Cross-national performance of the RAPS4/RAPS4-QF for tolerance and heavy drinking: data from 13 countries.

OBJECTIVE: There are little data available on the performance of brief screening instruments for alcohol-use disorders cross-nationally; therefore, we analyzed the performance of one such instrument in a number of countries. METHOD: Performance of the RAPS4 for tolerance and the RAPS4-QF for heavy drinking are analyzed from emergency room data across 13 countries included in the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the World Health Organization Collaborative Study on Alcohol and Injuries. RESULTS: The RAPS4 showed good sensitivity and specificity for tolerance across most of the countries, but was higher in countries that were higher on societal-level detrimental drinking patterns. Prevalence of tolerance was also higher in those countries with high detrimental drinking pattern scores. Sensitivity of the RAPS4-QF for heavy drinking was uniformly high across countries, while maintaining good specificity, and did not vary by detrimental drinking patterns. CONCLUSIONS: Findings suggest the RAPS4 and RAPS4-QF may hold promise cross-nationally. Future research should more fully address the performance of brief screening instruments for alcohol-use disorders (using standard diagnostic criteria) cross-nationally, with consideration of the impact of societal drinking patterns.

Older people maintaining well-being: an International Appreciative Inquiry study.

This paper reports on the progress of an international study investigating older people's strategies for maintaining well-being in the UK, Germany, South Africa and Australia. It uses an Appreciative Inquiry framework for investigation.

When the trivial becomes meaningful: reflections on a process evaluation of a home visitation programme in South Africa.

This paper reflects on a process evaluation of a home visitation programme in South Africa. The programme, implemented in two low-income communities, focused on the reduction of risks to unintentional childhood injuries. The evaluation comprised a combination of qualitative and quantitative methods, including observations in conjunction with an evaluator's journal, diaries kept by the home visitors, interviews and focus group discussions. Short questionnaires were administered to programme staff and home visitors. Caregivers were visited to attain their assessment of visitors and the programme. These methods resulted in a detailed description of implementation processes, but more importantly gave insight into the experiences and perceptions of the social actors, i.e. programme staff, visitors and caregivers. It also offered possible explanations for the difference in the intervention effect between the two sites. Two major challenges to the evaluation were: (i) the power-imbalance between the evaluator and community participants (visitors and caregivers) and (ii) the language- and cultural barriers between evaluator and community participants. The evaluation demonstrated that process information can contribute towards explaining outcome results, but also that active participation from all social actors is a necessary condition if process evaluations are to result in programme improvement.

Gender differences in the relationship between alcohol and violent injury: an analysis of cross-national emergency department data.

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 heavydrinking women, particularly in the United States.

Validity of self-reported drinking before injury compared with a physiological measure: cross-national analysis of emergency-department data from 16 countries.

OBJECTIVE: Self-reports of alcohol consumption among patients visiting an emergency department (ED) have been used extensively in the investigation of the relationship between drinking and injury. Little is known, however, about the associations between validity of self-reports with patient and injury characteristics and whether these relationships vary across regions or countries. Both of these issues are explored in this article. METHOD: In the construct of a multilevel logistical model, validity of self-reports was estimated as the probability of a positive self-report given a positive blood alcohol concentration (BAC). The setting included 44 EDs across 28 studies in 16 countries. Participants included 10,741 injury patients from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the World Health Organization Collaborative Study of Alcohol and Injuries. Data were analyzed on self-reported drinking within 6 hours before injury compared with BAC results obtained from breath-analyzer readings in all but two studies, which used urine screens. Covariates included demographic, drinking, and injury characteristics and aggregate-level contextual variables. RESULTS: At the individual level, a higher BAC measurement was associated with a higher probability of reporting drinking, as was heavy drinking and sustaining injuries in traffic accidents or violence-related events. At the study level, neither aggregate BAC nor other sociocultural variables affected the validity of self-reported drinking. CONCLUSIONS: This study provides further evidence of the validity of self-reported drinking measures in crossnational ED studies based on the objective criterion of BAC estimates.

Risk factors for elder abuse and neglect: brief descriptions of different scenarios in South Africa.

Aim. To describe various situations in which older people in South Africa are vulnerable. Background. Poverty compromises the health of many older people in South Africa but the circumstances and ways in which this is managed and risk thought of is poorly understood. This paper presents three scenarios that describe individual studies and provide insight into the factors influencing the lives of some older people. Method. Scenario 1 concerns people with dementia. Pilot work has collected interview data from four people with dementia, their four informal carers and three hospital nursing staff. Scenario 2 concerns an analysis of data collected routinely as part of the Halt Elder Abuse Line, a telephone-based service for people to report abuse. Scenario 3 concerns an interview study with farm workers who have retired and who are vulnerable to being displaced from the farms. Conclusion. A variety of policy, social and individual factors result in older people being vulnerable and continuing research is required to further develop an understanding of these dynamics of risk to promote changes to current policy and practices.

Cannabis and other drug use among trauma patients in three South African cities, 1999-2001.

OBJECTIVE: To assess the extent of cannabis and other drug use among patients presenting with recent injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001. DESIGN: Cross-sectional surveys were conducted during a 4-week period at each of the above sites in 1999, 2000 and 2001. The concept of an idealised week was used to render representative samples. OUTCOME MEASURES: Cause of injury and biological markers to assess use of cannabis, methaqualone (Mandrax), opiates, cocaine, amphetamine, and methamphetamine. RESULTS: Over half of all patients tested experienced violent injuries. Excluding opiates, across sites and over time between 33% and 62% of patients tested positive for at least one drug (N = 1565). In most cases the drugs were cannabis and/or methaqualone. While no inter-city differences were found, male patients were typically more likely to test positive for drugs in general and specific drugs such as cannabis and the cannabis/methaqualone ('white pipe') combination than female patients. Drug positivity was higher in 2001 than in the previous 2 years in Cape Town, and patients injured as a result of violence in Cape Town and Durban were more likely to test positive for drugs than patients with certain other types of injuries. CONCLUSIONS: Drug use among trauma patients has remained consistently high for each of the 3 study periods. Efforts to combat the abuse of drugs such as cannabis and methaqualone would appear to be paramount in reducing the burden of injuries on health care services. The study has raised numerous issues requiring further research.