Solitary drinkers in Great Britain: How do their sociodemographic characteristics, consumption patterns, and drinking occasions differ from those who drink with others?

OBJECTIVE: Inequalities in alcohol-related harm may arise partly from differences in drinking practices between population groups. One under-researched practice associated with harm is consuming alcohol alone. We identify sociodemographic characteristics associated with drinking alone and the occasion-level characteristics associated with occasions when people drink alone. METHOD: A cross-sectional analysis of one-week drinking diaries collected between 2015 and 2019 was conducted using event-level data on 271,738 drinking occasions reported by 83,952 adult drinkers in Great Britain. Our two dependent variables were a binary indicator of reporting at least one solitary drinking occasion in the diary-week at the individual-level and a binary indicator of drinking alone at the occasion-level (event-level). RESULTS: Individual-level characteristics associated with solitary drinking were being a man (OR 1.88, 95%CI [1.80,1.96]), aged over 50 (OR 2.60, 95%CI [2.40,2.81]), not in a relationship (OR 3.39, 95%CI [3.20, 3.59]), living alone (OR 2.51, 95%CI [2.37, 2.66]), and a high-risk drinker (OR 1.54, 95%CI [1.52,1.59]). Occasion-level characteristics associated with solitary drinking were that they were more likely to occur in the off-trade (OR 3.08, 95%CI [2.95,3.21]), Monday-Thursday (OR 1.36, 95%CI [1.27,1.47]), and after 10pm (OR 1.36, 95%CI [1.27,1.47]) controlling for geographic region and the month the interview took place. CONCLUSIONS: Characteristics of solitary drinking largely align with characteristics we associated with drinking problems. Those who partake in at least one solitary drinking occasion are overall more likely to consume alcohol at risky levels, however, the number of drinks consumed in each occasion was lower during a solitary drinking occasion.

The effect of power stretchers on occupational injury rates in an urban emergency medical services system.

BACKGROUND: To examine occupational injury rates in a dual-response emergency medical services (EMS) system before and after implementation of a power-lift stretcher system. METHODS: The seasonally-adjusted occupational injury rate was estimated relative to medical call volume (per 1000 calls) and workers (per 100 FTEs) from 2009 to 2019, and stratified by severity (lost-time, healthcare only), role (EMS, FIRE) and type (patient-handling). Power-lift stretchers were adopted between 2013 and 2015. Preinjury versus postinjury rates were compared using binomial tests. Interrupted time series (ITS) analysis was used to estimate the trend and change in injuries related to patient-handling, with occupational illnesses serving as control. RESULTS: Binomial tests revealed varied results, with reductions in the injury rate per 1000 calls (-14.0%) and increases in the rate per 100 FTEs (+14.1%); rates also differed by EMS role and injury severity. ITS analysis demonstrated substantial reductions in patient-handling injuries following implementation of power-lift stretchers, both in the injury rate per 1000 calls (-50.4%) and per 100 FTEs (-46.6%), specifically among individuals deployed on the ambulance. Injury rates were slightly elevated during the winter months (+0.8 per 100 FTEs) and lower during spring (-0.5 per 100 FTEs). CONCLUSIONS: These results support the implementation of power-lift stretchers for injury prevention in EMS systems and demonstrate advantages of ITS analysis when data span long preintervention and postintervention periods.

Database quality assessment in research in paramedicine: a scoping review.

BACKGROUND: Research in paramedicine faces challenges in developing research capacity, including access to high-quality data. A variety of unique factors in the paramedic work environment influence data quality. In other fields of healthcare, data quality assessment (DQA) frameworks provide common methods of quality assessment as well as standards of transparent reporting. No similar DQA frameworks exist for paramedicine, and practices related to DQA are sporadically reported. This scoping review aims to describe the range, extent, and nature of DQA practices within research in paramedicine. METHODS: This review followed a registered and published protocol. In consultation with a professional librarian, a search strategy was developed and applied to MEDLINE (National Library of Medicine), EMBASE (Elsevier), Scopus (Elsevier), and CINAHL (EBSCO) to identify studies published from 2011 through 2021 that assess paramedic data quality as a stated goal. Studies that reported quantitative results of DQA using data that relate primarily to the paramedic practice environment were included. Protocols, commentaries, and similar study types were excluded. Title/abstract screening was conducted by two reviewers; full-text screening was conducted by two, with a third participating to resolve disagreements. Data were extracted using a piloted data-charting form. RESULTS: Searching yielded 10,105 unique articles. After title and abstract screening, 199 remained for full-text review; 97 were included in the analysis. Included studies varied widely in many characteristics. Majorities were conducted in the United States (51%), assessed data containing between 100 and 9,999 records (61%), or assessed one of three topic areas: data, trauma, or out-of-hospital cardiac arrest (61%). All data-quality domains assessed could be grouped under 5 summary domains: completeness, linkage, accuracy, reliability, and representativeness. CONCLUSIONS: There are few common standards in terms of variables, domains, methods, or quality thresholds for DQA in paramedic research. Terminology used to describe quality domains varied among included studies and frequently overlapped. The included studies showed no evidence of assessing some domains and emerging topics seen in other areas of healthcare. Research in paramedicine would benefit from a standardized framework for DQA that allows for local variation while establishing common methods, terminology, and reporting standards.

Patterns of change in prehospital spinal motion restriction: A retrospective database review.

BACKGROUND: Acute management of trauma patients with potential spine injuries has evolved from uniform spinal immobilization (SI) to spinal motion restriction (SMR). Little research exists describing how these changes have been implemented. This study aims to describe and analyze the practice of SMR in one emergency medical services (EMS) agency over the time frame of SMR adoption. METHODS: This was a retrospective database review of electronic patient care reports from 2009 to 2020. The effects of key practice changes (revised documentation and a collar-only treatment option) were analyzed in an interrupted time series using the rate of SI/SMR as the primary outcome. Secondary outcomes included patient age, sex, acuity, mechanism of injury, treatment provided, cervical collar size, and positioning. These were assessed for changes from year to year by Poisson regression. Associations between patient and treatment characteristics were investigated with binomial logistic regression. RESULTS: There were 25,747 instances of SI/SMR included. Among all patients, the median age was 40 (interquartile range 24-56), 58% (14,970) were male, and 20% (5062) were high-acuity. The rate of SI/SMR declined from 31.2 to 12.7 treatments per 100 trauma calls per month. The proportion of high-acuity patients increased by 9.6% per year on average (95% CI 8.7%-10.0%). When first available, collar-only treatment was provided to 47% of patients, rising by 6.3% per year (95% CI 3.2%-9.5%) to 60% in 2020. Collar-only treatment (compared to board-and-collar) was more likely to be applied to low-acuity patients (as compared to high): odds ratio 3.01 (95% CI 2.64-3.43). CONCLUSIONS: This study shows decreasing SI/SMR treatment and changing patient and practice characteristics. These patterns of care cannot be attributed solely to formal protocol changes. Similar patterns and their possible explanations should be investigated elsewhere.

Paramedic attitudes towards prehospital spinal care: a cross-sectional survey.

BACKGROUND: The optimal application of spinal motion restriction (SMR) in the prehospital setting continues to be debated. Few studies have examined how changing guidelines have been received and interpreted by emergency medical services (EMS) personnel. This study surveys paramedics' attitudes, observations, and self-reported practices around the treatment of potential spine injuries in the prehospital setting. METHODS: This was a cross-sectional survey of a North American EMS agency. After development and piloting, the final version of the survey contained four sections covering attitudes towards 1) general practice, 2) specific techniques, 3) assessment protocols, and 4) mechanisms of injury (MOI). Questions used Likert-scale, multiple-choice, yes/no, and free-text responses. Exploratory factor analysis (EFA) was used to identify latent constructs within responses, and factor scores were analyzed by ordinal logistic regression for associations with demographic characteristics (including qualification level, gender, and years of experience). MOI evaluations were assessed for inter-rater reliability (Fleiss' kappa). Inductive qualitative content analysis, following Elo & Kyngäs (2008), was used to examine free-text responses. RESULTS: Two hundred twenty responses were received (36% of staff). Raw results indicated that respondents felt that SMR was seen as less important than in the past, that they were treating fewer patients than previously, and that they follow protocol in most situations. The EFA identified two factors: one (Judging MOIs) captured paramedics' estimation that the presented MOI could potentially cause a spine injury, and another (Treatment Value) reflected respondents' composite view of the effectiveness, importance, and applicability of SMR. Respondents with advanced life support (ALS) qualification were more likely to be skeptical of the value of SMR compared to those at the basic life support (BLS) level (OR: 2.40, 95%CI: 1.21-4.76, p = 0.01). Overall, respondents showed fair agreement in the evaluation of MOIs (k = 0.31, 95%CI: 0.09-0.49). Content analysis identified tension expressed by respondents between SMR-as-directed and SMR-as-applied. CONCLUSION: Results of this survey show that EMS personnel are skeptical of many elements of SMR but use various strategies to balance protocol adherence with optimizing patient care. While identifying several areas for future research, these findings argue for incorporating provider feedback and judgement into future guideline revision.

Database quality assessment in research in paramedicine: a scoping review protocol.

INTRODUCTION: The paramedic practice environment presents unique challenges to data documentation and access, as well as linkage to other parts of the healthcare system. Variable or unknown data quality can influence the validity of research in paramedicine. A number of database quality assessment (DQA) frameworks have been developed and used to evaluate data quality in other areas of healthcare. The extent these or other DQA practices have been applied to paramedic research is not known. Accordingly, this scoping review aims to describe the range, extent and nature of DQA practices within research in paramedicine. METHODS AND ANALYSIS: This scoping review will follow established methods for the conduct (Johanna Briggs Institute; Arksey and O'Malley) and reporting (Preferred Reporting Items in Systematic Reviews and Meta-Analyses extension for scoping reviews) of scoping reviews. In consultation with a professional librarian, a search strategy was developed representing the applicable population, concept and context. This strategy will be applied to MEDLINE (National Library of Medicine), Embase (Elsevier), Scopus (Elsevier) and CINAHL (EBSCO) to identify studies published from 2011 through 2021 that assess paramedic data quality as a stated goal. Studies will be included if they report quantitative results of DQA using data that relate primarily to the paramedic practice environment. Protocols, commentaries, case studies, interviews, simulations and experimental data-processing techniques will be excluded. No restrictions will be placed on language. Study selection will be performed by two reviewers, with a third available to resolve conflicts. Data will be extracted from included studies using a data-charting form piloted and iteratively revised based on studies known to be relevant. Results will be summarised in a chart of study characteristics, DQA-specific outcomes and key findings. ETHICS AND DISSEMINATION: Ethical approval is not required. Results will be submitted to relevant conferences and peer-reviewed journals. TRIAL REGISTRATION: 10.17605/OSF.IO/Z287T.

Head-Neck Motion in Prehospital Trauma Patients under Spinal Motion Restriction: A Pilot Study.

BACKGROUND: Spinal precautions are intended to limit motion of potentially unstable spinal segments. The efficacy of various treatment approaches for motion restriction in the cervical spine has been rigorously investigated using healthy volunteers and, to a lesser extent, cadaver samples. No previous studies have objectively measured this motion in trauma patients with potential spine injuries during prehospital care. Objective: The purpose of this study was to characterize head-neck (H-N) kinematics in a sample of trauma patients receiving spinal precautions in the field. Methods: This was a prospective observational study of trauma patients in the prehospital setting. Trauma patients meeting criteria for spinal precautions were eligible for inclusion. Participants received usual care, consisting of either a long backboard, cervical collar, and head blocks (BC) or a cervical collar only (CO), and behavior was categorized as compliant (C) or non-compliant (N). Three inertial measurement units (IMUs), placed on each participant's forehead, sternum, and stretcher, yielded data on H-N motion. Outcomes were described in terms of H-N displacement and acceleration, including single- and multi-planar values, root mean square (RMS), and bouts of continuous motion above pre-determined thresholds. Data were analyzed to compare H-N motion by phase of prehospital care, as well as treatment type and patient behavior. RESULTS: Substantial single- and multi-plane H-N motion was observed among all participants. Maximum single-plane displacements were between 11.3 ± 3.0 degrees (rotation) and 19.0 ± 16.6 degrees (flexion-extension). Maximum multi-plane displacements averaged 31.2 ± 7.2 degrees (range: 7.2 to 82.1 degrees). Maximum multi-plane acceleration averaged 5.8 ± 1.4 m/s2 (range: 1.2 to 19.9 m/s2). There were no significant differences among participants between prehospital phase and treatment type. Non-compliant participants showed significantly more motion than compliant participants. Conclusion: Among actual patients, movement appears to be greater than previously recorded in simulation studies, and to be associated with patient behavior. Miniature IMUs are a feasible approach to field-based measurement of H-N kinematics in trauma patients. Future research should evaluate the effects of patient compliance, treatment, and phase of care using larger samples. Key words: spinal immobilization; cervical spine; cervical collar; long backboard.

Assessing the contribution of alcohol-specific causes to socio-economic inequalities in mortality in England and Wales 2001-16.

BACKGROUND AND AIMS: When measuring inequalities in health, public health and addiction research has tended to focus on differences in average life-span between socio-economic groups. This does not account for the extent to which age of death varies between individuals within socio-economic groups or whether this variation differs between groups. This study assesses (1) socio-economic inequalities in both average life-span and variation in age at death, (2) the extent to which these inequalities can be attributed to alcohol-specific causes (i.e. those attributable only to alcohol) and (3) how this contribution has changed over time. DESIGN: Cause-deleted life table analysis of national mortality records. SETTING: England and Wales, 2001-16. CASES: All-cause and alcohol-specific deaths for all adults aged 18+, stratified by sex, age and quintiles of the index of multiple deprivation (IMD). MEASUREMENTS: Life expectancy at age 18 yearss and standard deviation in age at death within IMD quintiles and the contribution of alcohol to overall differences in both measures between the highest and lowest IMD quintiles by comparing observed and cause-deleted inequality 'gaps'. FINDINGS: In 2016, alcohol-specific causes reduced life expectancy for men and women by 0.26 and 0.14 years, respectively, and increased the standard deviation in age at death. These causes also increased the inequality gap in life expectancy by 0.33 years for men and 0.17 years for women, and variation in age at death by 0.14 years and 0.13 years, respectively. For both measures, the contribution of alcohol to mortality inequalities rose after 2001 and subsequently fell back. For women, alcohol accounted for 3.6% of inequality in age at death and 6.0% of life-span uncertainty, suggesting that using only the former may underestimate alcohol-induced inequalities. There was no comparable difference for men. CONCLUSIONS: Deaths from alcohol-specific causes increase inequalities in both life expectancy and variation in age of death between socio-economic groups. Using both measures can provide a fuller picture of overall inequalities in health.

Effects of Spinal Immobilization and Spinal Motion Restriction on Head-Neck Kinematics during Ambulance Transport.

Objective: To determine the influence of ambulance motion on head-neck (H-N) kinematics and to compare the effectiveness of two spinal precaution (SP) protocols: spinal immobilization (SI) and spinal motion reduction (SMR). Methods: Eighteen healthy volunteers (7 females) underwent a series of standardized ambulance transport tasks, across various speeds, under the two SP protocols in a balanced order (n = 12 drivers, n = 7 ambulances). Inertial measurement units were placed on participants' heads and sternums, with another affixed to the stretcher mattress frame. Outcome measures included H-N displacement and acceleration. Results: Ambulance accelerations varied across driving tasks (2.5-9.5 m/s2) and speeds (3.0-6.2 m/s2) and resulted in a wide range of H-N displacements (7.2-22.6 deg) and H-N accelerations (1.4-10.9 m/s2). Relative to SMR, SI resulted in reduced H-N motion during turning, accelerating, and speed bumps (1.9-10.7 deg; 0.4-2.6 m/s2), but increased H-N accelerations during abrupt starts/stops and some higher speed tasks (0.4-2.5 m/s2). Ambulance acceleration was moderately correlated to H-N acceleration (r = 0.68) and displacement (r = 0.42). Conclusion: H-N motion was somewhat coupled to ambulance acceleration and varied across a wide range, regardless of SP approach. In general, SI resulted in a modest reduction in H-N displacement and acceleration, with some exceptions. The results inform clinical decisions on SP practice during prehospital transport and demonstrate a novel approach to quantifying H-N motion in prehospital care.

Prehospital Spinal Immobilization: Effect of Effort on Kinematics of Voluntary Head-neck Motion Assessed using Accelerometry.

INTRODUCTION: Standards for immobilizing potentially spine-injured patients in the prehospital environment are evolving. Current guidelines call for more research into treatment practices. Available research into spinal immobilization (SI) reveals a number of limitations. PROBLEM: There are currently few techniques for measuring head and neck motion that address identified limitations and can be adapted to clinically relevant scenarios. This study investigates one possible method. METHODS: Study participants were fitted with miniaturized accelerometers to record head motion. Participants were exposed to three levels of restraint: none, cervical-collar only, and full immobilization. In each condition, participants were instructed to move in single planes, with multiple iterations at each of four levels of effort. Participants were also instructed to move continuously in multiple planes, with iterations at each of three levels of simulated patient movement. Peak and average displacement and acceleration were calculated for each immobilization condition and level of effort. Comparisons were made with video-based measurement. Participant characteristics also were tracked. RESULTS: Acceleration and displacement of the head increased with effort and decreased with more restraint. In some conditions, participants generated measurable acceleration with minimal displacement. Continuous, multi-dimensional motions produced greater displacement and acceleration than single-plane motions under similar conditions. CONCLUSION: Study results suggest a number of findings: acceleration complements displacement as a measure of motion in potentially spine-injured patients; participant effort has an effect on outcome measures; and continuous, multi-dimensional motion can produce results that differ from single-plane motions. Miniaturized accelerometers are a promising technology for future research to investigate these findings in realistic, clinically relevant scenarios.

Relationship between ambulatory performance and self-rated disability in patients with lumbar spinal stenosis.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To identify the relationship between performance measures derived from accelerometry and subjective reports of pain, disability, and health in patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: Accelerometers have emerged as a measure of performance, providing the ability to characterize the pattern and magnitude of real-life activity, and sedentarism. Pain and loss of function, particularly ambulation, are common in LSS. The extent to which pain, perceived disability, and self-rated health relate to performance in patients with LSS is not well known. METHODS: Data regarding self-reported pain, disability (Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Disabilities of the Arm, Shoulder, and Hand), and health (36-Item Short Form Health Survey [SF-36]) were collected from patients with LSS (n = 33). Physical activity, ambulation, and inactivity performance measures were derived from 7-day accelerometer records. Correlation and stepwise regression were used. RESULTS: The physical function subscale of the SF-36, a non-pathology-specific outcome, had the best overall correlation to physical activity and ambulation (average r = 0.53) compared with pain (average r = 0.32) and disability (average r = -0.45) outcomes. Stepwise regression models for performance were predominantly single-variable models (4 of 8 models); pain was not selected as a predictor. A second non-pathology-specific outcome, the Disabilities of Arm Shoulder and Hand, improved the prediction of performance in 5 of 8 models. CONCLUSION: Subjective measures of pain and disability had limited ability to account for real-life performance in patients with LSS. Future research is required to identify determinants of performance in patients with LSS because barriers to activity may not be disease-specific.