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Biomedical subjects

R E Mann

Publications and source records attributed to R E Mann.

At least 19 recordsLinked to original sources
PubMed2001

The effects of introducing or lowering legal per se blood alcohol limits for driving: an international review.

In this review evidence on the impact of introducing or lowering legal blood alcohol limits on traffic safety measures is examined. There is substantial variability in the types and rigour of methods used to evaluate these legislative measures, and thus not surprisingly there is variability in the results observed. In most but not all cases where an evaluation of an introduced or lowered legal limit has been conducted, some beneficial effect on traffic safety measures has been reported. These effects are in some cases relatively small, and in other cases may be temporary. In some jurisdictions, lasting reductions in collision rates have been reported. Available evidence suggests that where beneficial effects are observed they are due to general deterrence, and not restricted only to drivers at blood alcohol concentrations (BAC) specifically affected by the legal change.

Accidents, Traffic↗
PubMed2000

The impact of programs for high-risk drinkers on population levels of alcohol problems.

AIMS: Historically, treatment programs and related activities for alcoholics or high-risk drinkers have been viewed as not relevant to efforts to prevent alcohol problems, and in particular population-based prevention efforts. In this review we consider evidence that high-risk programs may have an impact on population or aggregate levels of these problems. DESIGN: We first summarize recent reviews of the clinical impact of programs for high-risk drinkers, since some level of effectiveness at the individual level is necessary for these programs to have an aggregate level impact. Following that, correlational evidence on the impact of high-risk programs on aggregate problem levels is examined. Estimates of the potential impact of high-risk programs on aggregate problem levels, based on available information on the impact of these programs and the numbers of individuals affected, are then considered, as are estimations of the comparative aggregate level impact of high-risk and consumption reduction strategies. FINDINGS: There is increasing evidence that high-risk programs have beneficial effects for individuals. Available correlational evidence supports the proposal that increases in treatment and AA have contributed to the declines in alcohol-related morbidity and mortality observed in some countries in recent years. Studies estimating the recent impact of increases in levels of treatment and AA membership support that interpretation, and studies comparing estimated effects of high-risk and population strategies find similar potential for aggregate effects. CONCLUSIONS: Programs for high-risk drinkers can have beneficial aggregate-level effects and are thus a valuable component of population-based efforts to reduce alcohol problems.

Alcohol-Related Disorders↗
PubMed2000

The direct and indirect relationships between alcohol prevention measures and alcoholic liver cirrhosis mortality.

OBJECTIVE: The objective of this article is to investigate direct and indirect relationships between prevention measures and alcoholic liver cirrhosis mortality in Canadian provinces from 1968 to 1986. METHOD: The data base that was assembled included alcoholic cirrhosis mortality rates, alcohol availability measures (rate of licensed premises, year in which the legal drinking age was reduced), per capita consumption of alcohol, rates of AA members and groups, and economic and demographic measures. This article develops a two-equation analytic model based on the availability theory of alcohol problems and prevention (Single, 1988). The distinction between direct and indirect effects of prevention measures can be made explicitly with this model. RESULTS: Alcohol availability measures, but not AA measures, had a significant direct potential impact on alcohol consumption. AA measures had a significant direct relationship to cirrhosis mortality rates. Alcohol consumption also had a significant direct relationship to cirrhosis mortality, and alcohol availability measures had an important indirect relationship through their influence on per capita alcohol consumption. CONCLUSIONS: While these observations need to be interpreted cautiously, the two-equation model shows promise as an approach to understanding direct and indirect influences on alcohol problems. As expected, AA measures and per capita alcohol consumption demonstrated significant direct relationship to cirrhosis mortality. In addition, important indirect influences of drinking-age changes and rates of licensed premises on cirrhosis mortality were observed through their relationships to per capita alcohol consumption.

Adult↗
PubMed2000

Do changes in per capita consumption mirror changes in drinking patterns?

OBJECTIVE: The goal of this study was to examine how well per capita alcohol consumption figures derived from beverage sales data relate to changes over time in survey-based measures of drinking patterns. It was expected that strong associations would be found among these various measures of consumption. METHOD: Data from 12 household surveys conducted in Ontario between 1977 and 1997 provided information on: percentages of drinkers; daily drinkers; those drinking five or more drinks at a sitting weekly; those reporting two or more alcohol-related harms; and average number of drinks per week. These variables were then correlated with per capita consumption. RESULTS: Significant correlations were found only between per capita consumption and percentage of daily drinkers, and between percentage of drinkers and average number of drinks per week. CONCLUSIONS: The relationship of per capita consumption to survey measures of drinking is weak. The absence of consistent associations over time between per capita consumption and survey measures may be attributable to the small number of available data points or to increases in unrecorded consumption. Further research is needed to verify and explain these results.

Adult↗
PubMed1999

Reasons for living versus reasons for dying: examining the internal debate of suicide.

The Reasons for Living vs. Reasons for Dying (RFL/RFD) Assessment was used to obtain suicidal outpatients' top five reasons for living and for dying, respectively. Forty-nine suicidal university counseling center patients provided 173 RFL and 145 RFD responses. These responses were organized into eight RFL coding categories and nine RFD coding categories. Two coders trained in the RFL/RFD coding system showed high levels of interrater reliability (KRFL = .81; KRFD = .80). Chi-square results for RFL and RFD coding categories showed that the coding categories were not equally salient to these suicidal patients.

Adult↗
PubMed1998

Changes in liver cirrhosis death rates in different countries in relation to per capita alcohol consumption and Alcoholics Anonymous membership.

OBJECTIVE: This study examines how trends in liver cirrhosis relate to per capita alcohol consumption and Alcoholics Anonymous (AA) membership in 33 countries between 1965 and 1991. It was expected that reductions in liver cirrhosis deaths seen in many countries would be related to both decreased consumption and increased AA membership. METHOD: Data on liver cirrhosis death rates, alcohol consumption and AA membership were gathered from a variety of international sources. The data were analyzed with regression analyses (Ordinary Least Squares). RESULTS: Cirrhosis deaths and alcohol consumption levels were positively related in all analyses. In two of the four analyses, the negative relationship between cirrhosis deaths and AA group rates was marginally significant. CONCLUSIONS: Liver cirrhosis rates were strongly related to alcohol consumption and showed some relationship to AA group rates. The modest impact of AA may be due to the weakness of the true relationship but also to incompleteness in the cirrhosis and AA data in some countries.

Alcohol Drinking↗
PubMed1998

Adolescents, bush parties and drinking-driving.

OBJECTIVE: We describe the prevalence of bush party (an outdoor gathering of youth) attendance and examine predictors of attendance and of driving after drinking at bush parties. METHOD: The 1995 Ontario Student Drug Use Survey (OSDUS) data on students (n = 1,853) in schools across the province in grades 7, 9, 11 and 13 are employed to estimate prevalence of bush party attendance within the previous 12 months. The 1994 Graduated Licensing Study (GLS), a multi-community survey of drivers (n = 1,157, 53.6% male) in grades 11 and 12 in Ontario, data are employed to study predictors of attendance and of drinking-driving. RESULTS: Based on the OSDUS, the prevalence of bush party attendance is 37.6%. Based on the GLS, 38.4% attended bush parties, and among attenders 71.5% drank at bush parties, 63.5% observed drinking-driving, 16.1% rode with a drinking-driver and 16.6% drove after drinking at bush parties. Logistic regression reveals that attendance at bush parties is positively associated with number of other places alcohol was consumed, tobacco use, number of alcohol-related problems, number of kilometers ever driven, sensation seeking and northern residents. Among attenders who drank at bush parties, males were three and a half times more likely to drive after drinking at a bush party, and the probability of drinking and driving increased with the number of other drugs used. CONCLUSIONS: Despite important differences in the design and purpose of the two surveys, both indicate that bush party attendance is prevalent among adolescents. Driving after drinking at these events is common and warrants community action.

Adolescent↗
PubMed1996

Does increased spending on alcoholism treatment lead to lower cirrhosis death rates?

The purpose of this study was to see if recent changes in the funding of alcoholism programmes in the United States were related to changes in liver cirrhosis death rates. Data on per-capita spending, per-capita alcohol consumption and cirrhosis death rates were gathered from various sources for the years 1979 and 1989 for the 50 states and the District of Columbia. Regression analysis showed that greater increases in spending on alcoholism across US states were associated with greater declines in cirrhosis mortality rates. Since alcohol-related deaths cause large productivity losses and treatment is relatively cheap this creates large savings for society.

Alcoholism↗
PubMed1996

Alcohol-related measures as factors in traffic fatalities.

OBJECTIVE: The purpose of this study was to determine if alcohol-related measures (per capita consumption, drinking-driving arrest rate, alcohol abuse treatment rate and Alcoholics Anonymous [AA] membership rate) were related to differences between states in traffic fatality rates (total and alcohol-related). METHOD: Fatality rates were regressed onto the alcohol-related variables, using state level data for 1982 and 1990 as well as measures of relative change between the 2 years. RESULTS: Fatality rates demonstrated significant positive relationships with per capita consumption and drinking-driving arrest rates, and significant negative relationships with AA membership rates, for the years 1982 and 1990. Also, changes in per capita consumption were significantly and positively related to changes in both traffic fatality measures. CONCLUSIONS: Per capita alcohol consumption measures were the strongest and most consistent determinants of traffic fatality measures. The negative relationship between AA membership rates and traffic fatality measures for 1982 and 1990 suggests a beneficial impact of AA on these measures at the aggregate level, although other explanations are possible.

Accidents, Traffic↗
PubMed1995

Changes in cancer mortality rates and per capita alcohol consumption in Ontario, 1963-1983.

Data on Ontario per capita alcohol consumption and alcohol-related cancer mortality rates from 1963 to 1983 generally correlated positively and significantly. Correlations for the period of rising consumption (1963-1974) were similar to those observed for the total period, but during the period of stabilization and decline of alcohol consumption the magnitude of nearly all relationships decreased substantially. The overall positive and significant correlation between per capita alcohol consumption and various cancer site mortality rates may be partly due to lag effects from the period when consumption was on the rise.

Adolescent↗
PubMed1995

Treatment, health promotion and alcohol controls and the decrease of alcohol consumption and problems in Ontario: 1975-1993.

We report information on trends in alcohol problems, alcohol consumption, alcohol availability and prevention measures in Ontario for the period 1975-1993. Problem measures show substantial declines over the period. Measures of consumption have declined as well, but not as much as problem measures. Economic availability (relative price) has remained stable, while physical availability has increased. Prevention measures show substantial increases over the period.

Accidents, Traffic↗
PubMed1994

Rehabilitation for convicted drinking drivers (second offenders): effects on mortality.

The mortality experience of convicted drinking drivers (second offenders) (N = 347) randomly assigned to rehabilitation and control groups in two Ontario cities was examined. Over a follow-up period ranging between 8 and 13 years, 14 (11.0%) of the controls and 17 (7.7%) of the rehabilitation group died. Direct comparisons of the randomly assigned control and treatment groups revealed a tendency for lower total mortality and significantly lower mortality from accidental and violent death in those assigned to rehabilitation. Additional comparisons involving a combined rehabilitation group (N = 487) (rehabilitation participants randomly and not randomly assigned) confirmed these observations.

Accidents, Traffic↗
PubMed1993

Recent liver cirrhosis declines: estimates of the impact of alcohol abuse treatment and alcoholics anonymous.

This paper examines the proposition that increased treatment for alcohol abuse and Alcoholics Anonymous (AA) membership can account for a large part of the recent declines in cirrhosis mortality and morbidity. Data on treatment and AA membership in the USA between 1979 and 1987 and in Ontario between 1975 and 1986 are used, together with estimates of cirrhosis risk and the likely impact of treatment and AA membership. The results show that increased treatment levels and AA membership could account for all of the reductions in cirrhosis deaths and hospital admissions in Ontario. In the USA all of the deaths and about 40% of the admissions could be accounted for by these factors.

Alcohol Drinking↗