Impact of Model for End-stage Liver Disease Score in Post-Liver Transplantation Prognosis.

Although the Model for End-Stage Liver Disease (MELD) score has been used to evaluate mortality of patients on the waiting list for liver transplantation, it has not established if it correlates with post-liver transplantation prognosis. The aim of this study is to assess if there is a relationship between pretransplantation MELD and post-transplantation results, especially regarding 30-day post-LT survival rates. We analyzed data from 172 patients who underwent deceased-donor liver transplantation between February 2013 and May 2015 in a single center. The sample was divided in two groups according to their MELD scores: group 1, with MELD <25 (n = 134), and group 2, with MELD ≥25 (n = 38). The groups were compared with regard to 1-, 3-, and 12-month postoperative survival; total length of stay and in intensive care unit; and perioperative blood transfusion. The global 30-day post-liver transplantation survival rate was 87.2% (89.55% for group 1 and 78.99% for group 2 (P = .090). The evaluation of 3- and 12-month survival showed that in group 2 the mortality was higher (P = .01). Our data suggests a positive relationship between the higher MELD group and longer length of stay in intensive care unit (P = .0345), but not for total time of hospital admission (P = .524). Perioperative blood product transfusion was needed in 35.82% of patients in group 1 and 71.05% in group 2; this correlated with a higher 30- day postoperative mortality (P < .001).

Adding a choice-based program for tobacco smoking to an abstinence-based addiction treatment program.

A smoking program that provides awareness education about smoking to all chemical dependency (CD) clients and staff, while allowing treatment for smoking to be optional, was developed at an abstinence-based addiction treatment center. This study measured the effects of introducing this mixed model for treatment of smoking and other substances on clients and staff. Attitude and program utilization data were collected, and CD clients were followed-up. The value of offering a smoking program during CD treatment and of framing it within a choice-based philosophy was strongly endorsed by staff and CD clients. Smoking program CD clients did not report major problems with other clients continuing to smoke. Most (55.6%) of the staff who smoked (n = 18) entered the smoking program during the first year of implementation; 38.0% of CD clients who smoked (n = 424) actively joined the smoking program; and of CD clients who chose cessation, 17.5% were abstinent at follow-up.

Adolescents, bush parties and drinking-driving.

OBJECTIVE: We describe the prevalence of bush party (an outdoor gathering of youth) attendance and examine predictors of attendance and of driving after drinking at bush parties. METHOD: The 1995 Ontario Student Drug Use Survey (OSDUS) data on students (n = 1,853) in schools across the province in grades 7, 9, 11 and 13 are employed to estimate prevalence of bush party attendance within the previous 12 months. The 1994 Graduated Licensing Study (GLS), a multi-community survey of drivers (n = 1,157, 53.6% male) in grades 11 and 12 in Ontario, data are employed to study predictors of attendance and of drinking-driving. RESULTS: Based on the OSDUS, the prevalence of bush party attendance is 37.6%. Based on the GLS, 38.4% attended bush parties, and among attenders 71.5% drank at bush parties, 63.5% observed drinking-driving, 16.1% rode with a drinking-driver and 16.6% drove after drinking at bush parties. Logistic regression reveals that attendance at bush parties is positively associated with number of other places alcohol was consumed, tobacco use, number of alcohol-related problems, number of kilometers ever driven, sensation seeking and northern residents. Among attenders who drank at bush parties, males were three and a half times more likely to drive after drinking at a bush party, and the probability of drinking and driving increased with the number of other drugs used. CONCLUSIONS: Despite important differences in the design and purpose of the two surveys, both indicate that bush party attendance is prevalent among adolescents. Driving after drinking at these events is common and warrants community action.

Introduction of high-alcohol beer in Ontario: preliminary observations on its use by underage drinkers.

Preliminary data are reported on the use of high-alcohol beer by underage drinkers in Ontario. Students in grades 11 and 12 with a valid driver's licence completed a questionnaire between January and May, 1994 (i.e., between three and seven months after the introduction of high-alcohol beer). About one-half of students who had drunk alcohol within the previous four weeks reported consuming high-alcohol beer within that period. In this group, males were much more likely to report high-alcohol beer consumption in the previous month. Both male and female high-alcohol beer consumers drank alcohol more frequently, got drunk more frequently, and drank five or more drinks on the same occasion more frequently than non-consumers. One reason for trying high-alcohol beer, "wanted a higher alcohol content", was endorsed by more than one-third of high-alcohol beer consumers. Our data suggest that the users of high-alcohol beer among this underage drinking sample tend to be heavier drinkers and more likely to experience alcohol-related problems.

Interventions by students in friends' alcohol, tobacco, and drug use.

This article investigates self-reported interventions by students in the alcohol, tobacco, illicit drug use, and drinking-driving of their friends. The data came from a study of 1184 students in Ontario schools in grades 7, 9, 11, and 13. We found that about a third of students intervened in friends' illegal drug use and drinking-driving but about half intervened about smoking. Students who intervened were more likely to be older and spend fewer nights at home. They were less likely to use cannabis, but had more friends using cannabis and illegal drugs. Also, they had more exposure to drug education and were more disapproving of drug use. Drug education may give students the knowledge and confidence to intervene in friends' drug use.

Psychosocial sequelae of motor vehicle collisions: a follow-up study.

One-hundred-and-forty-nine motor vehicle collision trauma victims were interviewed one year after discharge from a Regional Trauma Unit. Follow-up data indicated major post trauma problems such depression, anxiety, family stress, financial problems and driving fears. Almost 40% reported drinking driving after the crash with a greater proportion of alcohol (blood alcohol content) positive drivers engaging in drinking driving than blood alcohol content negative drivers. Notably, almost 16% of the blood alcohol content positive and 13% of the blood alcohol content negative reported involvement in another crash in the year since discharge.

Substance use as a measure of social integration for women of different ethnocultural groups into mainstream culture in a pluralist society: the example of Canada.

Analysis of Canadian data from the 1989 National Alcohol and Drugs Survey was used to identify profiles of alcohol and other drug-using behaviors among Canadian women of different ethnic or cultural groups. The profile considered 110 different substance use variables including alcohol or drug type used, quantity, frequency, drinking or drug-taking circumstances, beverage preference, reasons for drinking or not drinking, and opinions regarding appropriate drinking or drug-taking behavior of Canadian women who described themselves as belonging to the "Canadian," French, English, German/Dutch, Irish, Scottish, Ukrainian/Polish, Italian/Portuguese, and "Other" (Chinese, Jewish, and "Other") ethnic or cultural groups. Alcohol, tobacco, and drug use behavior was found to differ by ethnocultural group. Further, each ethnocultural group was found to differ from the national average. The amount of difference between the national average and each ethnocultural group was related to the period of arrival and the length of time that an ethnocultural group has been present in Canada. The degree of similarity or difference between each ethnocultural group and the mainstream national average for alcohol, tobacco, and drug use and drug-use behavior may be used to measure the degree of social integration of each ethnocultural group and the degree of acculturation of women of specific ethnocultural groups into mainstream Canadian society.

Psychosocial characteristics of alcohol-involved and nonalcohol-involved seriously injured drivers.

This study compared two groups of alcohol-positive and alcohol-negative, seriously injured, crash-involved drivers on demographics, personality characteristics, driving-related attitudes, prior driving history, lifestyle, substance use, and antecedent driver condition. The study sample was drawn from motor vehicle accident admissions to the Sunnybrook Health Science Centre Regional Trauma Unit. One hundred and six interviews were completed between August 1986 and November 1989, with blood alcohol concentration (BAC) data available for 96 drivers. These data suggest no driving-related attitude differences between the two groups. Self-reported driving histories indicated significantly fewer graduates of driving schools and more licence suspensions for the BAC-positive group. The only consistently significant differences were found for the drinking-related variables, with a greater percentage of the BAC-positive group reporting: lower age of first intoxication; a greater self-perceived drinking problem; a greater frequency of intoxication in the month before the accident; and greater self-reported drinking-driving in the month before the accident. Principal-components factor analysis revealed a four-factor solution labelled: Alcohol Use, Deviant/Illicit Drug Use, Aggression, and Neuroticism. Alcohol Use was the only factor found to contribute substantially to the discriminant function, together with the job-related stress item. These data suggest that seriously injured, alcohol-positive and alcohol-negative crashed drivers are similar except that the alcohol-positive drivers show more signs of an alcohol problem.

Psychosocial characteristics and follow-up of drinking and non-drinking drivers in motor vehicle crashes.

Eight hundred fifty-four consecutive motor vehicle crash (MVC) victims admitted from August 1, 1986, through August 31, 1989, were prospectively assessed including measurement of blood alcohol concentration (BAC). One hundred six in-hospital interviews were conducted on competent consenting drivers > or = 18 years old; 22.9% (n = 22) of those who were BAC tested (n = 96) were positive for alcohol on admission. The blood alcohol concentration positive [BAC(+)] and the BAC negative (-) drivers differed significantly on the following variables; driver education [BAC(-) > BAC(+): p < 0.01], license suspension < or = 2 years before admission [BAC(+) > BAC(-): p < 0.01], frequency of self-reported intoxication in month before crash [BAC(+) > BAC(-): p < 0.05], driving within 2 hours of drinking < or = 1 month before admission [BAC(+) > BAC(-): p = 0.01] and self-reported driving with BAC > 17 mmol/L < or = 1 month before admission [BAC(+) > BAC(-): p < 0.01]. Follow-up interviews (n = 106) were conducted 1 year after discharge; drivers originally testing BAC(+) were more likely to drive within 2 hours of drinking (p < 0.05), and were more likely to admit to driving with a BAC > 17 mmol/L (p < 0.01). Original BAC(+) drivers were also more likely to report a subsequent MVC in the year following discharge (not statistically significant). There is a need to develop an assessment system to identify high crash-risk drivers and establish rehabilitation programs to reduce crash recidivism.

Alcohol and drug use among motor vehicle collision victims admitted to a regional trauma unit: demographic, injury, and crash characteristics.

This study examined the incidence of alcohol and drugs in a sample of seriously injured motor vehicle collision victims, and differences related to pre-crash use of alcohol and/or other drugs on demographic variables, injury severity measures, and crash variables. The sample selected were all motor vehicle collision admissions to the Regional Trauma Unit at the Sunnybrook Health Science Centre in Toronto, Ontario, over a 37-month period (N = 854). Prospective demographic and injury-related information were collected from hospital charts, and crash data were collected from motor vehicle collision police reports. Blood samples were routinely collected on admission and tested for blood alcohol concentration (BAC). We found 32.0% of the BAC-tested motor vehicle collision admissions and 35.5% of drivers tested positive for blood alcohol. The drivers' mean BAC on admission was found to be 145.2 mg/100 ml, and the mean estimated BAC at crash time was 181 mg/100 ml. Drug screens were performed on a two-year subsample (n = 474), of whom 339 were drivers. Drug screens revealed that 41.3% of drivers tested positive for other drugs in body fluids, and 16.5% were positive for alcohol in combination with other drugs. Other than alcohol, the drugs most frequently detected in the drivers were cannabinoids (13.9%), benzodiazepines (12.4%), and cocaine (5.3%). Investigation of differences on demographic, injury, and crash characteristics related to precrash use of alcohol and/or drugs yielded significant findings. In the drug screened sample we found sex, admission type, and occupant status were related to precrash alcohol use. Also, use of drugs was found to interact with admission type and mean BAC on admission. Elapsed time was found to be significantly different for BAC by other drug use, with a greater length of elapsed time found for the subjects testing other drug positive but BAC negative. We found that BAC-positive drug-screened drivers were significantly more likely to be male, involved in a single-vehicle collision, not wearing a seat belt, ejected from the vehicle, and travelling at higher speeds than BAC negative drivers. No significant differences were found between BAC and/or other drug use on injury severity measures.

Blood alcohol testing of motor vehicle crash admissions at a regional trauma unit.

Motor vehicle crashes remain a leading cause of death and injury in the industrialized world. Alcohol consumption is implicated as a major factor in fatal motor vehicle crashes (MVCs), but only poor estimates of blood alcohol concentrations among nonfatally injured crash victims are available. A 3-year study was undertaken at a Regional Trauma Unit to determine the demographics, injury severity, and alcohol positivity of motor vehicle crash victims. Between August 1, 1986 and July 31, 1989, 825 motor vehicle crash victims were available for study; 368 drivers were admitted to the unit within a period of 4 hours. Of 715 patients tested for alcohol, 31.0% were positive. A total of 333 drivers were tested for blood alcohol; 128 (38.4%) were positive. The mean blood alcohol concentration (BAC) at admission for the drivers was 145.6 mg/100 ml; the estimated mean BAC at crash was 180.9 mg/100 ml. The mean age of BAC positive drivers was 31.4 years, compared to a mean age in the BAC negative drivers of 35.2 years (p less than 0.02). Male patients represented 76.6% of the drivers, yet represented 83.6% of the BAC positive drivers (p less than 0.05). There was a marked seasonal variation in BAC positivity, with 46.1% of drivers positive during the summer months. Alcohol appears to be a significant factor in nonfatal MVCs.