Publications by authors named "Maristela G Monteiro"

16 Publications

  • Page 1 of 1

Road traffic injuries and substance use among emergency department patients in the Dominican Republic and Peru.

Rev Panam Salud Publica 2021 24;45:e31. Epub 2021 Mar 24.

Inter-American Development Bank Washington, D.C. United States of America Inter-American Development Bank, Washington, D.C., United States of America.

Objective: To report demographic and substance use characteristics and risk of road traffic injury (RTI) from alcohol use, cannabis use, and combined use in a sample of emergency department patients from two countries in Latin America and the Caribbean.

Methods: A cross-sectional study in which patients 18 years and older admitted within six hours of suffering an RTI to one emergency department in Santa Domingo, Dominican Republic ( = 501) and in Lima, Peru ( = 431) were interviewed. Case-crossover analysis, based on self-reported use prior to the RTI, was used to analyze risk from alcohol, cannabis, and co-use.

Results: Overall, 15.3% reported alcohol use prior to the event and 2.5% cannabis use. Drivers using alcohol only were over twice as likely to have an RTI (OR = 2.46, < 0.001), and nearly eight times more likely if using both alcohol and cannabis (OR = 6.89, < 0.01), but risk was not elevated for cannabis alone. Significant differences were not found for passengers or pedestrians.

Conclusions: Risk of RTI for drivers in these two samples is significantly elevated from alcohol use, and more so for co-use with cannabis. Differences between the two countries underscore the need for similar data from the region to determine risk of RTI from substance use, including risk for passengers and pedestrians. Data suggest that alcohol contributes significantly to the burden of RTI, which calls for more stringent enforcement of alcohol control policy related to drink driving in the region.
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http://dx.doi.org/10.26633/RPSP.2021.31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993299PMC
March 2021

What is associated with the increased frequency of heavy episodic drinking during the COVID-19 pandemic? Data from the PAHO regional web-based survey.

Drug Alcohol Depend 2021 04 16;221:108621. Epub 2021 Feb 16.

Universidade Federal de São Paulo - UNIFESP, Department of Preventive Medicine, São Paulo, Brazil. Electronic address:

Background: To estimate the prevalence of changes in the frequency of self-reported heavy episodic drinking (HED) among drinkers in Latin America and Caribbean countries on alcohol consumption during the COVID-19 pandemic, and to assess self-reported factors associated with the increased frequency of HED.

Methods: Data from 12,328 adults who responded to the cross-sectional survey conducted in 33 countries of Latin America and the Caribbean by Pan American Health Organization were used. Logistic regression analyses were performed to estimate the effect of the sociodemographic characteristics, quarantine practices, and anxiety symptoms on the increase in frequency of HED among the 2019 drinkers.

Results: 65 % of drinkers in 2019 self-reported HED during the COVID-19 pandemic with 13.8 % of the drinkers reporting an increase in HED compared to a 33.38 % decrease in HED. Multivariable analysis indicated that male gender (aOR 1.29, 95 %CI 1.13; 1.49), higher income (aOR 1.64, 95 %CI 1.35; 1.99) and higher level of quarantine practices (aOR 1.10, 95 %CI 1.04; 1.16) were positively associated with increased frequency of HED; unemployment (aOR 0.78, 95 %CI 0.64; 0.96), student status (aOR 0.53, 95 %CI 0.43; 0.64) and living with children (aOR 0.91, 95 %CI 0.84; 0.99) were negatively associated with increased frequency of HED. A gradient of association was found between generalized anxiety disorder and an increase in HED frequency during the pandemic.

Conclusion: Along with other measures to decrease the spread of COVID-19, it is important to include measures to reduce alcohol consumption and address mental health conditions in the national response to the pandemic.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108621DOI Listing
April 2021

Alcohol Policy and Coronavirus: An Open Research Agenda.

J Stud Alcohol Drugs 2020 05;81(3):297-299

Director of Strategy and Advocacy, Movendi International, Stockholm, Sweden.

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May 2020

Dose-Response Relative Risk of Injury From Acute Alcohol Consumption in 22 Countries: Are Women at Higher Risk Than Men?

Alcohol Alcohol 2019 Jul;54(4):396-401

Pan American Health Organization, Washington, DC, USA.

Aims: The risk of injury from alcohol consumption was analyzed by gender, controlling for frequency of heavy drinking occasions, and by cause of injury (traffic, violence, fall, other).

Methods: Case-crossover analysis was conducted on 18,627 injured patients arriving at the emergency department (ED) within six hours of the event.

Findings: Risk of injury was similar for females and males at ≤3 drinks prior to injury (OR = 2.74 vs. 2.76, respectively). At higher volume levels females were at greater risk than males, and significantly so at 3.1-6 drinks and 6.1-10 drinks (gender by volume interaction: OR = 0.60, CI = 0.39-0.93 and OR = 0.50, CI = 0.27-0.93, respectively). For those reporting 5+ ≥ monthly, females were at higher risk than males at all volume levels, and the gender by volume interaction was stronger than for those consuming 5+
Conclusions: Females are at higher risk of injury than males, regardless of frequency of heavy drinking and for all causes other than those related to traffic.
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http://dx.doi.org/10.1093/alcalc/agz018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6671521PMC
July 2019

Dose-Response Relationship of Alcohol and Injury Cause: Effects of Country-Level Drinking Pattern and Alcohol Policy.

Alcohol Clin Exp Res 2019 05 13;43(5):850-856. Epub 2019 Mar 13.

National Institute on Alcohol Abuse and Alcoholism, Washington, District of Columbia.

Background: The dose-response relationship of alcohol and injury and the effects of country-level detrimental drinking pattern (DDP) and alcohol control policy on this relationship are examined for specific causes of injury.

Methods: The dose-response risk of injury is analyzed on 18,627 injured patients in 22 countries included in the International Collaborative Alcohol and Injury Study, using case-crossover analysis by cause of injury (traffic, violence, falls, other), DDP, and the International Alcohol Policy and Injury Index.

Results: Risk of all injury was higher at all volume levels in higher DDP countries compared to lower DDP countries and for each cause of injury. Risk of injury from traffic was significantly greater in higher DDP than lower DDP countries at 3.1 to 6 drinks (odds ratio (OR) = 2.64, confidence interval (CI) = 1.17 to 5.97) and at ≤3 drinks for falls (OR = 2.51, CI = 1.52 to 4.16) and injuries from other causes (OR = 1.72, CI = 1.10 to 2.69). Countries with higher restrictive alcohol policy were at a lower risk of injury at lower levels of consumption (≤3 drinks) for all injuries (OR = 0.72, CI = 0.56 to 0.92) and for injuries from other causes (OR = 0.46, CI = 0.29 to 0.73) and at a lower risk of traffic injuries at higher levels of consumption (≥10 drinks). At higher levels of consumption (≥10 drinks), countries with higher alcohol policy restrictiveness were at greater risk of all injuries (OR = 2.03, CI = 1.29 to 3.20) and those from violence (OR = 9.02, CI = 3.00 to 27.13) and falls (OR = 4.29, CI = 1.86 to 9.91).

Conclusions: Countries with high DDP are at higher risk of injury from most causes at a given level of consumption, while countries with low restrictiveness of alcohol policy are at higher risk of injury at lower levels of consumption and at higher risk of traffic injuries at high levels of consumption. These findings underscore the importance of aggregate-level factors which need to be considered in developing effective intervention and prevention strategies for reducing alcohol-related injury.
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http://dx.doi.org/10.1111/acer.13986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502645PMC
May 2019

Actual and predicted prevalence of alcohol consumption during pregnancy in Latin America and the Caribbean: systematic literature review and meta-analysis.

Rev Panam Salud Publica 2017 Jun 8;41:e89. Epub 2017 Jun 8.

Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, Ontario, Canada.

Objective: To estimate the prevalence of alcohol consumption during pregnancy among the general population of Latin America and the Caribbean, by country, in 2012.

Methods: Three steps were taken: a comprehensive, systematic literature search; meta-analyses, assuming a random-effects model for countries with published studies; and regression modelling (data prediction) for countries with either no published studies or too few to obtain an estimate.

Results: Based on 24 existing studies, the pooled prevalence of alcohol consumption during pregnancy among the general population was estimated for Brazil (15.2%; 95% confidence interval [95%CI]: 10.4%-20.8%) and Mexico (1.2%; 95%CI: 0.0%-2.7%). The prevalence of alcohol consumption during pregnancy among the general population was predicted for 31 countries and ranged from 4.8% (95%CI: 4.2%-5.4%) in Cuba to 23.3% (95%CI: 20.1%-26.5%) in Grenada.

Conclusions: Greater prevention efforts and measures are needed in the countries of Latin America and the Caribbean to prevent pregnant women from consuming alcohol during pregnancy and decrease the rates of Fetal Alcohol Spectrum Disorder. Additional high quality studies on the prevalence of alcohol consumption during pregnancy in Latin America and the Caribbean are also needed.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645189PMC
June 2017

Alcohol marketing regulation: from research to public policy.

Addiction 2017 01;112 Suppl 1:3-6

UK Health Forum, London, UK.

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http://dx.doi.org/10.1111/add.13660DOI Listing
January 2017

Public policies to prevent alcohol-related harm.

Epidemiol Serv Saude 2016 Jan-Mar;25(1):171-174

Organização Pan-Americana da Saúde, Departamento de Doenças Não Transmissíveis e Saúde Mental, Washington-DC, Estados Unidos da América.

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http://dx.doi.org/10.5123/S1679-49742016000100017DOI Listing
August 2018

Exploring structural relationships between blood alcohol concentration and signs and clinical assessment of intoxication in alcohol-involved injury cases.

Alcohol Alcohol 2014 Jul-Aug;49(4):417-22. Epub 2014 Apr 4.

Pan American Health Organization, Washington, DC, USA.

Aims: Although the relationship between the Y90 (blood alcohol concentration, BAC) and Y91 (clinician intoxication assessment) ICD-10 codes has received attention recently, the role of 10 signs of intoxication in the Y91-Y90 relationship has not been studied yet. This work examines these signs in the estimation of alcohol intoxication levels of patients in medical settings.

Methods: Collected and analyzed were data on 1997 injured emergency room patients from 17 countries worldwide reporting drinking prior to injury or presenting with a non-zero BAC from 17 countries worldwide. A model is estimated describing how the 10 signs inform the Y91, Y90 prediction with the goal of the use of observations on patients in place of a biological measure.

Results: Signs were consistent with a single underlying construct that strongly predicted Y91. Smell of alcohol on breath predicted Y91 above its contribution through the construct and was stronger for those with tolerance to alcohol than for those without. Controlling for Y91, no sign further contributed to prediction of Y90 indicating that Y91 incorporated all intoxication sign information in predicting Y90. Variance explained was high for Y91 (R(2) = 0.84) and intoxication signs (above 0.72 for all but smell on the breath, 0.57) and lower for Y90 (0.38).

Conclusion: Intoxication assessments are well predicted by overall intoxication severity, which itself is well represented by intoxication signs along with differential emphasis on smell of alcohol on breath, especially for those with alcohol tolerance. However, BAC levels remain largely unexplained by intoxication signs with a clinician's assessment serving as the primary predictive measure.
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http://dx.doi.org/10.1093/alcalc/agu014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060734PMC
April 2015

Mortality from diseases, conditions and injuries where alcohol is a necessary cause in the Americas, 2007-09.

Addiction 2014 Apr 14;109(4):570-7. Epub 2014 Jan 14.

Health Analysis and Information Unit, Communicable Diseases and Health Analysis Department, Pan American Health Organization, Washington, DC, USA.

Aims: To describe mortality from diseases, conditions and injuries where alcohol was a necessary cause in selected countries in the Americas.

Design: A descriptive, population-based study.

Setting: The data come from 16 countries in North, Central and South America for the triennium 2007-09 (latest available data).

Participants/cases: A total of 238 367 deaths were analyzed.

Measurements: We calculated age-adjusted and age-specific mortality rates by sex and country using the Pan American Health Organization (PAHO) mortality database.

Findings: The annual average of deaths where alcohol was a necessary cause in the 16 countries was 79, 456 (men comprised 86% and women 14%). People aged 40-59 years represented 55% overall. Most deaths were due to liver diseases (63% overall) and neuropsychiatric disorders (32% overall). Overall age-adjusted rates/100,000 were higher in El Salvador (27.4), Guatemala (22.3), Nicaragua (21.3) and Mexico (17.8) and lower in Colombia (1.8), Argentina (4.0) and Canada (5.7). The age groups at the highest risk were 54-59 to 64-69 years in most countries. In Guatemala, El Salvador and Nicaragua the rates increased earlier, among those aged 30-49 years. Male rates were higher than female rates in all countries, but the male : female ratio varied widely.

Conclusions: Diseases, conditions or injuries where alcohol is a necessary cause are an important cause of premature mortality in the Americas, especially among men. Some countries show high risk of dying from this group of causes.
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http://dx.doi.org/10.1111/add.12418DOI Listing
April 2014

Lost in translation.

Addiction 2013 Oct;108(10):1734-5

Alcohol and Substance Abuse, Pan American Health Organization, 525 23rd Street NW, Washington, DC, 20037, USA.

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http://dx.doi.org/10.1111/add.12280DOI Listing
October 2013

[Alcohol and public health in Latin America: how to prevent a health disaster?].

Adicciones 2013 ;25(2):99-105

Alcohol consumption is a public health problem in Latin America, being responsible for thousands of annual deaths and millions of healthy life years lost to acute and chronic conditions caused by alcohol. Consumption is higher and more prevalent among men, but women and adolescent girls are increasing their consumption more rapidly than men and adolescent boys. Beer is the alcoholic beverage most consumed, followed by distilled spirits; however, there are countries differences as some countries drink mostly wine. The industry which produces, distributes and sells alcoholic beverages is powerful, mostly globalized and with great political influence, so the current situation favors commercial interests at the expense of public health. Public policies in Latin America are insufficient to respond to the situation at national level, with little o no regulatory control of the availability of alcoholic beverages, prices and taxation policies or government control of marketing and promotion. There is limited research which can inform policy actions. Gaps in prevention and treatment of alcohol consumption and related problems are discussed as well as some perspectives for the future.
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April 2014

The road to a world health organization global strategy for reducing the harmful use of alcohol.

Alcohol Res Health 2011 ;34(2):257-60

Pan American Health Organization, Washington, DC.

Harmful alcohol use and the related health effects are a global problem and therefore need to be addressed not only by individual nations but also on an international level. For example, the World Health Organization (WHO) noted that harmful alcohol use is the third leading risk factor for premature deaths and disabilities in the world, accounting for approximately 2.5 million deaths worldwide (corresponding to 3.8 percent of all deaths) in 2004 (WHO 2010). Moreover, harmful alcohol use was considered responsible for 4.5 percent of the global burden of disease as measured in disability-adjusted life-years lost in the same year. Given this scope of the impact, the WHO initiated a series of efforts that culminated in the development of a global strategy for reducing the harmful use of alcohol. This article reviews the alcohol-related activities of the WHO over the years and summarizes the central issues addressed by the global strategy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860563PMC
http://dx.doi.org/DOI Listing
April 2015

Alcohol policy in Latin America.

J Stud Alcohol 2006 May;67(3):484-5

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http://dx.doi.org/10.15288/jsa.2006.67.484DOI Listing
May 2006

Going Swiss?

Soz Praventivmed 2003 ;48 Suppl 1:S17-8; discussion S25-7

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http://dx.doi.org/10.1007/s00038-003-4813-5DOI Listing
January 2004