Browsing by Author "Cremonte, Mariana"

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Alcohol and violence in the emergency department: a regional report from the WHO collaborative study on alcohol and injuries
(Dirección General de Evaluación del Desempeño, Secretaría de Salud. Reforma 450, piso 12.col. Juárez. 06600 México DF, México., 2008) Borges, Guilherme; Orozco, Ricardo; Cremonte, Mariana; Buzi-Figlie, Neliana; Cherpitel, Cheryl; Poznyak, Vladimir; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mx
Determinar el riesgo relativo (RR) de lesiones no intencionales y relacionadas con la violencia, asociadas al consumo de alcohol en tres Servicios de Urgencia de América Latina (2001-2002). Material y métodos. Se usó un diseño case-crossover en 447 pacientes de Argentina (A), 489 de Brasil (B) y 455 de México (M). Resultados. El 46% de los casos relacionados a la violencia consumieron alcohol (vs. 11.5% de los no-violentos). El riesgo de una lesión relacionada con la violencia se incrementó con el consumo, y tuvo una RM= 15.0, intervalo de confianza al 95% (IC= 5.8-39.1), pero correspondió a 4.2 (IC= 2.7-6.5) para las lesiones nointencionales. Conclusiones. Mayores cantidades de alcohol tienen consecuencias en el riesgo de desencadenar una lesión, especialmente en lesiones relacionadas con la violencia. Los estimadores del RR que se presentan pueden ser usados como nuevas fuentes para estimadores de la carga de la enfermedad asociada al consumo de alcohol.
Alcohol-related injury in the ER: a cross-national meta-analysis from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP)
(New Brunswick, N.J. : Journal of Studies on Alcohol, 2003) Cherpitel, Cheryl J.; Bond, Jason; Ye, Yu; Borges, Guilherme; MacDonald, Scott; Stockwell, Tim; Giesbrecht, Norman; Cremonte, Mariana; Public Health Institute, Alcohol Research Group, 2000 Hearst Avenue, Berkeley, California 94709
Performance of a Craving Criterion in DSM Alcohol Use Disorders
(Alcohol Res Documentation Inc Cent Alcohol Stud Rutgers Univ, C/O Deirdre English, 607 Allison RD, Piscataway, NJ 08854-8001 USA, 2010) Cherpitel, Cheryl J.; Borges, Guilherme; Ye, Yu; Bond, Jason; Cremonte, Mariana; Moskalewicz, Jacek; Swiatkiewicz, Grazyna; Alcohol Res Grp, Emeryville, CA 94608 USA; ccherpitel@arg.org
Objective: Adding a craving criterion presently in the International Classification of Diseases, 10th Revision, diagnosis of alcohol dependence has been under consideration as one possible improvement to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and was recently proposed for inclusion by the DSM Substance-Related Disorders Work Group in the Fifth Revision of diagnostic criteria for alcohol use disorders. To inform cross-cultural applicability of this modification, performance of a craving criterion was examined in emergency departments in four countries manifesting distinctly different culturally based drinking patterns (Mexico, Poland, Argentina, United States). Method: Exploratory factor analysis and item response theory were used to examine psychometric properties and individual item characteristics of the 11 DSM-IV abuse and dependence criteria with and without craving for each country separately. Differential item functioning analysis was performed to examine differences in the difficulty of endorsement (severity) and discrimination of craving across countries. Results: Exploratory factor analysis found craving fit well within a one-dimensional solution, and factor loadings were high across all countries. Results from item-response theory analyses indicated that both discrimination and difficulty estimates for the craving item were located in the middle of the corresponding discrimination and difficulty ranges for the other 11 items for each country but did not substantially increase the efficiency (or information) of the overall diagnostic scheme. Across the four countries, no differential item functioning was found for difficulty, but significant differential item functioning was found for discrimination (similar to other DSM-IV criteria). Conclusions: Findings suggest that, although craving performed similarly across emergency departments in the four countries, it does not add much in identification of individuals with alcohol use disorders. (J. Stud. Alcohol Drugs, 71, 674-684, 2010)
Psychometric properties of alcohol screening tests in the emergency department in Argentina, Mexico and the United States
(PERGAMON-ELSEVIER SCIENCE LTD, THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 1GB, ENGLAND, 2010) Cremonte, Mariana; Daniel Ledesma, Ruben; Cherpitel, Cheryl J.; Borges, Guilherme; Univ Nacl Mar del Plata, Consejo Nacl Invest Cient & Tecn, Fac Psicol, Ctr Interdiscipliario Invest Psicol Matemat & Exp, RA-7600 Mar Del Plata, Argentina; mcremont@mdp.edu.ar
The objective of this article is to report psychometric characteristics of the AUDIT, CAGE, RAPS4, and TWEAK and to compare them across three countries: Argentina, Mexico, and the United States which used a similar protocol and methodology. Probability samples of patients 18 years and older were drawn from emergency departments in Mar del Plata, Argentina (n = 780), Pachuca, Mexico (n=1624) and Santa Clara, U.S. (n=1220). Concurrent validity was assessed by comparing their performance against a diagnosis of alcohol dependence (DSM-IV) obtained through the Composite International Diagnostic Interview, and for the briefer measures, also by their correlation with the AUDIT. The internal consistency of the CAGE, RAPS4, and TWEAK scores was estimated by the KR-20 formula and by Cronbach's Alpha for the AUDIT. Corrected item-total correlation and D-values were used as item discrimination measures. In Argentina and Mexico the AUDIT and the RAPS4 showed the highest validity. Reliability of all instruments was higher in the US than in Argentina or Mexico. In all three countries, reliability of the TWEAK was lowest, while the AUDIT was highest. With a few exceptions, all items showed good discrimination powers. (C) 2010 Elsevier Ltd. All rights reserved.
The dimensionality of alcohol use disorders and alcohol consumption in a cross-national perspective
(WILEY-BLACKWELL, COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA, 2010) Borges, Guilherme; Ye, Yu; Bond, Jason; Cherpitel, Cheryl J.; Cremonte, Mariana; Moskalewicz, Jacek; Swiatkiewicz, Grazyna; Rubio-Stipec, Maritza; Inst Nacl Psiquiatria Ramon de la Fuente, Direcc Invest Epidemiol & Psicosociales, Mexico City 14370, DF, Mexico; guibor@imp.edu.mx
Aims: To replicate the finding that there is a single dimension trait in alcohol use disorders and to test whether the usual 5+ drinks for men and 4+ drinks for women and other measures of alcohol consumption help to improve alcohol use disorder criteria in a series of diverse patients from emergency departments (EDs) in four countries. Design: Cross-sectional surveys of patients aged 18 years and older that reflected consecutive arrival at the ED. The Composite International Diagnostic Interview Core was used to obtain a diagnosis of DSM-IV alcohol dependence and alcohol abuse; quantity and frequency of drinking and drunkenness as well as usual number of drinks consumed during the last year. Setting: Participants were 5195 injured and non-injured patients attending seven EDs in four countries: Argentina, Mexico, Poland and the United States (between 1995-2001). Findings: Using exploratory factor analyses alcohol use disorders can be described as a single, unidimensional continuum without any clear-cut distinction between the criteria for dependence and abuse in all sites. Results from item response theory analyses showed that the current DSM-IV criteria tap people in the middle-upper end of the alcohol use disorder continuum. Alcohol consumption (amount and frequency of use) can be used in all EDs with the current DSM-IV diagnostic criteria to help tap the middle-lower part of this continuum. Even though some specific diagnostic criteria and some alcohol consumption variables showed differential item function across sites, test response curves were invariant for ED sites and their inclusion would not impact the final (total) performance of the diagnostic system. Conclusions: DSM-IV abuse and dependence form a unidimensional continuum in ED patients regardless of country of survey. Alcohol consumption variables, if added, would help to tap patients with more moderate severity. The DSM diagnostic system for alcohol use disorders showed invariance and performed extremely well in these samples.
The Relationship Between Self-Reported Drinking and BAC Level in Emergency Room Injury Cases: Is it a Straight Line?
(Wiley-Blackwell, Commerce Place, 350 Main ST, Malden 02148, MA USA, 2010) Bond, Jason; Ye, Yu; Cherpitel, Cheryl J.; Room, Robín; Rehm, Juergen; Borges, Guilherme; Cremonte, Mariana; Gmel, Gerhard; Hao, Wei; Sovinova, Hana; Stockwell, Tim; Alcohol Res Grp, Emeryville, CA 94608 USA; jbond@arg.org
Background: While the validity of self-reported consumption based on blood alcohol concentration (BAC) has been found to be high in emergency room (ER) samples, little research exists on the estimated number of drinks consumed given a BAC level. Such data would be useful in establishing a dose-response relationship between drinking and risk (e.g., of injury) in those studies for which the number of drinks consumed is not available but BAC is. Methods: Several methods were used to estimate the number of drinks consumed in the 6 hours prior to injury based on BAC obtained at the time of ER admission of n = 1,953 patients who self-reported any drinking 6 hours prior to their injury and who arrived to the ER within 6 hours of the event, from the merged Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the World Health Organization Collaborative Study on Alcohol and Injury across 16 countries. Results: The relationship between self-reported consumption and averaged BAC within each consumption level appeared to be fairly linear up to about 7 drinks and a BAC of approximately 100 mg/dl. Above about 7 reported drinks, BAC appeared to have no relationship with drinking, possibly representing longer consumption periods than only the 6 hours before injury for those reporting higher quantities consumed. Both the volume estimate from the bivariate BAC to self-report relationship as well as from a Widmark calculation using BAC and time from last drink to arrival to the ER indicated a somewhat weak relationship to actual number of self-reported drinks. Conclusions: Future studies may benefit from investigating the factors suspected to be driving the weak relationships between these measures, including the actual time over which the reported alcohol was consumed and pattern of drinking over the consumption period.
Threshold and Optimal Cut-Points for Alcohol Use Disorders Among Patients in the Emergency Department
(WILEY-BLACKWELL, COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA, 2011) Borges, Guilherme; Cherpitel, Cheryl J.; Ye, Yu; Bond, Jason; Cremonte, Mariana; Moskalewicz, Jacek; Swiatkiewicz, Grazyna; Inst Nacl Psiquiatria, Dept Invest Epidemiol, Direcc Invest Epidemiol & Psicosociales, Calzada Mexico Xochimilco 101, Mexico City 14370, DF, Mexico.; guibor@imp.edu.mx
Background: Current research suggests that Diagnostic and Statistical Manual of Mental Disorder (DSM)-IV alcohol abuse and dependence form a unidimensional continuum in emergency department (ED) patients in 4 countries: Argentina, Mexico, Poland, and the United States. In this continuum of alcohol use disorder (AUD), there are no clear-cut distinctions between the criteria for dependence and abuse in the severity dimension based on prior results from item response theory (IRT) analysis. Nevertheless, it is desirable to find a threshold for identifying cases for clinical practice and cut-points of clinical utility in this continuum to distinguish between patients more or less affected by an AUD, using a scale of symptoms count. Methods: Data from 5,193 patients in 7 ED sites in the same 4 countries (3,191 current drinkers) were used to study the structure, threshold, and possible cut-points for the diagnoses of AUD. Results: The proposed changes in the DSM-V, dropping the abuse item "legal problems" and adding an item on "craving," did not impact the IRT performance and unidimensionality of AUD in this sample. With a total set of 11 items (deleting "legal problems" and adding "craving" to the current set of DSM criteria), an endorsement of 2 or more criteria can be used as the threshold to define those with an AUD in clinical practice. Furthermore, we can distinguish at least 2 levels of clinical severity, 2 to 3 criteria (moderate), and 4 or more criteria (severe). Conclusions: A dimensional approach to AUD using the proposed new set of criteria for the DSM-V can be used to propose a threshold and levels of severity. More research in different populations and countries is needed to further substantiate a threshold and cut-points that could be used in new formulations of substance use disorders.