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Romero-Rodríguez E, Amezcua-Prieto C, Morales Suárez-Varela M, Ayán-Pérez C, Mateos-Campos R, Martín-Sánchez V, Ortíz-Moncada R, Redondo-Martín S, Alguacil Ojeda J, Delgado-Rodríguez M, Blázquez Abellán G, Alonso-Molero J, Cancela-Carral JM, Valero Juan LF, Fernández-Villa T. Patterns of Alcohol Consumption and Use of Health Services in Spanish University Students: UniHcos Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6158. [PMID: 35627695 PMCID: PMC9141368 DOI: 10.3390/ijerph19106158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
The aim of the study was to examine the association of alcohol consumption patterns (hazardous alcohol use and binge drinking) and the use of emergency services and primary care consultations in university students. An observational, descriptive, cross-sectional study was conducted at eleven Spanish universities collaborating within the uniHcos Project. University students completed an online questionnaire that assessed hazardous alcohol use and binge drinking using the AUDIT questionnaire and evaluated the use of emergency services and primary care. A descriptive analysis of the data was performed, as well as the chi-squared test and Student’s t-test and nonconditional logistic regression models to examine this association. Results: There were 10,167 participants who completed the questionnaire. The prevalence of hazardous alcohol use was 16.9% (95% CI: 16.2−17.6), while the prevalence of binge drinking was 48.8% (95% CI: 47.9−49.8). There were significant differences in the use of emergency services in those surveyed with hazardous alcohol use (p < 0.001) or binge drinking pattern (p < 0.001). However, no significant differences were observed in terms of attendance during primary care visits in individuals with hazardous alcohol use (p = 0.367) or binge drinking pattern (p = 0.755). The current study shows the association between university students with a pattern of hazardous alcohol use or binge drinking and greater use of emergency services. However, no significant association was observed between the said consumption patterns and the use of primary care services.
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Affiliation(s)
- Esperanza Romero-Rodríguez
- Maimonides Biomedical Research Institute, Reina Sofia University Hospital, University of Córdoba, 14001 Cordoba, Spain;
| | - Carmen Amezcua-Prieto
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain; (C.A.-P.); (M.M.S.-V.); (V.M.-S.); (M.D.-R.)
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
| | - María Morales Suárez-Varela
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain; (C.A.-P.); (M.M.S.-V.); (V.M.-S.); (M.D.-R.)
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, University of Valencia, 46100 Valencia, Spain
| | - Carlos Ayán-Pérez
- Well-Move Research Group, Department of Special Didactics, University of Vigo, 36310 Vigo, Spain;
| | - Ramona Mateos-Campos
- Area of Preventive Medicine and Public Health, University of Salamanca, 37007 Salamanca, Spain; (R.M.-C.); (L.F.V.J.)
| | - Vicente Martín-Sánchez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain; (C.A.-P.); (M.M.S.-V.); (V.M.-S.); (M.D.-R.)
- Department of Biomedical Sciences, University of León, 24071 León, Spain
- The Research Group in Gene-Environment and Health Interactions, Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain
| | - Rocío Ortíz-Moncada
- Public Health Research Group, Food and Nutrition Research Group, University of Alicante, 03550 Alicante, Spain;
| | - Susana Redondo-Martín
- Department of Preventive Medicine and Public Health, University of Valladolid, 47005 Valladolid, Spain;
| | - Juan Alguacil Ojeda
- Department of Clinical and Experimental Psychology, University of Huelva, 21071 Huelva, Spain;
| | - Miguel Delgado-Rodríguez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain; (C.A.-P.); (M.M.S.-V.); (V.M.-S.); (M.D.-R.)
- Department of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | - Gemma Blázquez Abellán
- Department of Medical Sciences, School of Pharmacy, University of Castilla-La Mancha, 02008 Albacete, Spain;
| | - Jéssica Alonso-Molero
- Department of Preventive Medicine and Public, University of Cantabria-IDIVAL, 39008 Santander, Spain;
| | - José María Cancela-Carral
- Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain;
- Department of Specials Didactics, University of Vigo, 36310 Vigo, Spain
| | - Luis Félix Valero Juan
- Area of Preventive Medicine and Public Health, University of Salamanca, 37007 Salamanca, Spain; (R.M.-C.); (L.F.V.J.)
| | - Tania Fernández-Villa
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain; (C.A.-P.); (M.M.S.-V.); (V.M.-S.); (M.D.-R.)
- Department of Biomedical Sciences, University of León, 24071 León, Spain
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Direct Alcohol Biomarkers Prediction Capacity on Relapse and Mortality in Liver Transplantation Candidates: A Follow-Up Study. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Liver transplantation is a complex procedure that requires multiple evaluations, including abstinence monitorization. While literature assessing the impact of different variables on relapse, survival, and graft loss exists, little is known about the predictive capacity of direct alcohol biomarkers. The primary aim of this study was to evaluate the prediction capacity of direct alcohol biomarkers regarding patient survival and clinical relapse. We hypothesized that patients screening positive for any of the experimental biomarkers would show an increased risk of clinical alcohol relapse and death. We conducted a retrospective data recollection from medical files of patients awaiting liver transplantation, who were at baseline screened with Peth, EtG in hair and urine, and EtS. We tested the prediction capacity of the biomarkers with two Cox-regression models. A total of 50 patients were included (84% men, mean age 59 years (SD = 6)). Biomarkers at baseline were positive in 18 patients. The mean follow-up time for this study was 26 months (SD = 10.4). Twelve patients died, liver transplantation was carried out in 12 patients, and clinical relapse was observed in eight patients. The only significant covariate in the Cox-regression models was age with clinical relapse, with younger patients being at greater risk of relapse. This study could not find a significant prediction capacity of direct alcohol biomarkers for mortality or clinical relapse during follow-up. Higher sample sizes might be needed to detect statistically significant differences. All in all, we believe that direct alcohol biomarkers should be widely used in liver transplantation settings due to their high sensitivity for the detection of recent drinking.
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Barrio P, Baldaquí N, Andreu M, Kilian C, Rehm J, Gual A, Manthey J. Abstinence Among Alcohol Use Disorder Patients During the COVID-19 Pandemic: Insights From Spain. Alcohol Clin Exp Res 2021; 45:802-807. [PMID: 33667019 DOI: 10.1111/acer.14555] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with alcohol use disorder (AUD) are likely to suffer disproportionate harms related to the COVID-19 pandemic and related policy measures. While many surveys have been conducted, most are focused on drinking changes in the general population and validation with biological markers is lacking. METHOD We performed a retrospective cohort study among patients with AUD attending a urine drug screening program. With mixed-effects logistic regression models, we assessed the probability of screening positive for ethyl glucuronide according to patients' main clinical characteristics and time of analysis (either prior to or after a lockdown was implemented in Spain). RESULTS A total of 362 patients provided 2,040 urine samples (1,295 prior to lockdown, 745 during lockdown). The mean age of participants was 52.0 years (SD 12.6), and 69.2% were men. Of the 43% of patients tested for other drugs 22% screened positive. After adjusting for all covariates, the odds of screening positive for ethyl glucuronide during lockdown almost doubled (OR = 1.99, 95% CI 1.20 to 3.33, p = 0.008). Other significant covariates included testing positive for other drugs (OR = 10.79, 95% CI 4.60 to 26.97) and length of treatment (OR = 0.59, 95% CI 0.47 to 0.74). CONCLUSIONS Our data support an association between the lockdown due to COVID-19 and increased alcohol use in patients with AUD. Thus, addiction healthcare systems could face significant challenges ahead. In light of these findings, it is essential to evaluate prospectively how patients with AUD are affected by the pandemic and how health systems respond to their needs.
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Affiliation(s)
- Pablo Barrio
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Nuria Baldaquí
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Magalí Andreu
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
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Mercurio I, Politi P, Mezzetti E, Agostinelli F, Troiano G, Pellegrino A, Gili A, Melai P, Rettagliata G, Mercurio U, Sannicandro D, Lancia M, Bacci M. Ethyl Glucuronide and Ethyl Sulphate in Urine: Caution in their use as markers of recent alcohol use. Alcohol Alcohol 2021; 56:201-209. [PMID: 33170266 DOI: 10.1093/alcalc/agaa113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/27/2020] [Accepted: 09/29/2020] [Indexed: 01/27/2023] Open
Abstract
AIM To clarify the role of the ethanol metabolites, ethyl glucuronide (EtG) and ethyl sulfate (EtS), in monitoring alcohol consumption. METHOD We recruited 7 female and 17 male volunteers who were instructed to consume a quantity of beer (containing 48 gm ethanol) with food in one session. We examined urinary excretion of EtG and EtS over time and looked for correlations between the concentrations of the metabolites EtG and EtS. RESULTS EtG concentrations in urine varied between 0.026 and 430.372 μg/ml with average values between 11.85 μg/ml (SD 19.75), 30 min after alcohol intake, and 100.39 μg/ml (SD 101.34), 4.5 h after alcohol intake. EtS urinary concentration ranged from 0.006 to 101.432 μg/ml with average values between 4.77 μg/ml (SD 5.42), 30 min after alcohol intake, and 30.14 μg/ml (SD 27.20), 4.5 h after alcohol intake. Spearman's test showed that urinary EtG and EtS correlated significantly at several time points. CONCLUSION The great interindividual variability in their excretion suggests caution in the use of urinary measurement of these metabolites in forensic investigations.
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Affiliation(s)
- Isabella Mercurio
- Section of Legal Medicine, Forensic Science and Sports Medicine, University of Perugia, Perugia 06123, Italy
| | - Pamela Politi
- Section of Legal Medicine, Forensic Science and Sports Medicine, University of Perugia, Perugia 06123, Italy
| | | | - Fausto Agostinelli
- Section of Legal Medicine, Forensic Science and Sports Medicine, University of Perugia, Perugia 06123, Italy
| | | | | | - Alessio Gili
- Department of Experimental Medicine, Hygiene and Public Health Section, University of Perugia, Perugia 06123, Italy
| | - Paola Melai
- Hospital of Perugia, Department of Surgical and Biomedical Sciences ,Section of Forensic Medicine, Perugia 06123, Italy
| | | | - Umberto Mercurio
- Hospital of Potenza, Nephrology and Dialysis Division, Potenza 85100, Italy
| | | | - Massimo Lancia
- Section of Legal Medicine, Forensic Science and Sports Medicine, University of Perugia, Perugia 06123, Italy
| | - Mauro Bacci
- Section of Legal Medicine, Forensic Science and Sports Medicine, University of Perugia, Perugia 06123, Italy
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Phosphatidylethanol for Monitoring Alcohol Use in Liver Transplant Candidates: An Observational Study. J Clin Med 2020; 9:jcm9093060. [PMID: 32971960 PMCID: PMC7564451 DOI: 10.3390/jcm9093060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/06/2020] [Accepted: 09/18/2020] [Indexed: 01/28/2023] Open
Abstract
Liver transplantation remains an essential procedure for many patients suffering from alcoholic liver disease. Alcohol use monitoring remains paramount all through the stages of this complex process. Direct alcohol biomarkers, with improved specificity and sensibility, should replace traditional indirect markers. Phosphatidylethanol (PEth) has been recently tested in alcoholic liver disease patients, but more evidence is needed, especially in comparison with other direct biomarkers. We conducted an observational study among patients awaiting liver transplantation. We analyzed Peth in blood, ethylglucuronide (EtG) in hair and urine and ethylsulphate (EtS) in urine, using mass spectrometry methods. In addition, transaminases, and self-reports were analyzed. A total of 50 patients were included (84% men, mean age 59 years (SD = 6)). 18 patients (36%) screened positive for any marker. Self-reports were positive in 3 patients. EtS was the biomarker with more positive screens. It also was the most frequently exclusive biomarker, screening positive in 7 patients who were negative for all other biomarkers. PEth was positive in 5 patients, being the only positive biomarker in 2 patients. It showed a false negative in a patient admitting alcohol use the previous week and screening positive for EtG and EtS. Hair EtG was positive in 3 patients who had negative Peth, EtG. EtG did not provide any exclusive positive result.A combination of biomarkers seems to be the best option to fully ascertain abstinence in this population. Our study suggest EtS might also play a significant role.
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Sliedrecht W, de Waart R, Witkiewitz K, Roozen HG. Alcohol use disorder relapse factors: A systematic review. Psychiatry Res 2019; 278:97-115. [PMID: 31174033 DOI: 10.1016/j.psychres.2019.05.038] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, the Netherlands.
| | - Ranne de Waart
- Mentrum/Arkin, Wisselwerking 46-48, 1112 XR Diemen, the Netherlands.
| | - Katie Witkiewitz
- The University of New Mexico (UNM), MSC 03-2220, Univ of New Mexico, Albuquerque, NM 87131, USA.
| | - Hendrik G Roozen
- The University of New Mexico (UNM), Center on Alcoholism, Substance Abuse, and Addictions (CASAA), MSC 11 6280, 1 Univ of New Mexico, Albuquerque, NM 87106, USA.
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Barrio P, Teixidor L, Ortega L, Lligoña A, Rico N, Bedini JL, Vieta E, Gual A. Filling the gap between lab and clinical impact: An open randomized diagnostic trial comparing urinary ethylglucuronide and ethanol in alcohol dependent outpatients. Drug Alcohol Depend 2018; 183:225-230. [PMID: 29291550 DOI: 10.1016/j.drugalcdep.2017.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/02/2017] [Accepted: 11/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Efforts aimed at reducing alcohol-related harm include early detection of risky drinkers as well as detection of early relapse in patients with alcohol dependence. Ethyl glucuronide (EtG) has been proven to be a reliable biomarker for the detection of recent drinking; however, no randomized, diagnostic trial to date has tested its impact on drinking outcomes. The aim of this study was to assess, in a randomized design, the implications of EtG screening on alcohol outcomes, compared to screening with a low sensitivity biomarker such as ethanol. METHODS Alcohol dependent outpatients were randomized to either 24 weeks of continuous screening with EtG or ethanol. Patients were aware of screening methods and results. After 24 weeks, all participants were screened with EtG. Self-reports were also gathered. A logistic regression compared the rate of EtG positive results at study end between groups. Generalized estimating equations evaluated the descending monthly rate of EtG positive patients in the EtG group. RESULTS A total of 162 patients were randomized. During the study period, the ethanol group showed less patients with positive screens (19/64 (29.7%) vs 58/98 (59%)). After 24 weeks, the EtG group showed a greater number of patients having a negative screening test compared to ethanol subjects when they were all screened with EtG (5/62 (8.1%) vs 13/39 (33.3%)). A significant decrease in the rate of EtG positive patients was found for the first three months of the study. CONCLUSIONS Routine screening with EtG seems to reduce drinking and improve abstinence rates in alcohol dependent outpatients.
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Affiliation(s)
- Pablo Barrio
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Clinic Hospital, Villarroel 170 08036, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Casanova 143 08036 Barcelona, Spain; Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Villarroel 170 08036 Barcelona, Spain.
| | - Lídia Teixidor
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Clinic Hospital, Villarroel 170 08036, Barcelona, Spain; Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Villarroel 170 08036 Barcelona, Spain
| | - Lluisa Ortega
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Clinic Hospital, Villarroel 170 08036, Barcelona, Spain; Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Villarroel 170 08036 Barcelona, Spain
| | - Anna Lligoña
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Clinic Hospital, Villarroel 170 08036, Barcelona, Spain; Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Villarroel 170 08036 Barcelona, Spain
| | - Nayra Rico
- Department of Biochemistry, Hospital Clinic Barcelona, Spain
| | | | - Eduard Vieta
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Casanova 143 08036 Barcelona, Spain; Centro de Investigación en Red de Salud mental (CIBERSAM), Pabellón 11, 28029, Madrid, Spain; Bipolar Disorder Program, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Villarroel 170 08036 Barcelona, Spain
| | - Antoni Gual
- Addictive Behaviors Unit, Clinical Neuroscience Institute, Clinic Hospital, Villarroel 170 08036, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Casanova 143 08036 Barcelona, Spain; Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Villarroel 170 08036 Barcelona, Spain
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