Environment, alcohol intoxication and overconfidence: evidence from a lab-in-the-field experiment

Alcohol has long been known as the demon drink; an epithet owed to the numerous social ills it is associated with. Our lab-in-the-field experiment assesses the extent to which changes in intoxication and an individual's environment lead to changes in overconfidence or cognitive ability that are, in turn, often linked to problematic behaviours. Results indicate that it is the joint effect of being intoxicated in a bar, rather than simply being intoxicated, that matters. Subjects systematically underestimated the magnitude of their behavioural changes, suggesting that they cannot be held fully accountable for their actions

Behavioural change and alcohol-fuelled violence: an experiment

One of the many papers accepted for but denied presentation at the Society’s annual conference earlier this year was one that looked at why the consumption of alcohol appears to be associated with increased violent behaviour. Iain Long has produced this summary of the paper which reports on an experiment carried out at Cardiff Universit

Violence in England and Wales in 2017: An Accident and Emergency perspective

Executive Summary • Serious violence levels and trends in England and Wales were studied based on data from a structured sample of 94 Emergency Departments (EDs), Minor Injury Units (MIUs) and Walk-in Centres. All are certified members of the National Violence Surveillance Network (NVSN). • Overall, an estimated 190,747 people attended EDs in England and Wales for treatment following violence in 2017, 1942 more than in 2016; a 1% increase. Falls or no change in overall violence levels in England and Wales according to this public health measure over the past decade were maintained in 2017. • In 2017, males (4.6 per 1,000 residents) were more than twice as likely as females (1.9 per 1,000 residents) to be treated in EDs following injury in violence. • Increases in violent injury among those aged 0-10 years (11%), 31-50 years (4.6%) and those aged 51 years and over (2.1%) were offset by the 1.8% decrease in violence among those aged 18-30 years. Due to small numbers, NVSN is unable to provide reliable violence trends for those aged 0-10 years. • Implementation of the new Emergency Care Data Set (ECDS) in Type 1 EDs in England led to increases in violence recording in the three months, October to December 2017. • Those most at risk of violence-related injury were males and those aged 18 to 30. Violence-related ED attendance was most frequent on Saturdays and Sundays

Why public health must contribute to reduce violence [Letter]

Florence and colleagues found that systematic collection, analysis, and use of anonymised emergency department recorded information on violence significantly reduced violence related hospital admissions.1 Although violence has long been a public health matter, there is ambivalence in making it a health priority. After all, crime reduction is the responsibility of government departments other than health, and other public services—the police, courts, and probation and prison services—are there to tackle it. It has been known for some time that police records underestimate serious community violence and that emergency department injury records are more representative. We suggest that data matching studies in Denmark and Norway indicate that the extent to which serious violence is under-ascertained by police services is consistent across Europe.2 3 Data matching (between emergency department and police violence records) from three north European countries has shown that on average the police record a third or less of violence that results in emergency department treatment.4 The main reasons for under-recording have been identified in the UK, and these factors may exert a remarkably similar influence across national boundaries. There are important policy implications—that police data are a poor measure of serious violence; that health services provide information about violence that is not available elsewhere; and that violence in a city, for example, can be understood and targeted only if police and health data are combined. Such an approach, together with involvement of trauma service doctors in community safety partnerships, is proving effective, particularly by directing police activity.5 Public health and trauma services have much to contribute to violence prevention across Europe

Links between deprivation and risk of violence-related injury: a qualitative study to identify potential causal mechanisms

Background Deprivation has been shown to have a greater effect on risk of violent injury among adolescent girls than boys, but the mechanisms underlying this association have not been identified. Methods In this qualitative study designed to identify causal mechanisms, focus groups involving girls aged 14–16 years attending secondary schools in South Wales, UK, were convened. Schools were recruited based on a measure of area-level deprivation. Discussions were audiorecorded and transcripts analysed thematically. Results Girls from more deprived areas tended not to participate in organized activities, obtained alcohol from multiple sources, consumed alcoholic drinks of varying strengths in both supervised and unsupervised settings, and tended not to feel trusted by their parents; this led to poor adolescent–parent communication. Girls from less deprived areas tended to participate in organized activities, obtain alcohol from parents, consume low strength alcohol in supervised settings, and have a trusting and communicative relationship with their parents. Conclusion Deprivation may increase risk of adolescent girls sustaining violence-related injury by increasing their time spent in unsupervised environments, with alcohol and without parental knowledge

Overconfidence, alcohol and the environment: evidence from a lab-in-the-field experiment

Alcohol has long been known as the demon drink; an epithet owed to numerous social ills associated with it. Our lab-in-the-field experiment assesses the extent to which intoxication leads to changes in overconfidence or cognitive ability that are often linked to problematic behaviours. Results suggest that it is the joint effect of being intoxicated in a bar that matters. Subjects systematically underestimated their magnitude, suggesting that they cannot be held fully accountable for their actions

Preventing violence-related injuries in England and Wales: A panel study examining the impact of on-trade and off-trade alcohol prices

Objective To examine the influence of real on-trade and off-trade alcohol prices and socioeconomic and environmental factors on rates of violence-related emergency department (ED) attendances in England and Wales over an 8-year period. Methods Anonymised injury data which included attendance date, age and gender of patients aged over 18 years who reported injury in violence were collected from a structured sample of 100 EDs across England and Wales between 1 January 2005 and 31 December 2012. Alcohol prices and socioeconomic measures were obtained from the UK Office for National Statistics. Panel techniques were used to derive a statistical model. Results Real on-trade (β=−0.661, p<0.01) and off-trade (β=−0.277, p<0.05) alcohol prices were negatively related with rates of violence-related ED attendance among the adult population of England and Wales, after accounting for the effects of regional poverty, income inequality, youth spending power and seasonal effects. It is estimated that over 6000 fewer violence-related ED attendances per year in England and Wales would result from a 1% increase in both on-trade and off-trade alcohol prices above inflation. Of the variables studied, changes in regional poverty and income inequality had the greatest effect on violence-related ED attendances in England and Wales. Conclusions Small increases in the price of alcohol, above inflation, in both markets, would substantially reduce the number of patients attending EDs for treatment of violence-related injuries in England and Wales. Reforming the current alcohol taxation system may be more effective at reducing violence-related injury than minimum unit pricing

Oral surgery referrals at a UK dental hospital in the context of a managed vlinical network: a mixed-methods study

Background and aims: To inform the first Welsh OS Managed Clinical Network (MCN), a mixed-methods study investigated existing patterns, quality, suitability and reasons for referral to secondary care at the University Dental Hospital in Wales. Materials and methods: A random sample of 298 OS referrals were studied over a six-month period. Data recording proforma included details on referral practitioner, patient and referral diagnosis. Referrals were categorised by Levels of complexity (Levels 1, 2 and 3) and face-to-face, semi-structured and audio-recorded interviews were conducted with five frequent referrers. Results: The age range of patients was between 1 and 92 years, with over 58% (n=174) female. Majority of referrals (80%) were from GDPs. Top six practices accounted for a fifth (21%) of referrals, with three of these practices were corporate dental chains. Approximately, a third of referrals were categorised as Level 1 (37%), Level 2 (33%) and Level 3 (30%) complexity. 16% provided no medical history, and only 13% included supporting radiographs. Five themes emerged as reasons for oral surgery referrals: contract limitations, perception that new graduates lack OS practical skills, communication, practice resources and risk. Conclusions: Priorities for the Wales OS MCN are to reduce inappropriate referrals to secondary care and to ensure quality referrals. Introduction of the pan-Wales electronic Referral Management System in May 2019 is welcome in this context. The newly formed Health Education and Improvement Wales, with lead roles in education, training and shaping the healthcare workforce, will form a vital part in tackling barriers for safe OS in primary care