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Biomedical subjects

J Rehm

Publications and source records attributed to J Rehm.

At least 19 recordsLinked to original sources
PubMed2000

Incorporating the AUDIT into a general population telephone survey: a methodological experiment.

This study assessed potential ordering and wording effects of the alcohol use disorders identification test (AUDIT). In total, 688 respondents were randomly assigned to one of four experimental conditions: Intact order/original wording (n=148), intact order/revised wording (n=183), split order/original wording (n=192), split order/revised wording (n=166). Changes to question order and wording had no discernable impact on the scores of the AUDIT. Our results suggest that alterations to the AUDIT can be made in order to integrate it within a larger survey without adversely affecting its measurement properties.

Adult↗
PubMed2000

The relative risks and etiologic fractions of different causes of death and disease attributable to alcohol, tobacco and illicit drug use in Canada.

BACKGROUND: In 1996 the number of deaths and admissions to hospital in Canada that could be attributed to the use of alcohol, tobacco and illicit drugs were estimated from 1992 data. In this paper we update these estimates to the year 1995. METHODS: On the basis of pooled estimates of relative risk, etiologic fractions were calculated by age, sex and province for 90 causes of disease or death attributable to alcohol, tobacco or illicit drugs; the etiologic fractions were then applied to national mortality and morbidity data for 1995 to estimate the number of deaths and admissions to hospital attributable to substance abuse. RESULTS: In 1995, 6507 deaths and 82,014 admissions to hospital were attributed to alcohol, 34,728 deaths and 194,072 admissions to hospital were attributed to tobacco, and 805 deaths and 6940 admissions to hospital were due to illicit drugs. INTERPRETATION: The use and misuse of alcohol, tobacco and illicit drugs accounted for 20.0% of deaths, 22.2% of years of potential life lost and 9.4% of admissions to hospital in Canada in 1995.

Alcohol Drinking↗
PubMed2000

Perception of traffic accident risk and decision to drive under light alcohol consumption--a double-blind experimental study.

PURPOSE: Public traffic safety campaigns in Germany have focussed on the changing risk perception of young drivers. While there is some consensus that perceptions of risk affect driving, less is understood about the relationship and interaction of alcohol consumption and risk perception on the decision to drive. We examined the influence of light alcohol consumption on risk perception and decision to drive, and the interaction of alcohol consumption and cognitive feedback on the handicapping effect of alcohol on risk perception and decision to drive. METHOD: In a double-blind block-randomized experimental study of 104 young drivers between 19 and 24 years of age, with two experimentally manipulated independent factors of alcohol consumption (three levels: 0% BAC, 0.015% BAC, 0.03% BAC) and feedback (positive or negative), we assessed three dependent variables: perception of traffic accident risk, subjective judgement about driving-relevant cognitive performance, decision to drive a car. Analyses of variance and covariance were used to analyze differences between levels of experimental factors. RESULTS: We found that persons with 0.015 BAC performed better than persons in both other alcohol conditions on the standardized risk perception task. Perceived handicap of driving was significantly more pronounced for negative feedback compared to positive feedback with no influence of the level of alcohol consumption. No significant influence on decision to drive was found of either level of alcohol consumption, feedback or sex. IMPLICATIONS: Decision to drive in young drivers could not be influenced by feedback or light consumption. Public health approaches have to find better determining factors.

Accidents, Traffic↗
PubMed1999

Multiple-informant ranking of the disabling effects of different health conditions in 14 countries. WHO/NIH Joint Project CAR Study Group.

BACKGROUND: The Global Burden of Disease study provided international statistics on the burden of diseases, combining mortality and disability, that can be used for priority setting and policy making. However, there are concerns about the universality of the disability weights used. We undertook a study to investigate the stability of such weighting in different countries and informant groups. METHODS: 241 key informants (health professionals, policy makers, people with disabilities, and their carers) from 14 countries were asked to rank 17 health conditions from most disabling to least disabling. Kruskal-Wallis ANOVA was used to test for differences in ranking between countries or informant groups and Kendall tau-B correlations to measure association between different rank orders. FINDINGS: For 13 of 17 health conditions, there were significant (p<0.05) differences in ranking between countries; in the comparison of informant groups, there were significant differences for five of the 17 health conditions. The overall rank order in the present study was, however, almost identical to the ranking of the Global Burden of Disease study, which used a different method. Most of the rank correlations between countries were between 0.50 and 0.70 (average 0.61 [95% CI 0.59-0.64]). The average correlation of rank orders between different informant groups was 0.76. INTERPRETATION: Rank order of disabling effects of health conditions is relatively stable across countries, informant groups, and methods. However, the differences are large enough to cast doubt on the assumption of universality of experts' judgments about disability weights. Further studies are needed because disability weights are central to the calculation of disability-adjusted life years.

Analysis of Variance↗
PubMed1999

The economic consequences of smoking in Ontario.

Smoking causes health and social problems such as sickness, death, fire, injury, pain and suffering. This paper provides an estimate of the economic burden imposed by the adverse health and social consequences of smoking in Ontario in 1992. The cost-of-illness method, in particular, the human-capital approach is used to estimate the prevalence-based economic costs of smoking. The direct and indirect components of smoking-related costs are estimated and the total cost in Ontario is US$2.91 billion. Associated with these economic costs are health-related harms: 69,318 hospital separations; 1,007,647 days stay in hospitals; 11,648 deaths resulting in more than 171,443 person-years lost.

Adolescent↗
PubMed1999

A reliable and efficient technique for laparoscopic needle positioning.

Needle positioning can be a difficult, frustrating, and time-consuming step during laparoscopic suturing. Utilizing the reliable and efficient technique described in this article, needle positioning is expedited. This technique is applicable for any type of needledriver or suture.

Humans↗
PubMed1999

Factor structures for DSM-IV substance disorder criteria endorsed by alcohol, cannabis, cocaine and opiate users: results from the WHO reliability and validity study.

AIMS: The factor structure of DSM-IV substance disorder criteria is examined among alcohol, cannabis, cocaine and opiate users to determine the dimensionality of abuse and dependence criteria within each of these drug classes and whether a common construct can be generalized across drug classes. DESIGN: 12-month criterion prevalence was assessed as part of the World Health Organization's Study on the Reliability and Validity of the Alcohol and Drug Use Disorder Instruments in various settings at eight sites around the world using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). A majority of respondents were recruited from non-treatment settings. In addition to exploratory factor analysis, confirmatory factor analysis was used to analyse factor structures using weighted least square methods and tetrachoric correlation matrices. Multi-sample analysis techniques were used to model differences between drug-classes. FINDINGS: In the full data analyses identified a single factor solution for each user population and across user populations. However, analyses of data from users reporting low to moderate symptomatology identified a two-dimensional construct among alcohol, cannabis and opiate users consisting of a major "dependence" factor and a lesser "abuse" factor. In addition, results showed that neither the abuse criterion "(A2) use in physical hazardous situations" or the dependence criterion "(D7) use despite knowledge of psychological/physical problems" were central to the latent construct in any of the user populations, except for D7 among alcohol users. CONCLUSIONS: The multi-dimensional results found among users with low to moderate symptomatology indicate that: (1) previous results from relatively homogeneous populations may have been biased towards lesser order solutions, and that (2) the DSM-IV substance disorder criteria describe at least two distinct phenomena, supporting the current DSM-IV organization of substance disorder criteria. Further work needs to evaluate whether prevalent symptoms are present in random or predictable combinations, whether combinations reflecting a specific hierarchy of severity can be identified, and whether incident symptoms are accumulated in a predictable pattern, within specific user populations and across user populations.

Alcoholism↗
PubMed1999

Patterns of alcohol consumption and social consequences. Results from an 8-year follow-up study in Switzerland.

AIMS: (1) To estimate the impact of drinking patterns on negative social (behaviour) consequences. (2) To test for the additional impact of overall volume of alcohol consumed on these social consequences. (3) To explore whether the impact on social consequences of drinking patterns is comparable for measures that do and do not explicitly mention alcohol consumption. DESIGN AND SETTING: An 8-year follow-up to a 1987 study of the Swiss general population carried out through face-to-face interviews; the follow-up data presented in this article was collected in 1995 through a mailed questionnaire. PARTICIPANTS: Nine hundred and fifty-three respondents from the 1987 survey who also completed the mailed questionnaire in 1995. MEASUREMENTS: Variables used were as follows: volume of drinking, eight drinking patterns differentiated by volume and frequency, four social consequences without mention of alcohol and six with mention of alcohol. All multivariate analyses control for sex, age and linguistic region. FINDINGS: High volumes of drinking per occasion predicted negative social consequences independently of overall drinking volume. This finding was independent of explicit mention of alcohol in item formulation. For unemployment and accidents, if assessed independently of alcohol consumption, no significant relationship with either overall volume of drinking or drinking pattern was observed. CONCLUSIONS: Patterns of alcohol consumption are an important determinant of social problems. Future research with better design is necessary to establish their exact risk relations with different social consequences.

Adolescent↗
PubMed1999

Privatizing alcohol sales and alcohol consumption: evidence and implications.

AIM: To provide an overview of recent privatization/deregulation experiences in North America and other settings, in order to draw conclusions about the impacts that might be expected from such changes on rates of alcohol consumption and related problems. METHODS: Critical review of research evidence on the effect of changes in availability, particularly changes in physical availability and economic availability that typically accompany privatization of alcohol retail monopolies. FINDINGS: Deregulation/privatization experiences commonly involve higher density of outlets, longer hours or more days of sale, changes in price, a strong orientation to commercial aspects of alcohol sales and the introduction of new vested economic interests into alcohol management arrangements in the jurisdiction. In many instances these changes in access to alcohol are accompanied by an increase in the per capita rates of consumption. In the short term changes in prices are likely to either increase or demonstrate opposite patterns for beverages with different base prices. Longer-term patterns point to a decline in real price with privatization, which very probably stimulates per capita alcohol sales. CONCLUSION: The existing evaluation literature on the subject of privatization has tended to focus on examining the net short-term results in terms of alcohol consumption levels. Overall, there are too few studies employing adequate statistical methodologies to explore the underlying causes of changing alcohol consumption and alcohol-related harm. Finally, seven specific suggestions that may assist future studies are discussed.

Alcohol Drinking↗
PubMed1999

Assessment methods for alcohol consumption, prevalence of high risk drinking and harm: a sensitivity analysis.

BACKGROUND: There are no standardized ways to assess alcohol consumption in epidemiological studies. The main objective of the present study was to compare three widely used methods for assessing alcohol consumption with respect to resulting prevalence estimates for high risk drinking and harm as defined by morbidity and mortality indicators. METHODS: A within-subjects design was used to compare a quantity frequency, a graduated frequency, and a weekly drinking recall measure. Data consisted of a representative sample of 3961 adult residents of the province of Ontario, Canada, who participated in a multi-wave cross-sectional survey between 1990-1994. Cross-tabulation, Spearman correlation, and standard methodologies for prevalence-based cost-of-illness studies were used. RESULTS: The graduated frequency measure consistently yielded higher estimates of the prevalences of high risk drinking and harm. Differences were marked on all indicators, but were most pronounced for harmful drinking as defined by consuming an average of >60 g pure alcohol per day for males, and >40 g per day for females. Prevalence estimates of harmful drinking were almost five times higher for graduated frequency versus weekly drinking measures, and almost three times higher for graduated frequency versus quantity frequency measures. CONCLUSIONS: The characteristics of different measures of alcohol consumption should be considered in future research in epidemiology.

Adult↗