Victor Cisneros

Assessment of Alcohol Use Patterns Among Spanish-Speaking Patients

ABSTRACT Objective: The objective of this study was to assess drinking patterns of Spanish-speaking patients using a bilingual computerized alcohol screening and brief intervention (CASI) tablet computer equipped with the Alcohol Use Disorders Identification Test (AUDIT). Methods: This retrospective study was conducted in a tertiary university hospital emergency department (ED) between 2006 and 2010. Data from 1816 Spanish-speaking ED patients were analyzed using descriptive statistics, the chi-square test for independence, and the Kruskal-Wallis rank sum test for comparisons using quantitative variables. Results: Overall, 15% of Spanish-speaking patients were at-risk drinkers, and 5% had an AUDIT score consistent with alcohol dependency (≥20). A higher percentage of Spanish-speaking males than females were at-risk drinkers or likely dependent. Spanish-speaking males exhibited higher frequency of drinking days per week and higher number of drinks per day compared with females. Among older patients, nondrinking behavior increased and at-risk drinkers decreased. The majority of males and females were ready to change their behavior after the CASI intervention; 61% and 69%, respectively, scored 8–10. Conclusions: This study indicated that CASI was an effective tool for detecting at-risk and likely dependent drinking behavior in Spanish-speaking ED patients. The majority of patients were ready to change their drinking behavior. More alcohol screening and brief intervention tools should be tested and become readily accessible for Spanish-speaking patients.

Assessment of Readiness to Change and Relationship to AUDIT Score in a Trauma Population Utilizing Computerized Alcohol Screening and Brief Intervention

Trauma patient readiness-to-change score and its relationship to the Alcohol Use Disorder Identification Test (AUDIT) score were assessed in addition to the feasibility of computerized alcohol screening and brief intervention (CASI). A bilingual computerized tablet for trauma patients was utilized and the data were analyzed using Stata. Twenty-five percent of 1145 trauma patients drank more than recommended and 4% were dependent. As many Spanish-speaking as English-speaking males did not drink, but a higher percentage of Spanish-speaking males drank more than recommended and were dependent. Half of patients who drank more than recommended rated themselves 8 or higher on a 10-point readiness-to-change scale. CASI also provided personalized feedback. A high percentage of trauma patients (92%) found CASI easy and a comfort in use (87%). Bilingual computerized technology for trauma patients is feasible, acceptable, and an innovative approach to alcohol screening, brief intervention, and referral to treatment in a tertiary care university.

Emergency departments and older adult motor vehicle collisions.

In 2009 the Centers for Disease Control and Prevention reported that there were 33 million licensed drivers 65 years and older in the U.S. This represents a 23 percent increase from 1999, a number that is predicted to double by 2030. Although motor vehicle collisions related to emergency department visits for older adults are lower per capita than for younger adults, the older-adults MVCs require more resources, such as additional diagnostic imaging and increased odds of admission. Addressing the specific needs of older adults could lead to better outcomes, yet not enough research exists. It is important to continue training emergency physicians to treat the increasing older-patient population, but it is also imperative that we increase our injury prevention and screening methodology. We review research findings from the article “Emergency Department Visits by Older Adults for Motor Vehicle Collisions: A Five-Year National Study,” with commentary on current recommendations and policies for the growing older-adult driving population.

Distracted Driving, A Major Preventable Cause of Motor Vehicle Collisions: “Just Hang Up and Drive”

For years, public health experts have been concerned about the effect of cell phone use on motor vehicle collisions, part of a phenomenon known as “distracted driving.” The Morbidity and Mortality Weekly Report (MMWR) article “Mobile Device Use While Driving - United States and Seven European Countries 2011” highlights the international nature of these concerns. Recent (2011) estimates from the National Highway Traffic Safety Administration are that 10% of fatal crashes and 17% of injury crashes were reported as distraction-affected. Of 3,331 people killed in 2011 on roadways in the U.S. as a result of driver distraction, 385 died in a crash where at least one driver was using a cell phone. For drivers 15–19 years old involved in a fatal crash, 21% of the distracted drivers were distracted by the use of cell phones. Efforts to reduce cell phone use while driving could reduce the prevalence of automobile crashes related to distracted driving. The MMWR report shows that there is much ground to cover with distracted driving. Emergency physicians frequently see the devastating effects of distracted driving on a daily basis and should take a more active role on sharing the information with patients, administrators, legislators, friends and family.

A retrospective analysis of ethnic and gender differences in alcohol consumption among emergency department patients: A cross-sectional study

BackgroundPrevious studies of alcohol use have recognized several trends in consumption patterns among gender and age yet few have examined ethnic differences. This study examines the intra- and inter-ethnic differences in alcohol consumption among a population of patients seen in the emergency department.MethodsThis is a cross-sectional study conducted in the emergency department in a large urban setting. Information on drinking behavior and ethnicity was collected using the Computerized Alcohol Screening and Brief Intervention (CASI) tool. We explored differences in drinking patterns using a multivariate multinomial logistic regression model.ResultsWe analyzed the drinking habits of 2,444 patients surveyed between November 2012 and May 2014. The results indicate that when compared to non-Hispanic whites, Asians have the lowest odds of drinking within normal limits or excessively, followed by other Latinos, and Mexicans. Age and gender consistently showed statistically significant associations with alcohol-use. The odds of drinking within normal limits or excessively are inversely associated with age and were lower among females. The predicted probabilities show a marked gender-specific difference in alcohol use both between and within ethnic/racial groups. They also highlight an age-related convergence in alcohol use between men and women within ethnic groups.DiscussionThe results of this study show intra-racial/ethnic variability associated with sex and education. The highlighted differences within and between ethnic groups reinforce the need to use refined categories when examining alcohol use among minorities.ConclusionThe results of this study confirm some alcohol consumption trends among ethnic minorities observed in literature. It provides empirical evidence of the marked gender differences and highlights an age-related convergence for gender-specific alcohol use. Health-care personnel should be aware of these differences when screening and counseling.

Vital signs: fatalities and binge drinking among high school students: a critical issue to emergency departments and trauma centers.

The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to drinking and driving among United States (U.S.) high school students. National data from 1991–2011 shows an overall 54% relative decrease (from 22% to 10.3%) in drinking and driving among U.S. high school students aged ≥ 16 years. In 2011, this still represents approximately 950,000 high school students ages 16–19 years. The decrease in drinking and driving among teens is not fully understood, but is believed to be due to policy developments, enforcement of laws, graduated licenses, and economic impacts. Most significant to emergency physicians is that even with these restrictions, in 2010 approximately 2,700 teens (ages 16–19) were killed in the U.S. and about 282,000 were treated and released from emergency departments for injuries suffered in motor-vehicle accidents. In the same year, 1 in 5 drivers between the ages of 16–19 who were involved in fatal crashes had positive (>0.00%) blood alcohol concentration (BAC). We present findings from the CDCs Morbidity and Mortality Weekly Report with commentary on current recommendations and policies for reducing drinking and driving among adolescents.

Balancing life and medical school

Medical school is a challenging academic experience by definition and it is one of the most stressful times of a student’s life. In our experience we usually spend about 10-12 hours a day studying; not even counting the number of hours spent in lecture or other academic activities. A typical day in the life of a first year medical student begins at 6:30 am – when the alarm clock rings and we grab a quick bite and pack 10 lbs of notes, books, and laptops, which have been sprawled all over the desk from late-night studying into the backpack. At 8:00 am the lecture begins and the classroom is about 60% full. Latecomers slowly file into the lecture theater, while others are just waking up to the smell of coffee. At 12:00 pm – Lunch break, an excellent opportunity to grab a free meal during a lunchtime talk in order to save a couple of dollars and maybe cram in a few minutes of studying. At 1:00 pm – We go back to the lecture or anatomy lab to dissect cadavers. At 4:00 pm – School day officially ends, but the real work begins. At 4:30 pm – Study, Study and more studying! At 7:00 pm – Dinner, where normally whatever is most convenient is first choice. At 8:00 pm to late night - Study, Study, and more studying until you fall asleep, and do it all over again the next day. Medical school brings all new sources of anxiety from the demanding curriculum, juggling an unfamiliar academic workload, feeling overwhelmed by the amount of information to be mastered, and the fear of taking tests because you are afraid of failure, falling behind, or simply no longer performing in the top 10% your class.1 Another significant stressor reported by medical students is the inability to handle social issues. It can be difficult for some to balance extracurricular activities and social relationships without affecting academic performance. In addition to these stressors and a challenging curriculum, students often have poor diets, which include eating junk food during late-night studying sessions and indulging in excessive alcohol during the weekends.1,2 Some argue that a certain amount of stress is necessary for medical students to perform well because more relaxed attitudes could lead to lower quality work. Despite these views, there are significant studies that illustrate the relationship between medical school stressors and mental illness.1,3,4, A large multicenter study showed that 53% of US medical students met criteria for what is considered burnout,2,5 with burnout being defined as emotional exhaustion, depersonalization, and low sense of personal accomplishment.2,5 Furthermore, Dyrbye et al.5 suggests that depressive symptoms are more commonly reported by medical students and resident/fellows compared to similarly aged college graduates.6 Given that these studies consistently report high rates of medical student stress, mental illness, and burnout there is a need for intervention; yet it seems students, like physicians, are reluctant to seek care.4,6 Many medical students report that they prefer to turn to their families and friends for support instead of using their University’s help. They are afraid of the stigma associated with mental illness and how seeking help might affect their future medical careers.7 Drybe et al.5,6 suggest a solution could be to make a culture change where mental health is treated like hypertension or diabetes thus removing the stigma associated with mental health. In reviewing the article by Bitonte et al.,8 it is apparent that the authors are optimistic regarding the implementation of physical exercise into the medical school curriculum. The article does a great job of addressing the issues that are commonly experienced during medical school including burn out, the episodes of dysthymia, and even major depression. Furthermore, the article touches upon physiologic aspects such as angiogenesis and neurogenesis that are associated with exercise, which may lead to improved memory and mental illness prevention. In addition, the article demonstrates that medical students have higher tendencies toward mental health and depression issues than the general population. The statistics presented clearly illustrate that there are certain stressors experienced by medical students that make them more susceptible to depression and suicide than the general population. The article reviews data that shows that exercise is beneficial in improving mood and self-esteem, and it suggests that exercise may be a pragmatic approach toward the reduction of mental health issues within medical schools. Lastly, the article offers specific changes to the curriculum that can be implemented to bring exercise into medical school- the mandating of exercise 90 minutes a week. While the article made well-founded arguments based on research, it did have several short-comings. Primarily, the article stated that medical students had increased thoughts of suicide and dropping out when compared to the general population.8 In our opinion, it seems that those parameters are difficult to compare between subjects. A better model-such as comparing students with diagnosed depression following initiation of medical school or total suicide attempts- would lead to a more objective comparison with the general population. Furthermore, medical students are more likely to have a more concrete understanding of medical terminology and pathology than the general population, and may over-interpret or circumvent questions based on that knowledge. In addition, the article made the claim that implementing physical education into the medical school curriculum would be more cost effective than eventual counseling.8 That statement appears to be very broad which makes it difficult to accept without more concrete evidence. Implementing mandatory exercise would entail hiring faculty that would develop a physical education curriculum for the medical students. Depending on what that curriculum would entail, it could substantially affect the cost of such a program. In addition, would 90 minutes of mandated exercise per week lead to a substantial difference in the students’ mental illness rates if they are struggling to catch up on work to compensate for that time? Also, would that mean that certain students would not have enough time to participate in physical exercise that they enjoy? For example, if a certain student usually allocates 1 hour per night to basketball, with this new curriculum he/she may be forced to do physical activity that he/she does not want to partake in and not have enough time for physical exercise that he/she enjoys. Lastly, from our experience in medical school, there are varied levels of athletic ability between the students. What if certain students are more athletic than others and the physical education requirement would be boring or too easy for some of them, or on the other hand too rigorous and exhausting? For others, requiring physical activity would not only be pointless, but might make them more upset or even depressed that they are not able to partake in activities that they used to de-stress previously. As shown above, enforcing exercise in medical school would be beneficial to student health. Maintaining a healthy state of mind is essential to the medical student, yet it is difficult to achieve with the hours that each student must spend to be successful in their future careers as physicians. However, implementing such a mandatory physical fitness policy, as demonstrated by Bitone et al.,8 would be cumbersome and may result in a financial loss for the medical school. That being said, the long term mental and physical benefits that would come from exercising at least 90 minutes a week should be acknowledged by medical students. It is widely known that the health benefits of physical activity include decreased risk of coronary artery disease, decreased development of type II diabetes, and decreased rates of obesity.9 In addition, it has been shown that physical activity not only proves effective in reducing depressive symptoms, but may also stave off other mental health issues altogether.9 For medical students to receive the maximum benefit from routine exercise, we would suggest medical schools create a wellness class that would count for course credit. This wellness class would require students to log at least 90 minutes of exercise a week, record healthy eating, and other healthy habits as the semester progresses, allowing an open forum for discussion of healthy lifestyles as well as an incentive for students to exercise and eat well. This way, students would not feel forced to exercise at a certain time, exercise in a certain way, or be pushed too hard or too little. Medical students’ time is extremely valuable and by giving students free rein as to when and where they may exercise, they can choose something they enjoy at a time that works for them rather than a set time and activity allocated by the school. By making it a requirement for school credit, it is more likely that students will view it as homework, something they must do even if they feel that they should be studying. This will reinforce the idea that medical students should be exercising, as well as hopefully allowing time to establish exercise routines. As many medical students view seeking mental health services as stigmatized, implementing such a course into all 4 years of the medical school curriculum would be beneficial to students, both in combating current mental health symptoms as well as preventing future health problems.

Vital Signs: Emergency Department and Older Adult Motor Vehicle Collisions: Prevention is Paramount

In 2009 the Centers for Disease Control and Prevention reported that there were 33 million licensed drivers 65 years and older in the U.S. This represents a 23 percent increase from 1999, a number that is predicted to double by 2030. Although motor vehicle collisions related to emergency department visits for older adults are lower per capita than for younger adults, the older-adults MVCs require more resources, such as additional diagnostic imaging and increased odds of admission. Addressing the specific needs of older adults could lead to better outcomes, yet not enough research exists. It is important to continue training emergency physicians to treat the increasing older-patient population, but it is also imperative that we increase our injury prevention and screening methodology. We review research findings from the article “Emergency Department Visits by Older Adults for Motor Vehicle Collisions: A Five-Year National Study,” with commentary on current recommendations and policies for the growing older-adult driving population.

Vital Signs: Emergency Department and Older Adult Motor Vehicle Collisions: Prevention is Paramount - eScholarship

In 2009 the Centers for Disease Control and Prevention reported that there were 33 million licensed drivers 65 years and older in the U.S. This represents a 23 percent increase from 1999, a number that is predicted to double by 2030. Although motor vehicle collisions related to emergency department visits for older adults are lower per capita than for younger adults, the older-adults MVCs require more resources, such as additional diagnostic imaging and increased odds of admission. Addressing the specific needs of older adults could lead to better outcomes, yet not enough research exists. It is important to continue training emergency physicians to treat the increasing older-patient population, but it is also imperative that we increase our injury prevention and screening methodology. We review research findings from the article “Emergency Department Visits by Older Adults for Motor Vehicle Collisions: A Five-Year National Study,” with commentary on current recommendations and policies for the growing older-adult driving population.