Andrés Villaveces

Bio: Andrés Villaveces is an academic researcher from Centers for Disease Control and Prevention. The author has contributed to research in topics: Poison control & Injury prevention. The author has an hindex of 26, co-authored 98 publications receiving 3207 citations. Previous affiliations of Andrés Villaveces include World Bank Group & World Health Organization.

Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence

Abstract: Regional trauma centers were developed 25 years ago in response to studies showing that 40% of deaths from injuries in the United States could have been prevented if the patient had been treated in a facility with special expertise in treating injuries. 1 With the advent of regional trauma systems, the preventable death rate has now been reduced to <2% to 3%; therefore, future decreases in the trauma death rate are not likely to occur as a result of improvements in the delivery of care. 2 Nearly half of all trauma deaths occur at the scene; these also are not responsive to improvements in care. 3,4 Future significant decreases in the death rate for injuries, therefore, depend primarily on progress in injury prevention. By far the most common underlying causes of injuries in the United States are alcohol abuse and dependence. 5,6 Studies repeatedly demonstrate that approximately 50% of patients admitted to a trauma center are under the influence of alcohol, and the mean blood alcohol concentration of such patients is 187 mg/dl, nearly twice the legal level for driving in most states. 7,8 When questionnaires such as the Short Michigan Alcohol Screening Test (SMAST) are administered to trauma patients, as many as 44% test positive for chronic alcohol abuse. 9,10 Alcoholism plays such a significant role in trauma that efforts to reduce the risk of injuries or their recurrence are unlikely to be successful if it remains untreated. In the past several years, there has been increasing interest in the use of brief, motivational interventions designed to assist patients with alcohol abuse or mild symptoms of alcohol dependency to reduce or eliminate their alcohol consumption. A series of randomized trials conducted in a variety of health care settings have demonstrated a significant reduction in alcohol consumption with the use of brief interventions in appropriately targeted populations. 11–13 Addressing alcohol problems in trauma centers is currently not routine. Only 19% of trauma centers routinely measure blood alcohol concentrations on injured patients, and <15% formally assess patients for an alcohol use disorder using screening questionnaires; the provision of alcohol counseling as a routine component of trauma care is even rarer. 14 Preliminary data suggest that a recent life-threatening injury increases the receptivity of patients toward alcohol counseling. 15–19 We hypothesized that alcohol interventions, coupled with trauma center admission, would significantly reduce alcohol consumption and decrease the risk of reinjury. We report the first prospective, randomized, controlled trial on the use of alcohol interventions in a level 1 trauma center as a means of injury prevention.

Gun storage practices and risk of youth suicide and unintentional firearm injuries.

Abstract: ContextHousehold firearms are associated with an elevated risk of firearm death to occupants in the home. Many organizations and health authorities advocate locking firearms and ammunition to prevent access to guns by children and adolescents. The association of these firearm storage practices with the reduction of firearm injury risk is unclear.ObjectiveTo measure the association of specific household firearm storage practices (locking guns, locking ammunition, keeping guns unloaded) and the risk of unintentional and self-inflicted firearm injuries.Design and SettingCase-control study of firearms in events identified by medical examiner and coroner offices from 37 counties in Washington, Oregon, and Missouri, and 5 trauma centers in Seattle, Spokane, and Tacoma, Wash, and Kansas City, Mo.Cases and ControlsCase firearms were identified by involvement in an incident in which a child or adolescent younger than 20 years gained access to a firearm and shot himself/herself intentionally or unintentionally or shot another individual unintentionally. Firearm assaults and homicides were excluded. We used records from hospitals and medical examiners to ascertain these incidents. Using random-digit dial telephone sampling, control firearms were identified by identification of eligible households with at least 1 firearm and children living or visiting in the home. Controls were frequency matched by age group and county.Main Exposure MeasuresThe key exposures of interest in this study were: (1) whether the subject firearm was stored in a locked location or with an extrinsic lock; (2) whether the firearm was stored unloaded; (3) whether the firearm was stored both unloaded in a locked location; (4) whether the ammunition for the firearm was stored separately; and (5) whether the ammunition was stored in a locked location. Data regarding the storage status of case and control guns were collected by interview with respondents from the households of case and control firearms.ResultsWe interviewed 106 respondents with case firearms and 480 with control firearms. Of the shootings associated with the case firearms, 81 were suicide attempts (95% fatal) and 25 were unintentional injuries (52% fatal). After adjustment for potentially confounding variables, guns from case households were less likely to be stored unloaded than control guns (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.16-0.56). Similarly, case guns were less likely to be stored locked (OR, 0.27; 95% CI, 0.17-0.45), stored separately from ammunition (OR, 0.45; 95% CI, 0.34-0.93), or to have ammunition that was locked (OR, 0.39; 95% CI, 0.23-0.66) than were control guns. These findings were consistent for both handguns and long guns and were also similar for both suicide attempts and unintentional injuries.ConclusionsThe 4 practices of keeping a gun locked, unloaded, storing ammunition locked, and in a separate location are each associated with a protective effect and suggest a feasible strategy to reduce these types of injuries in homes with children and teenagers where guns are stored.

Preventing violence: a guide to implementing the recommendations of the World Report on Violence and Health.

Abstract: Interpersonal violence is violence between individuals or small groups of individuals. It is an insidious and frequently deadly social problem and includes child maltreatment youth violence intimate partner violence sexual violence and elder abuse. It takes place in the home on the streets and in other public settings in the workplace and in institutions such as schools hospitals and residential care facilities. The direct and indirect financial costs of such violence are staggering as are the social and human costs that cause untold damage to the economic and social fabric of communities. With the publication in 2002 of the World report on violence and health an initial sense of the global extent of the interpersonal violence problem was provided and the central yet frequently overlooked role of the health sector in preventing such violence and treating its victims was made explicit. The report clearly showed that investing in multi-sectoral strategies for the prevention of interpersonal violence is not only a moral imperative but also makes sound scientific economic political and social sense and that health sector leadership is both appropriate and essential given the clear public health dimensions of the problem and its solutions. The report also reviewed the increasing evidence that primary prevention efforts which target the root causes and situational determinants of interpersonal violence are both effective and cost-effective. In support of such approaches the report recommended six country-level activities namely: 1. Increasing the capacity for collecting data on violence. 2. Researching violence – its causes consequences and prevention. 3. Promoting the primary prevention of violence. 4. Promoting gender and social equality and equity to prevent violence. 5. Strengthening care and support services for victims. 6. Bringing it all together – developing a national action plan of action. (excerpt)

What Do We Know About the Association Between Firearm Legislation and Firearm-Related Injuries?

Abstract: Firearms account for a substantial proportion of external causes of death, injury, and disability across the world. Legislation to regulate firearms has often been passed with the intent of reducing problems related to their use. However, lack of clarity around which interventions are effective remains a major challenge for policy development. Aiming to meet this challenge, we systematically reviewed studies exploring the associations between firearm-related laws and firearm homicides, suicides, and unintentional injuries/deaths. We restricted our search to studies published from 1950 to 2014. Evidence from 130 studies in 10 countries suggests that in certain nations the simultaneous implementation of laws targeting multiple firearms restrictions is associated with reductions in firearm deaths. Laws restricting the purchase of (e.g., background checks) and access to (e.g., safer storage) firearms are also associated with lower rates of intimate partner homicides and firearm unintentional deaths in children, respectively. Limitations of studies include challenges inherent to their ecological design, their execution, and the lack of robustness of findings to model specifications. High quality research on the association between the implementation or repeal of firearm legislation (rather than the evaluation of existing laws) and firearm injuries would lead to a better understanding of what interventions are likely to work given local contexts. This information is key to move this field forward and for the development of effective policies that may counteract the burden that firearm injuries pose on populations.

Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research.

Abstract: Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record

Motivational interviewing: a systematic review and meta-analysis

Abstract: Background Motivational Interviewing is a well-known, scientifically tested method of counselling clients developed by Miller and Rollnick and viewed as a useful intervention strategy in the treatment of lifestyle problems and disease. Aim To evaluate the effectiveness of motivational interviewing in different areas of disease and to identify factors shaping outcomes. Design of study A systematic review and meta-analysis of randomised controlled trials using motivational interviewing as the intervention. Method After selection criteria a systematic literature search in 16 databases produced 72 randomised controlled trials the first of which was published in 1991. A quality assessment was made with a validated scale. A meta-analysis was performed as a generic inverse variance meta-analysis. Results Meta-analysis showed a significant effect (95% confidence interval) for motivational interviewing for combined effect estimates for body mass index, total blood cholesterol, systolic blood pressure, blood alcohol concentration and standard ethanol content, while combined effect estimates for cigarettes per day and for HbA1c were not significant. Motivational interviewing had a significant and clinically relevant effect in approximately three out of four studies, with an equal effect on physiological (72%) and psychological (75%) diseases. Psychologists and physicians obtained an effect in approximately 80% of the studies, while other healthcare providers obtained an effect in 46% of the studies. When using motivational interviewing in brief encounters of 15 minutes, 64% of the studies showed an effect. More than one encounter with the patient ensures the effectiveness of motivational interviewing. Conclusion Motivational interviewing in a scientific setting outperforms traditional advice giving in the treatment of a broad range of behavioural problems and diseases. Large-scale studies are now needed to prove that motivational interviewing can be implemented into daily clinical work in primary and secondary health care.