Abstract: OBJECTIVE: Most studies on alcohol as a risk factor for injuries have been mechanism specific, and few have considered several mechanisms simultaneously or reported alcohol-attributable fractions (AAFs)-which was the aim of the current study. METHOD: Data from 3,592 injured and 3,489 noninjured patients collected between January 2003 and June 2004 in the surgical ward of the emergency department of the Lausanne University Hospital (Switzerland) were analyzed. Four injury mechanisms derived from the International Classification of Diseases, 10th Revision, were considered: transportation-related injuries, falls, exposure to forces and other events, and interpersonal violence. Multinomial logistic regression models were calculated to estimate the risk relationships of different levels of alcohol consumption, using noninjured patients as quasi-controls. The AAFs were then calculated. RESULTS: Risk relationships between injury and acute consumption were found across all mechanisms, commonly resulting in dose-response relationships. Marked differences between mechanisms were observed for relative risks and AAFs, which varied between 15.2% and 33.1% and between 10.1% and 35.9%, depending on the time window of consumption (either 6 hours or 24 hours before injury, respectively). Low and medium levels of alcohol consumption generally were associated with the most AAFs. CONCLUSIONS: This study underscores the implications of even low levels of alcohol consumption on the risk of sustaining injuries through any of the mechanisms considered. Substantial AAFs are reported for each mechanism, particularly for injuries resulting from interpersonal violence. Observation of a so-called preventive paradox phenomenon is discussed, and prevention or intervention measures are described.

Abstract: BACKGROUND: Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are the two blood-borne pathogens most commonly transmitted among injection drug users via multi-person use of syringes and other injection equipment. However, important differences exist in the epidemiology of HIV and HCV within different populations of intravenous drug users. METHOD: A literature review was carried out to summarize publications describing the epidemiology and natural history of HIV and HCV in injection drug users. RESULTS: Among injection drug users worldwide, HIV prevalence varies from <5% to >80%, with annual HIV incidence between <1% and 50%. More consistency is shown in HCV prevalence (50–90%) and incidence (10–30% per year). Host, environmental and viral factors that favor rapid spread of HCV among IDUs suggest that HCV infection in a population of injection drug users may become endemic over a relatively short period of time. Lower transmission efficiency for HIV also indicates that its spread among injection drug users may be somewhat slower. CONCLUSIONS: Successful efforts to prevent transmission of blood-borne viruses among IDUs typically result in risk reduction; however, no intervention has resulted in elimination of risk behavior. To reduce HIV transmission, risk reduction may be sufficient, whereas control of HCV may necessitate the use of injection practices that guarantee elimination of exposure to equipment contaminated with even small amounts of blood.

Abstract: BACKGROUND: Acute alcohol consumption has been reported to be an important risk factor for injury, but clear scientific evidence on issues such as injury type is not available. The present study aims to improve the knowledge of the importance of alcohol consumption as an injury determinant with regards to two dimensions of the type of injury, namely the nature and the body region involved. METHODS: Risk relationships between two injury type components and acute alcohol use were estimated through multinomial and logistic regression models based on data from 7,529 patients-among whom 3,682 had injury diagnoses-gathered in a Swiss emergency department. RESULTS: Depending on the type of injury, between 31.1% and 48.7% of casualties report alcohol use before emergency department attendance. The multinomial regression models show that even low alcohol levels are consistently associated with nearly all natures of injury and body regions. A persistent dose-response effect between alcohol levels and risk associations was observed for almost all injury types. CONCLUSIONS: The results highlight the importance and consistency of the risk association between low and moderate levels of acute alcohol consumption and all types of injury. None of the body regions and natures of injury could pride on absence of association between alcohol and injury. Public health, prevention, and care implications are considered.