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Sherk A, Churchill S, Cukier S, Grant SC, Shield K, Stockwell T. Distributions of alcohol use and alcohol-caused death and disability in Canada: Defining alcohol harm density functions and new perspectives on the prevention paradox. Addiction 2024; 119:696-705. [PMID: 38237919 DOI: 10.1111/add.16414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/15/2023] [Indexed: 03/05/2024]
Abstract
AIMS The aims of this study were to examine the distribution of alcohol use and to define 'harm density functions' representing distributions of alcohol-caused health harm in Canada, by sex, towards better understanding which groups of drinkers experience the highest aggregate harms. DESIGN This was an epidemiological modeling study using survey and administrative data on alcohol exposure, death and disability and risk relationships from epidemiological meta-analyses. SETTING This work took place in Canada, 2019. PARTICIPANTS Canadians aged 15 years or older participated. MEASUREMENTS Measures included modeled life-time mean daily alcohol use in grams of pure alcohol (ethanol) per day, alcohol-caused deaths and alcohol-caused disability-adjusted life-years. FINDINGS As a life-time average, more than half of Canadians aged 15+ (62.8% females, 46.9% males) use fewer than 10 g of pure alcohol per day (g/day). By volume, the top 10% of the population consume 45.9% of the total ethanol among males and 47.1% of the total ethanol among females. The remaining 90% of the population experience a slim majority of alcohol-caused deaths (males 55.3%, females 46.9%). Alcohol harm density functions compose the size of the using population and the risk experienced at each volume level to show that the population-level harm experienced is highest for males at 25 g/day and females at 13 g/day. CONCLUSIONS Almost 50% of alcohol use in Canada is concentrated among the highest 10% of drinkers, but more than half of the alcohol-caused deaths in Canada in 2019 were experienced by the bottom 90% of the population by average volume, providing evidence for the prevention paradox. New alcohol harm density functions provide insight into the aggregate health harm experienced across the mean alcohol use spectrum and may therefore be used to help determine where alcohol policies should be targeted for highest efficacy.
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Affiliation(s)
- Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Samuel Churchill
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Samantha Cukier
- School of Health Sciences, Dalhousie University, Halifax, Canada
| | - Sierra C Grant
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Kevin Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
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Jaswal H, Sohi I, Rehm J, Churchill S, Sherk A, Stockwell T, Levesque C, Sanger N, Edalati H, Butt PR, Paradis C, Shield KD. A drink equals how many cigarettes? Equating mortality risks from alcohol and tobacco use in Canada. Front Public Health 2024; 12:1331190. [PMID: 38476483 PMCID: PMC10928000 DOI: 10.3389/fpubh.2024.1331190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
Objective To quantify and communicate risk equivalencies for alcohol-and tobacco-attributable mortality by comparing per standard drinks consumed to per number of cigarettes smoked in Canada. Methods Alcohol-and tobacco-attributable premature deaths (≤75 years of age) and years of life lost (YLL) were estimated using a lifetime risk modeling approach. Alcohol-attributable death statistics were obtained from the 2023 Canadian Guidance on Alcohol and Health data source. Tobacco-attributable death statistics were derived from the Mortality Population Risk Tool (MPoRT) model. Results The risk of alcohol use on premature death and YLL increased non-linearly with the number of drinks consumed, while the risk for tobacco use on these two measures increased linearly with the number of cigarettes smoked. Males who consumed 5 drinks/day-a standard drink contains 13.45 grams of alcohol in Canada-had an equivalent risk as smoking 4.9 cigarettes/day (when modeling for premature death) and 5.1 cigarettes/day (when modeling for YLL). Females who consumed 5 drinks/day experienced an equivalent risk as smoking 4.2 cigarettes/day for premature deaths and YLL. At all levels of alcohol consumption females and males who consumed <5 drinks/day have less risks from consuming a standard drink than from smoking a cigarette. For males who consumed 5 drinks/day, the increased risks of death from per drink consumed and per cigarette smoked were equal. Conclusion Risk equivalencies comparing alcohol use to tobacco use could help people who drink improve their knowledge and understanding of the mortality risks associated with increased number of drinks consumed per day.
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Affiliation(s)
- Harpreet Jaswal
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ivneet Sohi
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Samuel Churchill
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | | | - Nitika Sanger
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Hanie Edalati
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Peter R. Butt
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Kevin D. Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Hammarberg SI, Wallhed Finn S, Rosendahl I, Andréasson S, Jayaram-Lindström N, Hammarberg A. Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial. Addiction 2024; 119:86-101. [PMID: 37658776 DOI: 10.1111/add.16325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 07/21/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND AIMS Controlled drinking (CD) is an attractive treatment goal for a large proportion of individuals with alcohol use disorder (AUD), but the availability of treatment methods supporting a goal of CD is scarce. We tested if behavioural self-control training (BSCT) was superior to motivational enhancement therapy (MET) for individuals with AUD with a treatment goal of CD. DESIGN Randomized controlled two-group trial. Follow-ups were conducted at 12 and 26 weeks (primary end-point) after inclusion. SETTING Three specialized dependency care clinics in Stockholm, Sweden. PARTICIPANTS Two hundred and fifty self-referred adults (52% men) fulfilling criteria of AUD (DSM-5) and a stated treatment goal of CD. INTERVENTION AND COMPARATOR BSCT (n = 125), a five-session treatment based on cognitive behavioural therapy versus the active comparator, MET (n = 125), containing four sessions based on Motivational Interviewing. MEASUREMENTS Primary outcome measure was mean weekly alcohol consumption at the 26-week follow-up, adjusted for baseline consumption. CONCLUSIONS A randomized controlled trial found no evidence of a difference between behavioural self-control training and motivational enhancement therapy in reducing weekly alcohol consumption. Both groups substantially reduced consumption and behavioural self-control training was superior in reducing hazardous drinking.
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Affiliation(s)
- Stina Ingesson Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sara Wallhed Finn
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ingvar Rosendahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sven Andréasson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Guarino G, Strollo F, Della Corte T, Satta E, Gentile S. Effect of Policaptil Gel Retard on Liver Fat Content and Fibrosis in Adults with Metabolic Syndrome and Type 2 Diabetes: A Non-invasive Approach to MAFLD. Diabetes Ther 2023; 14:2089-2108. [PMID: 37789214 PMCID: PMC10597984 DOI: 10.1007/s13300-023-01478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Non-alcoholic fatty liver disease (NAFLD) is part of a disease spectrum ranging from steatosis to steatohepatitis (NASH), fibrosis, and cirrhosis, and when associated with metabolic syndrome (MS), and overt diabetes is defined as metabolic NAFLD (MAFLD). Some easily available, inexpensive biomarkers have been validated based on common anthropometric and laboratory parameters, including the Fatty Liver Index (FLI), the Fibrosis (FIB)-4 Score (FIB-4), and the NAFLD Fibrosis Score (NFS). In people with overweight/obesity, MS, and diabetes, the pathogenesis of fatty liver involves parameters known to be positively affected by Policaptil Gel Retard (PGR), a phytocomplex already successfully used in adolescents and adults with MS and type 2 diabetes mellitus (T2DM). This study's primary outcome was to assess PGR's ability to improve indirect validated signs of liver steatosis and fibrosis, i.e., FLI, FIB-4, and NFS Scores; as the secondary outcome, we aimed to confirm PGR's positive effects on anthropometric parameters and lipid levels and to assess any eventually occurring cytolysis liver marker changes in patients with MS/T2DM and MAFLD/NASH. METHODS In this spontaneous, longitudinal, single-blind, randomized clinical study, 245 outpatients with MS/T2DM were enrolled and randomized to PGR or placebo for 24 weeks. All underwent a low-calorie diet (20-25% less than the calories required to maintain current weight) and were encouraged to intensify physical activity. Fat distribution, liver fat content/fibrosis, and biochemical parameters were evaluated at baseline and after 24 weeks. RESULTS Our data show for the first time in adults with MAFLD that, when added to lifestyle changes including a hypocaloric diet and intensified physical activity, PGR improves lipid and glucose metabolism-related parameters, including insulin-resistance, and significantly reduces not only visceral fat but also liver fat content and related liver fibrosis severity. The prevalence of subjects with severe steatosis (FLI > 60) significantly decreased from 95.08 to 47.53% (p < 0.001) only in the treatment group, which also displayed a significantly decreased prevalence of medium-severe cases (F3-F4) from 83.62% to 52.35% (p < 0.001) and a markedly increased prevalence of low degree cases (F0-F1) from 9.01 to 42.15% (p < 0.001). CONCLUSIONS The effect of PGR is related to a reduction in the post-meal blood glucose and insulin peaks. As glucose absorption (GA) directly regulates pancreatic insulin release, the attenuated insulin response is likely due to delayed GA with decreased body weight, visceral fat, and cardiovascular risk. Also, an effect on the intestinal microbiota, already documented in the animal model, cannot be excluded, especially considering the reported PGR-related shift from the Firmicutes, notoriously responsible for increased lipid gut absorption, to the Bacteroides phylum.
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Affiliation(s)
- Giuseppina Guarino
- Campania University "Luigi Vanvitelli", Naples, Italy
- Nefrocenter Research Network & Nyx Research Start-Up, Naples, Italy
| | | | | | - Ersilia Satta
- Nefrocenter Research Network & Nyx Research Start-Up, Naples, Italy
| | - Sandro Gentile
- Campania University "Luigi Vanvitelli", Naples, Italy.
- Nefrocenter Research Network & Nyx Research Start-Up, Naples, Italy.
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Barré T, Di Beo V, Roux P, Mourad A, Verger P, Fressard L, Herault T, Buyck JF, Beck F, Carrieri P. Screening for alcohol use in primary care: assessing French general practitioner practices. Alcohol Alcohol 2023; 58:672-682. [PMID: 37818974 DOI: 10.1093/alcalc/agad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
Alcohol use is a leading risk factor for premature death and disability. To tackle this issue, more systematic and accurate screening for at-risk consumption is needed in healthcare systems, especially by general practitioners (GPs). We assessed the frequency of at-risk consumption screening by GPs in France. We also identified characteristics associated with more frequent screening and greater use of validated screening tools by these healthcare providers. A cross-sectional survey was conducted among a representative sample of French GPs. Multinomial logistic regressions were used to identify factors associated with more frequent screening and greater use of validated screening tools. Response rate was of 73%. Of the 2412 participants, 42.8% screened all their patients systematically and repeatedly, while 48.0% never used standardized tools to screen potentially at-risk patients. Among other characteristics, being aware of and using the "early identification and brief intervention" screening strategy, and feeling absolutely comfortable talking with patients about reducing or stopping their alcohol use, were both associated with more frequent screening and use of standardized tools. Our results on at-risk alcohol use screening highlight an improvement over data from previous studies. Nevertheless, better training of French GPs in good alcohol screening practices-specifically, increased screening frequency and greater use of standardized tools-may improve identification of at-risk patients.
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Affiliation(s)
- Tangui Barré
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
| | - Vincent Di Beo
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
| | - Perrine Roux
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
| | - Abbas Mourad
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Faculté des Sciences Médicales et Paramédicales, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Lisa Fressard
- ORS PACA, Southeastern Health Regional Observatory, Faculté des Sciences Médicales et Paramédicales, 27 Boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Thomas Herault
- Union Régionale des Médecins Libéraux des Pays de La Loire, 13 rue de la Loire, Bâtiment C2, 44230 Saint Sébastien-sur-Loire, Nantes, France
| | - Jean-François Buyck
- Observatoire Régional de La Santé Des Pays de La Loire, 2 Rue de la Loire, 44200 Nantes, France
| | - François Beck
- Santé Publique France, 12, rue du Val d'Osne 94 415 Saint-Maurice cedex, France
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Inserm U1018, Université Paris-Saclay, Université Paris-Sud, Université Versailles Saint-Quentin (UVSQ), 16 Av. Paul Vaillant Couturier, 94800 Villejuif, France
| | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France
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6
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Müller CP, Schumann G, Rehm J, Kornhuber J, Lenz B. Self-management with alcohol over lifespan: psychological mechanisms, neurobiological underpinnings, and risk assessment. Mol Psychiatry 2023; 28:2683-2696. [PMID: 37117460 PMCID: PMC10615763 DOI: 10.1038/s41380-023-02074-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/30/2023]
Abstract
Self-management includes all behavioural measures and cognitive activities aimed at coping with challenges arising throughout the lifespan. While virtually all of these challenges can be met without pharmacological means, alcohol consumption has long been instrumentalized as a supporting tool to help coping with problems arising selectively at adolescence, adulthood, and ageing. Here, we present, to our knowledge, the first systematic review of alcohol instrumentalization throughout lifespan. We searched MEDLINE, Google Scholar, PsycINFO and CINAHL (from Jan, 1990, to Dec, 2022) and analysed consumption patterns, goals and potential neurobiological mechanisms. Evidence shows a regular non-addictive use of alcohol to self-manage developmental issues during adolescence, adulthood, and ageing. Alcohol is selectively used to overcome problems arising from dysfunctional personality traits, which manifest in adolescence. A large range of psychiatric disorders gives rise to alcohol use for the self-management of distinct symptoms starting mainly in adulthood. We identify those neuropharmacological effects of alcohol that selectively serve self-management under specific conditions. Finally, we discuss the adverse effects and associated risks that arise from the use of alcohol for self-management. Even well-controlled alcohol use adversely impacts health. Based on these findings, we suggest the implementation of an entirely new view. Health policy action may actively embrace both sides of the phenomenon through a personalized informed use that allows for harm-controlled self-management with alcohol.
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Affiliation(s)
- Christian P Müller
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia.
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Gunter Schumann
- The Centre for Population Neuroscience and Stratified Medicine (PONS), ISTBI, Fudan University, Shanghai, China
- PONS Centre, Charite Mental Health, Department of Psychiatry and Psychotherapie, CCM, Charite Universitaetsmedizin Berlin, Berlin, Germany
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Bernd Lenz
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159, Mannheim, Germany
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7
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Sidorchuk A, Engström K, Möller J, Gémes K. Predictors of beverage-specific, alcohol consumption trajectories: A Swedish population-based cohort study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:233-249. [PMID: 37255610 PMCID: PMC10225962 DOI: 10.1177/14550725221124386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/22/2022] [Indexed: 09/30/2023] Open
Abstract
Aim: The aim of the study was to examine whether changes in alcohol consumption over time differ according to beverage types, and to what extent socioeconomic, lifestyle and health-related factors predict beverage-specific trajectories in Sweden. Study design: We included participants from the Stockholm Public Health Cohort who were surveyed repeatedly in 2002, 2010 and 2014. Alcohol consumption trajectories were constructed for 13,152 individuals with valid information on amount and frequency of drinking. Preferred beverage types (i.e., beer, wine or spirits) were defined based on the most consumed beverages. Multinomial logistic regression was used to quantify individual predictors of different trajectories, overall and by beverage type. Results: Overall 56.9% of respondents were women, the mean age was 49.2 years, SD (13.1). Wine was cited as the preferred beverage for 72.4% of participants, and stable moderate drinking was the most common trajectory regardless of beverage type (68.2%, 54.9% and 54.2% in individuals with wine, beer and spirits as preferred beverages, respectively). Associations between drinking trajectories and baseline lifestyle factors did not differ by beverage type. Lower socioeconomic position (SEP) was associated with unstable moderate wine drinking (for unskilled manual SEP: adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.23, 1.93), unstable heavy beer drinking (for skilled manual SEP: aOR 1.99, 95% CI 1.14, 3.52; and unskilled manual SEP: aOR 1.72, 95% CI 1.05, 2.82), and former beer drinking trajectory (for skilled manual SEP: aOR 1.81; 95% CI 1.21, 2.72; and unskilled manual SEP: aOR 1.66; 95% CI 1.17, 2.37). Conclusion: Lower SEP was associated with unstable heavy drinking of beer, former beer drinking, and unstable moderate wine drinking trajectories indicating that targeted alcohol prevention programmes need to focus on these groups.
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Affiliation(s)
- Anna Sidorchuk
- Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
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Byrne P. Premature mortality of people with severe mental illness: a renewed focus for a new era. Ir J Psychol Med 2023; 40:74-83. [PMID: 35357297 DOI: 10.1017/ipm.2022.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This perspective article applies public health principles to improve the physical health of selected populations with mental disorders. Two preventable adverse outcomes, poorer physical health and premature mortality, are described across mental disorders. Evidence of the lifetime effects of adverse childhood experiences and inequalities is presented: these are the 'causes of the causes'. Seven drivers of physical disorders are illustrated that drive preventable deaths and as doctors, psychiatrists must lead from the front to reverse rising mortality. Evidence supports universal and selective interventions and even the most difficult challenges such as weight gain and opioid misuse are an opportunity for psychiatry to engage with individual patients and their organisations, public health colleagues, health systems and beyond. Interventions complement and do not replace existing clinical practices that reduce self-harm and prevent suicide. Mental health teams already do most of the work in this arena, and the case is made to refocus on physical health with task sharing. The top 10 recommendations within a personalised medicine framework are listed in this paper as a starting point.
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Affiliation(s)
- Peter Byrne
- Department of Psychological Medicine, Royal London Hospital, London, UK
- Public Mental Health Implementation Centre, Royal College of Psychiatrists, London, UK
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9
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Xu Y, Geldsetzer P, Manne-Goehler J, Theilmann M, Marcus ME, Zhumadilov Z, Quesnel-Crooks S, Mwalim O, Moghaddam SS, Koolaji S, Karki KB, Farzadfar F, Ebrahimi N, Damasceno A, Aryal KK, Agoudavi K, Atun R, Bärnighausen T, Davies J, Jaacks LM, Vollmer S, Probst C. The socioeconomic gradient of alcohol use: an analysis of nationally representative survey data from 55 low-income and middle-income countries. Lancet Glob Health 2022; 10:e1268-e1280. [PMID: 35961350 PMCID: PMC9582994 DOI: 10.1016/s2214-109x(22)00273-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Alcohol is a leading risk factor for over 200 conditions and an important contributor to socioeconomic health inequalities. However, little is known about the associations between individuals' socioeconomic circumstances and alcohol consumption, especially heavy episodic drinking (HED; ≥5 drinks on one occasion) in low-income or middle-income countries. We investigated the association between individual and household level socioeconomic status, and alcohol drinking habits in these settings. METHODS In this pooled analysis of individual-level data, we used available nationally representative surveys-mainly WHO Stepwise Approach to Surveillance surveys-conducted in 55 low-income and middle-income countries between 2005 and 2017 reporting on alcohol use. Surveys from participants aged 15 years or older were included. Logistic regression models controlling for age, country, and survey year stratified by sex and country income groups were used to investigate associations between two indicators of socioeconomic status (individual educational attainment and household wealth) and alcohol use (current drinking and HED amongst current drinkers). FINDINGS Surveys from 336 287 participants were included in the analysis. Among males, the highest prevalence of both current drinking and HED was found in lower-middle-income countries (L-MICs; current drinking 49·9% [95% CI 48·7-51·2] and HED 63·3% [61·0-65·7]). Among females, the prevalence of current drinking was highest in upper-middle-income countries (U-MIC; 29·5% [26·1-33·2]), and the prevalence of HED was highest in low-income countries (LICs; 36·8% [33·6-40·2]). Clear gradients in the prevalence of current drinking were observed across all country income groups, with a higher prevalence among participants with high socioeconomic status. However, in U-MICs, current drinkers with low socioeconomic status were more likely to engage in HED than participants with high socioeconomic status; the opposite was observed in LICs, and no association between socioeconomic status and HED was found in L-MICs. INTERPRETATION The findings call for urgent alcohol control policies and interventions in LICs and L-MICs to reduce harmful HED. Moreover, alcohol control policies need to be targeted at socially disadvantaged groups in U-MICs. FUNDING Deutsche Forschungsgemeinschaft and the National Center for Advancing Translational Sciences of the US National Institutes of Health.
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Affiliation(s)
- Yuanwei Xu
- School of Economics and Management, Gottfried Wilhelm Leibniz University of Hannover, Hannover, Germany; Faculty of Management and Economics, Ruhr University Bochum, Bochum, Germany.
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jen Manne-Goehler
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Maja-E Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | | | - Sarah Quesnel-Crooks
- Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | | | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sogol Koolaji
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Khem B Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ebrahimi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Krishna K Aryal
- Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | | | - Rifat Atun
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Till Bärnighausen
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Boston, MA, USA; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany; Africa Health Research Institute, Somkhele, South Africa
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lindsay M Jaacks
- Global Academy of Agriculture and Food Security, The University of Edinburgh, Easter Bush Campus, Midlothian, UK
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.
| | - Charlotte Probst
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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10
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Guckel T, Miller CL, Longo M, Cooke R, Bowden JA. Alcohol consumption and mental health conditions: Insights from a South Australian population survey to inform policy and practice. Aust N Z J Public Health 2022; 46:668-675. [DOI: 10.1111/1753-6405.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 03/01/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tara Guckel
- School of Public Health University of Adelaide South Australia
- The Matilda Centre for Research in Mental Health and Substance Use The University of Sydney New South Wales
| | - Caroline L. Miller
- School of Public Health University of Adelaide South Australia
- South Australian Health and Medical Research Institute Adelaide South Australia
| | - Marie Longo
- Drug and Alcohol Services South Australia Stepney South Australia
| | - Richard Cooke
- Drug and Alcohol Services South Australia Stepney South Australia
| | - Jacqueline A. Bowden
- School of Public Health University of Adelaide South Australia
- South Australian Health and Medical Research Institute Adelaide South Australia
- National Centre for Education and Training on Addiction Bedford Park South Australia
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11
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Investigation of Alcohol-Drinking Levels in the Swiss Population: Differences in Diet and Associations with Sociodemographic, Lifestyle and Anthropometric Factors. Nutrients 2022; 14:nu14122494. [PMID: 35745224 PMCID: PMC9230148 DOI: 10.3390/nu14122494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 12/04/2022] Open
Abstract
Alcohol-drinking levels in Switzerland were investigated to identify dietary differences and explore the relationship between drinking levels and sociodemographic, lifestyle and anthropometric factors using the National Nutrition Survey menuCH (n = 2057, 18−75 years). After two 24 h dietary recalls (24HDRs), participants were categorized into four subgroups: abstainers (both self-declared alcohol avoidance and no alcohol reported); no alcohol reported; moderate drinkers (women/men < 12 g/<24 g mean daily alcohol, respectively); and heavy drinkers (women/men > 12 g/>24 g mean daily alcohol, respectively). Differences in diet between these groups were described by comparing daily total energy and non-alcohol energy intake, macronutrient energy contribution, food group intake, and diet quality (Alternate Healthy Eating Index excluding alcohol). The sociodemographic, anthropometric and lifestyle factors that determine alcohol-drinking levels were investigated using multinomial logistic regression. Abstainers reported the lowest daily energy intake (total and non-alcohol), heavy drinkers had the highest total energy intake and the lowest diet quality, and moderate drinkers had the highest non-alcohol energy intake. Sex, age, language region, body mass index, household size, smoking status, self-reported health status and following a diet were significantly associated with different alcohol-drinking subgroups. Results could facilitate interventions that target subgroups who exceed safe alcohol-drinking levels and lead unfavorable lifestyles.
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12
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Córdoba García R, Camarelles Guillem F. [Screening and brief intervention on alcohol consumption]. Aten Primaria 2022; 54:102349. [PMID: 35550977 PMCID: PMC9108444 DOI: 10.1016/j.aprim.2022.102349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
La morbilidad asociada al consumo de alcohol incluye patología digestiva, psiquiátrica, neurológica, infecciosa, cáncer de diversos tipos, enfermedades cardiovasculares, lesiones intencionales, no intencionales, patología social y problemas familiares. Las evidencias más recientes no indican que el consumo «moderado» sea beneficioso para la salud. Por lo tanto, debe enfatizarse más bien la idea de evitar los consumos de riego y transmitir a los pacientes que lo más beneficioso para la salud sería no consumir alcohol o hacerlo en dosis de bajo riesgo. El instrumento más adecuado de cribado es el AUDIT-C. Las bases de la intervención breve consisten en estrategias cognitivo-conductuales y motivacionales. Hay que dar una información positiva sobre los beneficios de la moderación e informar sobre el peligro de la ingesta de alcohol. En fases precoces de la dependencia se contempla la oferta de tratamiento farmacológico de desintoxicación, deshabituación y seguimiento. Los casos más graves requieren coordinación con los servicios de adicciones. En España se ha podido comprobar que la intervención breve es efectiva y que disminuye el consumo 100 gramos de alcohol a la semana. Las estrategias comunitarias son el marco normativo adecuado para lograr los mejores resultados de la intervención breve. Estas deberán ir encaminadas a reducir la oferta y la disponibilidad para el consumo, mediante la adopción de medidas legislativas, de manera que se limite tanto la accesibilidad económica como la física. Por otra parte, habrá que implementar medidas para disminuir la demanda del alcohol mediante la educación para la salud a determinados grupos de riesgo.
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13
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Leong C, Bolton JM, Ekuma O, Prior HJ, Singal D, Nepon J, Konrad G, Paillé M, Finlayson G, Nickel N. Association of alcohol use disorder on alcohol-related cancers, diabetes, ischemic heart disease and death: a population-based, matched cohort study. Addiction 2022; 117:368-381. [PMID: 34286922 DOI: 10.1111/add.15646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/04/2020] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS High-risk alcohol consumption is associated with compromised health. This study aimed to compare the incidence of alcohol-related cancers, diabetes, ischemic heart disease (IHD) and mortality between those with and without an indication of alcohol use disorder (AUD). DESIGN Retrospective, population-based, matched cohort study using data from the Manitoba Population Research Data Repository. Rates were modeled using generalized linear models with either negative binomial distribution or Poisson distribution and a log offset of person-years to account for each person's time to follow-up. SETTING Manitoba, Canada. PARTICIPANTS Individuals aged ≥ 12 years with a first indication of AUD (index date) between 1 April 1990 and 31 March 2015 were matched to five controls based on age, sex and geographical region at index. This study included 53 410 individuals with AUD and 264 857 matched controls. MEASUREMENTS Adjusted rate ratios (aRR) and 95% confidence intervals (CI) were determined for each outcome from 5 years prior to and 20 years after AUD detection. FINDINGS Alcohol-related cancers (aRR = 4.85, 95% CI = 3.88-6.07 and aRR = 1.85, 95% CI = 1.35-2.53 for men and women, respectively), diabetes (aRR = 1.74, 95% CI = 1.50-2.02 and aRR = 2.43, 95% CI = 2.20-2.68) and IHD (aRR = 3.59, 95% CI = 3.31-3.90 and aRR = 2.92, 95% CI = 2.50-3.41) peaked in the 1 year prior to index for those with AUD compared with matched controls. All-cause mortality (aRR = 3.31, 95% CI = 3.09-3.55 and aRR =3.61, 95% CI = 3.21-4.04) was highest in the year of index and remained higher among cases compared with controls throughout the 20-year follow-up. CONCLUSION People with alcohol use disorder appear to have higher rates of adverse health outcomes in the year before alcohol use disorder recognition, and death at the time of alcohol use disorder recognition, compared with matched controls.
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Affiliation(s)
- Christine Leong
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Deepa Singal
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Josh Nepon
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoffrey Konrad
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael Paillé
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Greg Finlayson
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Nathan Nickel
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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14
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Di Castelnuovo A, Costanzo S, Bonaccio M, McElduff P, Linneberg A, Salomaa V, Männistö S, Moitry M, Ferrières J, Dallongeville J, Thorand B, Brenner H, Ferrario M, Veronesi G, Pettenuzzo E, Tamosiunas A, Njølstad I, Drygas W, Nikitin Y, Söderberg S, Kee F, Grassi G, Westermann D, Schrage B, Dabboura S, Zeller T, Kuulasmaa K, Blankenberg S, Donati MB, de Gaetano G, Iacoviello L. Alcohol intake and total mortality in 142 960 individuals from the MORGAM Project: a population-based study. Addiction 2022; 117:312-325. [PMID: 34105209 DOI: 10.1111/add.15593] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/02/2020] [Accepted: 05/26/2021] [Indexed: 12/12/2022]
Abstract
AIM To test the association of alcohol consumption with total and cause-specific mortality risk. DESIGN Prospective observational multi-centre population-based study. SETTING Sixteen cohorts (15 from Europe) in the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project. PARTICIPANTS A total of 142 960 individuals (mean age 50 ± 13 years, 53.9% men). MEASUREMENTS Average alcohol intake by food frequency questionnaire, total and cause-specific mortality. FINDINGS In comparison with life-time abstainers, consumption of alcohol less than 10 g/day was associated with an average 11% [95% confidence interval (CI) = 7-14%] reduction in the risk of total mortality, while intake > 20 g/day was associated with a 13% (95% CI = 7-20%) increase in the risk of total mortality. Comparable findings were observed for cardiovascular (CV) deaths. With regard to cancer, drinking up to 10 g/day was not associated with either mortality risk reduction or increase, while alcohol intake > 20 g/day was associated with a 22% (95% CI = 10-35%) increased risk of mortality. The association of alcohol with fatal outcomes was similar in men and women, differed somewhat between countries and was more apparent in individuals preferring wine, suggesting that benefits may not be due to ethanol but other ingredients. Mediation analysis showed that high-density lipoprotein cholesterol explained 2.9 and 18.7% of the association between low alcohol intake and total as well as CV mortality, respectively. CONCLUSIONS In comparison with life-time abstainers, consuming less than one drink per day (nadir at 5 g/day) was associated with a reduced risk of total, cardiovascular and other causes mortality, except cancer. Intake of more than two drinks per day was associated with an increased risk of total, cardiovascular and especially cancer mortality.
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Affiliation(s)
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | | | - Patrick McElduff
- University of Newcastle & Hunter Medical Research Institute, Australia
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Satu Männistö
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marie Moitry
- Department of Public Health, University Hospital of Strasbourg and Department of Epidemiology and Public Health, University of Strasbourg, France
| | - Jean Ferrières
- Department of Cardiology and INSERM UMR 1295, Toulouse University Hospital, Toulouse, France
| | - Jean Dallongeville
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Barbara Thorand
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research and Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Marco Ferrario
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Emanuela Pettenuzzo
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Inger Njølstad
- Department of community Medicine, University of Tromsø - the Arctic University of Norway, Norway
| | - Wojciech Drygas
- Department of Epidemiology CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland
| | - Yuri Nikitin
- The Institute of Internal and Preventive Medicine, Novosibirsk, Russia
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Sweden
| | - Frank Kee
- Centre for Public Health, Queens University of Belfast, Belfast, Northern Ireland
| | - Guido Grassi
- Clinica Medica, Università Milano-Bicocca, Milano, Italy
| | - Dirk Westermann
- Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Benedikt Schrage
- Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Salim Dabboura
- Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Tanja Zeller
- Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Kari Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Stefan Blankenberg
- Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | | | | | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.,Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
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15
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Fischer B, Robinson T, Bullen C, Curran V, Jutras-Aswad D, Medina-Mora ME, Pacula RL, Rehm J, Room R, van den Brink W, Hall W. Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103381. [PMID: 34465496 DOI: 10.1016/j.drugpo.2021.103381] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis. METHODS Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process. RESULTS A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible. CONCLUSIONS Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
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Affiliation(s)
- Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Tessa Robinson
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Chris Bullen
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Health Innovation (NIHI), The University of Auckland, Auckland, New Zealand
| | - Valerie Curran
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Maria Elena Medina-Mora
- Center for Global Mental Health Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico; Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosalie Liccardo Pacula
- Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, United States
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction & Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Wim van den Brink
- Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Wayne Hall
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, QLD 4072, Australia; National Addiction Centre, Institute of Psychiatry, Kings College London, United Kingdom
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16
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Rehm J, Neufeld M, Yurasova E, Bunova A, Gil A, Gornyi B, Breda J, Bryun E, Drapkina O, Fadeeva E, Kalinina A, Khaltourina D, Klimenko T, Kontsevaya A, Koshkina E, Martynova N, Nadezhdin A, Soshkina K, Tetenova E, Vujnovic M, Vyshinsky K, Ferreira-Borges C. Adaptation of and Protocol for the Validation of the Alcohol Use Disorders Identification Test (AUDIT) in the Russian Federation for Use in Primary Healthcare. Alcohol Alcohol 2021; 55:624-630. [PMID: 32728707 PMCID: PMC7576502 DOI: 10.1093/alcalc/agaa067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 01/10/2023] Open
Abstract
Aims To adapt and validate the Alcohol Use Disorders Identification Test (AUDIT) for use in the Russian Federation and countries with Russian-speaking populations by: Methods Systematic review of past use and validation of the Russian-language AUDIT. Interviews to be conducted with experts to identify problems encountered in the use of existing Russian-language AUDIT versions. A pilot study using a revised translation of the Russian-language AUDIT that incorporates country-specific drinking patterns in the Russian Federation. Results and Conclusions The systematic review identified over 60 different Russian-language AUDIT versions without systematic validation studies. The main difficulties encountered with the use of the AUDIT in the Russian Federation were related to the lack of: A revised version of the Russian-language AUDIT was created based on the pilot studies, and was validated in primary healthcare facilities in all regions in 2019/2020.
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Affiliation(s)
- Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer St. 46, Dresden 01187, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, Ontario M5T 1R8, Canada.,Institute of Medical Science (IMS), University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario M5S 1A8, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada.,Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya St., 8, b. 2, Moscow 119992, Russian Federation
| | - Maria Neufeld
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer St. 46, Dresden 01187, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.,WHO European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Elena Yurasova
- WHO Office in the Russian Federation, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Anna Bunova
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Artyom Gil
- Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya St., 8, b. 2, Moscow 119992, Russian Federation
| | - Boris Gornyi
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - João Breda
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Evgeniy Bryun
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Oxana Drapkina
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Eugenia Fadeeva
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Anna Kalinina
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Daria Khaltourina
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Dobrolyubov Street 11, Moscow 127254, Russian Federation
| | - Tatiana Klimenko
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Anna Kontsevaya
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Evgenia Koshkina
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Lublinskay Street 37/1, Moscow 109390, Russian Federation
| | - Natalya Martynova
- Department of Public Health and Communications, Ministry of Health of the Russian Federation, Rakhmanovsky Pereulok 3, Moscow 127051, Russian Federation
| | - Alexey Nadezhdin
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Lublinskay Street 37/1, Moscow 109390, Russian Federation
| | - Kristina Soshkina
- Department of Public Health and Communications, Ministry of Health of the Russian Federation, Rakhmanovsky Pereulok 3, Moscow 127051, Russian Federation
| | - Elena Tetenova
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Lublinskay Street 37/1, Moscow 109390, Russian Federation
| | - Melita Vujnovic
- WHO Office in the Russian Federation, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Konstantin Vyshinsky
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Carina Ferreira-Borges
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
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Kinnunen J, Satopää J, Niemelä M, Putaala J. Coagulopathy and its effect on treatment and mortality in patients with traumatic intracranial hemorrhage. Acta Neurochir (Wien) 2021; 163:1391-1401. [PMID: 33759013 PMCID: PMC8053656 DOI: 10.1007/s00701-021-04808-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/10/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The role of coagulopathy in patients with traumatic brain injury has remained elusive. In the present study, we aim to assess the prevalence of coagulopathy in patients with traumatic intracranial hemorrhage, their clinical features, and the effect of coagulopathy on treatment and mortality. METHODS An observational, retrospective single-center cohort of consecutive patients with traumatic intracranial hemorrhage treated at Helsinki University Hospital between 01 January and 31 December 2010. We compared clinical and radiological parameters in patients with and without coagulopathy defined as drug- or disease-induced, i.e., antiplatelet or anticoagulant medication at a therapeutic dose, thrombocytopenia (platelet count < 100 E9/L), international normalized ratio > 1.2, or thromboplastin time < 60%. Primary outcome was 30-day all-cause mortality. Logistic regression analysis allowed to assess for factors associated with coagulopathy and mortality. RESULTS Of our 505 patients (median age 61 years, 65.5% male), 206 (40.8%) had coagulopathy. Compared to non-coagulopathy patients, coagulopathy patients had larger hemorrhage volumes (mean 140.0 mL vs. 98.4 mL, p < 0.001) and higher 30-day mortality (18.9% vs. 9.7%, p = 0.003). In multivariable analysis, older age, lower admission Glasgow Coma Scale score, larger hemorrhage volume, and conservative treatment were independently associated with mortality. Surgical treatment was associated with lower mortality in both patients with and without coagulopathy. CONCLUSIONS Coagulopathy was more frequent in patients with traumatic intracranial hemorrhage presenting larger hemorrhage volumes compared to non-coagulopathy patients but was not independently associated with higher 30-day mortality. Hematoma evacuation, in turn, was associated with lower mortality irrespective of coagulopathy.
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Affiliation(s)
- Janne Kinnunen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland.
| | - Jarno Satopää
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, 00260, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland
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Rosário F, Santos MI, Angus K, Pas L, Ribeiro C, Fitzgerald N. Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework. Implement Sci 2021; 16:6. [PMID: 33413487 PMCID: PMC7791720 DOI: 10.1186/s13012-020-01073-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Alcohol is a leading risk factor contributing to the global burden of disease. Several national and international agencies recommend that screening and brief interventions (SBI) should be routinely delivered in primary care settings to reducing patients' alcohol consumption. However, evidence shows that such activities are seldom implemented in practice. A review of the barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking. This study aimed to conduct a theory-informed review of the factors influencing general practitioners' and primary care nurses' routine delivery of alcohol SBI in adults. METHODS A systematic literature search was carried out in four electronic databases (Medline, CINAHL, CENTRAL, PsycINFO) using comprehensive search strategies. Both qualitative and quantitative studies were included. Two authors independently abstracted and thematically grouped the data extracted. The barriers and facilitators identified were mapped to the domains of the Capability-Opportunity-Motivation-Behaviour system/Theoretical Domains Framework (TDF). RESULTS Eighty-four out of the 258 studies identified met the selection criteria. The majority of the studies reported data on the views of general practitioners (n = 60) and used a quantitative design (n = 49). A total of 660 data items pertaining to barriers and 253 data items pertaining to facilitators were extracted and thematically grouped into 46 themes. The themes mapped to at least one of the 14 domains of the TDF. The three TDF domains with the highest number of data units coded were 'Environmental Context and Resources' (n = 158, e.g. lack of time), 'Beliefs about Capabilities' (n = 134, e.g. beliefs about the ability to deliver screening and brief advice and in helping patients to cut down) and 'Skills' (n = 99, e.g. lack of training). CONCLUSIONS This study identified a range of potential barriers and facilitators to the implementation of alcohol SBI delivery in primary care and adds to the scarce body of literature that identifies the barriers and facilitators from a theoretical perspective. Given that alcohol SBI is seldom implemented, this review provides researchers with a tool for designing novel theory-oriented interventions to support the implementation of such activity. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016052681.
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Affiliation(s)
- Frederico Rosário
- Instituto de Medicina Preventiva e Saúde Pública, Faculty of Medicine, Lisbon University, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal. .,Agrupamento de Centros de Saúde Dão Lafões, Av. António José de Almeida - Edíficio MAS, 3514-511, Viseu, Portugal.
| | - Maria Inês Santos
- Hospital Casa de Saúde São Mateus SA, Rua 5 de Outubro 183, 3500-093, Viseu, Portugal
| | - Kathryn Angus
- Institute for Social Marketing & Health (ISMH), Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK
| | - Leo Pas
- Academic Centre for General Practice, KU Leuven, Kapucijnenvoer 33 blok j - box 7001, 3000, Leuven, Belgium
| | - Cristina Ribeiro
- Instituto de Medicina Preventiva e Saúde Pública, Faculty of Medicine, Lisbon University, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal
| | - Niamh Fitzgerald
- Institute for Social Marketing & Health (ISMH), Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, Scotland, UK
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The Development of Empirically Derived Australian Low-Risk Gambling Limits. J Clin Med 2021; 10:jcm10020167. [PMID: 33418841 PMCID: PMC7824838 DOI: 10.3390/jcm10020167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/25/2022] Open
Abstract
This study derived a set of Australian low-risk gambling limits and explored the relative and absolute risk associated with exceeding these limits. Secondary analysis of population-representative Tasmanian and Australian Capital Territory (ACT) cross-sectional (11,597 respondents) and longitudinal studies (2027 respondents) was conducted. Balancing sensitivity and specificity, the limits were: gambling frequency of 20–30 times per year; gambling expenditure of AUD $380–$615 per year (USD $240–$388 per year); gambling expenditure comprising 0.83–1.68% of gross personal income; and two types of gambling activities per year. All limits, except number of activities, predicted subsequent harm, with limits related to gambling expenditure consistently the best-performing. Exceeding the limits generally conferred a higher degree of relative and absolute risk, with gamblers exceeding the limits being 3–20 times more likely to experience harm than those who do not, and having a 5–17% risk of experiencing harm. Only 7–12% of gamblers exceeding the limits actually experienced harm. Gambling consumption lower than the limits also conferred a considerable amount of harm. Using a relative risk method, this study derived similar limits from disparate Australian states and territories. These limits can serve as working guidelines for the consideration of researchers, clinicians, and policy makers, but need to be subject to further rigorous empirical investigation.
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Wicki M, Marmet S, Studer J, Epaulard O, Gmel G. Curvilinear associations between sexual orientation and problematic substance use, behavioural addictions and mental health among young Swiss men. Addict Behav 2021; 112:106609. [PMID: 32861992 DOI: 10.1016/j.addbeh.2020.106609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/10/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS It is well documented that individuals with a minority sexual orientation face greater risks of problematic substance use (e.g. heavy episodic drinking, alcohol use disorder) and mental health problems. Far less is known about how that risk varies within this population and their risk of behavioural addictions. This study estimated the risks of problematic substance use, behavioural addiction and poor mental health across the spectrum of sexual orientation. SAMPLE AND METHOD A sample of young Swiss men (N = 5294; mean age = 25.5, SD = 1.25; representative of 21 of Switzerland's 26 cantons) completed a self-reporting questionnaire on sexual orientation (attraction, 5-point scale) and criterion variables: problematic substance use (e.g. alcohol, cigarettes, cannabis and other illegal drugs), behavioural addictions (gambling, gaming, cybersex, internet, smartphone, work, exercise) and indicators of mental health (e.g. depression, stress). Curvilinear associations between sexual orientation (heterosexual, mostly-heterosexual, bisexual, mostly-homosexual or homosexual individuals) and criterion variables were explored using fractional polynomial regressions. RESULTS Although there were differences across criterion variables, in general, the highest risks of problematic substance use, behavioural addictions and mental health problems were estimated for mostly-heterosexual, bisexual or mostly-homosexual men, followed by homosexual men, and with heterosexual men facing the lowest risk. DISCUSSION AND CONCLUSION Aggregating the spectrum of sexual orientations into two or three distinct groups blurs important internal group differences. Outcome-specific explanations beyond minority stress and biphobia are necessary to understand the pathways between sexual orientation and risky behaviours. Considering sexual orientation is important to provide targeted healthcare prevention and interventions.
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Low-risk Drinking Guidelines Around the World: An Overview of the Current Situation. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Raffetti E, Donato F, De Palma G, Leonardi L, Sileo C, Magoni M. Polychlorinated biphenyls (PCBs) and risk of dementia and Parkinson disease: A population-based cohort study in a North Italian highly polluted area. CHEMOSPHERE 2020; 261:127522. [PMID: 32712378 DOI: 10.1016/j.chemosphere.2020.127522] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Serum polychlorinated biphenyls (PCBs) have been associated with some chronic diseases, but little evidence exists on their possible relationship with neurodegenerative diseases. We aimed to assess the relationship between PCB exposure and the occurrence of dementia and Parkinson disease in a prospective cohort study in a highly polluted area (Brescia-Caffaro). METHODS PCB exposure was assessed by measuring serum levels of 24 congeners. Data on the onset of dementia and Parkinson disease were retrieved by the Brescia Health Protection Agency Database. We used Poisson regression models adjusted for possible confounders to calculate rate ratios (RRs). A mediation analysis was performed to evaluate the mediatory role of cardiovascular diseases. RESULTS 699 subjects without neurologic diseases at baseline were enrolled (48.1% males, 63.2 years of mean age) in 2001-2013 and followed up to 2018. During a mean follow-up of 8.8 years, 36 and 20 subjects developed dementia and Parkinson disease. Subjects in the 2nd and 3rd tertiles of the total PCBs distribution, compared with those in the 1st tertile, had a higher risk of dementia (RR = 2.30 and RR = 4.35). The estimates for Parkinson disease included the null value with wide confidence intervals. In the mediation analysis, the association between PCB exposure and dementia was dominated by the direct pathway and not by the hypertension-mediated pathway. CONCLUSIONS We observed a positive association between total PCBs serum levels and the onset of dementia not mediated by hypertension. For Parkinson, the unstable risk estimates did not allow to draw a conclusion on a possible association.
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Affiliation(s)
- Elena Raffetti
- Department of Public Health Sciences, Karolinska Institutet, Italy; ATS Brescia (Brescia Health Protection Agency), Italy; Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology, and Public Health, University of Brescia, Italy.
| | - Francesco Donato
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology, and Public Health, University of Brescia, Italy
| | - Giuseppe De Palma
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Institute of Occupational Health and Industrial Hygiene, University of Brescia, Italy
| | | | - Claudio Sileo
- ATS Brescia (Brescia Health Protection Agency), Italy
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Grape ( Vitis vinifera L.) Seed Oil: A Functional Food from the Winemaking Industry. Foods 2020; 9:foods9101360. [PMID: 32992712 PMCID: PMC7599587 DOI: 10.3390/foods9101360] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022] Open
Abstract
Wine production is an ancient human activity that generates several by-products, which include some constituents known for their potential in health care and for their role in the food or cosmetic industries. Any variety of grape (Vitis vinifera L.) contains nutrients and bioactive compounds available from their juice or solid parts. Grape seed extract has demonstrated many activities in disease prevention, such as antioxidant effects, which make it a potential source of nutraceuticals. Grape seed is a remarkable winery industry by-product due to the bioactivity of its constituents. Methods for recovery of oil from grape seeds have evolved to improve both the quantity and quality of the yield. Both the lipophilic and hydrophilic chemicals present in the oil of V. vinifera L. make this wine by-product a source of natural nutraceuticals. Food and non-food industries are becoming novel targets of oil obtained from grape seeds given its various properties. This review focuses on the advantages of grape seed oil intake in our diet regarding its chemical composition in industries not related to wine production and the economic and environmental impact of oil production.
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Witkiewitz K, Heather N, Falk DE, Litten RZ, Hasin DS, Kranzler HR, Mann KF, O'Malley SS, Anton RF. World Health Organization risk drinking level reductions are associated with improved functioning and are sustained among patients with mild, moderate and severe alcohol dependence in clinical trials in the United States and United Kingdom. Addiction 2020; 115:1668-1680. [PMID: 32056311 PMCID: PMC7841874 DOI: 10.1111/add.15011] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/11/2019] [Accepted: 02/10/2020] [Indexed: 02/04/2023]
Abstract
AIMS To examine whether World Health Organization (WHO) risk-level reductions in drinking were achievable, associated with improved functioning and maintained over time among patients at varying initial alcohol dependence severity levels. Design and setting Secondary data analysis of multi-site randomized clinical trials: the US Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study and the UK Alcohol Treatment Trial (UKATT). PARTICIPANTS Individuals with alcohol dependence enrolled in COMBINE (n = 1383; 68.8% male) and seeking treatment for alcohol problems in UKATT (n = 742; 74.1% male). Interventions Naltrexone, acamprosate or placebo, and combined behavioral intervention or medication management in COMBINE. Social behavior network therapy or motivational enhancement therapy in UKATT. MEASUREMENTS WHO risk-level reductions were assessed via the calendar method. Alcohol dependence was measured by the Alcohol Dependence Scale, the Leeds Dependence Questionnaire and the Diagnostic and Statistical Manual of Mental Disorders. Measures of functioning included alcohol-related consequences (Drinker Inventory of Consequences and Alcohol Problems Questionnaire), mental health (Short Form Health Survey) and liver enzyme tests. FINDINGS One- and two-level reductions in WHO risk levels in the last month of treatment were maintained at the 1-year follow-up [adjusted odds ratio (OR), 95% confidence interval (CI) = one-level reduction in COMBINE: 3.51 (2.73, 4.29) and UKATT: 2.65 (2.32, 2.98)] and associated with fewer alcohol-related consequences [e.g. B, 95% CI = one-level reduction COMBINE: -26.22 (-30.62, -21.82)], better mental health [e.g. B, 95% CI = one-level reduction UKATT: 9.53 (7.36, 11.73)] and improvements in γ-glutamyltransferase [e.g. B, 95% CI = one-level reduction UKATT: -89.77 (-122.50, -57.04)] at the end of treatment, even among patients with severe alcohol dependence. Results were similar when abstainers were excluded. Conclusions Reductions in World Health Organization risk levels for alcohol consumption appear to be achievable, associated with better functioning and maintained over time in both the United States and the United Kingdom.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque NM, USA
| | - Nick Heather
- Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Daniel E. Falk
- National Institute on Alcohol Abuse and Alcoholism Bethesda MD USA
| | - Raye Z. Litten
- National Institute on Alcohol Abuse and Alcoholism Bethesda MD USA
| | | | - Henry R. Kranzler
- Department of Psychiatry University of Pennsylvania Philadelphia PA USA
| | - Karl F. Mann
- Central Institute of Mental Health, Medical Faculty Mannheim Heidelberg University Mannheim Germany
| | | | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina Charleston SC USA
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Pallari E, Soukup T, Kyriacou A, Lewison G. Assessing the European impact of alcohol misuse and illicit drug dependence research: clinical practice guidelines and evidence-base policy. EVIDENCE-BASED MENTAL HEALTH 2020; 23:67-76. [PMID: 32229480 PMCID: PMC10231490 DOI: 10.1136/ebmental-2019-300124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite alcohol and illicit drug dependence being one of the most common diagnoses in Europe, there is heterogeneity of research evidence used in policy and practice. OBJECTIVE We sought to (1) evaluate European research outputs on alcohol misuse and drug addiction in 2002-2018 in the Web of Science, (2) compare these with their burden of disease and (3) determine their impact in several ways. METHODS A bibliometric research was undertaken including an assessment of the citation counts, the influence of research on members of national health advisory committees, and their contribution to the evidence base of clinical practice guidelines (CPGs). FINDINGS There were 3201 analysed references cited in 28 CPGs across 11 European Countries on alcohol misuse and illicit drug abuse. Research conducted in the USA dominated both sets of CPGs, while many European countries were overcited relative to their research presence. The illicit drug research appeared to be adequate relative to the evidence of harm in Europe. However, alcohol misuse research appeared grossly inadequate to the harm it causes by a factor of 20. CONCLUSIONS The volume of research on illicit drug addiction is commensurate to the European burden, whereas alcohol misuse is far below what is needed to curb a significant source of harm. CLINICAL IMPLICATIONS The research asymmetries call for attention to the causes of the problem. Development of research-based solutions to a serious social harm is needed, including minimum pricing and collaborative work to harmonise efforts on disease management and treatment practices across European countries.
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Affiliation(s)
- Elena Pallari
- Medical Research Council Clinical Trials Unit, University College London, London, UK
- Department of Health Service and Population Research, King's College London, London, UK
| | - Tayana Soukup
- Department of Health Service and Population Research, King's College London, London, UK
| | - Andri Kyriacou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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26
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Raffetti E, Donato F, De Palma G, Leonardi L, Sileo C, Magoni M. Polychlorinated biphenyls (PCBs) and risk of hypertension: A population-based cohort study in a North Italian highly polluted area. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 714:136660. [PMID: 32018953 DOI: 10.1016/j.scitotenv.2020.136660] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/12/2019] [Accepted: 01/10/2020] [Indexed: 06/10/2023]
Abstract
This study aimed to assess the longitudinal association between PCB exposure and the subsequent occurrence of hypertension in a highly polluted area. The study subjects had at least one PCB serum measurement between 2003 and 2014 and were followed up to the end of 2017. Hypertension cases were obtained from the Brescia Health Protection Agency database. Risk ratios of hypertension for total PCBs, high-, middle- and low-chlorinated groups and some common congeners were estimated using Poisson regression models. 1031 subjects were included (43.4% males, mean age 45.3 years). 229 subjects developed hypertension during the follow-up. Total PCBs, middle- and high-chlorinated PCBs, and particularly PCB congeners 138, 153 and 180 were associated with an about 2-fold increased risk of hypertension comparing the third with first tertile of distribution. After lipid-standardization of PCB serum values, the excess risk showed only a slight attenuation. A dose-response linear relationship of the risk of hypertension by PCB serum concentrations as continuous variables was also observed. The PCBs-hypertension association was stronger in overweight/obese subjects than those with normal body mass index. In this prospective cohort study the serum levels of total and middle to high chlorinated (≥6 Cl) PCBs were associated with an increased risk of hypertension, particularly among overweight/obese subjects.
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Affiliation(s)
- Elena Raffetti
- Department of Public Health Sciences, Karolinska Institutet, Sweden; Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology, and Public Health, University of Brescia, Italy; ATS Brescia (Brescia Health Protection Agency), Brescia, Italy.
| | - Francesco Donato
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology, and Public Health, University of Brescia, Italy.
| | - Giuseppe De Palma
- Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Institute of Occupational Health and Industrial Hygiene, University of Brescia, Italy.
| | - Lucia Leonardi
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy.
| | - Claudio Sileo
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy.
| | - Michele Magoni
- ATS Brescia (Brescia Health Protection Agency), Brescia, Italy.
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Levitt EE, Oshri A, Clifton A, Stout R, Costello MJ, VanDellen M, Kelly JF, MacKillop J. Psychometric Validation of the Brief Alcohol Social Density Assessment in an Adult Community Sample. Alcohol Clin Exp Res 2019; 44:212-218. [PMID: 31828804 DOI: 10.1111/acer.14227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Individuals' social networks exert a strong influence on alcohol use, but valid assessment of network drinking behavior is typically lengthy and high in participant burden. The aim of this study was to validate the Brief Alcohol Social Density Assessment (BASDA), an efficient measure of perceived alcohol use within a person's social network, in a sample of adult drinkers from the general community. Specifically, the convergent, criterion-related, incremental validity and internal validity were investigated by examining the BASDA in relation to other established measures of drinking motives, weekly drinking level, and severity of involvement. METHODS Participants were 903 (56% female) adults who reported drinking in the last year and who completed the BASDA, the Drinking Motives Questionnaire, the Daily Drinking Questionnaire, and the Alcohol Use Disorders Identification Test (AUDIT). RESULTS Significant positive correlations were found between the BASDA and drinking motives, drinking quantity, and the AUDIT (rs = 0.21 to 0.51, ps < 0.001), providing support for convergent validity. There was a significantly higher BASDA score for those scoring at or above an AUDIT cutoff for hazardous drinking (p < 0.001), providing support for criterion-related validity. Finally, beyond motives and covariates, the BASDA was significantly associated with total AUDIT score (ΔR2 = 0.09, p < 0.001), indicating its additive contribution and providing support for incremental validity. Confirmatory factor analysis revealed excellent fit, and all items significantly loaded onto a single factor (p < 0.0001), providing evidence of internal validity. The resulting alcohol social density latent variable was significantly and robustly associated with drinks per week and AUDIT total score. CONCLUSIONS These findings provide further support for the BASDA as a valid and efficient measure of social network alcohol density for understanding social influences on alcohol misuse.
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Affiliation(s)
- Emily E Levitt
- From the, Peter Boris Centre for Addiction Research, (EEL, JM), St Joseph's Health Care, Hamilton, ON, Canada.,Homewood Research Institute, (EEL, MJC, JM), Guelph, ON, Canada
| | - Assaf Oshri
- Department of Human Development and Family Science, (AO), University of Georgia, Athens, Georgia
| | - Allan Clifton
- Department of Psychological Science, (AC), Vassar College, Poughkeepsie, New York
| | - Robert Stout
- Pacific Institute for Research and Evaluation, (RS), Providence, Rhode Island
| | | | | | - John F Kelly
- Recovery Research Institute, (JFK), Massachusetts General Hospital, Boston, Massachusetts.,Department of Psychiatry, (JFK), Harvard Medical School, Boston, Massachusetts
| | - James MacKillop
- From the, Peter Boris Centre for Addiction Research, (EEL, JM), St Joseph's Health Care, Hamilton, ON, Canada.,Homewood Research Institute, (EEL, MJC, JM), Guelph, ON, Canada
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Sherk A, Gilmore W, Churchill S, Lensvelt E, Stockwell T, Chikritzhs T. Implications of Cardioprotective Assumptions for National Drinking Guidelines and Alcohol Harm Monitoring Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4956. [PMID: 31817638 PMCID: PMC6950575 DOI: 10.3390/ijerph16244956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 01/16/2023]
Abstract
The existence and potential level of cardioprotection from alcohol use is contested in alcohol studies. Assumptions regarding the risk relationship between alcohol use and ischaemic heart disease (IHD) are critical when providing advice for national drinking guidelines and for designing alcohol harm monitoring systems. We use three meta-analyses regarding alcohol use and IHD risk to investigate how varying assumptions lead to differential estimates of alcohol-attributable (AA) deaths and weighted relative risk (RR) functions, in Australia and Canada. Alcohol exposure and mortality data were acquired from administrative sources and AA fractions were calculated using the International Model of Alcohol Harms and Policies. We then customized a recent Global Burden of Disease (GBD) analysis to inform drinking guidelines internationally. Australians drink slightly more than Canadians, per person, but are also more likely to identify as lifetime abstainers. Cardioprotective scenarios resulted in substantial differences in estimates of net AA deaths in Australia (between 2933 and 4570) and Canada (between 5179 and 8024), using GBD risk functions for all other alcohol-related conditions. Country-specific weighted RR functions were analyzed to provide advice toward drinking guidelines: Minimum risk was achieved at or below alcohol use levels of 10 g/day ethanol, depending on scenario. Consumption levels resulting in 'no added' risk from drinking were found to be between 10 and 15 g/day, by country, gender, and scenario. These recommendations are lower than current guidelines in Australia, Canada, and some other high-income countries: These guidelines may be in need of downward revision.
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Affiliation(s)
- Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada; (S.C.); (T.S.)
| | - William Gilmore
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia; (W.G.); (E.L.); (T.C.)
| | - Samuel Churchill
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada; (S.C.); (T.S.)
| | - Eveline Lensvelt
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia; (W.G.); (E.L.); (T.C.)
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada; (S.C.); (T.S.)
| | - Tanya Chikritzhs
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia; (W.G.); (E.L.); (T.C.)
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Gémes K, Moeller J, Engström K, Sidorchuk A. Alcohol consumption trajectories and self-rated health: findings from the Stockholm Public Health Cohort. BMJ Open 2019; 9:e028878. [PMID: 31427328 PMCID: PMC6701653 DOI: 10.1136/bmjopen-2018-028878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/20/2019] [Accepted: 07/12/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate whether poor self-rated health and psychological distress are differentially associated with drinking trajectories over time. METHODS From the Stockholm Public Health Cohort, two subcohorts surveyed in 2002-2010-2014 and 2006-2010-2014 (n=23 794 and n=34 667 at baseline, respectively) were used. Alcohol consumption, self-rated health, psychological distress (measured by General Health Questionnaire-12), lifestyle factors and longstanding illness were assessed by questionnaires. Demographic and socioeconomic variables were obtained by register linkage. Logistic regression was fitted to assess the associations with eight alcohol consumption trajectories, which were constructed among 30 228 individuals (13 898 and 16 330 from the 2002 and 2006 subcohorts, respectively) with measures of consumption at three time points. RESULTS Compared with stable moderate drinkers, all other trajectories were associated with poor self-rated health with multiadjusted OR for stable non-drinkers of 2.35 (95% CIs 1.86 to 2.97), unstable non-drinkers (OR=2.58, 95% CI 1.54 to 3.32), former drinkers (OR=2.81, 95% CI 2.31 to 3.41) and stable heavy drinkers (OR=2.16, 95% CI 1.47 to 3.20). The associations were not fully explained by sociodemographic and lifestyle factors and longstanding illness. Former drinking, but no other trajectories, was associated with psychological distress (OR=1.24; 95% CI 1.10 to 1.41). CONCLUSION We found a U-shape association between alcohol trajectories and self-rated health, but not with psychological distress. Compared with stable moderate drinking, former drinking was associated with the highest odds of both poor self-rated health and psychological distress. The study confirms the importance of a life-course approach to examining the effect of alcohol consumption on health and highlights the poorer general and mental health status of non-drinkers who were former drinkers.
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Affiliation(s)
- Katalin Gémes
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jette Moeller
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Karin Engström
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Anna Sidorchuk
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm & Healthcare Services, Stockholm County Council, CAP Research Center, Gävlegatan, Stockholm
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Holmes J, Angus C, Meier PS, Buykx P, Brennan A. How should we set consumption thresholds for low risk drinking guidelines? Achieving objectivity and transparency using evidence, expert judgement and pragmatism. Addiction 2019; 114:590-600. [PMID: 30133036 DOI: 10.1111/add.14381] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/10/2018] [Accepted: 07/04/2018] [Indexed: 01/05/2023]
Abstract
Most high-income nations issue guidelines on low-risk drinking to inform individuals' decisions about alcohol consumption. However, leading scientists have criticized the processes for setting the consumption thresholds within these guidelines for a lack of objectivity and transparency. This paper examines how guideline developers should respond to such criticisms and focuses particularly on the balance between epidemiological evidence, expert judgement and pragmatic considerations. Although concerned primarily with alcohol, our discussion is also relevant to those developing guidelines for other health-related behaviours. We make eight recommendations across three areas. First, recommendations on the use of epidemiological evidence: (1) guideline developers should assess whether the available epidemiological evidence is communicated most appropriately as population-level messages (e.g. suggesting reduced drinking benefits populations rather than individuals); (2) research funders should prioritize commissioning studies on the acceptability of different alcohol-related risks (e.g. mortality, morbidity, harms to others) to the public and other stakeholders; and (3) guideline developers should request and consider statistical analyses of epidemiological uncertainty. Secondly, recommendations to improve objectivity and transparency when translating epidemiological evidence into guidelines: (4) guideline developers should specify and publish their analytical framework to promote clear, consistent and coherent judgements; and (5) guideline developers' decision-making should be supported by numerical and visual techniques which also increase the transparency of judgements to stakeholders. Thirdly, recommendations relating to the diverse use of guidelines: (6) guideline developers and their commissioners should give meaningful attention to how guidelines are used in settings such as advocacy, health promotion, clinical practice and wider health debates, as well as in risk communication; (7) guideline developers should make evidence-based judgements that balance epidemiological and pragmatic concerns to maximize the communicability, credibility and general effectiveness of guidelines; and (8) as with scientific judgements, pragmatic judgements should be reported transparently.
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Affiliation(s)
- John Holmes
- Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Colin Angus
- Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Petra S Meier
- Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Penny Buykx
- Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alan Brennan
- Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Abstract
BACKGROUND Alcohol use has been identified as a risk factor for dementia and cognitive decline. However, some patterns of drinking have been associated with beneficial effects. METHODS AND RESULTS To clarify the relationship between alcohol use and dementia, we conducted a scoping review based on a systematic search of systematic reviews published from January 2000 to October 2017 by using Medline, Embase, and PsycINFO. Overall, 28 systematic reviews were identified: 20 on the associations between the level of alcohol use and the incidence of cognitive impairment/dementia, six on the associations between dimensions of alcohol use and specific brain functions, and two on induced dementias. Although causality could not be established, light to moderate alcohol use in middle to late adulthood was associated with a decreased risk of cognitive impairment and dementia. Heavy alcohol use was associated with changes in brain structures, cognitive impairments, and an increased risk of all types of dementia. CONCLUSION Reducing heavy alcohol use may be an effective dementia prevention strategy.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, Ontario M5S 2S1 Canada
- Dalla Lana School of Public Health, University of Toronto, 27 King’s College Circle, Toronto, M5S 1A1 Ontario Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, M5T 1R8 Ontario Canada
- Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King’s College Circle, Toronto, M5S 1A8 Ontario Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, M5T 1R8 Ontario Canada
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, Dresden, 01187 Germany
| | - Omer S. M. Hasan
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, Ontario M5S 2S1 Canada
- Dalla Lana School of Public Health, University of Toronto, 27 King’s College Circle, Toronto, M5S 1A1 Ontario Canada
| | - Sandra E. Black
- Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King’s College Circle, Toronto, M5S 1A8 Ontario Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Toronto, M4N 3M5 Ontario Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, M4N 3M5 Ontario Canada
| | - Kevin D. Shield
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, Ontario M5S 2S1 Canada
- Dalla Lana School of Public Health, University of Toronto, 27 King’s College Circle, Toronto, M5S 1A1 Ontario Canada
| | - Michaël Schwarzinger
- Translational Health Economics Network (THEN), 39 quai de Valmy, Paris, 75010 Paris France
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Stockwell T, Zhao J, Sherk A, Rehm J, Shield K, Naimi T. Underestimation of alcohol consumption in cohort studies and implications for alcohol's contribution to the global burden of disease. Addiction 2018; 113:2245-2249. [PMID: 30014539 DOI: 10.1111/add.14392] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/18/2018] [Accepted: 07/06/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Estimated alcohol consumption from national self-report surveys is often only 30-40% of official estimates based on sales or taxation data. Global burden of disease (GBD) estimates for alcohol adjust survey estimates up to 80% of total per capita consumption. This assumes that cohort studies needed to estimate relative risks for disease suffer less from under-reporting than typical national surveys. However, there is limited evidence on which to base that assumption. This paper aims to assess the extent of underestimation of alcohol consumption in cohort studies concerning alcohol and mortality compared with official total consumption estimates. DESIGN Comparisons of estimated per capita consumption from a comprehensive sample of cohort studies against official estimates by country and year. PARTICIPANTS A total of 1 876 046 participants in 40 cohort studies from 18 countries on alcohol use and all-cause mortality identified by systematic review. MEASUREMENTS Alcohol consumption data from the cohort studies were converted into usual grams of ethanol per day and then to total age 15+ per capita consumption. Matched estimates were sourced from the World Health Organization (WHO) Global Health Observatory. FINDINGS The cohort studies had mean coverages of age 15+ per capita alcohol consumption of 61.71% (ranging from 29.19% for Russia to 96.53% for Japan), after weighting estimates by sample size for within-country estimates and by number of studies per country for the overall estimate. Regional estimates were higher for the United States (66.22%) and lower for western European countries (55.35%). CONCLUSIONS Underestimation of alcohol consumption in cohort studies is less than in typical population surveys. Because some under-coverage is caused by under-sampling heavier drinkers, the current practice of uplifting survey estimates to 80% of total population consumption in global burden of disease studies appears to be appropriate.
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Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Jinhui Zhao
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kevin Shield
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tim Naimi
- School of Medicine, Clinical Addiction Research and Education Unit, Boston University, Boston, MA, USA
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Haseeb S, Alexander B, Santi RL, Liprandi AS, Baranchuk A. What's in wine? A clinician's perspective<sup/>. Trends Cardiovasc Med 2018; 29:97-106. [PMID: 30104174 DOI: 10.1016/j.tcm.2018.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/08/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022]
Abstract
Alcoholic beverages, specifically wine, have been consumed for many years. Wine is postulated to play an important role in the improvement of cardiovascular risk factors. Most epidemiological studies have found sustained consumption at light-to-moderate amounts to increase HDL cholesterol, reduce platelet aggregation, and promote fibrinolysis. Wine consumption has been inversely associated with ischemic heart disease, and the alcohol-blood pressure association, in most studies, follows a J-shaped curve. These outcomes have been attributed to the molecular constituents of wine, namely ethanol and polyphenols. Due to the continued interest in wine as a biological beverage, we review the chemistry of wine as clinicians, including its chemical composition, viticulture and enological practices, and other chemical factors that influence the bioactive components of wine. We also outline the biological effects of wine components and directions for future research.
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Affiliation(s)
- Sohaib Haseeb
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Bryce Alexander
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Ricardo Lopez Santi
- Division of Cardiology, Hospital Italiano de La Plata, Buenos Aires, Argentina
| | | | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.
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Wakefield MA, Brennan E, Dunstone K, Durkin SJ, Dixon HG, Pettigrew S, Slater MD. Immediate effects on adult drinkers of exposure to alcohol harm reduction advertisements with and without drinking guideline messages: experimental study. Addiction 2018; 113:1019-1029. [PMID: 29486097 DOI: 10.1111/add.14147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/17/2017] [Accepted: 12/14/2017] [Indexed: 01/08/2023]
Abstract
AIMS To compare the immediate effects on drinkers of television advertisements focusing upon short- versus long-term harms with and without low-risk drinking guidelines. DESIGN Between-participants on-line experiment, with random assignment to view: (a) alcohol product advertisements (ALC control); (b) advertisements unrelated to alcohol (NON-ALC control); (c) advertisements featuring short-term harms (STH) of alcohol; (d) advertisements featuring STH plus a STH guideline (STH+G); (e) advertisements featuring long-term harms (LTH); or (f) advertisements featuring LTH plus a LTH guideline (LTH+G). SETTING Australia, 2016. PARTICIPANTS A total of 3718 drinkers aged 18-64 years (48.5% male). MEASUREMENTS Post-exposure likelihood that participants provided a correct estimate of drinking levels associated with short- and long-term harms; post-exposure intentions to avoid alcohol or reduce consumption. FINDINGS After exposure to STH+G or LTH+G advertisements, participants were more likely to estimate correctly rather than overestimate drinking levels associated with harm, compared with those exposed to STH (P < 0.001) and LTH advertisements without guidelines, respectively (P = 0.019) and ALC control (STH+G, P < 0.001; LTH+G, P < 0.001) and NON-ALC control conditions (STH+G, P < 0.001; LTH+G, P = 0.011). Drinkers exposed to STH conditions were more likely to intend to reduce next-week alcohol consumption than those exposed to ALC control (both P < 0.001) and NON-ALC control conditions (STH, P = 0.001; STH+G, P < 0.001); a similar pattern was observed for intentions to avoid alcohol. Drinkers exposed to LTH conditions were also more likely than drinkers exposed to ALC or NON-ALC controls to intend to avoid and reduce alcohol in the next week. Additionally, drinkers exposed to LTH+G were more likely to intend to reduce drinking than those exposed to LTH advertisements without guidelines (P = 0.022). Response patterns for low- and high-risk drinkers by condition were similar. CONCLUSIONS Alcohol harm television advertisements increase intentions to reduce alcohol consumption among both low- and high-risk drinkers. The addition of low-risk drinking guidelines can enhance these effects for advertisements featuring long-term harms and improve estimates of both short- and long-term harmful drinking levels.
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Affiliation(s)
- Melanie A Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Kimberley Dunstone
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Sarah J Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Helen G Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Simone Pettigrew
- School of Psychology and Speech Pathology, Curtin University, Western Australia
| | - Michael D Slater
- School of Communication Ohio State University, Columbus, OH, USA
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35
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Böckerman P, Hyytinen A, Kaprio J, Maczulskij T. If you drink, don't smoke: Joint associations between risky health behaviors and labor market outcomes. Soc Sci Med 2018; 207:55-63. [PMID: 29730550 DOI: 10.1016/j.socscimed.2018.04.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 01/30/2023]
Abstract
This paper examines the links between risky health behaviors and labor market success. We provide new evidence on the joint relationships between the most prominent forms of risky health behavior - alcohol consumption, smoking and physical inactivity - and long-term labor market outcomes. We use twin data for Finnish men and women linked to register-based individual information on earnings and labor market attachment. The twin data allow us to account for shared family and environmental factors and to measure risky health behaviors in 1975 and 1981. The long-term labor market outcomes were measured in adulthood as an average over the period 1990-2009. The sample sizes are 2156 and 2498 twins, for men and women, respectively. We find that being both a smoker and a heavy drinker in early adulthood is negatively related to long-term earnings and employment later in life, especially for men. We conclude that how and why risky health behaviors cluster and how that affects individual level outcomes call for more attention.
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Affiliation(s)
- Petri Böckerman
- University of Jyväskylä, School of Business and Economics, Labour Institute for Economic Research and IZA, Pitkänsillanranta 3A, FI-00530 Helsinki, Finland.
| | - Ari Hyytinen
- University of Jyväskylä, School of Business and Economics, Jyväskylä, Finland.
| | - Jaakko Kaprio
- University of Helsinki, Institute for Molecular Medicine (FIMM), P.O. Box 20 (Tukholmankatu 8), 00014 Helsinki, Finland; University of Helsinki, Department of Public Health, P.O.Box 20 (Tukholmankatu 8B), 00014 Helsinki, Finland.
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36
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Abstract
Alcohol consumption constitutes a substantial burden of disease. Older people are being admitted to hospital for alcohol problems in increasing numbers. A recent systematic review reports cautious supportive evidence for primary prevention interventions in reducing excessive alcohol consumption in older drinkers, but does not focus on treatment of dependent drinkers. The evidence base for treatment interventions for dependent drinkers is comparatively limited, but it is growing. In addition to brief interventions, specialist outpatient treatment and inpatient treatment have been evaluated.The responses of older people to treatment are promising: they want to abstain, they have the capacity to change, they respond well to brief advice and motivational enhancement therapy, they achieve improvements at least as comparable to younger counterparts-and sometimes better-and they do have the prospect of long-term recovery.There is a need to develop services tailored to the needs of older substance misusers. Education of the workforce, including medical students and other health care professionals, is the key. Collaboration and coordination of services, training, research and policy are essential.There are very few designated services for older substance misusers in the UK and only 7% of older people who need treatment for alcohol problems access them. There is a massive gap in the whole gamut of research from basic to clinical research in this vulnerable patient population: this has to be developed if management is to be effective and up to date.
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Affiliation(s)
- Ilana B Crome
- Keele University, Newcastle under Lyme, Staffordshire ST5 5BG, UK
| | - Peter Crome
- Keele University, Newcastle under Lyme, Staffordshire ST5 5BG, UK
- University College London, London, UK
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37
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Shield KD, Gmel G, Mäkelä P, Probst C, Room R, Gmel G, Rehm J. Risk, individual perception of risk and population health. Addiction 2017; 112:2272-2273. [PMID: 28948666 DOI: 10.1111/add.14011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/21/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Kevin D Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Pia Mäkelä
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare THL, Helsinki, Finland
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia.,Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Gerhard Gmel
- Epidemiology and Statistics Section, Addiction Suisse, Lausanne, Switzerland
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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38
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Cardiovascular effects of alcohol consumption. Trends Cardiovasc Med 2017; 27:534-538. [DOI: 10.1016/j.tcm.2017.06.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/28/2017] [Accepted: 06/01/2017] [Indexed: 12/15/2022]
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39
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Britton A. Commentary on Shield et al. (2017): The concept of 'acceptable risk' of premature mortality. Addiction 2017; 112:1545-1546. [PMID: 28778121 DOI: 10.1111/add.13883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 01/01/2023]
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40
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Mann K, Aubin HJ, Witkiewitz K. Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence? Eur Addict Res 2017; 23:219-230. [PMID: 28934736 DOI: 10.1159/000481348] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/03/2017] [Indexed: 12/22/2022]
Abstract
Abstinence from alcohol has been the prevailing treatment goal for individuals with alcohol dependence (AD) within the context of specialty alcohol treatment. Yet, alcohol use has been conceptualized as existing on a continuum. Importantly, most people who meet criteria for AD and could benefit from treatment never receive treatment. About half of these individuals do not seek treatment because they report a desire to continue drinking. To increase acceptability of treatment, reductions in alcohol consumption have been examined as alternative outcomes in treatment trials for AD. The current study reviews data which indicate that long-term reduction in alcohol consumption among patients with AD is possible. Controlled studies have tested reduced alcohol consumption and show sustained improvements in drinking reductions for many patients following behavioral treatments and pharmacotherapy. Evidence-based treatment guidelines and medicines development guidance authorities have taken note of these developments and accept "intermediate harm reduction" (European Medicines Agency) or "low-risk drinking limits" (US Federal Drug Administration) as optional trial endpoints. In conclusion, while abstinence remains the safest treatment goal for individuals with AD, evidence supports that reduced drinking approaches may be an important extension in the treatment of AD.
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Affiliation(s)
- Karl Mann
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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