Dangerous to your health: the role of chronic drug use in serious injuries and trauma

This study estimated the differential risks of serious injury or trauma for a community-based sample of chronic drug users (CDUs; n = 926) and a matched group of nondrug users (NDUs; n = 553). The study also estimated whether CDUs and NDUs differed in their utilization of health care services for serious injury or trauma. Data were collected in 1996 and 1997 through community outreach activities in Miami-Dade County, Florida. The analysis estimated the effects of drug use on (1) any lifetime serious injury or trauma, (2) any serious injury or trauma during the past 12 months, and (3) utilization of health care services for serious injury or trauma. All analyses were gender specific and the models were also estimated with a measure of problematic alcohol use in addition to CDU. To examine the potential endogeneity of drug use, various specification tests were conducted. For females, CDUs experienced significantly more serious injury, trauma, or both (both lifetime and past year) than nonusers. Drug use status was not a significant predictor of serious injury or trauma (lifetime and past year) for males. Regardless of gender, conditional on experiencing any serious injury or trauma during the past year, CDUs and NDUs did not differ in their utilization of health care services. Various statistical tests determined that CDU was exogenous in all specifications and the findings were largely unchanged when problematic alcohol use was included in the models. The elevated risk for serious injury or trauma for female CDUs renders these persons vulnerable to severe medical problems. Specific training in substance abuse issues may be necessary if health care providers are to identify, engage, knowledgeably serve, and refer CDUs for appropriate services

The Health Benefits of Moderate Drinking Revisited: Alcohol Use and Self-Reported Health Status

Purpose. To examine the association between alcohol use and self-reported health status. In particular, we sought to determine whether moderate drinkers are more likely to self-report above-average health status compared with other current drinkers, former drinkers, and lifetime abstainers. Design. Cross-sectional survey. Setting. Continental United States. Subjects. The sample adult component of the 2002 U.S. National Health Interview Survey (n = 31,044), representative of the U.S. noninstitutionalized civilian household population. Measures. Dichotomous measure of above-average self-reported health status relative to all other health states. Several measures characterized alcohol use patterns (i.e., continuous and categorical measure of alcohol use, a proxy measure of problem drinking, former drinking, lifetime abstaining). Chronic health conditions and various demographic and lifestyle factors were included as covariates in all regression models. Results. For both men and women, current moderate drinkers had the highest odds (OR = 1.27 for men, p < .01; OR = 2.03 for women, p < .01) of reporting above-average health status compared with other current drinkers, former drinkers, and lifetime abstainers. The odds dropped to 1.12 and 1.34, respectively, when all past-year drinkers were collapsed into a single group. Conclusion. Moderate alcohol consumption was associated with the highest odds of reporting above-average health status, even after controlling for chronic health conditions and demographic and lifestyle factors associated with health

Decision latitude and workload demand: implications for full and partial absenteeism

This research examined the relative importance of two components of job stress--decision latitude and workload demand--on employee absenteeism. The analysis was based on confidential self-reported data from employees at two worksites, which were collected in three independent cross-sections beginning in 1995. The negative binomial technique was used to estimate the effects of decision latitude and workload demand on employee attendance, while controlling for employee demographics and other workplace characteristics. Estimation results show that high decision latitude was negatively and significantly related to number of full days absent from work (full absenteeism) and number of days arriving late to work or leaving work early (partial absenteeism). Conversely, the coefficient estimates for low decision latitude were positive in every model and significantly related to partial absenteeism. Low workload demand was negatively and significantly related to partial absenteeism, but not full days absent. The interaction effects of decision latitude and workload demand on absenteeism were not statistically significant. Several recent studies have estimated a significant relationship between decision latitude, workload demand, and medical problems such as cardiovascular disease. The current findings suggest that decision latitude and workload demand are also related to workplace attendance. Employers and occupational hygienists should consider decision latitude and workload demand as a means to improve workplace productivity and employee health

Guidelines and challenges for estimating the economic costs and benefits of adolescent substance abuse treatments

Many economic evaluations have been conducted for adult substance abuse treatments, but only a few have been conducted for adolescent-specific treatments. This is the first article to present rigorous methodological guidelines for estimating the economic costs and benefits of adolescent substance abuse treatments while also addressing the potential challenges associated with such research activities. A representative case study of two adolescent substance abuse treatment programs (one residential and one outpatient) is presented to show some of the initial steps of a comprehensive economic evaluation (e.g., cost analyses, selection of treatment outcome measures, and valuation of outcome measures via monetary conversion factors). Cost data were collected and analyzed using the Drug Abuse Treatment Cost Analysis Program. Monetary conversion factors were obtained and presented for a variety of treatment outcomes. The methodological guidelines, discussion of analytic challenges, and recommendations set forth in this article provide a foundation for future economic studies on adolescent substance abuse treatments

Cost-effectiveness analysis of four interventions for adolescents with a substance use disorder

Alcohol, tobacco, and illicit drug use among adolescents in the United States continues to be a serious public health challenge. A variety of outpatient treatments for adolescent substance use disorders have been developed and evaluated. Although no specific treatment modality is effective in all settings, a number of promising adolescent interventions have emerged. As policy makers try to prioritize which programs to fund with limited public resources, the need for systematic economic evaluations of these programs is critical. The present study attempted a cost-effectiveness analysis of four interventions, including family-based, individual, and group cognitive behavioral approaches, for adolescents with a substance use disorder. The results indicated that treatment costs varied substantially across the four interventions. Moreover, family therapy showed significantly better substance use outcome compared to group treatment at the 4-month assessment, but group treatment was similar to the other interventions for substance use outcome at the 7-month assessment and for delinquency outcome at both the 4- and 7-month assessments. These findings over a relatively short follow-up period suggest that the least expensive intervention (group) was the most cost-effective. However, this study encountered numerous data and methodological challenges in trying to supplement a completed clinical trial with an economic evaluation. These challenges are explained and recommendations are proposed to guide future economic evaluations in this area

Guidelines and challenges for estimating the economic costs and benefits of adolescent substance abuse treatments

Abstract Many economic evaluations have been conducted for adult substance abuse treatments, but only a few have been conducted for adolescent-specific treatments. This is the first article to present rigorous methodological guidelines for estimating the economic costs and benefits of adolescent substance abuse treatments while also addressing the potential challenges associated with such research activities. A representative case study of two adolescent substance abuse treatment programs (one residential and one outpatient) is presented to show some of the initial steps of a comprehensive economic evaluation (e.g., cost analyses, selection of treatment outcome measures, and valuation of outcome measures via monetary conversion factors). Cost data were collected and analyzed using the Drug Abuse Treatment Cost Analysis Program. Monetary conversion factors were obtained and presented for a variety of treatment outcomes. The methodological guidelines, discussion of analytic challenges, and recommendations set forth in this article provide a foundation for future economic studies on adolescent substance abuse treatments.

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2