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Interventions for preventing injuries in problem drinkers

  1. Tho Bella Dinh-Zarr1,*,
  2. Cynthia W Goss2,
  3. Elizabeth Heitman3,
  4. Ian G Roberts4,
  5. Carolyn DiGuiseppi2

Editorial Group: Cochrane Injuries Group

Published Online: 19 JUL 2004

Assessed as up-to-date: 31 MAR 2004

DOI: 10.1002/14651858.CD001857.pub2


How to Cite

Dinh-Zarr TB, Goss CW, Heitman E, Roberts IG, DiGuiseppi C. Interventions for preventing injuries in problem drinkers. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001857. DOI: 10.1002/14651858.CD001857.pub2.

Author Information

  1. 1

    MAKE ROADS SAFE - The Campaign for Global Road Safety, Road Safety, FIA Foundation, Washington , DC, USA

  2. 2

    University of Colorado Denver, Colorado Injury Control Research Center, Colorado School of Public Health, Denver, CO, USA

  3. 3

    Vanderbilt University Medical Center, Center for Clinical and Research Ethics, Nashville, TN, USA

  4. 4

    London School of Hygiene & Tropical Medicine, Cochrane Injuries Group, London, UK

*Tho Bella Dinh-Zarr, Road Safety, FIA Foundation, MAKE ROADS SAFE - The Campaign for Global Road Safety, 336 13th Street, NE, Washington , DC, 20002, USA. dinhzarr@dinhzarr.org.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2004

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Alcohol consumption has been linked with injuries through motor vehicle crashes, falls, drowning, fires and burns, and violence. In the US, half of the estimated 100,000 deaths attributed to alcohol each year are due to intentional and unintentional injuries. The identification of effective interventions for the reduction of unintentional and intentional injuries due to problem drinking is, therefore, an important public health goal.

Objectives

To assess the effect of interventions for problem drinking on subsequent injury risk.

Search methods

We searched 12 twelve computerized databases: MEDLINE (1966 to 2002), EMBASE (1982 to 2002), CENTRAL (The Cochrane Library 2002, Issue 2), PsycINFO (1967 to 2002), CINAHL (1982 to10/96), ERIC (1966 to12/96), Dissertation Abstracts International (1861 to11/96), IBSS (1961 to 2002), ISTP (1982 to 2002) and three specialized transportation databases (Transport 1988 to 2002/03). Bibliographies of relevant trials were searched and authors were contacted. Government agencies were also contacted for further information and grey literature. Most of the electronic and bibliographic database searches were last run in May 2002.

Selection criteria

Randomized controlled trials of interventions among participants with problem drinking, which are intended to reduce alcohol consumption or to prevent injuries or their antecedents, and which measured injury-related outcomes.

Data collection and analysis

Two authors extracted data on participants, interventions, follow-up, allocation concealment, and outcomes, and independently rated allocation concealment quality.

Main results

Of 23 eligible trials identified, 22 had been completed and 17 provided results for relevant outcomes. Completed trials comparing interventions for problem drinking to no intervention reported reduced motor-vehicle crashes and related injuries, falls, suicide attempts, domestic violence, assaults and child abuse, alcohol-related injuries and injury emergency visits, hospitalizations and deaths. Reductions ranged from 27% to 65%. Because few trials were sufficiently large to assess effects on injuries, individual effect estimates were generally imprecise. We did not combine the results quantitatively because the interventions, patient populations, and outcomes were so diverse. The most commonly evaluated intervention was brief counseling in the clinical setting. This was studied in seven trials, in which injury-related deaths were reduced: relative risk (RR) 0.65; 95% confidence interval (CI) 0.21 to 2.00. However, this reduction may have been due to chance. The majority of trials of brief counseling also showed beneficial effects on diverse non-fatal injury outcomes.

Authors' conclusions

Interventions for problem drinking appear to reduce injuries and their antecedents (e.g. falls, motor vehicle crashes, suicide attempts). Because injuries account for much of the morbidity and mortality from problem drinking, larger studies are warranted to evaluate the effect of treating problem drinking on injuries.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Action with problem drinkers can cut risk of injury

Drinking too much alcohol can be dangerous, and injuries (both intentional and unintentional) are one of the most important ways in which excess alcohol use can result in harm. Are there ways of working with people known to be "problem drinkers" that can reduce the number of these injuries? The reviewers found 17 studies of programs that reported whether working with problem drinkers reduced injuries. Several different approaches were evaluated, the most common being brief counseling by health workers. The evidence from these studies suggests that action with problem drinkers is effective in reducing both injuries and events that lead to injury (such as falls, motor vehicle crashes, and suicide attempts). However, more research is needed to calculate the level of effectiveness accurately and to determine which type of program works best.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

預防問題性飲酒者受傷的介入措施

飲酒與機車事故,跌倒,溺水,火災與燒傷,及暴力等相關聯。在美國,每年因為酒精造成的100,000死亡個案中有一半是因為有意與無意的傷害所造成。因此,確定介入措施對於減少因問題性飲酒造成無意與有意受傷的效果是一項重要的公共衛生目標。

目標

評估介入措施對於問題性飲酒造成後續受傷風險的效果。

搜尋策略

我們檢索12個電腦化資料庫:MEDLINE (1966 – 8/96),EMBASE (1982 – 1/97),Cochrane Controlled Trials Register (1997,第1期), PsycINFO (1967 – 1/97),CINAHL (1982 – 10/96),ERIC (1966 – 12/96),Dissertation Abstracts International (1861 – 11/96),IBSS (1961 – 1/97),ISTP (1982 – 1/97)及三個專門的交通運輸資料庫,採用問題性飲酒合併對照試驗等詞語進行檢索;相關試驗的參考書目;並連絡作者及政府機構。於2002年5月更新電子與參考書目的檢索結果。

選擇標準

傾向減少問題性飲酒者飲酒或預防受傷或他們的經歷的介入措施,並測量受傷相關結果的隨機對照試驗。

資料收集與分析

兩名作者摘錄有關研究對象,介入措施,追蹤時間,分組隱匿與結果的資料,並分別評估分組隱匿的品質。

主要結論

確定23篇合格的試驗,22篇已被完成而其中17篇提供相關的結果。完成的試驗其比較介入措施與沒有介入措施對於減少問題性飲酒之機車事故與相關的受傷,跌倒,企圖自殺,家庭暴力,攻擊與虐待兒童,酒精相關的受傷與受傷緊急就醫,住院與死亡的報告。減少的範圍從27%至65%。由於幾乎沒有大型的試驗足以評估對於受傷的影響,因此個別效果的估計普遍是不精確的。由於介入措施,病患族群,及結果大不相同,因此我們不將結果量化地整合。最常見的評估介入措施為臨床機構的簡易諮詢。七篇研究這項介入措施的試驗發現,受傷相關的死亡減少了:relative risk (RR)為0.65;95% confidence interval (CI)為0.21至2.00。然而,這種減少的效果也許是隨機的。大多數的試驗也顯示簡易諮詢對於各種非致死性受傷結果具有利的效果。

作者結論

問題性飲酒的介入措施似乎可以減少受傷與他們的經歷(如跌倒,機車事故,企圖自殺)。由於問題性飲酒造成的受傷佔多數的罹病率與死亡率,因此值得大型的研究來評估問題性飲酒所造成之傷害的治療效果。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對問題性飲酒者所採取的行動措施可以減少受傷的風險。飲用太多酒精是危險的,且在酒精過量造成的傷害中,受傷(有意與無意兩者)是其中最重要的一種。對於已知為“問題性飲酒者”,是否有方法可以減少受傷的數量?回顧的作者找到17篇研究,其報導了何種計畫能否減少問題性飲酒者受傷。評估數種不同的方法,最常見的就是健康工作者的簡易諮詢。這些研究的證據認為,對於問題性飲酒者所採取的行動措施可有效的減少受傷與導致受傷的事件(如跌倒,機車事故,與企圖自殺)。然而,需要更多的研究以精準地計算有效程度,並決定何種類型的計畫效果最好。