Hydroxyethyl starch 130/0.4 decreases inflammation, neutrophil recruitment, and neutrophil extracellular trap formation.

BACKGROUND: During systemic inflammation, leucocytes are activated and extravasate into damaged tissue. Activation and recruitment are influenced by different mechanisms, including the interaction of leucocytes with platelets and neutrophil extracellular traps (NET) formation. Here, we investigated the molecular mechanism by which hydroxyethyl starch (HES 130/0.4) dampens systemic inflammation in vivo. METHODS: Systemic inflammation was induced in C57Bl/6 wild-type mice by caecal ligation and puncture and cytokine concentrations in the blood, neutrophil recruitment, platelet-neutrophil aggregates, and NET formation were investigated in vivo. Intravascular adherent and transmigrated neutrophils were analysed by intravital microscopy (IVM) of the cremaster muscle and the kidneys. Flow chamber assays were used to investigate the different steps of the leucocyte recruitment cascade. RESULTS: By using flow cytometry, we demonstrated that HES 130/0.4 reduces neutrophil recruitment into the lung, liver, and kidneys during systemic inflammation (n=8 mice per group). IVM revealed a reduced number of adherent and transmigrated neutrophils in the cremaster and kidney after HES 130/0.4 administration (n=8 mice per group). Flow chamber experiments showed that HES 130/0.4 significantly reduced chemokine-induced neutrophil arrest (n=4 mice per group). Furthermore, HES 130/0.4 significantly reduced the formation of platelet-neutrophil aggregates, and NET formation during systemic inflammation (n=8 mice per group). CONCLUSIONS: Our findings suggest that HES 130/0.4 significantly reduces neutrophil-platelet aggregates, NET formation, chemokine-induced arrest, and transmigration of neutrophils under inflammatory conditions.

Economic contraction, alcohol intoxication and suicide: analysis of the National Violent Death Reporting System.

OBJECTIVES: Although there is a large and growing body of evidence concerning the impact of contracting economies on suicide mortality risk, far less is known about the role alcohol consumption plays in the complex relationship between economic conditions and suicide. The aims were to compare the postmortem alcohol intoxication rates among male and female suicide decedents before (2005-2007), during (2008-2009) and after (2010-2011) the economic contraction in the USA. METHODS: Data from the restricted National Violent Death Reporting System (2005-2011) for male and female suicide decedents aged 20 years and older were analysed by Poisson regression analysis to test whether there was significant change in the fractions of suicide decedents who were acutely intoxicated at the time of death (defined as blood alcohol content ≥0.08 g/dL) prior, during and after the downturn. RESULTS: The fraction of all suicide decedents with alcohol intoxication increased by 7% after the onset of the recession from 22.2% in 2005-2007 to 23.9% in 2008-2011. Compared with the years prior to the recession, male suicide decedents showed a 1.09-fold increased risk of alcohol intoxication within the first 2 years of the recession. Surprisingly, there was evidence of a lag effect among female suicide decedents, who had a 1.14-fold (95% CI 1.02 to 1.27) increased risk of intoxication in 2010-2011 compared with 2005-2007. CONCLUSIONS: These findings suggest that acute alcohol intoxication in suicide interacts with economic conditions, becoming more prevalent during contractions.

Trends in public opinion on alcohol policy measures: Ontario 1989-1998.

OBJECTIVE: This article presents trend data concerning public opinion on alcohol policy in the Canadian province of Ontario over a 10-year period (1989-98), highlights the currently debated issue of private venues for retail alcohol sales and assesses correspondence between public opinion and actual and proposed policy decisions. METHOD: Selected policy-related items from nine probability surveys on representative samples of male and female Ontario adults (range of unweighted n 's: 953 to 1,947) were analyzed by means of logistic regression. RESULTS: We found strong support for the status quo for a number of items, including beer and liquor store hours, corner store sales and taxes. Across all years, less than 6% of the total sample wanted to lower the legal drinking age. Over time, a linear trend showed a gradual but not entirely consistent development of attitudes among the Ontario public, favoring relaxation of some controls. However, contrary to this trend, disapproval of retail sales in corner stores increased significantly from 1992 to 1996. Demographic breakdown shows that relaxation of controls is most favored by those who report consumption of five or more drinks per occasion at least weekly over the past 12 months, and most strongly opposed by women and nondrinkers. Of those who seldom or never consume five or more drinks per occasion, the majority express satisfaction with the status quo. CONCLUSIONS: These data call into question the suitability of changes in alcohol policy that would diminish controls. It is of particular interest that there seems to be little public support for privatization proposals in the province. Public opinion against comer store sales of alcoholic beverages increased over time.

Alcohol-related policy measures in Ontario: who supports what and to what degree?

Using 1998 provincial survey data (n = 1,205), the authors examine responses to 7 items concerning public opinion on alcohol-related policy in Ontario. The purpose of the study is to get a sense of overall public opinion on certain topical policy-related measures and to see whether this opinion is predicted by demographic characteristics of respondents (sex, age and self-reported drinking pattern). Cross-tabulations of opinion items with demographic variables revealed strong majority support for the status quo with regard to number of liquor and beer stores, beer and liquor store hours, and prohibition of the sale of alcohol in corner stores. A somewhat less robust majority also supported the status quo for alcohol taxes and legal drinking age. Among the demographic groups, high-risk heavy drinkers stood out for their greater support of relaxation of controls and this finding was confirmed by means of logistic regression. The majority of all groups, except frequent bar-goers, liked the idea of warning labels on alcoholic beverage containers. The authors conclude that, according to these survey data, policy initiatives towards greater access to alcohol, such as extended liquor store hours and sale of alcohol in corner stores, are not mandated by the majority of the population of Ontario.

Reducing alcohol problems through community action research projects: contexts, strategies, implications, and challenges.

Community-based action research projects may include a number of challenges. The secular context may impede a project; for example, reducing aggregate rates of drinking-related problems may involve curtailing very popular high-risk drinking occasions. These projects may also embrace important but unrealistic goals, require matching competing goals emerging from multifoci project teams, or involve convoluted funding arrangements. Attention to team development, priority setting, and project design and evaluation issues is essential. Many projects downplay conceptual issues, such as understanding the nature of communities, organizations, systems, their operation, and social change and prevention models. Focus populations, community members and leaders, change agents team members, funding agencies, and policymakers can benefit from these projects.

Roles of commercial interests in alcohol policies: recent developments in North America.

This paper examines recent developments in Canada and the United States and the role of commercial interests in alcohol-related policies bearing on taxes, outlet density, advertising, counter-advertising, health messages and prevention. Case-study material is drawn from published papers, project reports, government documents and newspaper accounts. The main focus is at the federal level, with some reference to provincial, state and local experience. Alcohol industries have as their primary agenda that of maintaining and expanding their markets and maximizing profits. In order to achieve this they typically oppose restrictions on access to alcohol, tax increases, controls on marketing and some counter-advertising campaigns. They are powerful in influencing policy in both countries, at national and regional levels, and their efforts impact policy agenda and outcome of government deliberations. Their prevention efforts, which tend to be oriented to information and education, are mainly individualistic in focus and typically not supportive of environmentally based policy reforms. Governments appear to have a declining interest in policy issues, due partly to resistance by the industries to alcohol control policies. Governments are encouraged to apply an evidence-based orientation to funding prevention, and facilitate evaluation of industry-sponsored prevention efforts. Greatest attention and resources should be directed to interventions that are most likely to have the greatest impact in reducing drinking-related problems, and funding for prevention from alcohol industries should involve arms-length arrangements. Alcohol industries are encouraged to consider strategies that do not increase access to alcohol but rather reduce drinking-related risks.

Public opinions on alcohol policy issues: a comparison of American and Canadian surveys.

AIMS: To study international and within country differences with regard to views by the general public on alcohol policy topics, describe associations with socio-demographic characteristics and drinking practices, and contrast opinions with variations in actual policies. DESIGN, SETTING, SUBJECTS: Large-scale cross-sectional household surveys were conducted in Canada (n = 11,550) and the United States (n = 4004) in 1989-90, involving representative samples of adults aged 18 and older. MEASURES: Eleven alcohol policy topics were examined: alcohol taxes; hours of off-premise sale; legal drinking age; alcohol sales in corner stores; government advertising against alcohol; warning labels on alcohol products; alcohol advertising on TV; industry sponsorship or cultural or sports events; efforts to prevent service to drunken customers; prevention and education; and treatment. FINDINGS: Even after controlling for drinking levels and respondent characteristics, policy measures that control physical or economic access to alcohol are not as strongly supported as those that provide information or focus on the heavy drinker. There was greater polarization of opinion within both countries for policy items relating to promotion of alcohol or control of physical, demographic or economic access, and virtually no polarization with regard to items such as curtailing service to drunken customers or providing information or treatment. In the jurisdiction with less restrictive measures on a particular policy, there seems to be greater public support for curtailing access to alcohol and, in some instances, more restrictive policies are associated with lower support for increasing restrictions. CONCLUSION: Public opinion data are an important resource in determining whether actual policies are compatible with the views of those affected by them. Disjunctions between research on the most effective policy interventions and views by the public point to special agenda for information dissemination and prevention initiatives.

Reducing risks associated with drinking among young adults: promoting knowledge-based perspectives and harm reduction strategies.

The situation with regard to drinking is particularly complex for young adults: they are typically faced with pressures on one hand to abstain or drink small quantities, and on the other hand there may be expectations to drink heroic amounts and engage in risk-taking while drinking. Furthermore, in some cultures a very short transition period time is evident between condoned occasional experimentation with alcohol and the expectations of being able to manage alcohol use in a wide range of settings. Also, the perceived invincibility among youth stands in sharp contrast to their high rates of traumatic events involving alcohol. The paper by Barbara Leigh examines the nature and dimensions of risk-taking particularly among young adults. For example, her analysis encourages us to look beyond preliminary associations about the proportion of certain events where drinking was involved, and consider whether drinking was a correlate or a contributing cause. The paper by James Mosher points to the importance of obtaining information about the population, situation and drinker as a basis for population-level interventions, involving environmental changes in the promotion and distribution of alcoholic beverages. The papers point to a search for interventions that are distinguished by their effectiveness in reducing harm, and not necessarily by their faddish value. An essential step is drawing the younger drinker into an accurate documentation of risk-taking experiences, and also in collaborating in developing humane, reasonable and effective approaches in reducing drinking-related harm.

Alcohol and injury: a comparison of emergency room populations in two Canadian provinces.

The few comparative emergency room (ER) studies reported have found alcohol's role in injury occurrence to vary and suggest that regional and cultural differences in drinking patterns may account, in part, for this variation. To further this research, a probability sample of 1708 ER patients was interviewed regarding the role of alcohol in the event, usual drinking patterns, and alcohol-related problems and a urine sample was obtained to estimate blood alcohol concentration (BAC). The sample was from ERs in two Canadian provinces with distinctly different cultures: primarily English-speaking Alberta and French-speaking Quebec. While differences in demographic and drinking characteristics between injured and noninjured in both the Alberta and Quebec ERs were similar to those in other ER studies, the injured in the Alberta ER were more likely to be positive for estimated BAC; to have higher BAC levels; to report drinking prior to the event; and, among those reporting drinking, to have consumed a larger number of drinks and to report feeling drunk at the time of injury compared to those in Quebec. These differences may be associated with cultural differences in typical drinking patterns, with higher rates of abstinence reported in the Alberta ER, but also with higher rates of heavy drinking and alcohol-related problems, while those in the Quebec ER were more likely to report consuming smaller quantities with greater frequency (typical of wine-drinking cultures). Additional research is needed to explicate further alcohol's role in injury occurrence for planning effective prevention strategies that are both culturally relevant and specific.

Demographic and substance use factors related to violent and accidental injuries: results from an emergency room study.

OBJECTIVE: The primary goal of this study was to identify demographic and substance use factors associated with violent injuries, accidental injuries, and medical conditions or illnesses (non-injured). METHOD: Data were examined from a sample of 1701 admissions to emergency rooms at two Canadian hospitals. These patients were interviewed and provided urine samples to detect the presence of drug metabolites for alcohol, THC, benzodiazepines, barbiturates, morphine, and codeine. RESULTS: Those with violent injuries were significantly (P<0.0001) more likely to be male and have lower incomes compared with both the accidental injury and non-injury groups. About 37% of violent injuries occurred at a bar or restaurant, which was significantly more than 3% for accidental injuries and 2% for non-injuries (P<0.00001). The violent injury group was significantly more likely than the other two groups to report feeling the effects of alcohol at the time of the injury and to report negative consequences of alcohol use (P<0.00001). Furthermore, about 42% of those with violent injuries had a blood alcohol level (BAL) over 80 mg% compared to only 4% with accidental injuries (P<0.00001) and 2% of non-injuries (P<0.00001). In terms of drug tests for other substances, the violent injury group was significantly more likely to test positive for benzodiazepines than the accidental injury group (P<0.01) while all between group comparisons for other drugs were not significant.

Changes in alcohol consumption patterns following the introduction of credit cards in Ontario liquor stores.

OBJECTIVE: In 1994, regulatory changes were introduced in Ontario, Canada, permitting the purchase of alcoholic beverages with credit cards at government-operated liquor stores. Two objectives of this study were: (1) to compare the characteristics of credit card shoppers with non credit card shoppers at liquor stores, and (2) to assess whether changes occurred in alcohol consumption patterns among shoppers following the introduction of credit cards. METHOD: Random digit dialing was used to interview 2,039 telephone participants prior to the introduction of credit cards (Time 1); 1,401 of these subjects were contacted 1 year later (Time 2). Independent sample t tests were used to compare credit card shoppers with shoppers not using credit cards, and paired t tests were performed to assess whether drinking behaviors changed from Time 1 to Time 2. RESULTS: The credit card shoppers were more likely than the non credit card shoppers to be highly educated (p < .001) and to have high incomes (p < .05). Credit card shoppers drank an average of 6.3 drinks over the previous week compared with 4.0 drinks among non credit card shoppers (p < .01). Although the overall amount of alcohol consumed among credit card shoppers dropped from 6.7 drinks at Time 1 to 6.3 at Time 2 (NS), credit card shoppers reported drinking significantly more often after credit cards were introduced (p < .05). CONCLUSIONS: The results suggest that credit cards may not present public health problems since significant increases in alcohol consumption among credit card shoppers were not found.

Gender, perceptions of harm, and other social predictors of alcohol use in a Punjabi community in the Toronto area.

Based on self-administered face-to-face interviews conducted in 1992-93 with 524 members of the Punjabi community in Peel, near Toronto, this study investigates the factors associated with alcohol use in the community. Results from alcohol and other drug surveys in Ontario are used for comparison between the two samples regarding drinking and sociodemographic characteristics. Bivariate analyses indicate a lower prevalence rate of drinking among the Punjabi sample than the Ontario population, especially among women. In spite of this, a majority of the Punjabi respondents perceive that alcohol problems are widespread in their community. Logistic regression results show that sex, importance of religion, perceived risk of alcohol, and opinion on alcohol price in the province are significantly associated with alcohol use. The effects of socioeconomic status, perception of public drunkenness, and levels of integration appear to be not significant. In light of these results, some implications for "alcohol abuse" prevention strategies are discussed.

Privatizing alcohol sales and alcohol consumption: evidence and implications.

AIM: To provide an overview of recent privatization/deregulation experiences in North America and other settings, in order to draw conclusions about the impacts that might be expected from such changes on rates of alcohol consumption and related problems. METHODS: Critical review of research evidence on the effect of changes in availability, particularly changes in physical availability and economic availability that typically accompany privatization of alcohol retail monopolies. FINDINGS: Deregulation/privatization experiences commonly involve higher density of outlets, longer hours or more days of sale, changes in price, a strong orientation to commercial aspects of alcohol sales and the introduction of new vested economic interests into alcohol management arrangements in the jurisdiction. In many instances these changes in access to alcohol are accompanied by an increase in the per capita rates of consumption. In the short term changes in prices are likely to either increase or demonstrate opposite patterns for beverages with different base prices. Longer-term patterns point to a decline in real price with privatization, which very probably stimulates per capita alcohol sales. CONCLUSION: The existing evaluation literature on the subject of privatization has tended to focus on examining the net short-term results in terms of alcohol consumption levels. Overall, there are too few studies employing adequate statistical methodologies to explore the underlying causes of changing alcohol consumption and alcohol-related harm. Finally, seven specific suggestions that may assist future studies are discussed.

Effects of others' drinking as perceived by community members.

A 1994 survey of adults from a northern Ontario city contained questions about alcohol consumption, problems experienced as a result of others' drinking, and opinions concerning solutions to such problems. The 180-question survey was administered to about 900 respondents, the vast majority of whom said they had consumed alcohol within the previous 12 months. At least one in five said they had been bothered by three types of experience caused by other drinkers: loudness, humiliation, and arguments. Young adults stood out as the group most likely to experience each type of problem caused by other drinkers. There was a robust level of support for most solutions proposed, with the exception of a city ban on drinking in indoor public places. The data suggest that comprehensive prevention efforts may be more effective than those focused on a single approach geared towards only one group or person.

Implications of privatizing/deregulating alcohol retail sales: projections of alcohol consumption in Ontario.

PURPOSE: To project the consequences of privatizing or deregulating current alcohol retail monopolies in Ontario, Canada. METHODS: The projection is based on a multiplicative model and applied to estimate per capita alcohol consumption for four hypothetical scenarios, including both partial and complete privatization for the Province of Ontario, Canada. Those scenarios are mainly focused on the two dimensions of changes affected by privatization: alcohol physical availability and economic availability (i.e., retail prices). Various assumptions involving availability and prices are largely based on the Canadian and international research literature on deregulation/privatization. RESULTS AND IMPLICATIONS: The study showed that per capita alcohol consumption in the short/medium term is expected to increase in all four hypothetical scenarios examined, with the magnitude ranging from 11% to 27%. The sensitivity analysis also revealed a similar increase in alcohol consumption, even though the magnitude of the increase would be less for some scenarios. Therefore, any deliberations on modifying alcohol control policies are well advised to proceed with caution, since an increase in alcohol consumption is likely to be associated with elevated levels of drinking-related problems.

Introduction of high-alcohol beer in Ontario: preliminary observations on its use by underage drinkers.

Preliminary data are reported on the use of high-alcohol beer by underage drinkers in Ontario. Students in grades 11 and 12 with a valid driver's licence completed a questionnaire between January and May, 1994 (i.e., between three and seven months after the introduction of high-alcohol beer). About one-half of students who had drunk alcohol within the previous four weeks reported consuming high-alcohol beer within that period. In this group, males were much more likely to report high-alcohol beer consumption in the previous month. Both male and female high-alcohol beer consumers drank alcohol more frequently, got drunk more frequently, and drank five or more drinks on the same occasion more frequently than non-consumers. One reason for trying high-alcohol beer, "wanted a higher alcohol content", was endorsed by more than one-third of high-alcohol beer consumers. Our data suggest that the users of high-alcohol beer among this underage drinking sample tend to be heavier drinkers and more likely to experience alcohol-related problems.

On the emerging paradigm of drinking patterns and their social and health consequences.

Recent epidemiological and social studies have increasingly pointed to the importance of drinking patterns in explaining consequences of alcohol consumption. This paper presents recommendations for research in the area based on the presentations and discussions of the first "International Conference on Social and Health Effects of Different Drinking Patterns" held in Toronto in November 1995. In particular, the social dimension in pattern research, and the relationship between patterns of drinking and casualties as well as social harm, are stressed. The paper also argues for better theories, incorporating knowledge from related basic disciplines. In addition, we emphasize the need for improved methodologies and standardized methods for assessing drinking patterns. Finally, implications of research on drinking patterns for policy and programme development are discussed.