logging in or signing up Preventing Alcohol Related Violence Dario Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 368 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: January 11, 2008 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: VK415 (40 month(s) ago) Hi, Dear, How long an intervention continues depends on the addiction person. It depends on how long it takes the individual to see their need for help. The cognition sometimes occurs days after the intervention happened. They normally realize that they need to join a rehab program and that tells you that the intervention worked. --------------------------------- vijendra jain ---------------------------------- [url=http://www.drug-intervention.com/co lorado-drug-intervention.html]Drug Intervention Colorado [/URL] - Drug Intervention Colorado Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Slide1: Health Challenge Wales: alcohol misuse Preventing Alcohol Related Violence Jonathan Shepherd FMedSci Professor of Oral & Maxillofacial Surgery Director, Violence Research GroupSITE AND TYPE OF INJURY IN CONSECUTIVE ASSAULT VICTIMS: SITE AND TYPE OF INJURY IN CONSECUTIVE ASSAULT VICTIMS Number of Patients (n=530) Face Other head/neck Thorax Abdomen Lower limb Upper limbINCIDENCE OF VIOLENCE/MAXILLOFACIAL INJURY: INCIDENCE OF VIOLENCE/MAXILLOFACIAL INJURY Death rate: 28.8/100,000 population worldwide 2000. (WHO 2003) Mean annual risk of assault injury in UK 1995-2000/10,000 population (Sivarajasingam et al 2004) 75: males 26: females 28: Southeast 100: Northwest 76,000 assault patients treated by UK Maxillofacial services in 1997. (BAOMS Face Injury Survey 1998). Antisocial lifestyles include offending and injury (Shepherd et al 2004)RECORDING OF VIOLENT OFFENCES BY THE POLICE: RECORDING OF VIOLENT OFFENCES BY THE POLICE Crime Surveys in Sweden, UK and US demonstrate low recording rates Police recording varies by victim age and gender and violence location 23% of people injured in violence (hospital data) recorded by policeSlide7: VIOLENCE IN ODENSE MUNICIPALITY 1403 (100%) victims 869 (62%) victims 327 (23%) victims 207 (15%) victims ODENSE UNIVERSITY HOSPITAL POLICE (Faergemann 2006)Slide8: Police recording not related statistically to Injury Severity Scores 13% of firearm violence recorded in Atlanta EDs not recorded by policeSlide10: -4 -2 0 2 4 6 8 10 12 Before CCTV Control towns CCTV towns Percentage change After CCTV EFFECT OF CCTV ON POLICE VIOLENCE DETECTIONSlide11: EFFECT OF CCTV ON A&E ASSAULT ATTENDANCE Control towns After CCTV Percentage change Before CCTV CCTV townsSlide12: Trends in Violence in England and Wales Slide14: Community Safety Partnership CARDIFF VIOLENCE PREVENTION GROUPSlide15: OBJECTIVES Violence prevention Integrated victim services Slide16: CRIME AND DISORDER ACT 1998 334 partnerships Persons/bodies with statutory obligations include: Health Authorities National Health Trusts POLICE REFORM ACT 2002 Local Health Boards Primary Care Trusts Slide17: “To improve understanding of prevalence of disease … much greater use needs to be made of primary care data. [Their] potential … to guide both national understanding and lead activity must be fully realised.” WANLESS 2004 UK Treasury AdviserSlide19: National/Regional measurement ED data Local surveillance/prevention Slide20: INDEPENDENT NATIONAL CORRELATES WITH ASSAULT INJURY (ED measure) Unemployment/Deprivation Ethnic minority population Alcohol expenditure Lager price Season VIOLENCE HOTSPOTS IN 21st CENTURY CARDIFF: VIOLENCE HOTSPOTS IN 21st CENTURY CARDIFF CHOLERA HOTSPOTS IN VICTORIAN LONDON: CHOLERA HOTSPOTS IN VICTORIAN LONDON TARGETED POLICING: TARGETED POLICING Combined ED/Police intelligence High visibility/covert operations Patrols Day-time liaison with licensees Redeployment Door-staff regulation/enforcement Fast-food outlet relocation Traffic flow/car-park improvement EVALUATION: EVALUATION Marked decreases in assault injury in target premises Significantly greater decrease in assault injury in premises targeted by police and ED compared with targeted policing alone (OR=0.6. 95% CI 0.37-0.97) Marked increase in street assault in main entertainment thoroughfare Licensed premises capacity predicted street assaults Slide26: Monthly Assault Attendances – Cardiff ED VIOLENCE PREVENTION: VIOLENCE PREVENTION Primary prevention Community RCT of toughened glass Secondary prevention Court and Clinic RCTs of alcohol misuse motivational interview Tertiary prevention RCT of cognitive behavioural therapy to prevent post traumatic stress disorder Slide29: Primary Prevention: glass injurySlide30: Toughened glass Non-toughened glassRCT OF TOUGHENED GLASSES: RCT OF TOUGHENED GLASSES 57 UK Bars randomised to toughened or non-toughened beer glasses. Injury data from 1,229 bar workers. Relative Risk: 1.5 (95% CI:1.1-2.3). Injury rate 60% higher in intervention group. But, impact resistance of toughened glasses significantly higher: double blind trial Conclusion: toughened glass resulted in lower injury risk. Slide32: Secondary Prevention RCT OF A BRIEF ALCOHOL (motivational interviewing) INTERVENTION: Victims Maxillofacial clinics Men aged 16-35 with facial injury 7 units in 6 hours pre-injury Slide33: ABSTINENT DAYS Abstinent Days (± Standard Error) Baseline 3 months 12 months Control Group Intervention Group 65 60 55 50 45 40 35 Slide34: Re-offending at 12 months 95%CI= -0.11, +0.14 MAGISTRATES COURT RCT: OffendersSlide35: Injury at 12 months 95%CI= -0.23, -0.009* Slide36: MAGISTRATES COURT RCT: Offenders No effect on alcohol misuse No effect on offending Significant reduction in injury In sum, reducing alcohol misuse may reduce victim vulnerability more than the propensity to offend Slide37: Tertiary Prevention: post traumatic stressRCT: FOUR SESSION COGNITIVE BEHAVIOURAL THERAPY: RCT: FOUR SESSION COGNITIVE BEHAVIOURAL THERAPY Bisson, Shepherd, Joy, Probert & Newcombe (2004)Slide39: PREVENTING COMMUNITY VIOLENCE Combining care with prevention Secondary Prevention: alcohol misuse intervention Victim contacted to identify: Physical injury treated Core assault data recorded and anonymised Victim advised on police reporting Mental health needs Circumstances of assault Primary Prevention Tertiary Prevention: cognitive behavioural therapy You do not have the permission to view this presentation. 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Preventing Alcohol Related Violence Dario Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 368 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: January 11, 2008 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: VK415 (40 month(s) ago) Hi, Dear, How long an intervention continues depends on the addiction person. It depends on how long it takes the individual to see their need for help. The cognition sometimes occurs days after the intervention happened. They normally realize that they need to join a rehab program and that tells you that the intervention worked. --------------------------------- vijendra jain ---------------------------------- [url=http://www.drug-intervention.com/co lorado-drug-intervention.html]Drug Intervention Colorado [/URL] - Drug Intervention Colorado Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Slide1: Health Challenge Wales: alcohol misuse Preventing Alcohol Related Violence Jonathan Shepherd FMedSci Professor of Oral & Maxillofacial Surgery Director, Violence Research GroupSITE AND TYPE OF INJURY IN CONSECUTIVE ASSAULT VICTIMS: SITE AND TYPE OF INJURY IN CONSECUTIVE ASSAULT VICTIMS Number of Patients (n=530) Face Other head/neck Thorax Abdomen Lower limb Upper limbINCIDENCE OF VIOLENCE/MAXILLOFACIAL INJURY: INCIDENCE OF VIOLENCE/MAXILLOFACIAL INJURY Death rate: 28.8/100,000 population worldwide 2000. (WHO 2003) Mean annual risk of assault injury in UK 1995-2000/10,000 population (Sivarajasingam et al 2004) 75: males 26: females 28: Southeast 100: Northwest 76,000 assault patients treated by UK Maxillofacial services in 1997. (BAOMS Face Injury Survey 1998). Antisocial lifestyles include offending and injury (Shepherd et al 2004)RECORDING OF VIOLENT OFFENCES BY THE POLICE: RECORDING OF VIOLENT OFFENCES BY THE POLICE Crime Surveys in Sweden, UK and US demonstrate low recording rates Police recording varies by victim age and gender and violence location 23% of people injured in violence (hospital data) recorded by policeSlide7: VIOLENCE IN ODENSE MUNICIPALITY 1403 (100%) victims 869 (62%) victims 327 (23%) victims 207 (15%) victims ODENSE UNIVERSITY HOSPITAL POLICE (Faergemann 2006)Slide8: Police recording not related statistically to Injury Severity Scores 13% of firearm violence recorded in Atlanta EDs not recorded by policeSlide10: -4 -2 0 2 4 6 8 10 12 Before CCTV Control towns CCTV towns Percentage change After CCTV EFFECT OF CCTV ON POLICE VIOLENCE DETECTIONSlide11: EFFECT OF CCTV ON A&E ASSAULT ATTENDANCE Control towns After CCTV Percentage change Before CCTV CCTV townsSlide12: Trends in Violence in England and Wales Slide14: Community Safety Partnership CARDIFF VIOLENCE PREVENTION GROUPSlide15: OBJECTIVES Violence prevention Integrated victim services Slide16: CRIME AND DISORDER ACT 1998 334 partnerships Persons/bodies with statutory obligations include: Health Authorities National Health Trusts POLICE REFORM ACT 2002 Local Health Boards Primary Care Trusts Slide17: “To improve understanding of prevalence of disease … much greater use needs to be made of primary care data. [Their] potential … to guide both national understanding and lead activity must be fully realised.” WANLESS 2004 UK Treasury AdviserSlide19: National/Regional measurement ED data Local surveillance/prevention Slide20: INDEPENDENT NATIONAL CORRELATES WITH ASSAULT INJURY (ED measure) Unemployment/Deprivation Ethnic minority population Alcohol expenditure Lager price Season VIOLENCE HOTSPOTS IN 21st CENTURY CARDIFF: VIOLENCE HOTSPOTS IN 21st CENTURY CARDIFF CHOLERA HOTSPOTS IN VICTORIAN LONDON: CHOLERA HOTSPOTS IN VICTORIAN LONDON TARGETED POLICING: TARGETED POLICING Combined ED/Police intelligence High visibility/covert operations Patrols Day-time liaison with licensees Redeployment Door-staff regulation/enforcement Fast-food outlet relocation Traffic flow/car-park improvement EVALUATION: EVALUATION Marked decreases in assault injury in target premises Significantly greater decrease in assault injury in premises targeted by police and ED compared with targeted policing alone (OR=0.6. 95% CI 0.37-0.97) Marked increase in street assault in main entertainment thoroughfare Licensed premises capacity predicted street assaults Slide26: Monthly Assault Attendances – Cardiff ED VIOLENCE PREVENTION: VIOLENCE PREVENTION Primary prevention Community RCT of toughened glass Secondary prevention Court and Clinic RCTs of alcohol misuse motivational interview Tertiary prevention RCT of cognitive behavioural therapy to prevent post traumatic stress disorder Slide29: Primary Prevention: glass injurySlide30: Toughened glass Non-toughened glassRCT OF TOUGHENED GLASSES: RCT OF TOUGHENED GLASSES 57 UK Bars randomised to toughened or non-toughened beer glasses. Injury data from 1,229 bar workers. Relative Risk: 1.5 (95% CI:1.1-2.3). Injury rate 60% higher in intervention group. But, impact resistance of toughened glasses significantly higher: double blind trial Conclusion: toughened glass resulted in lower injury risk. Slide32: Secondary Prevention RCT OF A BRIEF ALCOHOL (motivational interviewing) INTERVENTION: Victims Maxillofacial clinics Men aged 16-35 with facial injury 7 units in 6 hours pre-injury Slide33: ABSTINENT DAYS Abstinent Days (± Standard Error) Baseline 3 months 12 months Control Group Intervention Group 65 60 55 50 45 40 35 Slide34: Re-offending at 12 months 95%CI= -0.11, +0.14 MAGISTRATES COURT RCT: OffendersSlide35: Injury at 12 months 95%CI= -0.23, -0.009* Slide36: MAGISTRATES COURT RCT: Offenders No effect on alcohol misuse No effect on offending Significant reduction in injury In sum, reducing alcohol misuse may reduce victim vulnerability more than the propensity to offend Slide37: Tertiary Prevention: post traumatic stressRCT: FOUR SESSION COGNITIVE BEHAVIOURAL THERAPY: RCT: FOUR SESSION COGNITIVE BEHAVIOURAL THERAPY Bisson, Shepherd, Joy, Probert & Newcombe (2004)Slide39: PREVENTING COMMUNITY VIOLENCE Combining care with prevention Secondary Prevention: alcohol misuse intervention Victim contacted to identify: Physical injury treated Core assault data recorded and anonymised Victim advised on police reporting Mental health needs Circumstances of assault Primary Prevention Tertiary Prevention: cognitive behavioural therapy