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Biomedical subjects

R Room

Publications and source records attributed to R Room.

At least 19 recordsLinked to original sources
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

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

Cross-cultural applicability in international classifications and research on alcohol dependence.

OBJECTIVE: Underlying cultural differences in the meaning of alcohol problems and dependence symptoms can lead people from different societies to systematically vary in their responses to a diagnostic interview, in ways that may be difficult for researchers to quantify or control. We identify four different ways that cultures can vary in their accounts of dependence symptoms, potentially leading to problems with the cross-cultural applicability of diagnostic criteria: (1) in terms of thresholds of symptom severity, or the point at which respondents from different societies recognize a symptom of dependence as something serious; (2) in the problematization of drinking-related states, or whether the symptoms described in official nomenclature on addiction even count as alcohol problems in all cultures; (3) in causal assumptions about how alcohol-related problems arise; and (4) in the extent to which there exist culture-specific manifestations of symptoms not adequately captured by official disease nomenclature. METHOD: Comparable data on the meaning of alcohol dependence criteria were collected from key informants in nine sites worldwide under the auspices of the WHO/NIH Cross-Cultural Applicability Research Project. Qualitative analysis compares and contrasts descriptions of ICD-10 dependence criteria across sites along the above four dimensions of cultural variation. RESULTS: While descriptions of dependence symptoms were quite similar among key informants from sites that share norms around drinking and drunkenness, they varied significantly in comparisons between sites with markedly different drinking cultures. Contrary to expectation, descriptions of physical dependence criteria appeared to vary across sites as much as the more subjective symptoms of psychological dependence. CONCLUSIONS: Problems with the cultural applicability of international nomenclature warrant careful consideration in future comparative research on addiction, although comparisons of dependence made across some cultural boundaries are likely to be much more problematic than comparisons made across others. Findings on dependence should be interpreted in light of what is known about the drinking cultures and norms of the societies involved. Future nosologies and diagnostic interview schedules should take into account a broad base of cultural experiences in conceptualizing alcohol dependence, in developing criteria and operationalizations and in determining the diagnostic significance of these.

Adolescent↗
PubMed1999

Harm reduction: concepts and practice. A policy discussion paper.

This paper provides an overview of the context, definition, and key features of the harm reduction approach, and provides several examples of current programs in various countries. Both licit and illicit drugs are included in these illustrations. Some of the critical issues, and the strategies needed to advance harm reduction, are discussed. [Translations are provided in the International Abstracts Section of this issue.]

Canada↗
PubMed1999

The rhetoric of international drug control.

The Commission on Narcotics Drugs, a United Nations political organ, meets every year in Vienna. Country statements from the Commission's general debate in 1994 and 1995 are analyzed in terms of their rhetorical framing. The dominant frame is of drugs as a scourge or menace against which a war must be waged. There is consensus that the war is being lost. International cooperation and solidarity are proposed as what will turn the tide; in the context of a losing battle, calls for decriminalization are seen as an unacceptable surrender. Fairly uniformly, this rhetorical framing is put forward by a majority of countries, and no clear alternative framing is presented. Historical resonances of the framing and possible future developments are considered.

Global Health↗
PubMed1998

Alcohol and aggression: general population views about causation and responsibility.

The purpose of this paper is to explore the public's perceptions about alcohol as a causal agent in aggressive behavior, and to assess how these beliefs are associated with notions of responsibility and the excuse-function of alcohol. In a 1995 probability survey, 994 adults across Ontario (50.3% female; mean age = 41.5, SD = 5.9) were asked questions about: alcohol-aggression expectancies; alcohol as an excuse; responsibility; personal drinking behavior; alcohol-aggression victimization; and demographics. Descriptive and regression analyses were conducted. Over three-quarters of respondents believed that alcohol is associated with aggression, with females, older respondents, those with less education, and those who do not drink heavily more likely to hold this view. A majority (92%) believed that an intoxicated person is responsible for any behavior, with very little subgroup variation. Analyses showed that the perception of alcohol as a causal agent was not associated with decreased personal responsibility attributions. In fact, the stronger the belief in the alcohol-aggression link, the more likely one was to hold the view that an intoxicated person is responsible for behavior. Beliefs that alcohol causes violence do not translate into the acceptance of intoxication as an excuse. Reasons as to why intoxication does not alleviate responsibility for the drunken actor--a result inconsistent with attribution theory--are discussed. The consistency of these results with the "New Temperance" movement in the United States is also discussed.

Adult↗
PubMed1998

Current directions in research on understanding and preventing intoxicated aggression.

The present paper describes promising research directions that emerged from a recent international conference on intoxication and aggression and from the scientific literature generally. In this overview, intoxicated aggression is seen as arising from an interactional process involving multiple contributing factors or causes. This model helps to define research directions that can further understanding and prevention. First, the societal/cultural framing of intoxication and aggression exerts a powerful influence on drinking behaviour and needs to be better understood. Another important area for research is the moderating role on alcohol-related aggression of personal factors such as predisposition to aggression and individual differences in expectations about alcohol and aggression. Research on the role of basic pharmacological effects of alcohol in increasing the likelihood of aggressive behaviour is also a critical aspect of understanding intoxicated aggression. Drinking contexts and environments play a considerable role in the relationship between intoxication and aggressive behaviour and need to be better understood. Another critical direction for future research is the study of intoxicated aggression as a process involving the interaction of the person, the situation and the effects of alcohol in natural and experimental settings. Finally, the paper highlights promising directions for research on interventions to prevent intoxicated aggression and violence.

Aggression↗
PubMed1998

Alcohol and the U.S.-Canada border: trade disputes and border traffic problems.

The public health interest in trade and in cross-border traffic of alcoholic beverages is considered in general terms. Within this framework, three specific issues in U.S.-Canada trade and borders are discussed: cross-border drinking and driving in both directions, particularly by youth; smuggling from the U.S. to Canada; and the "beer wars" and other U.S.-Canada trade disputes involving alcoholic beverages. While problems can be alleviated on each of these fronts, it is concluded that an important step internationally would be to establish that, because of the problems they entail, alcoholic beverages should be exempt from trade agreements, or else provision should be made for the public health interest to be represented in negotiations and dispute resolution involving alcoholic beverage controls.

Alcoholic Beverages↗
PubMed1997

WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results.

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments in an international study which has taken place in centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, kappa) were very good for dependence disorders (0.7-0.9), but were somewhat lower for the abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.

Adult↗
PubMed1997

Charting WHO--goals for licit and illicit drugs for the year 2000: are we 'on track'?

Both on a global and a regional basis, the World Health Organization (WHO) has set prominent goals for the turn of the millennium on the reduction of harms associated with licit and illicit drugs. Gauging what the world and its different regions are doing with respect to these specific public health goals is hindered by a conceptual problem: there is no clear concept and consistent way of defining or measuring 'harm' related to drugs, licit or illicit. In many instances, 'harm' is equated with substance use prevalence. Often, especially outside the developed world, basic harm data is not even available. Globally, a conceptually clear and consistently applied scheme of harm measurement related to licit and illicit drugs is needed, acknowledging the fact that drug-related harms occur at different individual and social levels as well as over different periods of time. Harms must also be recognized as an outcome of interactions between the substance user, the drug itself, and the physical and social environment. Looking at available macro-indicators of harm, it must be concluded with, we do not seem to be 'on track' globally in reducing harms related to drugs in accordance with the WHO goals. For alcohol and tobacco, trends for increased harm are just starting to show in the developing world, and will worsen over the next couple of decades. For illicit drugs, failing drug control policies have result in dramatically negative developments for public health, especially with respect to HIV infections and drug-related deaths, in the developed as well as developing world.

Alcohol Drinking↗
PubMed1997

Situational norms for drinking and drunkenness: trends in the US adult population, 1979-1990.

Drinking depends on time, place, situation and personal characteristics. Patterns and trends in situational drinking norms (subjective levels of acceptable consumption for various situations) for US adults are reported. Results are based on eight comparable normative questions from national household surveys conducted in 1979 (n = 1772), 1984 (n = 5221 including Hispanic and black oversamples) and 1990 (n = 2058). Across years and population subgroups, a correspondence in ordering of situations on acceptability of drinking and of drunkenness was found. There were contrasting secular trends in the acceptability of drunkenness in different situations: drinking "enough to feel the effects" became more acceptable when at home but less acceptable in several other situations, particularly for men at a bar. For a decreasing percentage of respondents of both genders, it remains more acceptable for men than women to drink in bars, but gender norms in such "wetter" situations were converging by 1990. Men remain more accepting of drinking (but not drunkenness) for "dryer" situations such as when driving, but the trend is towards reduced acceptance. Multiple regression models predicting "acceptance of drinking" and "acceptance of drunkenness" scores showed fair stability in explanatory variables over time, with drinking level and conservative Protestant affiliation (drinking) or age (drunkenness) the major contributors.

Adult↗
PubMed1997

Moderate drinking and health. Implications of recent evidence.

OBJECTIVE: To address three questions (Is moderate drinking good for health? Should people drink to prevent heart disease? What is moderate drinking?) and to examine and compare two recent Canadian guidelines on low-risk drinking in the context of counseling patients. DATA SOURCES: English-language data sources were searched, particularly peer-reviewed health and social science literature and recent expert reports. STUDY SELECTION: Studies and reports were selected for their scientific merit and direct relevance to the three questions addressed and to the formulation of guidelines on low-risk drinking. SYNTHESIS: While moderate drinking might protect some older people against coronary heart disease, it is associated with increased risk of hemorrhagic stroke, certain cancers, accidents and injuries, and a range of social problems. For most health outcomes, risk increases as consumption of alcohol increases. CONCLUSIONS: While the data have limitations, they provide a basis for formulating guidelines on low-risk drinking. The two Canadian guidelines, one developed from the perspective of health recovery, the other from the perspective of health promotion, complement each other in the context of counseling patients.

Accidents↗
PubMed1997

Alcohol, the individual and society: what history teaches us.

Drinkers derive both pleasure and pain from drinking, but harm may come also to others. Through religious or secular rules, societies have sought to limit these "externalities" of drinking. Societal reactions have primarily focused on social harms from drinking; policy attention to casualties and chronic health effects is fairly recent. Drinking behaviour varies greatly according to the cultural framing of alcohol; societal policies tend to vary accordingly. Ecological constraints and social norms on preparation and use meant that alcohol was often available only sporadically in tribal and village societies. Alcohol production has been increasingly industrialized and marketing increasingly globalized in the modern era. Now, free trade agreements and the doctrine of consumer sovereignty increasingly limit the scope of national alcohol control policies. On the other hand, modern society demands exacting standards of attention and care incompatible with intoxication, for instance when driving a car or minding children. Managing the conflict between these and alcohol's ready availability is seen as a wholly individual rather than a societal responsibility. Those who fail the task are defined as alcoholics, and modern states have increasingly provided treatment for them. While there is a renewed public health concern about the externalities of drinking, substantial availability reductions have historically often required the mobilization of strong popular movements of remoralization.

Alcohol Drinking↗
PubMed1996

Gender roles and interactions in drinking and drug use.

In gender-focused discussions of alcohol and other drug use and problems, the emphasis has usually been on the individual male or female or on the genders as aggregates of individuals. But most drinking and much drug use have strong social and interactional elements, where gender roles and often gendered interactions come into play. Drawing on the existing literature, opportunities for research on gender roles and interactions in drinking and drug use and problems are discussed under the following headings: courtship and affectional preference; sexuality; marriage and partnership; parenthood; friendship and peer relations; work roles; informal social control (spouse, relatives, friends); and domination, violence, and abuse.

Alcoholism↗
PubMed1996

WHO cross-cultural applicability research on diagnosis and assessment of substance use disorders: an overview of methods and selected results.

The cross-cultural applicability of criteria for the diagnosis of substance use disorders and of instruments used for their assessment were studied in nine cultures. The qualitative and quantitative methods used in the study are described. Equivalents for English terms and concepts were found for all instrument items, diagnostic criteria, diagnoses and concepts, although often there was no single term equivalent to the English in the languages studied. Items assuming self-consciousness about feelings, and imputing causal relations, posed difficulties in several cultures. Single equivalent terms were lacking for some diagnostic criteria, and criteria were sometimes not readily differentiated from one another. Several criteria--narrowing of the drinking repertoire, time spent obtaining and using the drug, and tolerance for the drug--were less easy to use in cultures other than the United States. Thresholds for diagnosis used by clinicians often differed. In most cultures, clinicians were more likely to make a diagnosis of drug dependence than of alcohol dependence although behavioural signs were equivalent. The attitudes of societies to alcohol and drug use affects the use of criteria and the making of diagnoses.

Alcoholism↗
PubMed1996

WHO working group on population levels of alcohol consumption: Oslo, 14-16 December 1994.

Target 17 of the Health Policy for Europe calls for the health-damaging consumption of dependence-producing substances such as alcohol, tobacco and psychoactive substances to be significantly reduced in all Member States between the year 1980 and the year 2000. With regard to alcohol, it is suggested that alcohol consumption be reduced by 25%, with particular attention to reducing harmful use. A question posed by a number of Member States is what is the level of per capita alcohol consumption of lowest risk to physical, psychological and social harm. A working group was convened to consider population levels of alcohol consumption with particular reference to the Member States of the European Region of WHO. A basis for understanding population problem experience can be established through the interaction between individual risk and distribution of consumption levels within the population. The working group concluded that public health policy within the European Region should continue to advise decreases of per capita consumption. Even when taking into account coronary heart disease, it can be concluded at the population level, across all ranges of alcohol consumption found in almost all countries of Europe, that a reduction in consumption is linked to better health. However, public health policy concerning alcohol should not be based solely on mortality. All outcomes of drinking, that is mortality, morbidity, social and criminal consequences, as well as quality of life, should be considered. The existing data relating alcohol consumption to health originates from countries primarily with a cultural experience of consuming alcohol. In those countries, where there is a cultural or religious tradition of not consuming alcohol, there can be no public health grounds for recommending alcohol consumption.

Adult↗