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Psychometric Properties of the CAGE Questionnaire Amongst Middle-Aged and Older Adults in Khuzistan Province of Iran. J Cross Cult Gerontol 2023; 38:97-109. [PMID: 36792867 DOI: 10.1007/s10823-023-09470-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
The CAGE questionnaire is an instrument, proved useful in helping to make a diagnosis of alcoholism. The questions focus on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. The questionnaire has been more pervasive simple tool than AUDIT and LAST scales to screen in busy medical settings where limited time is considered for adult patient interviews. The present study aimed to determine the reliability and validity of the CAGE questionnaire in Khuzistan province, Iran and evaluate its role in detecting alcohol-related problems. For this purpose, 382 men with mean age of 65 ± 5 were sampled by cluster-random sampling method in convenience model from the medical centers in eight counties of Khuzistan province during 2019 and they responded to the CAGE questionnaire. The coefficients of Cronbach's alpha (α = 0.82), convergent validity (0.73), divergent validity (-0.06), and criterion validity (0.87) were estimated (ρ < 0.01). The exploratory factor analysis demonstrated that the four -items related to the CAGE for the aged samples are organized into one factor, which clarifies 94% of the variance. Based on the results of the second-order confirmatory factor analysis, all factors were matched up well into a principal factor. Finally, the one -factor model was appropriate for the data by using the fit index techniques for adjusting the scale (AGFI = 0.81, TLI = 0.91, GFI = 0.93, RMSEA = 0.006, IFI = 0.94, NFI = 0.91, CFI = 0.97).The results could prove the well-adjusted reliability and validity of the CAGE and its usefulness for the relevant studies.
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Williamson L, Dell CA, Osgood N, Chalmers D, Lohnes C, Carleton N, Asmundson G. Examining Changes in Posttraumatic Stress Disorder Symptoms and Substance Use Among a Sample of Canadian Veterans Working with Service Dogs: An Exploratory Patient- Oriented Longitudinal Study. JOURNAL OF VETERANS STUDIES 2021. [DOI: 10.21061/jvs.v7i1.194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Szabo YZ, Breeding T, Hejl C, Guleria RS, Nelson SM, Zambrano-Vazquez L. Cortisol as a Biomarker of Alcohol Use in Combat Veterans: A Literature Review and Framework for Future Research. J Dual Diagn 2020; 16:322-335. [PMID: 32493131 PMCID: PMC7483986 DOI: 10.1080/15504263.2020.1771504] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: Alcohol use and alcohol use disorders (AUDs) are an increasing concern among veterans, particularly those from recent conflicts in Iraq and Afghanistan. The study of biomarkers in alcohol use and AUD has moved to enhancing the understanding of the development and maintenance of AUDs, as well as investigating its association with clinical severity and potential predictors of treatment response. Cortisol, a glucocorticoid known as a stress hormone, has been linked with both stress and trauma, as well as increased alcohol suppression effects. Method/Results: The present review summarizes existing literature and presents suggestions for future research to evaluate whether cortisol may be a possible biomarker of alcohol use disorder risk in combat veterans. Specifically, aspects of combat deployments and high levels of PTSD, coupled with the stress of reintegration may dysregulate cortisol and increase risk to AUD. There may also be bidirectional impacts, such that alcohol is used as a coping mechanism and can dysregulate hypothalamic pituitary adrenal (HPA) axis functioning and cortisol. Conclusions: In the context of this framework, cortisol may serve as a biomarker for the development of AUD, as well as a biomarker of risk or relapse. This review ends with both theoretical and clinical implications, as well as directions for future research.
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Affiliation(s)
- Yvette Z Szabo
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.,Department of Psychiatry, Texas A&M College of Medicine, Bryan, TX, USA.,Department of Health, Human Performance and Recreation, Baylor University, Waco, TX, USA
| | - Tessa Breeding
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
| | - Christina Hejl
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA
| | - Rakeshwar S Guleria
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.,Institute of Biomedical Studies, Baylor University, Waco, TX, USA
| | - Steven M Nelson
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.,Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.,Center for Vital Longevity, University of Texas at Dallas, Dallas, TX, USA
| | - Laura Zambrano-Vazquez
- Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.,Department of Psychiatry, Texas A&M College of Medicine, Bryan, TX, USA.,Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
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Noronha BP, Nascimento-Souza MA, Lima-Costa MF, Peixoto SV. [Alcohol consumption patterns and associated factors among elderly Brazilians: National Health Survey (2013)]. CIENCIA & SAUDE COLETIVA 2019; 24:4171-4180. [PMID: 31664390 DOI: 10.1590/1413-812320182411.32652017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/28/2018] [Indexed: 05/30/2023] Open
Abstract
The scope of this study was to analyze the pattern of alcohol consumption among elderly Brazilians (60 years and over) and their association with sociodemographic factors, lifestyle habits and health conditions. This is a cross-sectional study of 10,537 elderly (90.1%) participants from the National Health Survey of 2013. The consumption of alcoholic beverages was classified as non-use, mild / moderate use and risk use. The multinomial regression model was used to study the associated factors. The prevalence for mild / moderate and risk use was 9.4% (95% CI: 8.4- 10.6%) and 4.6% (95%CI: 4.0-5.3%), respectively. The two consumption patterns were inversely associated with age and more frequent among men, better schooling, smokers and physical activity practitioners. Mild / moderate consumption was less frequent among non-whites and those with a history of stroke and diabetes, whereas risk use was less frequent among the elderly diagnosed for heart disease and more frequent among those suffering from depression. This result identifies profiles of greater vulnerability, with small differences between two patterns of consumption. This information should be considered in the preparation of proposals to promote healthy habits and control of alcohol use among the elderly.
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Affiliation(s)
- Beatriz Prado Noronha
- Instituto René Rachou, Fiocruz. Av. Augusto de Lima 911, Barro Preto. 30190-002. Belo Horizonte, MG, Brasil.
| | - Mary Anne Nascimento-Souza
- Instituto René Rachou, Fiocruz. Av. Augusto de Lima 911, Barro Preto. 30190-002. Belo Horizonte, MG, Brasil.
| | - Maria Fernanda Lima-Costa
- Instituto René Rachou, Fiocruz. Av. Augusto de Lima 911, Barro Preto. 30190-002. Belo Horizonte, MG, Brasil.
| | - Sérgio Viana Peixoto
- Instituto René Rachou, Fiocruz. Av. Augusto de Lima 911, Barro Preto. 30190-002. Belo Horizonte, MG, Brasil.
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Association Between Alcohol Use and Angina Symptoms Among Outpatients From the Veterans Health Administration. J Addict Med 2019; 12:143-149. [PMID: 29334512 DOI: 10.1097/adm.0000000000000379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alcohol use is associated with angina incidence, but associations between alcohol use and experience of angina among patients with coronary artery disease (CAD) have not been described. METHODS Outpatients with CAD from 7 clinics in the Veterans Health Administration were surveyed; alcohol use was measured using the validated Alcohol Use Disorders Identification Test-Consumption scores categorized into 6 groups: nondrinking, low-risk drinking, and mild, moderate, severe, and very severe unhealthy alcohol use. Three domains of self-reported angina symptoms (frequency, stability, and physical function) were measured with the Seattle Angina Questionnaire. Linear regression models evaluated associations between alcohol use groups and angina symptoms. Models were adjusted first for age and then additionally for smoking, comorbidities, and depression. RESULTS Patients (n = 8303) had a mean age of 66 years. In age-adjusted analyses, a U-shaped association was observed between alcohol use groups and all angina outcomes, with patients in nondrinking and severe unhealthy alcohol groups reporting the greatest angina symptoms and lowest functioning. After full adjustment, no clinically important and few statistically important differences were observed across alcohol use in angina stability or frequency. Patients in the nondrinking group had statistically greater functional limitation from angina than those in all groups of unhealthy alcohol use, though differences were small. Patients in all groups of unhealthy alcohol use did not differ significantly from those with low-risk drinking. CONCLUSIONS Alcohol use was associated with some small statistically but no clinically important differences in angina symptoms among patients with CAD. This cross-sectional study does not support a protective effect of low-level drinking on self-reported angina.
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Teeters JB, Lancaster CL, Brown DG, Back SE. Substance use disorders in military veterans: prevalence and treatment challenges. Subst Abuse Rehabil 2017; 8:69-77. [PMID: 28919834 PMCID: PMC5587184 DOI: 10.2147/sar.s116720] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Substance use disorders (SUDs) are a significant problem among our nation's military veterans. In the following overview, we provide information on the prevalence of SUDs among military veterans, clinical characteristics of SUDs, options for screening and evidence-based treatment, as well as relevant treatment challenges. Among psychotherapeutic approaches, behavioral interventions for the management of SUDs typically involve short-term, cognitive-behavioral therapy interventions. These interventions focus on the identification and modification of maladaptive thoughts and behaviors associated with increased craving, use, or relapse to substances. Additionally, client-centered motivational interviewing approaches focus on increasing motivation to engage in treatment and reduce substance use. A variety of pharmacotherapies have received some support in the management of SUDs, primarily to help with the reduction of craving or withdrawal symptoms. Currently approved medications as well as treatment challenges are discussed.
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Affiliation(s)
- Jenni B Teeters
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Ralph H Johnson Veterans Affairs (VA) Medical Center, Charleston, SC, USA
| | - Cynthia L Lancaster
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Ralph H Johnson Veterans Affairs (VA) Medical Center, Charleston, SC, USA
| | - Delisa G Brown
- Department of Human Development and Psychoeducation, Howard University, Washington, DC, USA
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Ralph H Johnson Veterans Affairs (VA) Medical Center, Charleston, SC, USA
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Cairns A, Sarmiento K, Bogan R. Utility of home sleep apnea testing in high-risk veterans. Sleep Breath 2017; 21:647-655. [PMID: 28243925 DOI: 10.1007/s11325-017-1467-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Many Veterans Affairs Medical Centers (VAMCs) have implemented home sleep apnea testing (HSAT) in lieu of traditional in-lab testing to establish a timely and cost-sensitive diagnosis of obstructive sleep apnea (OSA). However, concern remains for the sensitivity and specificity of said technology in this population as many veterans are at increased risk for many of the comorbid conditions that can limit the accuracy of HSAT results. Hence, the purpose of this study is to evaluate rate of incongruent outcomes (e.g., negative HSAT results despite high clinical symptomology) as well as differences in study quality metrics and predictors of OSA between veteran sleep patients and general sleep patients being evaluated by a home sleep test. METHODS A random sample of HSAT outcomes from 1500 veterans and 1500 general sleep clinic patients was retrieved from a repository of anonymized HSAT outcomes from 2009 to 2013. General sleep clinic data were from patients referred for home sleep testing from a variety of clinical practices across North America, whereas VAMC patients were tested using a central dissemination process. All patients were tested for OSA using the Apnea Risk and Evaluation System (ARES), an HSAT that simultaneously records airflow, pulse oximetry, snoring, accelerometry, and EEG. Sample differences and rates of comorbidities, HSAT outcomes, predictors of OSA, and pretest OSA risk information were evaluated between groups. The presence of OSA was defined as an apnea-hypopnea index (AHI; using 4% desaturation criterion) of ≥5 and ≥15 events per hour. Sample differences in predictors of OSA were evaluated using logistic multiple regression. RESULTS Veterans (91.3% male) were more likely to report comorbidities, especially depression, insomnia, hypertension, diabetes, restless legs syndrome (RLS), and use of sleep and pain medications compared to general sleep clinic patients (57.1% male). Despite differences in the rate of medical comorbidities, no differences were observed between groups with regard to rates of positive studies, study integrity indicators, or predictors of OSA. Veterans, on average, had 30 min less recording time compared to those in the general clinic sample (p < .01). However, these differences did not impact the amount of the record that was deemed valid nor were veterans more likely to have wakefulness after sleep onset. Predictors of OSA for both groups included advancing age, and increased measures of adiposity (neck circumference and BMI). Mean AHI and respiratory disturbance index (RDI) were statistically similar for both groups and were similar for sleep stage and position. CONCLUSIONS Home sleep apnea testing for the diagnosis of OSA appears to yield similar results for VAMC patients deemed at high risk for OSA as it does with general sleep clinic patients.
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Affiliation(s)
- Alyssa Cairns
- SleepMed, Inc., 700 Gervais St. Suite 200, Columbia, SC, 29201, USA.
| | - Kathleen Sarmiento
- University of California, San Diego, 9300 Campus Point Drive MC 7381, La Jolla, CA, 92037, USA
| | - Richard Bogan
- SleepMed, Inc., 700 Gervais St. Suite 200, Columbia, SC, 29201, USA.,The University of South Carolina Medical School, 6439 Garners Ferry Rd, Columbia, SC, 29209, USA.,The Medical University of South Carolina, 9298 Medical Plaza Dr, Charleston, SC, 29406, USA
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Bhattacharya B, Pei K, Lui F, Rosenthal R, Davis K. Caring for the Geriatric Combat Veteran at the Veteran Affairs Hospital. CURRENT TRAUMA REPORTS 2016. [DOI: 10.1007/s40719-016-0068-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Clark BJ, Rubinsky AD, Ho PM, Au DH, Chavez LJ, Moss M, Bradley KA. Alcohol screening scores and the risk of intensive care unit admission and hospital readmission. Subst Abus 2016; 37:466-473. [PMID: 26730984 PMCID: PMC5669033 DOI: 10.1080/08897077.2015.1137259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The association between alcohol misuse and the need for intensive care unit admission as well as hospital readmission among those discharged from the hospital following a critical illness is unclear. This study sought to determine whether alcohol misuse was associated with (1) admission to an intensive care unit (ICU) among a cohort of patients receiving outpatient care and (2) hospital readmission among those discharged from the hospital following critical illness. METHODS This was a retrospective cohort study conducted with data from 24 Veterans Affairs (VA) health care facilities between 2004 and 2007. Scores on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire were used to identify patients with past-year abstinence, lower-risk alcohol use, moderate alcohol misuse, or severe alcohol misuse. The primary outcome was admission to a VA intensive care unit within the year following administration of the AUDIT-C. In an analysis focused on patients discharged from the ICU, the 2 main outcomes were hospital readmission within 1 year and within 30 days. RESULTS Among 486,115 veterans receiving outpatient care, the adjusted probability of ICU admission within 1 year was 2.0% (95% confidence interval [CI]: 1.7%-2.3%) for abstinent patients, 1.6% (95% CI: 1.3%-1.8%) for patients with lower-risk alcohol use, 1.8% (1.4%-2.3%) for patients with moderate alcohol misuse, and 2.5% (2.0%-2.9%) for patients with severe alcohol misuse. Among the 9,030 patients discharged from an ICU, the adjusted probability of hospital readmission within 1 year was 48% (46%-49%) in abstinent patients, 44% (42%-45%) in patients with lower-risk alcohol use, 42% (39%-45%) in patients with moderate alcohol misuse, and 55% (49%-60%) in patients with severe alcohol misuse. CONCLUSIONS Alcohol misuse may represent a modifiable risk factor for a cycle of ICU admission and subsequent hospital readmission.
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Affiliation(s)
- Brendan J. Clark
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, U.S
| | - Anna D. Rubinsky
- Center of Excellence for Substance Abuse Treatment and Education, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, U.S
- Health Services Research and Development, Department of Veterans Affairs Puget Sound health Care System, Seattle, WA, U.S
| | - P. Michael Ho
- Division of Cardiology, Department of Medicine, Denver VAMC, Denver, CO; University of Colorado, Aurora, CO, U.S
| | - David H. Au
- Health Services Research and Development, Department of Veterans Affairs Puget Sound health Care System, Seattle, WA, U.S
| | - Laura J. Chavez
- Health Services Research and Development, Department of Veterans Affairs Puget Sound health Care System, Seattle, WA, U.S
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, U.S
| | - Katharine A. Bradley
- Center of Excellence for Substance Abuse Treatment and Education, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, U.S
- Health Services Research and Development, Department of Veterans Affairs Puget Sound health Care System, Seattle, WA, U.S
- Group Health Research Institute – Seattle, WA, U.S
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Martens MP, Cadigan JM, Rogers RE, Osborn ZH. Personalized drinking feedback intervention for veterans of the wars in Iraq and Afghanistan: a randomized controlled trial. J Stud Alcohol Drugs 2016; 76:355-9. [PMID: 25978820 DOI: 10.15288/jsad.2015.76.355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Research has shown that U.S. military veterans are at risk relative to the general adult population for excessive alcohol consumption, and veterans of the wars in Afghanistan and Iraq (Operation Enduring Freedom [OEF], Operation Iraqi Freedom [OIF], and Operation New Dawn [OND]) particularly so. The purpose of this study was to examine the efficacy of a brief personalized drinking feedback intervention tailored for veterans. METHOD All veterans who presented to the OEF/OIF/OND Seamless Transition Clinic at the Harry S. Truman Memorial Veterans' Hospital (Columbia, MO) were eligible to participate. Participants were 325 veterans (93% male; 82% White, 75% Army, M(age) = 32.20 years) who were randomly assigned to one of two conditions: personalized drinking feedback (PDF) or educational information (EDU). Those in the PDF condition received personalized information about their alcohol use, including social norms comparisons, risks associated with reported drinking levels, and a summary of their alcohol-related problems. Follow-up assessments were completed at 1 and 6 months after intervention (response rates = 93% and 86%, respectively). RESULTS Results indicated a significant (p < .05) Omnibus Group × Time effect for estimated peak blood alcohol concentration, although tests of simple main effects did not indicate between-group differences at the individual follow-up points. Among baseline abstainers, those in the PDF condition were more likely than those in the EDU condition to remain an abstainer at 6-month follow-up (p < .05). CONCLUSIONS These findings provide preliminary support for the efficacy of a brief, inexpensive alcohol prevention/intervention for young adult military veterans.
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Affiliation(s)
- Matthew P Martens
- Department of Educational, School, and Counseling Psychology, University of Missouri, Columbia, Missouri
| | - Jennifer M Cadigan
- Department of Educational, School, and Counseling Psychology, University of Missouri, Columbia, Missouri
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González-Rubio E, San Mauro I, López-Ruíz C, Díaz-Prieto LE, Marcos A, Nova E. Relationship of moderate alcohol intake and type of beverage with health behaviors and quality of life in elderly subjects. Qual Life Res 2016; 25:1931-42. [PMID: 26797806 DOI: 10.1007/s11136-016-1229-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE This work was aimed to study the relationships of moderate alcohol intake and the type of beverages consumed with health behaviors and quality of life in elderly people. METHODS In this observational study, 231 subjects (55-85 years) voluntarily answering to advertisements were enrolled and divided in three study groups: abstainers and occasional consumers (ABS; n = 98), moderate drinkers of beer (BEER; n = 63) and moderate drinkers of all sorts of alcoholic beverages (MIXED; n = 70). Variables assessed included physical activity, activities of daily living, Mediterranean diet-adherence score, tobacco consumption, quality of sleep, body composition, medication and perception of health through the SF-36 questionnaire. Their relationship with alcohol consumption was assessed through general linear models including confounding variables (age, sex, chronic disease prevalence and socioeconomic status). ABS were also compared to moderate drinkers (MOD = BEER + MIXED). RESULTS The mean daily alcohol consumption in each group was (mean ± SD): ABS: 0.7 ± 1.1; BEER: 12.7 ± 8.1; MIXED: 13.9 ± 10.2 g/day. MOD and MIXED showed significantly higher physical activity (metabolic standard units; METs) than ABS (p = 0.023 and p = 0.004, respectively). MOD spent significantly less time doing housework activities than ABS (p = 0.032). Daily grams of alcohol consumption were significantly associated with METs (B = 21.727, p = 0.023). Specifically, wine consumption (g/day) was associated with METs (B = 46.196, p = <0.001) and showed borderline significant relationships with mental health (B = 0.245, p = 0.062) and vitality perception (B = 0.266, p = 0.054). CONCLUSION Moderate alcohol consumption, and in particular wine consumption, is associated with a more active lifestyle and better perception of own health in the Spanish elderly subjects studied.
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Affiliation(s)
- Elizabeth González-Rubio
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition, ICTAN-CSIC, C/Jose Antonio Novais 10, 28040, Madrid, Spain
| | - Ismael San Mauro
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition, ICTAN-CSIC, C/Jose Antonio Novais 10, 28040, Madrid, Spain
| | - Cristina López-Ruíz
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition, ICTAN-CSIC, C/Jose Antonio Novais 10, 28040, Madrid, Spain
| | - Ligia E Díaz-Prieto
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition, ICTAN-CSIC, C/Jose Antonio Novais 10, 28040, Madrid, Spain
| | - Ascensión Marcos
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition, ICTAN-CSIC, C/Jose Antonio Novais 10, 28040, Madrid, Spain
| | - Esther Nova
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition, ICTAN-CSIC, C/Jose Antonio Novais 10, 28040, Madrid, Spain.
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Chavez LJ, Liu CF, Tefft N, Hebert PL, Clark BJ, Rubinsky AD, Lapham GT, Bradley KA. Unhealthy alcohol use in older adults: Association with readmissions and emergency department use in the 30 days after hospital discharge. Drug Alcohol Depend 2016; 158:94-101. [PMID: 26644137 PMCID: PMC4749399 DOI: 10.1016/j.drugalcdep.2015.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Unhealthy alcohol use could impair recovery of older patients after medical or surgical hospitalizations. However, no prior research has evaluated whether older patients who screen positive for unhealthy alcohol use are at increased risk of readmissions or emergency department (ED) visits within 30 days after discharge. This study examined the association between AUDIT-C alcohol screening results and 30-day readmissions or ED visits. METHODS Veterans Affairs (VA) patients age 65 years or older, were eligible if they were hospitalized for a medical or surgical condition (2/1/2009-10/1/2011) and had an AUDIT-C score documented in their VA electronic medical record in the year before they were hospitalized. VA and Medicare data identified VA or non-VA index hospitalizations, readmissions, and ED visits. Primary analyses adjusted for demographics, comorbid conditions, and past-year health care utilization. RESULTS Among 579,330 hospitalized patients, 13.7% were readmitted and 12.0% visited an ED within 30 days of discharge. In primary analyses, high-risk drinking (n=7,167) and nondrinking (n=357,086) were associated with increased probability of readmission (13.8%, 95% CI 13.0-14.6%; and 14.2%, 95% CI 14.1-14.3%, respectively), relative to low-risk drinking (12.9%; 95% CI 12.7-13.0%). Only nondrinkers had increased risk for ED visits. CONCLUSIONS Alcohol screening results indicating high-risk drinking that were available in medical records were modestly associated with risk for 30-day readmissions and were not associated with risk for ED visits.
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Affiliation(s)
- Laura J. Chavez
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States,Departments of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States,Corresponding author at: University of Washington, Department of Health Services, 1959 NE Pacific Street, Box 357660, Seattle, WA 98195, United States. Tel.: +1 678 371 2197; fax: +1 206 543 3964
| | - Chuan-Fen Liu
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States.
| | - Nathan Tefft
- Bates College, 2 Andrews Rd, Lewiston, ME 04240, United States.
| | - Paul L Hebert
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States; Department of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States.
| | - Brendan J. Clark
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, 12700 East 19th Ave, Aurora, CO 80045, United States
| | - Anna D. Rubinsky
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States,Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States
| | - Gwen T. Lapham
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States,Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States
| | - Katharine A. Bradley
- Health Services Research & Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States,Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, United States,Departments of Health Services, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States,Departments of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States,Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States
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Muscari A, Bianchi G, Conte C, Forti P, Magalotti D, Pandolfi P, Vaccheri A, Zoli M. No Direct Survival Effect of Light to Moderate Alcohol Drinking in Community-Dwelling Older Adults. J Am Geriatr Soc 2015; 63:2526-2533. [PMID: 26592735 DOI: 10.1111/jgs.13837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the relationship between light to moderate alcohol consumption and mortality, particularly accounting for baseline health status and physical activity. DESIGN Prospective, longitudinal, population-based study. SETTING The Pianoro Study, which consisted of community-dwelling older adults in three towns in northern Italy. PARTICIPANTS Noninstitutionalized individuals of both sexes aged 65 and older (N = 5,256; 2,318 abstainers, 2,309 light to moderate drinkers (≤2 alcoholic units/d)). MEASUREMENTS Baseline information about demographic characteristics, lifestyle factors, physical activity (Physical Activity Scale for the Elderly (PASE)), perceived health status (visual analog scale (VAS)), dependency level, risk factors, and previous cardiovascular events was obtained using a structured questionnaire. Follow-up information was obtained 6 years later from 2,752 survivors, and mortality information was obtained from death certificates. RESULTS Male sex, being physically active, and good health status were independently associated with light to moderate drinking (P < .001). An apparent protective effect of light to moderate drinking on mortality was evident in the unadjusted analysis and after adjusting for age, sex, risk factors, and cardiovascular events (adjusted hazard ratio (aHR) = 0.77, 95% confidence interval (CI) = 0.68-0.88, P < .001), but after also adjusting for PASE and VAS, the relationship was no longer significant (aHR = 0.92, 95% CI = 0.80-1.05, P = .19). Follow-up physical activity was associated with baseline alcohol consumption; baseline physical activity did not predict alcohol consumption during follow-up. CONCLUSION After accounting for health status and physical activity, light to moderate alcohol drinking had no direct protective effect on mortality.
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Affiliation(s)
- Antonio Muscari
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Camilla Conte
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Paola Forti
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Donatella Magalotti
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Paolo Pandolfi
- Epidemiological and Health Promotion Unit, Department of Public Health, Azienda Unita Sanitaria Locale Bologna, Bologna, Italy
| | - Alberto Vaccheri
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Zoli
- Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Bakken-Gillen SK, Berven NL, Chan F, Brooks J, Resnick SG. Prediction of employment outcomes among veterans with substance use disorders: A chi-squared interaction detector analysis. JOURNAL OF VOCATIONAL REHABILITATION 2015. [DOI: 10.3233/jvr-150761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Fong Chan
- University of Wisconsin-Madison, Madison, WI, USA
| | | | - Sandra G. Resnick
- Yale University School of Medicine and VA Northeast Program Evaluation Center, New Haven, CT, USA
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15
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16
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Patil RD, Meinzen-Derr JK, Hendricks BL, Patil YJ. Improving access and timeliness of care for veterans with head and neck squamous cell carcinoma: A multidisciplinary team's approach. Laryngoscope 2015; 126:627-31. [PMID: 26267427 DOI: 10.1002/lary.25528] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/20/2015] [Accepted: 06/30/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS With the prevalence of head and neck squamous cell carcinoma (HNSCC) nearly twice as high in veterans (6%) than general populations (3%), the noted problems of long waits and access to care in United States Veterans Affairs (VA) hospitals across the country are pressing. We examined primary outcome measures of timeliness and access to care for our patients with HNSCC assessing a multidisciplinary team approach at our VA hospital. STUDY DESIGN Retrospective chart review. METHODS Our patients newly diagnosed with HNSCC were identified from two 24-month periods: diagnosis before (group 1, 2005-2006) and after (group 2, 2008-2009) implementing our multidisciplinary team in 2007. No significant differences in age (P = .13) or disease stage (P = .18) occurred between groups. Primary and secondary outcomes (i.e., treatment modality, imaging, completion of treatment, survival) were compared. RESULTS Timeliness to care improved for all measures. Improvement was significant for times from consult placed to seen in clinic (27.5-16.5 days; P < 0.0001) and from positive biopsy reported to date of initiating definitive treatment (35-27 days; P = 0.04). Pretreatment consults to various services represented by the multidisciplinary team increased from one to four (P < 0.0001). Two-year mortality was approximately the same between group 1 (33%) and group 2 (36%) (P = 0.035). Five-year mortality was slightly better in group 2 (50%) versus group 1 (61%), although not statistically significant. CONCLUSION Our veteran population with HNSCC had improved timeliness and access to care with our multidisciplinary approach. LEVEL OF EVIDENCE 4. Laryngoscope, 126:627-631, 2016.
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Affiliation(s)
- Reena Dhanda Patil
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A.,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A.,Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, Ohio, U.S.A
| | - Jareen K Meinzen-Derr
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A
| | - Brian L Hendricks
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A.,Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, Ohio, U.S.A
| | - Yash J Patil
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A.,Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A.,Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, Ohio, U.S.A
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17
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Alkohol im Alter. Z Gerontol Geriatr 2015; 48:557-68; quiz 569-70. [PMID: 26130109 DOI: 10.1007/s00391-015-0925-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/18/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
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18
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Bommersbach TJ, Lapid MI, Rummans TA, Morse RM. Geriatric alcohol use disorder: a review for primary care physicians. Mayo Clin Proc 2015; 90:659-66. [PMID: 25939937 DOI: 10.1016/j.mayocp.2015.03.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 11/26/2022]
Abstract
Alcohol use disorder in the geriatric population is a growing public health problem that is likely to continue to increase as the baby boomer generation ages. Primary care providers play a critical role in the recognition and management of these disorders. This concise review will focus on the prevalence, risk factors, screening, and clinical management of geriatric alcohol use disorder from a primary care perspective.
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Affiliation(s)
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Robert M Morse
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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Novier A, Diaz-Granados JL, Matthews DB. Alcohol use across the lifespan: An analysis of adolescent and aged rodents and humans. Pharmacol Biochem Behav 2015; 133:65-82. [PMID: 25842258 DOI: 10.1016/j.pbb.2015.03.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 01/26/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
Adolescence and old age are unique periods of the lifespan characterized by differential sensitivity to the effects of alcohol. Adolescents and the elderly appear to be more vulnerable to many of alcohol's physiological and behavioral effects compared to adults. The current review explores the differential effects of acute alcohol, predominantly in terms of motor function and cognition, in adolescent and aged humans and rodents. Adolescents are less sensitive to the sedative-hypnotic, anxiolytic, and motor-impairing effects of acute alcohol, but research results are less consistent as it relates to alcohol's effects on cognition. Specifically, previous research has shown adolescents to be more, less, and similarly sensitive to alcohol-induced cognitive deficits compared to adults. These equivocal findings suggest that learning acquisition may be differentially affected by ethanol compared to memory, or that ethanol-induced cognitive deficits are task-dependent. Older rodents appear to be particularly vulnerable to the motor- and cognitive-impairing effects of acute alcohol relative to younger adults. Given that alcohol consumption and abuse is prevalent throughout the lifespan, it is important to recognize age-related differences in response to acute and long-term alcohol. Unfortunately, diagnostic measures and treatment options for alcohol dependence are rarely dedicated to adolescent and aging populations. As discussed, although much scientific advancement has been made regarding the differential effects of alcohol between adolescents and adults, research with the aged is underrepresented. Future researchers should be aware that adolescents and the aged are uniquely affected by alcohol and should continue to investigate alcohol's effects at different stages of maturation.
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Affiliation(s)
- Adelle Novier
- Baylor University, Department of Psychology and Neuroscience, One Bear Place #97334, Waco, TX 76798, United States
| | - Jaime L Diaz-Granados
- Baylor University, Department of Psychology and Neuroscience, One Bear Place #97334, Waco, TX 76798, United States
| | - Douglas B Matthews
- Baylor University, Department of Psychology and Neuroscience, One Bear Place #97334, Waco, TX 76798, United States; University of Wisconsin - Eau Claire, Department of Psychology, HHH 273, Eau Claire, WI 54702, United States.
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20
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Fung CH, Martin JL, Dzierzewski JM, Jouldjian S, Josephson K, Park M, Alessi C. Prevalence and symptoms of occult sleep disordered breathing among older veterans with insomnia. J Clin Sleep Med 2013; 9:1173-8. [PMID: 24235899 DOI: 10.5664/jcsm.3162] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVES To determine the prevalence of occult sleep disordered breathing (SDB) and describe the relationship between classic SDB symptoms (e.g., loud snoring) and occult SDB in older veterans with insomnia. METHODS We analyzed baseline survey and in-home sleep study data for 435 veterans (mean age = 72.0 years [SD 8.0]) who had no known history of SDB, met International Classification of Sleep Disorders 2(nd) Edition criteria for insomnia, and were enrolled in a behavioral intervention trial for insomnia. Variables of interest included apnea-hypopnea index (AHI) ≥ 15, age, race/ethnicity, marital status, body mass index (BMI), insomnia subtype (i.e., onset, maintenance, or terminal), self-reported excessive daytime sleepiness, snoring, and witnessed breathing pause items from the Berlin Questionnaire. We computed the frequency of AHI ≥ 15 and assessed whether each classic SDB symptom was associated with an AHI ≥ 15 in 4 separate multivariate logistic regression models. RESULTS Prevalence of AHI ≥ 15 was 46.7%. Excessive daytime sleepiness (adjusted odds ratio 1.63, 95% CI 1.02, 2.60, p = 0.04), but not snoring loudness, snoring frequency, or witnessed breathing pauses was associated with occult SDB (AHI ≥ 15). Insomnia subtypes were not significantly associated with occult SDB (p > 0.38). CONCLUSIONS In our sample of older veterans with insomnia, nearly half had occult SDB, which was characterized by reported excessive daytime sleepiness, but not loud or frequent snoring or witnessed breathing pauses. Insomnia subtype was unrelated to the presence of occult SDB.
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Affiliation(s)
- Constance H Fung
- Geriatric Research, Education and Clinical Center (GRECC): Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA ; David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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21
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Novier A, Van Skike CE, Diaz-Granados JL, Mittleman G, Matthews DB. Acute alcohol produces ataxia and cognitive impairments in aged animals: a comparison between young adult and aged rats. Alcohol Clin Exp Res 2013; 37:1317-24. [PMID: 23550918 DOI: 10.1111/acer.12110] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 12/11/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Aging in both humans and rodents appears to be accompanied by physiological changes that increase biologic sensitivity to ethanol (EtOH) intoxication. However, animal models designed to investigate this increased alcohol sensitivity have yet to be established. For this reason, we sought to determine whether acute EtOH administration produces differential effects on motor coordination and spatial cognition in young adult and aged rats. METHODS Male young adult (postnatal day 70 to 72) and aged (~18 months) Sprague-Dawley rats were assessed on 2 motor tasks (the accelerating rotarod [RR] and the aerial righting reflex [ARR]) and a single cognitive performance task (the Morris water maze [MWM]). Following acute EtOH exposure via intraperitoneal injection, animals' performance was reassessed. RESULTS Aged rats showed a dramatic increase in EtOH-induced ataxia on the RR and the ARR relative to young adult animals. Similarly, results from the MWM revealed that aged animals had slightly greater EtOH-induced impairments compared with young adult animals. Importantly, the increased impairments produced by EtOH were not due to differential blood EtOH levels. CONCLUSIONS We demonstrate for the first time that aged rats show greater EtOH-induced deficits compared with young adults in tasks of motor and cognitive performance. The possible role of protein kinase C as a mechanism for increased sensitivity to the motor-impairing effects of EtOH is discussed. Given the high prevalence of alcohol use among the elderly, increased vulnerability to alcohol-induced deficits may have a profound effect on injury in this population.
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Affiliation(s)
- Adelle Novier
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
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22
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Williams EC, Bradley KA, Gupta S, Harris AHS. Association between alcohol screening scores and mortality in black, Hispanic, and white male veterans. Alcohol Clin Exp Res 2012; 36:2132-40. [PMID: 22676340 PMCID: PMC3443543 DOI: 10.1111/j.1530-0277.2012.01842.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 03/11/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Scores on the Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire are associated with mortality, but whether or how associations vary across race/ethnicity is unknown. METHODS Self-reported black (n = 13,068), Hispanic (n = 9,466), and white (n = 182,688) male Veterans Affairs (VA) outpatients completed the AUDIT-C via mailed survey. Logistic regression models evaluated whether race/ethnicity modified the association between AUDIT-C scores (0, 1 to 4, 5 to 8, and 9 to 12) and mortality after 24 months, adjusting for demographics, smoking, and comorbidity. RESULTS Adjusted mortality rates were 0.036, 0.033, and 0.054, for black, Hispanic, and white patients with AUDIT-C scores of 1 to 4, respectively. Race/ethnicity modified the association between AUDIT-C scores and mortality (p = 0.0022). Hispanic and white patients with scores of 0, 5 to 8, and 9 to 12 had significantly increased risk of death compared to those with scores of 1 to 4; Hispanic ORs: 1.93, 95% CI 1.50 to 2.49; 1.57, 1.07 to 2.30; 1.82, 1.04 to 3.17, respectively; white ORs: 1.34, 95% CI 1.29 to 1.40; 1.12, 1.03 to 1.21; 1.81, 1.59 to 2.07, respectively. Black patients with scores of 0 and 5 to 8 had increased risk relative to scores of 1 to 4 (ORs 1.28, 1.06 to 1.56 and 1.50, 1.13 to 1.99), but there was no significant increased risk for scores of 9 to 12 (ORs 1.27, 0.77 to 2.09). Post hoc exploratory analyses suggested an interaction between smoking and AUDIT-C scores might account for some of the observed differences across race/ethnicity. CONCLUSIONS Among male VA outpatients, associations between alcohol screening scores and mortality varied significantly depending on race/ethnicity. Findings could be integrated into systems with automated risk calculators to provide demographically tailored feedback regarding medical consequences of drinking.
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Affiliation(s)
- Emily C Williams
- Northwest Center of Excellence for Health Services Research & Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington 98101, USA.
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23
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Smoking cessation and the risk of hospitalization for pneumonia. Respir Med 2012; 106:1055-62. [DOI: 10.1016/j.rmed.2012.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 03/19/2012] [Accepted: 03/24/2012] [Indexed: 11/17/2022]
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Piazza-Gardner AK, Barry AE. Examining physical activity levels and alcohol consumption: are people who drink more active? Am J Health Promot 2012; 26:e95-104. [PMID: 22208422 DOI: 10.4278/ajhp.100929-lit-328] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Summarize/categorize current scientific literature examining the association between alcohol consumption (AC) and levels of physical activity (PA). DATA SOURCE Electronic databases spanning education, psychology, sociology, medicine, and interdisciplinary reports. STUDY INCLUSION AND EXCLUSION CRITERIA Included studies (n =17) must be published in a peer-reviewed, English language journal; measure either AC or PA as an independent/dependent variable; and primarily examine the relationship between AC and PA. DATA EXTRACTION Search terms/phrases included alcohol, alcohol consumption, drinking, physical activity, exercise, and physically active. DATA SYNTHESIS The Matrix Method and PRISMA guidelines organized pertinent literature and identified/extracted salient findings. RESULTS Alcohol consumers of all ages were more physically active than nondrinking peers. Further, several studies suggest a dose-response relationship between AC and PA, indicating that as drinking increases, so does PA level. CONCLUSION Reviewed studies support a positive association between AC and PA across all ages. Findings were contrary to the hypothesis of the investigators. Future research should place specific emphasis on identifying why alcohol consumers exercise at higher levels than non-alcohol consumers.
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Affiliation(s)
- Anna K Piazza-Gardner
- Department of Health Education and Behavior, University of Florida, Gainesville, FL 32611-8210, USA.
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25
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Broyles LM, Gordon AJ, Sereika SM, Ryan CM, Erlen JA. Predictive Utility of Brief Alcohol Use Disorders Identification Test (AUDIT) for human immunodeficiency virus antiretroviral medication nonadherence. Subst Abus 2012; 32:252-61. [PMID: 22014256 DOI: 10.1080/08897077.2011.599255] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Alcohol use negatively affects adherence to antiretroviral therapy (ART), thus human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) care providers need accurate, efficient assessments of alcohol use. Using existing data from an efficacy trial of 2 cognitive-behavioral ART adherence interventions, the authors sought to determine if results on 2 common alcohol screening tests (Alcohol Use Disorders Identification Test--Consumption [AUDIT-C] and its binge-related question [AUDIT-3]) predict ART nonadherence. Twenty-seven percent of the sample (n = 308) were positive on the AUDIT-C and 34% were positive on the AUDIT-3. In multivariate analyses, AUDIT-C-positive status predicted ART nonadherence after controlling for race, age, conscientiousness, and self-efficacy (P = .036). Although AUDIT-3-positive status was associated with ART nonadherence in unadjusted analyses, this relationship was not maintained in the final multivariate model. The AUDIT-C shows potential as an indirect screening tool for both at-risk drinking and ART nonadherence, underscoring the relationship between alcohol and chronic disease management.
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Affiliation(s)
- Lauren Matukaitis Broyles
- Center for Health Equity Research and Promotion, Department of Veterans Affairs Medical Center, Pittsburgh, Pennsylvania, USA.
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26
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Abstract
Rates of risky alcohol use appear to be elevated among active duty and veteran military personnel. Little is known, however, about characteristics associated with alcohol misuse in these groups. Furthermore, although there is evidence to suggest that patterns of alcohol use differ according to place of residence, no prior studies have investigated variability in alcohol use according to level of rurality and geographic region in US military veterans. The present study evaluated variations in alcohol use (ie, past 30-day use, heavy use, and binge drinking) and drinking and driving according to place of residence among 55,452 US military veterans participating in the Behavioral Risk Factor Surveillance System. Veterans residing in rural areas were significantly less likely than those from suburban and urban areas to have consumed alcohol in the past 30 days (p < .001). Conversely, rural-dwelling veterans who did drink alcohol had higher odds of binge drinking (p < .005) and (relative to urban residents) drinking and driving (p = .013). Veterans residing in the South were significantly less likely than those from other geographic regions to report past 30-day alcohol use (p < .001). In addition, veterans living in the Midwest were significantly more likely than those from the South to report drinking and driving (p = .017). No differences in heavy alcohol use were observed based on location of residence.
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Affiliation(s)
- Mark W Vander Weg
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Medical Center, 601 Highway 6 West, Iowa City, IA 52246, USA.
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Lima MG, Barros MBDA, César CLG, Goldbaum M, Carandina L, Alves MCGP. Health-related behavior and quality of life among the elderly: a population-based study. Rev Saude Publica 2011; 45:485-93. [PMID: 21552754 DOI: 10.1590/s0034-89102011000300006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 01/19/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the association between health-related behaviors and quality of life among the elderly. METHODS A population-based cross-sectional study was carried out including 1,958 elderly living in four areas in the state of São Paulo, southeastern Brazil, 2001/2002. Quality of life was assessed using the Medical Outcomes Study SF-36-Item Short Form Health Survey instrument. This instrument's eight subscales and two components were the dependent variables. Independent variables were physical activity, weekly frequency of alcohol consumption and smoking. Multiple linear regression models were used to control for the effect of gender, age, schooling, work, area of residence and number of chronic conditions. RESULTS Physical activity was positively associated with the eight SF-36 subscales. The stronger associations were found for role-physical (β=11.9), physical functioning (β=11.3) and physical component. Elderly individuals who consumed alcohol at least once a week showed a better quality of life than those did not consume alcohol. Compared to non-smokers, smokers had a poorer quality of life for the mental component (β=-2.4). CONCLUSIONS The study results showed that physical activity, moderate alcohol consumption and no smoking are positively associated with a better quality of life in the elderly.
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Affiliation(s)
- Margareth Guimarães Lima
- Departamento de Medicina Preventiva e Social, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.
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Chew RB, Bryson CL, Au DH, Maciejewski ML, Bradley KA. Are smoking and alcohol misuse associated with subsequent hospitalizations for ambulatory care sensitive conditions? J Behav Health Serv Res 2011; 38:3-15. [PMID: 20464519 DOI: 10.1007/s11414-010-9215-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hospitalizations for ambulatory care sensitive conditions (ACSCs) are used to assess quality of care, but studies rarely adjust for health behaviors. This study evaluated whether results of smoking or alcohol screening were associated with hospitalizations for ACSCs. Participants included 33,273 male Veterans Affairs general medicine outpatients who returned mailed surveys. The main outcome was hospitalization with a primary discharge diagnosis for an ACSC in the year following screening. Analyses were adjusted for demographics, comorbidity, and other health behaviors. Current and previous smoking and abstaining from alcohol were associated with significantly increased risk of hospitalization for ACSCs, but alcohol misuse was not. However, severe alcohol misuse was associated with increased risk of hospitalizations with a primary or secondary ACSC discharge diagnosis. When ACSCs are used to evaluate the quality of care, health systems caring for populations with higher rates of smoking or nondrinking could falsely appear to have poorer quality care if alcohol and tobacco use are not considered.
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Affiliation(s)
- Ryan B Chew
- VA Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA 98101, USA.
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Veterans Residing in Self-Governed Recovery Homes for Substance Abuse: Sociodemographic and Psychiatric Characteristics. Psychiatr Rehabil J 2011; 35:141-144. [PMID: 22020845 PMCID: PMC3595045 DOI: 10.2975/35.2.2011.141.144] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Veterans commonly experience both psychiatric and substance abuse problems following their reintegration into the community postwar. The present study describes a sample of veterans residing in self-governed recovery homes. METHODS A subsample of 24 veterans within a large national study were examined using demographic data and psychiatric and substance abuse measures. Participants were evaluated at baseline and at a one-year follow-up. RESULTS Abstinence rates for the veteran subsample were high. Additionally, results suggested that participants experienced a reduction in anxiety and depression over time. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The psychiatric and substance use improvements of this veteran subsample provide incentive for further research of this at-risk population as residents of self-governed recovery homes.
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Leurs P, Huvent-Grelle D, Lelievre-Leroy S, Roche J, Puisieux F. [Alcohol consumption patterns in older people living in nursing homes]. Presse Med 2010; 39:e280-8. [PMID: 20598499 DOI: 10.1016/j.lpm.2010.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 01/28/2010] [Accepted: 02/10/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although frail elderly people are particularly vulnerable to the adverse effects of alcohol, very little work on alcohol consumption patterns in older people living in nursing homes has been undertaken. OBJECTIVE To determine alcohol consumption patterns among the residents of 8 nursing homes of the Nord Pas-de-Calais in France, and the characteristics associated with heavy drinking (≥ 3 glasses of wine or equivalent/day). METHODS All residents were invited to participate in the study on condition that they satisfied the inclusion criteria (age ≥ 60 years, Mini Mental State of Folstein (MMSE) > 15, agreement) and the exclusion criteria (no oral communication, end of life). Two questionnaires were used, one for the residents and the other for the personnel nursing. RESULTS Three hundred and sixty-eight residents [242 females (65.8%) and 126 males (34.2%); mean age, 80.5 ± 8.9 years] participated in the study. Among them, 98 (26.6%) reported no consumption of alcohol and 21 (5.7%) reported occasional consumption. The 249 (67.7%) others reported every-day consumption, principally in the restaurant at the time of the meals. Sixty-seven (18.2%), were heavy drinkers with an early-onset alcoholism for two out of three. Compared with the other residents participating in the study, the at-risk alcohol drinkers were younger and more likely to be a man. CONCLUSION The study confirms that the prevalence of chronic at risk consumption is high in nursing homes. More efforts are needed to identify and improve management of alcohol disorders in this particular setting.
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Affiliation(s)
- Pascale Leurs
- Centre hospitalier de Denain, service de court séjour gériatrique, BP 225, 59220 Denain, France
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Williams EC, Palfai T, Cheng DM, Samet JH, Bradley KA, Koepsell TD, Wickizer TM, Heagerty PJ, Saitz R. Physical health and drinking among medical inpatients with unhealthy alcohol use: a prospective study. Alcohol Clin Exp Res 2010; 34:1257-65. [PMID: 20477765 DOI: 10.1111/j.1530-0277.2010.01203.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Unhealthy alcohol use is common in medical inpatients, and hospitalization has been hypothesized to serve as a "teachable moment" that could motivate patients to decrease drinking, but studies of hospital-based brief interventions have often not found decreases. Evaluating associations between physical health and subsequent drinking among medical inpatients with unhealthy alcohol use could inform refinement of hospital-based brief interventions by identifying an important foundation on which to build them. We tested associations between poor physical health and drinking after hospitalization and whether associations varied by alcohol dependence status and readiness to change. METHODS Participants were medical inpatients who screened positive for unhealthy alcohol use and consented to participate in a randomized trial of brief intervention (n = 341). Five measures of physical health were independent variables. Outcomes were abstinence and the number of heavy drinking days (HDDs) reported in the 30 days prior to interviews 3 months after hospitalization. Separate regression models were fit to evaluate each independent variable controlling for age, gender, randomization group, and baseline alcohol use. Interactions between each independent variable and alcohol dependence and readiness to change were tested. Stratified models were fit when significant interactions were identified. RESULTS Among all participants, measures of physical health were not significantly associated with either abstinence or number of HDDs at 3 months. Having an alcohol-attributable principal admitting diagnosis was significantly associated with fewer HDDs in patients who were nondependent [adjusted incidence rate ratio (aIRR) 0.10, 95% CI 0.03-0.32] or who had low alcohol problem perception (aIRR 0.36, 95% CI 0.13-0.99) at hospital admission. No significant association between alcohol-attributable principal admitting diagnosis and number of HDDs was identified for participants with alcohol dependence or high problem perception. CONCLUSIONS Among medical inpatients with nondependent unhealthy alcohol use and those who do not view their drinking as problematic, alcohol-attributable illness may catalyze decreased drinking. Brief interventions that highlight alcohol-related illness might be more successful.
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McDevitt-Murphy ME, Williams JL, Bracken KL, Fields JA, Monahan CJ, Murphy JG. PTSD symptoms, hazardous drinking, and health functioning among U.S.OEF and OIF veterans presenting to primary care. J Trauma Stress 2010; 23:108-11. [PMID: 20104586 PMCID: PMC2876344 DOI: 10.1002/jts.20482] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) and alcohol abuse both are negatively associated with health, and alcohol misuse may mediate the relationship between PTSD and functional health outcomes. The present study tested for such mediation using self-report measures of PTSD symptoms, hazardous alcohol use, and health functioning in 151 U.S. veterans (136 men and 15 women) of the wars in Iraq and Afghanistan recruited from a Veterans Affairs primary care clinic. Based on established cut scores, 39.1% screened positive for PTSD and 26.5% screened positive for hazardous drinking. PTSD symptoms and hazardous drinking were significantly correlated with each other and with health functioning. Hazardous drinking was found to partially mediate the relationship between PTSD and functional mental health, but not physical health.
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Affiliation(s)
- Meghan E McDevitt-Murphy
- Department of Psychology, University of Memphis and Memphis Veterans' Affairs Medical Center, Memphis, TN 38152, USA.
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Hirata ES, Nakano EY, Junior JAP, Litvoc J, Bottino CMC. Prevalence and correlates of alcoholism in community-dwelling elderly living in São Paulo, Brazil. Int J Geriatr Psychiatry 2009; 24:1045-53. [PMID: 19768699 DOI: 10.1002/gps.2224] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To assess the prevalence of alcoholism in elderly living in the city of São Paulo (Brazil) and investigate associated risk factors. METHODS A total of 1,563 individuals aged 60 years or older, of both genders of three districts of different socioeconomic classes (high, medium and low) in the city of São Paulo (Brazil) were interviewed. The CAGE screening test for alcoholism was applied and a structured interview was used to assess associated sociodemographic and clinical factors. The tests Mini Mental State Examination, Fuld Object Memory Evaluation, The Informant Questionnaire on Cognitive Decline in the Elderly and Bayer-Activities of Daily Living Scale were used for cognitive and functional assessment. RESULTS Prevalence of alcoholism was 9.1%. Multivariate regression analysis showed that alcoholism was associated with male gender, 'mulatto' ethnicity, smoking, and cognitive and functional impairment. In addition, the younger the individual and the lower the schooling level, the higher the risk for alcoholism. CONCLUSIONS The results obtained in this study show that alcoholism is highly frequent in the community-dwelling elderly living in São Paulo, and that it is associated with socio-demographic and clinical risk factors similar to those reported in the literature. This suggests that alcoholism in the elderly of a developing country shares the same basic characteristics seen in developed countries. These findings suggest that it is essential for health services and professional to be prepared to meet this demand that will significantly grow in the next years, especially in developing countries, where the rates of population aging are higher than those of developed countries.
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Affiliation(s)
- Edson Shiguemi Hirata
- Old Age Research Group (PROTER), Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil.
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Moderate Alcohol Use, Health Status, and Mortality in a Prospective Chinese Elderly Cohort. Ann Epidemiol 2009; 19:396-403. [DOI: 10.1016/j.annepidem.2009.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 12/17/2008] [Accepted: 01/27/2009] [Indexed: 11/22/2022]
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Batty GD, Hunt K, Emslie C, Lewars H, Gale CR. Alcohol problems and all-cause mortality in men and women: predictive capacity of a clinical screening tool in a 21-year follow-up of a large, UK-wide, general population-based survey. J Psychosom Res 2009; 66:317-21. [PMID: 19302889 DOI: 10.1016/j.jpsychores.2008.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2008] [Revised: 08/11/2008] [Accepted: 09/23/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE While the relation between alcohol consumption and mortality has been well explored, little is known about the link between alcohol problems and mortality in general population-based studies, particularly among women. This was the objective of the present study METHODS In this prospective cohort study, 5333 non-abstaining individuals (2539 women) from the UK-wide Health and Lifestyle Survey (aged 42.9 years at study induction) completed the CAGE questionnaire of alcohol problems and participated in a medical examination in 1984/1985; they were then followed up for mortality experience until 2005. RESULTS Alcohol problems at baseline were less common in women (2.4%) than in men (7.8%). A total of 21 years of follow-up gave rise to 1201 deaths. Elevated rates of mortality were evident in persons reporting symptoms of alcohol problems in comparison to those who did not. In gender-stratified analyses, alcohol problems were more strongly associated with mortality risk in women (age-adjusted hazards ratio: 2.25; 95% confidence interval: 1.22-4.12) than in men (1.49; 1.12-1.99), although this effect modification was not statistically significant (P value for interaction=0.125). Controlling for a range of covariates--including socioeconomic position, co-morbidity (somatic and psychiatric), and alcohol intake--had essentially no impact on these associations. CONCLUSION The CAGE questionnaire may have some utility in routine health assessments in the general population.
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Affiliation(s)
- G David Batty
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
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St John PD, Montgomery PR, Tyas SL. Alcohol misuse, gender and depressive symptoms in community-dwelling seniors. Int J Geriatr Psychiatry 2009; 24:369-75. [PMID: 18837057 DOI: 10.1002/gps.2131] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Alcohol misuse in seniors has been studied in clinical samples and in small communities, but relatively few studies are population-based. Objectives are: (1) to describe the characteristics of seniors who score 1 or more on the CAGE (Cut down; Annoyed; Guilty; Eye-opener) questionnaire of alcohol problems; (2) to determine if depressive symptoms are associated with alcohol misuse after accounting for other factors. METHODS Cross-sectional study of community-dwelling older people (65+ years) sampled from a representative population registry in Manitoba, Canada. Participants were initially interviewed in 1991-1992 and reinterviewed in 1996-1997. Data from Time 2 were used; 1,028 persons were included in the analyses. Sociodemographic characteristics, the CAGE questionnaire, Activities of Daily Living (ADLs) and instrumental ADLs (IADLs), the Center for Epidemiologic Studies-Depression (CES-D) scale and the Mini-Mental State Examination (MMSE) were assessed by trained interviewers. RESULTS Males were more likely to score positive on the CAGE questionnaire. After adjusting for gender, age, and education, there was a strong association between depressive symptoms and alcohol misuse. Poor self-rated health and impairments in IADLs were also associated with alcohol misuse. CONCLUSIONS Male gender, depressive symptoms, and poor functional status were associated with alcohol misuse in this population-based study. Attention to depressive symptoms and functional status may be important in the care of seniors with alcohol misuse. Alternatively, physicians should enquire about alcohol use in seniors with functional impairment or depressive symptoms.
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Affiliation(s)
- Philip D St John
- Section of Geriatric Medicine, Department of Medicine, Centre on Aging, University of Manitoba, Winnipeg, Canada.
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Balsa AI, Homer JF, Fleming MF, French MT. Alcohol consumption and health among elders. THE GERONTOLOGIST 2009; 48:622-36. [PMID: 18981279 DOI: 10.1093/geront/48.5.622] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This article estimates the effects of alcohol consumption on self-reported overall health status, injuries, heart problems, emergency room use, and hospitalizations among persons older than the age of 65. DESIGN AND METHODS We analyzed data from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative study. We used multivariate regression and instrumental variables methods to study the associations between alcohol consumption (current drinking, binge drinking, and average number of drinks consumed) and several indicators of health status and health care utilization. RESULTS Alcohol consumption by women was associated with better self-perceived health status, improved cardiovascular health, and lower rates of hospitalizations. We detected no significant negative or positive associations for older men. IMPLICATIONS These findings suggest that light to moderate alcohol use by older women may have beneficial health effects. Experimental trials, however, are needed to more rigorously assess the potential benefits of alcohol use by elders due to the inherent biases of observational studies.
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Affiliation(s)
- Ana I Balsa
- Health Economics Research Group, University of Miami, Coral Gables, FL 33124-2030, USA
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Harris AHS, Bryson CL, Sun H, Blough D, Bradley KA. Alcohol screening scores predict risk of subsequent fractures. Subst Use Misuse 2009; 44:1055-69. [PMID: 19544147 DOI: 10.1080/10826080802485972] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C; 0-12 points) was included on health surveys in a cohort of 32,622 general medicine outpatients from seven US Department of Veterans Affairs (VA) hospitals. Cox proportional hazards models were used to estimate the risk of fracture (mean follow-up = 1.6 years) by AUDIT-C category. After adjusting for confounders, AUDIT-C scores of 8-9 and 10-12 were associated with significantly increased risks for subsequent fractures, HR (95% CI) = 1.37 (1.03 to 1.83) and 1.79 (1.38 to 2.33) respectively. These results can be used to provide feedback to patients linking their alcohol screening scores to medical outcomes-a critical component of evidence-based brief counseling for alcohol misuse. The study's limitations are noted.
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Affiliation(s)
- Alex H S Harris
- Center for Health Care Evaluation (MC152), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
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Abstract
Using data from the National Survey of Homeless Assistance Providers and Clients (NSHAPC), predictors of current alcohol and drug misuse problems among homeless, previously homeless, and marginally housed older adults are identified. Childhood sexual assault, victimization, and neglect, being male, being younger, being homeless or previously homeless, being a minority, and having income below US$499 per month increased the odds of reporting a drug problem. Being male, being younger, being homeless, having mental illness increased the odds of reporting an alcohol problem. Reporting any type of substance use problem increased the odds of reporting the other.
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Stewart SH, Connors GJ. Perceived health status, alcohol-related problems, and readiness to change among medically hospitalized, alcohol-dependent patients. J Hosp Med 2007; 2:372-7. [PMID: 18080338 DOI: 10.1002/jhm.211] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Alcohol dependence is prevalent among medically hospitalized patients, and acute illness has the potential to increase motivation to change and provide a therapeutic window for treatment of alcohol dependence. This study evaluated the correlations of readiness to change drinking behavior with perceived physical and mental health status and specific alcohol-related consequences of medical inpatients. DESIGN AND MEASUREMENTS The study was a cross-sectional survey of 50 clinically recognized and subsequently confirmed alcohol-dependent patients admitted to general internal medicine teaching services with no evidence of chronic cognitive functional deficits. We estimated correlations of process-of-change variables (problem recognition, ambivalence about change, and taking steps to change drinking) with measures of patient perception of general physical and mental health status and self-reported alcohol-related consequences. RESULTS Problem recognition (r = -0.31, P = .028) and ambivalence about change (r = -0.41, P = .003), but not taking steps to change drinking (r = -0.26, P = .072) were significantly associated with perceived physical health. Perceived mental health was not associated with these variables, but greater alcohol-specific consequences were typically associated with greater recognition, ambivalence, and intent to change. CONCLUSIONS Among alcohol-dependent patients with acute medical illness requiring hospitalization, poorer perceived health status was associated with increased recognition of drinking problems and thoughts about changing drinking behavior. Future research should evaluate if problem recognition and ambivalence modify treatment involvement and outcomes following hospitalization and if hospital-based interventions designed to link medical conditions and their treatment to alcohol dependence enhance recognition and ambivalence.
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Affiliation(s)
- Scott H Stewart
- Center for Drug and Alcohol Programs, Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Satre DD, Gordon NP, Weisner C. Alcohol consumption, medical conditions, and health behavior in older adults. Am J Health Behav 2007; 31:238-48. [PMID: 17402864 PMCID: PMC3659165 DOI: 10.5555/ajhb.2007.31.3.238] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVES To examine associations between drinking patterns, medical conditions, and behavioral health risks among older adults. METHODS Analyses compared survey participants (health plan members ages 65 to 90, N = 6662) who drank moderately to those who drank over recommended limits or did not drink. RESULTS Overlimit drinking was associated with smoking; not trying to eat low-fat foods (in men), and lower BMI (in women). Predictors of not drinking during the prior 12 months included ethnicity, lower education, worse self-reported health, diabetes and heart problems. CONCLUSIONS Significant relationships exist between health and alcohol consumption patterns, which vary by gender.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA 94143, USA.
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Paganini-Hill A, Kawas CH, Corrada MM. Type of alcohol consumed, changes in intake over time and mortality: the Leisure World Cohort Study. Age Ageing 2007; 36:203-9. [PMID: 17350977 PMCID: PMC3377489 DOI: 10.1093/ageing/afl184] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND modifiable behavioural risk factors including smoking and alcohol consumption are major contributing or actual causes of mortality. OBJECTIVE to examine the effect of alcohol intake on all-cause mortality in older adults. DESIGN AND SETTING prospective population-based cohort study of residents of a California, United States retirement community. SUBJECTS 8,877 women and 5,101 men (median age, 74 years) who in the early 1980s completed a postal health srvey incluing details on alcohol consumption. METHODS participants were followed for 23 years (1981-2004) including two follow-up questionnaires (in 1992 and 1998) asking about current alcohol intake. Age-adjusted and multivariate-adjusted risk ratios of death and 95% confidence intervals were calculated separately for men and women, using proportional hazard regression. RESULTS of the 8,644 women and 4,980 men with complete information on the variables of interest and potential confounders, 6,930 women and 4,456 men had died (median age, 87 years). Both men and women who drank alcohol had decreased mortality compared with non-drinkers. Those who drank two or more drinks per day had a 15% reduced risk of death. The reduced risk was not limited to one type of alcohol. Stable drinkers (those who reported drinking both at baseline and follow-up) had a significantly decreased risk of death compared with stable non-drinkers. Those who started drinking at follow-up also had a significantly lower risk. Women who quit drinking were at increased risk of death. CONCLUSION in elderly men and women, moderate alcohol intake exhibits a beneficial effect on mortality. Those who quit may do so for health reasons that affect mortality.
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Affiliation(s)
- Annlia Paganini-Hill
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, USA.
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Au DH, Kivlahan DR, Bryson CL, Blough D, Bradley KA. Alcohol Screening Scores and Risk of Hospitalizations for GI Conditions in Men. Alcohol Clin Exp Res 2007; 31:443-51. [PMID: 17295729 DOI: 10.1111/j.1530-0277.2006.00325.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol misuse is a common cause of liver disease, upper gastrointestinal (GI) bleeding, and pancreatitis, but it is not known whether alcohol screening questionnaires can identify patients at increased risk for hospitalizations due to these conditions. OBJECTIVE To evaluate the association of alcohol screening scores with the risk of subsequent hospitalization for alcohol-related GI conditions. DESIGN Retrospective cohort study. PARTICIPANTS Male general medicine outpatients from 7 Veterans Affairs (VA) medical centers who returned mailed questionnaires. MEASUREMENTS The CAGE questionnaire (0-4 points) and the Alcohol Use Disorders Identification Test-Consumption questions (AUDIT-C; 0-12 points) were included on mailed surveys. The main outcome, "GI hospitalization," was a primary VA or Medicare discharge diagnosis indicating liver disease, upper GI bleeding, or pancreatitis. RESULTS Among 31,311 patients followed, a median of 3.75 years, patients with CAGE scores >or=2 points or AUDIT-C scores >or=6 points were at a significantly increased risk for GI hospitalizations. Adjusted hazard ratios (HR(adj)) ranged from 1.6 (95% CI 1.2-2.0) for CAGE score 2, to 1.7 (1.4-2.2) for CAGE 4, and from 1.4 (1.01-2.0) for AUDIT-C scores from 6 to 7, to 2.7 (1.9-3.8) for AUDIT-C scores from 10 to 12. Secondary analyses demonstrated that the association was the strongest among patients less than 50 years of age who reported drinking in the past year. CONCLUSIONS Brief alcohol screening questionnaires predict subsequent hospitalizations for alcohol-related GI conditions.
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Affiliation(s)
- David H Au
- Health Services Research & Development, Seattle, Washington, USA
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Kirchner JE, Zubritsky C, Cody M, Coakley E, Chen H, Ware JH, Oslin DW, Sanchez HA, Durai UNB, Miles KM, Llorente MD, Costantino G, Levkoff S. Alcohol consumption among older adults in primary care. J Gen Intern Med 2007; 22:92-7. [PMID: 17351846 PMCID: PMC1824716 DOI: 10.1007/s11606-006-0017-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Alcohol misuse is a growing public health concern for older adults, particularly among primary care patients. OBJECTIVES To determine alcohol consumption patterns and the characteristics associated with at-risk drinking in a large sample of elderly primary care patients. DESIGN Cross-sectional analysis of multisite screening data from 6 VA Medical Centers, 2 hospital-based health care networks, and 3 Community Health Centers. PARTICIPANTS Patients, 43,606, aged 65 to 103 years, with scheduled primary care appointments were approached for screening; 27,714 (63.6%) consented to be screened. The final sample of persons with completed screens comprised 24,863 patients. MEASUREMENTS Quantity and frequency of alcohol use, demographics, social support measures, and measures of depression/anxiety. RESULTS Of the 24,863 older adults screened, 70.0% reported no consumption of alcohol in the past year, 21.5% were moderate drinkers (1-7 drinks/week), 4.1% were at-risk drinkers (8-14 drinks/week), and 4.5% were heavy (>14 drinks/week) or binge drinkers. Heavy drinking showed significant positive association with depressive/anxiety symptoms [Odds ratio (OR) (95% CI): 1.79 (1.30, 2.45)] and less social support [OR (95% CI): 2.01 (1.14, 2.56)]. Heavy drinking combined with binging was similarly positively associated with depressive/anxiety symptoms [OR (95%): 1.70 (1.33, 2.17)] and perceived poor health [OR (95% CI): 1.27 (1.03, 1.57)], while at-risk drinking was not associated with any of these variables. CONCLUSIONS The majority of participants were nondrinkers; among alcohol users, at-risk drinkers did not differ significantly from moderate drinkers in their characteristics or for the 3 health parameters evaluated. In contrast, heavy drinking was associated with depression and anxiety and less social support, and heavy drinking combined with binge drinking was associated with depressive/anxiety symptoms and perceived poor health.
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Affiliation(s)
- JoAnn E Kirchner
- VA South Central Mental Illness Research Education and Clinic Center, Little Rock, AR, USA.
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Dietz TL. Predictors of reported current and lifetime substance abuse problems among a national sample of U.S. homeless. Subst Use Misuse 2007; 42:1745-66. [PMID: 17934993 DOI: 10.1080/10826080701212360] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), this study examined predictors of alcohol and drug problems among a national probability sample of homeless and previously homeless adults in the United States. Consistent with research, about one third and one quarter of the respondents reported a current alcohol and drug problem, respectively. A larger proportion reported lifetime substance abuse problems. As hypothesized, males, younger respondents, veterans, and those with mental and physical health problems were at greater risk. Results reveal that substance abuse treatment and prevention programs for the homeless should take into consideration these characteristics to maximize effectiveness.
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Affiliation(s)
- Tracy L Dietz
- Department of Sociology & Anthropology, University of Central Florida, Orlando, Florida 32816, USA.
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Timko C, Debenedetti A, Moos BS, Moos RH. Predictors of 16-Year Mortality Among Individuals Initiating Help-Seeking for an Alcoholic Use Disorder. Alcohol Clin Exp Res 2006; 30:1711-20. [PMID: 17010138 DOI: 10.1111/j.1530-0277.2006.00206.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND METHODS We examined rates and predictors of mortality in individuals (47% women) who had just initiated help-seeking for their alcohol use disorders (AUDs) at the start of the study (n=628) and were followed for 16 years. RESULTS For both women and men, the observed-to-expected mortality ratio (1.4) was lower than rates found in samples of treated individuals with AUDs, suggesting that those initiating help-seeking careers have better chances of long-term survival. Of the individuals for whom cause of death was known, 68% died of alcohol-related causes. Men were more likely to die than were women. When gender was controlled, individuals who were older and unmarried and had more alcohol dependence symptoms at baseline were more likely to die over the 16-year period. When these baseline characteristics were controlled, better drinking outcomes at 1 year were associated with a lower likelihood of subsequent death. The combination of a shorter duration of inpatient/residential care and better drinking outcomes at 1 year was related to a lower probability of death, as was the combination of a longer duration of outpatient care or Alcoholics Anonymous attendance and better drinking outcomes at 1 year. CONCLUSIONS Efforts should be made to help providers identify individuals who are not responding positively to inpatient or residential treatment and intervene to motivate participation in continuing outpatient care and community 12-step self-help groups to reduce the likelihood of a chronic and fatal AUD course.
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Affiliation(s)
- Christine Timko
- Center for Health Care Evaluation, Department of Veterans Affairs Health Care System and Stanford University Medical Center, Menlo Park, California 94025, USA.
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Abstract
We investigated the question, how do older men who drink alcohol differ from those who do not drink on measures of cognitive function, memory, affect, and health? Of the nonprobability sample of male participants (N = 60), 35 (58%) of the males reported some degree of alcohol consumption. Eleven men had one or more drinks per day, 14 had one or more drinks per week, and 9 were occasional drinkers. The drinkers reported significantly less depression, had higher self-reported general health and vitality, and had higher cognitive performance, cognitive flexibility, and verbal memory, and greater knowledge of memory processes.
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Affiliation(s)
- Graham J McDougall
- The University of Texas at Austin, School of Nursing, Austin, 78701, USA.
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