher than that of the control group. The bivariate odds ratios (and 95% confidence intervals) for self-report of alcohol consumption in the 6 hours prior to the suicide attempt were: abstainers (baseline); 0.001-100 g of alcohol = 2.01 (0.44, 7.85); > 100 g = 31.11 (10.13, 98.61). For habitual alcohol consumption; abstainers (baseline); 0.001-100 g of alcohol = 0.67 (0.25, 1.77); > 100 g = 1.10 (0.44, 2.75). For Alco-Sensor: < or = 9 mg of alcohol/100 ml of blood (baseline); 10.99 mg/100 ml = 8.21 (2.81, 23.73); > or = 100 mg/100 ml = 2.97 (0.42, 15.95). Multiple logistic models did not change these findings. CONCLUSIONS: Alcohol consumption prior to the suicide attempt is a more important risk factor than the habitual alcohol consumption pattern. New research should emphasize life events and psychiatric variables and find explanations for differences between the self-reported and the Alco-Sensor estimates.

Prevention issues in a multicultural developing country: the Mexican case.

This paper reviews some cultural issues in Mexican society related to alcohol/drug use and misuse. The aim is to provide information that could aid in the identification of opportunities and barriers for preventive actions appropriate to this country. Some of the country's sociodemographic characteristics and a historical overview of alcohol/drug use and misuse are presented, as are also data obtained through different research strategies such as anthropological studies and epidemiological surveys among different populations. An overview of the current preventive interventions and some suggestions to improve conceptualization on alcohol/drug use and misuse for future research and to guide preventive actions are included.

[Epidemiology of suicide in Mexico, 1970-1984]. / Epidemiología del suicidio en México de 1970 a 1994.

OBJECTIVE: This paper reports data of suicide as a cause of death in Mexico from 1970 to 1994. MATERIAL AND METHODS: Death certificates and census data were used as the main sources for this study. RESULTS: In 1970 554 suicide deaths were reported for both genders. In 1994 there were 2 603 deaths. During this period the suicide death rate increased from 1.13 per 100 000 inhabitants to 2.89 per 100 000 inhabitants, which represents an increase of 156% in 24 years. Nevertheless, a higher increase was seen among males; 169% for this period as compared to 98% among females. In 1970 the proportional suicide mortality rate was 0.11% of total deaths; in 1994, an increase to 0.62% was observed. During the study period, the highest increase in the suicide rate was seen in the older groups (65 years and over). Nevertheless, an increase was also seen among the younger population (those aged under 19 years). In 1994, the last year of the series, the highest rates were found among males, especially among those aged 65 and over. Differences were found also in the suicide rates among the states of the Mexican Republic. In 1994 the State of Tlaxcala and the State of Mexico reported the lowest rates. The highest rates were found in Tabasco and Campeche. Thus, the highest suicide rates were seen in the southeast and the lowest rates in the central part of the country. CONCLUSIONS: Suicide is a growing problem in Mexico, mainly occurring among male older adults. Nevertheless, growing rates among young adults call for suicide prevention and care programs.

Drinking in the injury event: a comparison of emergency room populations in the United States, Mexico, and Spain.

Variables related to drinking in the injury event were compared among probability samples of emergency room patients in Contra Costa County, California (N = 1,001), Mexico City (N = 1,688) and Barcelona, Spain (N = 1,684). Drinking companions and places of drinking prior to injury, place of injury associated with drinking, amount of alcohol consumed, proximity of drinking with the injury event, perceived drunkenness at the time, and causal attribution of drinking with the event were all found to vary among the samples. The data suggest that the context in which alcohol is involved in the injury event is affected by the context in which alcohol is typically consumed in a culture and is important in analyzing alcohol's role in injury occurrence and situations which may be considered high-risk for alcohol-related injuries.

[Liver cirrhosis mortality in Mexico. I. Relevant epidemiological characteristics]. / La mortalidad por cirrosis hepática en México. I. Características epidemiológicas relevantes.

Previous studies have emphasized the impact of alcoholism on public health, especially on the incidence of liver cirrhosis, which ranks among one of the main causes of death in Mexico. Accordingly, the epidemiologic features of liver cirrhosis mortality (LCM) are examined, highlighting its historical trends, its geographical distribution and other risk factors like age and sex. The data show a consistently high LCM rate over time, male rates moving slightly up and female rates down. Proportional mortality has been increasing. The significant risk increment with age has determined LCM to be the leading cause of death for both sexes in the 30-64 years age group. A particularly interesting finding relates to the continuous excess of LCM seen in Mexico City and four surrounding states; on the contrary, in the northern states, LCM is considerably low. This difference is valid for women too. Comparing all states, a gradient of LCM rates from high to low mortality areas is observed. The social and health implications of LCM regional distribution demand the conduction of epidemiological studies to identify possible explanatory variables related to the pattern of alcohol consumption or other risk factors. Nonetheless, these data alone justify the implementation of an effective action plan in the high-risk areas to deal with this health problem, inherently associated with individual and social behaviors.

[Liver cirrhosis mortality in Mexico. II. Excess mortality and pulque consumption]. / La mortalidad por cirrosis hepática en México. II. Exceso de mortalidad y consumo de pulque.

Over the years high cirrhosis mortality rates have been reported in Mexico City and in the surrounding states (Hidalgo, Tlaxcala, Puebla and the State of Mexico); on the contrary, well defined areas, such as the northern states, have shown a considerably lower mortality rate. This situation may indicate that some factors such as the pattern of alcoholic intake and other environmental characteristics could explain this striking difference. To determine the role of alcohol, the availability and consumption of alcohol at regional and state level were compared with cirrhosis mortality rates. A high and statistically significant correlation was found with pulque availability and consumption (r = 72-92%, p less than 0.01) in all periods of time under examination. On the contrary, a statistically significant negative association was observed with beer consumption and a positive, but not significant correlation, with distilled alcoholic beverages. Infectious hepatitis incidence, prevalence of exclusive use of native languages (as an indirect index of ethnic background) and nutritional deficiencies were also studied as possible risk factors. Nutritional deficiencies and the prevalence of exclusive use of náhuatl and otomí languages were positively correlated. These results can be useful to conduct further epidemiological studies still needed to determine the etiologic role of pulque consumption as well as of the other risk factors. Nonetheless, the current data stress the need to implement public health programs to reduce alcohol consumption, especially pulque, and to minimize the impact of these risk factors in high mortality areas.

Validity of self-reported alcohol consumption in the emergency room: data from the United States, Mexico and Spain.

The validity of self-reported alcohol consumption within 6 hours prior to injury based on breath-analyzer readings obtained at the time of emergency room (ER) admission is compared among probability samples of ER patients in Contra Costa County, California (n = 450), Mexico City (n = 500) and Barcelona, Spain (n = 864). The same questionnaire, study design and methods were used in all three countries to maintain comparability for comparative analyses. The analysis was restricted to those breath analyzed within 6 hours of injury occurrence who reported no drinking following the event. Validity of self-reports was high in all three samples. The proportion of those reporting not drinking prior to injury who had positive breath-analyzer readings was .5% in the U.S., 1.5% in Spain and 3.3% in Mexico. Validity of self-reports was not associated with cause of injury in the United States. In Mexico those injured in motor vehicle accidents or by violence were most likely to deny drinking, while in Spain those injured in violent situations were most likely to report not drinking. Validity of self-reports in these studies is much higher than that found in other U.S. studies, but this may be partly due to the fact that self-reports were obtained after the patient had been breath analyzed.

Alcohol consumption and casualties: a comparison of emergency room populations in the United States and Mexico.

This study compares alcohol consumption and casualties in probability samples of emergency room populations in the U.S. and Mexico: four hospitals representative of a Bay Area California county (N = 3,609) and eight hospitals representative of Mexico City (N = 2,507). Both studies used similar methods and data collection instruments. Patients were breath analyzed and interviewed regarding self-reported alcohol consumption 6 hours prior to the injury or illness event, usual drinking patterns and alcohol-related problems. Similar associations of alcohol consumption and casualties were found between the two populations with positive admission breath-analyzer readings and moderate consumption being positively associated with injuries. Both samples reported higher rates of heavy drinking, drunkenness and alcohol-related problems than that found in general surveys of their respective populations. Differences found between the two samples were largely due to varying drinking patterns in the two cultures and to differing uses of the emergency room for treatment.