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Abstract
The Singapore Resuscitation and First Aid Council is updating the guidelines for first aid based on the latest evidence-based review from the International First Aid Taskforce Consensus on Science with Treatment Recommendations published in 2020. This is part of the regular updating of standards of care and training for first aid. This article presents some of the updated evidence-based approaches to first aid treatments in common emergencies such as asthma, chronic bronchitis, anaphylaxis, shock, unresponsiveness, seizure, heat disorders, ingested poisons, bleeding, head and spinal injury, bites and dental injuries. These updated treatments will be incorporated into the Standard and Child First Aid course syllabus in Singapore.
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Affiliation(s)
- Faraz Zarisfi
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Jen Heng Pek
- Department of Emergency Medicine, Sengkang General Hospital, Singapore
| | - Janice Hui Hong Oh
- Emergency Medical Services Department, Singapore Civil Defence Force, Singapore
| | - Jun Hao Loke
- Singapore Resuscitation and First Aid Council Unit for Pre-hospital Emergency Care, Singapore
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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Rehm J, Hasan OS. Is burden of disease differentially linked to spirits? A systematic scoping review and implications for alcohol policy. Alcohol 2020; 82:1-10. [PMID: 31260796 DOI: 10.1016/j.alcohol.2019.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 12/26/2022]
Abstract
Most epidemiological research on alcohol as a risk factor is based on the assumption that outcomes are linked to pattern and level of alcohol exposure, where different beverages are converted into grams of ethanol. This review examines this basic assumption, that alcohol has the same impact, independent of beverage type. We conducted a systematic search on comparative research of beverage-specific alcohol exposure and consequences. Research was divided by methodology (survey, case-control, cohort, time-series analyses, interventional research). Overall, many studies showed higher risks for spirits compared to beer or wine; however, most research was not controlled adequately for confounders such as patterns of drinking. While there is no conclusive evidence for spirits being associated with more harm, given the same pattern and level of alcohol exposure, some evidence supports for certain outcomes such as injuries and poisonings, a potential excess risk with spirits consumption due to rapid ethanol intake and intoxication. Accordingly, encouraging people to opt for beverages with lower alcohol content via taxation strategies has the potential to reduce alcohol-attributable harm. This does not necessarily involve switching beverage type, but also can achieved within the same beverage category, by shifting from higher to lower concentration beverages.
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Sørensen HJ, Holst C, Knop J, Mortensen EL, Tolstrup JS, Becker U. Alcohol and delirium tremens: effects of average number of drinks per day and beverage type. Acta Psychiatr Scand 2019; 139:518-525. [PMID: 30697683 DOI: 10.1111/acps.13006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Associations of amount of alcohol intake and beverage type with the risk of delirium tremens (DT) have not been studied. This longitudinal study investigated if the average number of drinks per day and beverage type predict DT. METHODS A cohort of 3 582 alcohol-dependent men and women aged 19-82 without previous DT were interviewed about alcohol intake and beverage type at baseline in 1994-2005 and followed through record linkage in Danish nationwide registers to identify incident DT. Data were analyzed by means of Cox regression models. RESULTS An average number of drinks per day of 20-30 or >30 was associated with hazard ratios (HRs) of 1.38 (95% CI 1.03-1.84) and 1.64 (95% CI 1.19-2.27) relative to the reference category (1-9 drinks). Independently of amount consumed and covariates (age, gender, civil status and work status), beverage type (spirits vs. mixed alcohol) was associated with a HR of 1.63 (95% CI 1.08-2.46). Male gender was robustly associated with increased risk (HR = 1.62 (95% CI 1.25-2.08). CONCLUSIONS In alcohol-dependent men and women, daily alcohol intake above a threshold of 20 beverages or 240 g alcohol and a preference for spirits increase the risk of developing DT.
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Affiliation(s)
- H J Sørensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Mental Health Centre Copenhagen, The Capital Region, Copenhagen, Denmark
| | - C Holst
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - J Knop
- Department of Clinical Epidemiology, Frederiksberg & Bispebjerg Hospital, Copenhagen, Denmark
| | - E L Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - J S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - U Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Mété D. [Taxation of traditional rums in French overseas territories and public health: The example of Reunion Island]. Rev Epidemiol Sante Publique 2017; 65:443-452. [PMID: 29110959 DOI: 10.1016/j.respe.2017.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/30/2017] [Accepted: 06/29/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND France has a complex system for the taxation of alcoholic beverages. In the French overseas territories (FOT), the system includes little-known specificities whose purpose is to preserve the sugar-cane-rum sector, a pillar for the weak economies in these territories. Taxes are reduced for traditional rums produced and sold locally. This favors the marketing of alcoholic spirits at low prices. In metropolitan France, on the contrary, spirits are heavily taxed drinks and their share in consumption is minor. Reunion Island (RI) is a FOT confronted with significant socioeconomic precariousness and with one of the highest national morbidity and mortality rates associated with alcohol abuse. Spirits account for half of the total consumption of pure alcohol, with a strong predominance for local traditional rums. These products are preferentially consumed by vulnerable subjects, often affected by an alcohol-use disorder. METHODS This study consists of three parts. First, a comparative analysis of alcoholic beverage prices between RI and mainland France. Second, an analysis of the bibliography on the consequences of preferential consumption of spirits. Third, a literature review on the impact of taxation on alcohol-related morbidity and mortality. RESULTS In France, the cheapest gram of pure alcohol is found in the FOT. The preferential consumption of spirits is associated with more frequent and more rapid complications. It is correlated with the level of alcoholic psychoses. Taxation is effective in reducing damage caused by the abuse of alcoholic beverages. The World Health Organization recommends the application of a minimum price for alcohol and tax increases. CONCLUSION The reduced taxation of the traditional rums of the FOT does not take into account public health data. Its purpose is economic. In RI, it contributes to a high level of consumption of spirits and encourages excess mortality through alcohol abuse. It constitutes an inequality of health for these populations. Changes in this tax system is desirable in order to reduce the harm caused by alcohol. It should be closer to the tax system in force in metropolitan France. Alcohol lobbies and lack of political courage have so far inhibited this change to the detriment of the health of the populations.
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Affiliation(s)
- D Mété
- Service d'addictologie, CHU Félix-Guyon, route de Bellepierre, 97405 Saint-Denis cedex, La Réunion; Fédération régionale d'addictologie de La Réunion, CHU Félix-Guyon, route de Bellepierre, 97405 Saint-Denis cedex, La Réunion.
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Asiimwe SB, Fatch R, Patts G, Winter M, Lloyd-Travaglini C, Emenyonu N, Muyindike W, Kekibiina A, Blokhina E, Gnatienko N, Kruptisky E, Cheng DM, Samet JH, Hahn JA. Alcohol Types and HIV Disease Progression Among HIV-Infected Drinkers Not Yet on Antiretroviral Therapy in Russia and Uganda. AIDS Behav 2017; 21:204-215. [PMID: 28856539 DOI: 10.1007/s10461-017-1895-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In HIV-infected drinkers, alcohol types more likely to cause inflammation could plausibly increase the risk of HIV disease progression. We therefore assessed the association between alcohol type and plasma HIV RNA level (HIV viral load) among HIV-infected drinkers not on antiretroviral therapy (ART) in Russia and Uganda. We analyzed the data of participants from cohorts in Russia and Uganda and assessed their HIV viral load at enrollment by the alcohol type predominantly consumed. We defined predominant alcohol type as the alcohol type contributing >50% of total alcohol consumption in the 1 month (Russia) or 3 months (Uganda) prior to enrollment. Using multiple linear regression, we compared log10 HIV viral load by predominant alcohol type, controlling for age, gender, socioeconomic status, total number of standard drinks, frequency of drinking ≥6 drinks/occasion, and in Russia, history of injection drug use. Most participants (99.2% of 261 in Russia and 98.9% of 352 in Uganda) predominantly drank one alcohol type. In Russia, we did not find evidence for differences in viral load levels between drinkers of fortified wine (n = 5) or hard liquor (n = 49), compared to drinkers of beer/low-ethanol-content cocktails (n = 163); however, wine/high-ethanol-content cocktail drinkers (n = 42) had higher mean log10 viral load than beer/low-ethanol-content cocktail drinkers (β = 0.38, 95% CI 0.07-0.69; p = 0.02). In Uganda, we did not find evidence for differences in viral load levels between drinkers of locally-brewed beer (n = 41), commercially-distilled spirits (n = 38), or locally-distilled spirits (n = 43), compared to drinkers of commercially-made beer (n = 218); however, wine drinkers (n = 8) had lower mean log10 HIV viral load (β = -0.65, 95% CI -1.36 to 0.07, p = 0.08), although this did not reach statistical significance. Among HIV-infected drinkers not yet on ART in Russia and Uganda, we observed an association between the alcohol type predominantly consumed and the HIV viral load level in the Russia sample. These exploratory results suggest that, in addition to total number of drinks and drinking patterns, alcohol type might be a dimension of alcohol use that merits examination in studies of HIV and alcohol related outcomes.
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Affiliation(s)
- Stephen B Asiimwe
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda.
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, 2nd floor, Mission Hall: Global Health and Clinical Sciences Building, San Francisco, CA, 94158, USA.
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Gregory Patts
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- School of Public Health, Data Coordinating Center, Boston University, Boston, MA, USA
| | - Michael Winter
- School of Public Health, Data Coordinating Center, Boston University, Boston, MA, USA
| | - Christine Lloyd-Travaglini
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- School of Public Health, Data Coordinating Center, Boston University, Boston, MA, USA
| | - Nneka Emenyonu
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Winnie Muyindike
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Allen Kekibiina
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Elena Blokhina
- School of Public Health, Data Coordinating Center, Boston University, Boston, MA, USA
| | - Natalia Gnatienko
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Evgeny Kruptisky
- First St. Petersburg Pavlov State Medical University, St. Petersburg, Russia
- St. Petersburg Bekhterev Research Psychoneurological Institute, St. Petersburg, Russia
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith A Hahn
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, 2nd floor, Mission Hall: Global Health and Clinical Sciences Building, San Francisco, CA, 94158, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Lushin V, Jaccard J, Ivaniushina V, Alexandrov D. Vocational education paths, youth activities, and underage drinking in Russia: How early does the trouble start? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 45:48-55. [PMID: 28618283 DOI: 10.1016/j.drugpo.2017.05.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/13/2017] [Accepted: 05/09/2017] [Indexed: 11/16/2022]
Abstract
Working-class educational paths tend to be associated with elevated drinking. Little research has examined whether disproportionate alcohol use among vocationally oriented youth begins before or after the start of their vocational education. The present study analyzes a large sample of Russian middle-school students (N=1269; mean age=14.9), comparing the patterns of drinking among middle-schoolers oriented towards vocational educational, and their peers who do not plan a vocational education path. Results suggest that the orientation towards vocational education is associated with disproportionately high alcohol involvement among Russian middle-school students, even before they enter vocational schools. We studied if such difference could be partially explained by how youth orient towards extracurricular activities: discretionary peer time in risky contexts, reading for pleasure, working for pay, and religious activities. Reading demonstrated the strongest (negative) association with alcohol use, while religious activity unexpectedly revealed a positive (though weak) association with drinking. Research and policy implications are discussed.
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Affiliation(s)
- Viktor Lushin
- New York University, 1 Washington Square North, New York, NY, 10003, United States.
| | - James Jaccard
- New York University, 1 Washington Square North, New York, NY, 10003, United States
| | - Valeria Ivaniushina
- National Research University Higher School of Economics, Soyuza Pechatnikov, 16, St. Petersburg, 190008, Russia
| | - Daniel Alexandrov
- National Research University Higher School of Economics, Soyuza Pechatnikov, 16, St. Petersburg, 190008, Russia
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Sudakov SK, Alekseeva EV, Bogdanova NG, Kolpakov AA, Nazarova GA. Anxiolytic, Psychostimulant, and Analgesic Effects of Various Volumes of Ethanol Solution in Different Concentrations, but in the Same Dose. Bull Exp Biol Med 2016; 161:1-3. [PMID: 27270926 DOI: 10.1007/s10517-016-3330-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Indexed: 11/24/2022]
Abstract
We studied the effect of ethanol (dose 2 g/kg) in various concentrations (5, 13, and 40%) and different volumes (40, 15.5, and 5 ml/kg) on the level of anxiety, locomotor activity, and pain sensitivity in rats. Administration of 40 ml/kg water to animals was followed by a significant increase in the time spent in the open arms of the elevated plus maze. Administration of water in a volume of 5 or 15.5 ml/kg had little effect on the level of anxiety. The greater was the volume of intragastrically administered ethanol, the stronger was the anxiolytic effect. The psychostimulant and analgesic effects of ethanol were more pronounced after administration of medium volumes and intermediate concentrations of ethanol-containing solutions. Since administration of these solutions cannot produce maximum blood concentration of ethanol, we believe that the observed effects are mainly related to the direct effect of ethanol on the stomach tissue.
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Affiliation(s)
- S K Sudakov
- P. K. Anokhin Research Institute of Normal Physiology, Moscow, Russia.
| | - E V Alekseeva
- P. K. Anokhin Research Institute of Normal Physiology, Moscow, Russia
| | - N G Bogdanova
- P. K. Anokhin Research Institute of Normal Physiology, Moscow, Russia
| | - A A Kolpakov
- P. K. Anokhin Research Institute of Normal Physiology, Moscow, Russia
| | - G A Nazarova
- P. K. Anokhin Research Institute of Normal Physiology, Moscow, Russia
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9
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Razvodovsky Y. The Effect of Beverage Type on the Alcoholic Psychoses Rate in Russia: Fig. 1. Alcohol Alcohol 2015; 50:626-7. [DOI: 10.1093/alcalc/agv063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Asiimwe SB, Fatch R, Emenyonu NI, Muyindike WR, Kekibiina A, Santos GM, Greenfield TK, Hahn JA. Comparison of Traditional and Novel Self-Report Measures to an Alcohol Biomarker for Quantifying Alcohol Consumption Among HIV-Infected Adults in Sub-Saharan Africa. Alcohol Clin Exp Res 2015; 39:1518-27. [PMID: 26148140 DOI: 10.1111/acer.12781] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 05/11/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND In Sub-Saharan Africa (SSA), HIV-infected patients may underreport alcohol consumption. We compared self-reports of drinking to phosphatidylethanol (PEth), an alcohol biomarker. In particular, we assessed beverage-type-adjusted fractional graduated frequency (FGF) and quantity frequency (QF) measures of grams of alcohol, novel nonvolume measures, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). METHODS We analyzed cohort entry data from the Biomarker Research of Ethanol Among Those with HIV cohort study (2011 to 2013). Participants were HIV-infected past-year drinkers, newly enrolled into care. Self-report measures included FGF and QF grams of alcohol, the AUDIT-C, number of drinking days, and novel adaptations of FGF and QF methods to expenditures on alcohol, time spent drinking, and symptoms of intoxication. PEth levels were measured from dried blood spots. We calculated Spearman's rank correlation coefficients of self-reports with PEth and bias-corrected bootstrap 95% confidence intervals (CIs) for pairwise differences between coefficients. RESULTS A total of 209 subjects (57% men) were included. Median age was 30; interquartile range (IQR) 25 to 38. FGF grams of alcohol over the past 90 days (median 592, IQR 43 to 2,137) were higher than QF grams (375, IQR 33 to 1,776), p < 0.001. However, both measures were moderately correlated with PEth: ρ = 0.58, 95% CI 0.47 to 0.66 for FGF grams and 0.54, 95% CI 0.43 to 0.63 for QF grams (95% CI for difference -0.017 to 0.099, not statistically significant). AUDIT-C, time drinking, and a scale of symptoms of intoxication were similarly correlated with PEth (ρ = 0.35 to 0.57). CONCLUSIONS HIV-infected drinkers in SSA likely underreport both any alcohol consumption and amounts consumed, suggesting the need to use more objective measures like biomarkers when measuring drinking in this population. Although the FGF method may more accurately estimate drinking than QF methods, the AUDIT-C and other nonvolume measures may provide simpler alternatives.
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Affiliation(s)
- Stephen B Asiimwe
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, California
| | - Nneka I Emenyonu
- Department of Medicine, University of California, San Francisco, California
| | - Winnie R Muyindike
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda.,Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Allen Kekibiina
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, San Francisco, California.,Department of Community Health Systems, University of California, San Francisco, California
| | | | - Judith A Hahn
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California.,Department of Medicine, University of California, San Francisco, California
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