Borges G, Mondragón L, Cherpitel C, Ye Y, Rosovsky H

Language: Spanish
References: 30
Page: 19-27
PDF size: 208.53 Kb.

ABSTRACT

Since 1986 the National Institute of Psychiatry Ramón de la Fuente (INPRF) has conducted research on the relationship between alcohol consumption and injuries/ medical emergencies in representative samples of patients who attend the emergency department. The main goals of these studies have been to measure the prevalence of alcohol use among emergency department patients, to study their risk factors and consequences, and to propose interventions to reduce alcohol use and their consequences.
This review is not extensive in the sense to include all studies among emergency department patients in Mexico, but solely the ones performed by our institution (INPRF), all of which have used a common methodology. Our goal is to review in a general framework the main results, by presenting the characteristics of the 16 emergency departments studied in the country by the National Institute of Psychiatry during the last 17 years. Through this, it will be possible to observe variations that have been in the four studies and the points of convergence of such enterprise. Data from all of these ERs were collected using a similar methodology developed by Cherpitel. A sample of adult patients, 18 years and older, admitted to the emergency room and reporting an injury is drawn from ED admission forms which reflected consecutive patient arrival in the ED over several-weeks period. All eligible patients seen in the ED during a 24 hour period are approached and asked for participation. Patients with severe psychiatric disorders and follow-ups of previous consultation are excluded. Patients were approached to be breathalyzed and interviewed (with informed consent) as soon as possible after admission to the ED. Patients who were too severely injured or ill to be interviewed in the ED were followed into the hospital and interviewed after their condition had stabilized. A cadre of trained interviewers at each site obtained the BAC estimate and administered a standard 25-minute questionnaire. Patients were interviewed regarding the reason for the ER visit, drinking in the six hours prior to the injury or illness event, quantity and frequency of usual drinking during the last year, and demographic characteristics, among other items.
The first of these studies was carried out in Mexico City in 1986. The second took place Acapulco, Guerrero, in 1987. The third study was carried out in Pachuca, Hidalgo, in 1996-97 and, finally, the fourth study was made in 2002, on a hospital located at the south of the Mexico City (Tlalpan). The results used 4,950 patients of three different cities of the Republic. In all studies, it is clear that the alcohol represents a very prevalent factor between these patients. The episodic and intoxicated use of alcohol consumption appears frequently in traumatic urgencies, and chronic and heavy consumption, sometimes with symptoms of alcohol dependency, is present among the medical emergency patients. Both patients, from trauma and medical emergencies, that have used alcohol within six hours prior to the event, are very likely to attribute their emergency to the use of alcohol and may be willing to change their behavior. As is common with other emergency department studies, cases cannot be assumed to be representative of injuries that do not seek medical attention. Nevertheless, these results show that alcohol plays a prominent role among patients who seek emergency department care for injuries in Mexico. Converting these results into public health measures has proven difficult in the country and is a matter of further inquiry.

REFERENCES

1. BORGES G, CHERPITEL CH: Selection of screening items for alcohol abuse and alcohol dependence among Mexicans and Mexican Americans in the Emergency Department. J Stud Alcohol, 62(3):277-285, 2001.

2. BORGES G, CHERPITEL CH, MEDINA-MORA ME, MONDRAGÓN L, CASANOVA L: Alcohol consumption in emergency room patients and the general population: a population-based study. Alcohol Clin Exp Res, 22(9):1986- 1991, 1998a.

3. BORGES G, CHERPITEL CH, MEDINA-MORA ME, MONDRAGÓN L: Violence related injuries in the emergency room: Alcohol, depression and conduct problems. Subst Use Misuse, (en prensa) 2003b.

4. BORGES G, CHERPITEL CH, MEDINA-MORA ME, MONDRAGÓN L, POZNYAK V, PEDEN M, GUTIERREZ I: Episodic alcohol use and risk of injury. Am J Epidemiol, (en dictamen) 2003c.

5. BORGES G, CHERPITEL CH, ROSOVSKY H: Male drinking and violence-related injury in the emergency room. Addiction, 93:103-112,1998b.

6. BORGES G, GARCÍA G, GIL A, VANDALE S: Casualties in Acapulco: Results of study on alcohol use and emergency room care. Drug Alcohol Depen, 36:1-7, 1994.

7. BORGES G, MEDINA-MORA ME, CHERPITEL CH, CASANOVA L, MONDRAGÓN L, FIERRO L, ROMERO M: Consumo de bebidas alcohólicas en pacientes de los servicios de urgencias de la ciudad de Pachuca, Hidalgo. Salud Publica Mex, 41(1):3-11, 1999.

8. BORGES G, MONDRAGÓN L, CASANOVA L, ROJAS E, ZAMBRANO J, CHERPITEL CH, GUTIÉRREZ I: Substance and alcohol use and dependence in a sample of patients from an emergency department in Mexico City. Salud Mental, 26(1):23-31,2003a.

9. BORGES G, ROSOVSKY H: Suicide attempts and alcohol consumption in an emergency room sample. J Stud Alcohol, 57:543-548, 1996.

10. CASANOVA L, BORGES G, MONDRAGÓN L, MEDINAMORA ME, CHERPITEL CH: El alcohol como factor de riesgo en accidentes vehiculares y peatonales. Salud Mental, 24(5):3-11, 2001.

11. CELIS A, GOMEZ Z, MARTINEZ-SOTOMAYOR A, ARCILA L, VILLASEÑOR M: Family characteristics and pedestrian injury risk in Mexican children. Inj Prev, 9(1):58- 61, 2003.

12. CHERPITEL CJ: Study of alcohol use and injuries among emergency room patients. En: Giesbrecht N, González R, Grant M, Osterberg E, Room R, Rootman I, Towle L (eds). Drinking and casualties: Accidents, poisonings and violence in an international perspective. Routledge, 288-299, New York, 1989.

13. CHERPITEL CJ, BOND J, YE Y, BORGES G, Mac- DONALD S, GIESBRECHT N, STOCKWELL T: A crossnational meta-analysis of alcohol and injury: data from the emergency room collaborative alcohol analysis project (ERCAAP). Adicction, (en prensa), 2003.

14. CHERPITEL CJ, BORGES G: Performance of screening instruments for alcohol problems in the ER: a comparison of Mexican-Americans and Mexicans in Mexico. Am J Drug Alcohol Abuse, 26(4):683-702, 2000.

15. CHERPITEL CJ, PARES A, RODES J, ROSOVSKY H: Validity of self-reported alcohol consumption in the emergency room: data from the United States, Mexico and Spain. J Stud Alcohol, 53(3):203-7, 1992.

16. CHERPITEL CJ, ROSOVSKY H: Alcohol consumption and casualties: a comparison of emergency room populations in the United States and Mexico. J Stud Alcohol, 51(4):319-26, 1990.

17. GARCÍA G, BORGES G: El alcohol como factor de riesgo en los traumatismos, en tres servicios de urgencias de Acapulco, Gro. Anales Reseña V Reunión de Investigación, Instituto Mexicano de Psiquiatría (ED) IMP, México.56-63, 1990.

18. GARCÍA G, BORGES G: El alcohol y el riesgo de traumatismos en tres servicios de urgencias de Acapulco, México. Bol Of Sanit Panam, 111(3):231-239, 1991.

19. GENTILELLO LM, RIVARA FP, DONOVAN DM, JURKOVICH GJ, DARANCIANG E, DUNN CW, VILLAVECES A, COPASS M, RIES RR: Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg, 230(4):473-80, 1999.

20. HÍJAR M, CARRILLO C, FLORES M, ANAYA R, LÓPEZ V: Risk factors in highway traffic accidents: a case control study. Accid Anal Prev, 32(5):703-9, 2000.

21. HÍJAR MC, LOZANO R, VALDEZ R, BLANCO J. Intentional injuries as a cause for demanding attention from the emergency rooms of public hospitals in Mexico City. Salud Mental, 25 (1): 35-42, 2002.

22. KRUG EG, SHARMA GK, LOZANO R: The global burden of injuries. Am J Public Health, 90(4):523-6, 2000.

23. LAZCANO-PONCE E, SALAZAR-MARTINEZ E, HERNANDEZ-AVILA M: Case-control epidemiological studies: theoretical bases, variants and applications. Salud Pública Mex, 43(2):135-50, 2001.

24. LÓPEZ JL: Patrón de consumo de alcohol en pacientes captados en salas de urgencias. Salud Pública Mex, 40(6):487- 493, 1998b.

25. LÓPEZ J: Validez del Autoinforme en el consumo de bebidas alcohólicas. Rev Mex Psicología, 15(1):19-25, 1998a.

26. LÓPEZ, JL, ROSOVSKY H: El papel que desempeña el alcohol en los motivos por los que se les da atención en los servicios de urgencia, y estimación del riesgo asociado en los traumatismos. Salud Mental, 21(3):32-38, 1998c.

27. MENESES-GONZÁLEZ F, REA R, RUIZ-MATUS C, HERNANDEZ-AVILA M: Accidents and injuries in 4 general hospitals of the Distrito Federal. Salud Pública Mex, 35(5):448-55, 1993.

28. PINERO-DE FUENTES S, MEDINA-OROZCO E, ROJAS M: Prevalence of drug abuse in patients receiving care in adult emergency. Salud Pública Mex, 40(3):234-40, 1998.

29. ROSOVSKY H, GARCÍA G, LÓPEZ J, NARVÁEZ A: El papel del consumo de alcohol en las urgencias médicas y traumáticas. IV Reunión de Investigación del Instituto Mexicano de Psiquiatría, 261-267, 1988.

30. STOCKWELL T, CHIKRITZHS T, BRINKMAN S: The role of social and health statistics in measuring harm from alcohol. J Subst Abuse, 12(1-2):139-54, 2000.