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Zhai X, Tong HHY, Lam CK, Xing A, Sha Y, Luo G, Meng W, Li J, Zhou M, Huang Y, Wong LS, Wang C, Li K. Association and causal mediation between marital status and depression in seven countries. Nat Hum Behav 2024:10.1038/s41562-024-02033-0. [PMID: 39496771 DOI: 10.1038/s41562-024-02033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/26/2024] [Indexed: 11/06/2024]
Abstract
Depression represents a significant global public health challenge, and marital status has been recognized as a potential risk factor. However, previous investigations of this association have primarily focused on Western samples with substantial heterogeneity. Our study aimed to examine the association between marital status and depressive symptoms across countries with diverse cultural backgrounds using a large-scale, two-stage, cross-country analysis. We used nationally representative, de-identified individual-level data from seven countries, including the USA, the UK, Mexico, Ireland, Korea, China and Indonesia (106,556 cross-sectional and 20,865 longitudinal participants), representing approximately 541 million adults. The follow-up duration ranged from 4 to 18 years. Our analysis revealed that unmarried individuals had a higher risk of depressive symptoms than their married counterparts across all countries (pooled odds ratio, 1.86; 95% confidence interval (CI), 1.61-2.14). However, the magnitude of this risk was influenced by country, sex and education level, with greater risk in Western versus Eastern countries (β = 0.36; 95% CI, 0.16-0.56; P < 0.001), among males versus females (β = 0.25; 95% CI, 0.003-0.47; P = 0.047) and among those with higher versus lower educational attainment (β2 = 0.34; 95% CI, 0.11-0.56; P = 0.003). Furthermore, alcohol drinking causally mediated increased later depressive symptom risk among widowed, divorced/separated and single Chinese, Korean and Mexican participants (all P < 0.001). Similarly, smoking was as identified as a causal mediator among single individuals in China and Mexico, and the results remained unchanged in the bootstrap resampling validation and the sensitivity analyses. Our cross-country analysis suggests that unmarried individuals may be at greater risk of depression, and any efforts to mitigate this risk should consider the roles of cultural context, sex, educational attainment and substance use.
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Affiliation(s)
- Xiaobing Zhai
- Faculty of Applied Sciences, Macao Polytechnic University, Macau, Macau SAR
| | - Henry H Y Tong
- Faculty of Applied Sciences, Macao Polytechnic University, Macau, Macau SAR
| | - Chi Kin Lam
- Faculty of Applied Sciences, Macao Polytechnic University, Macau, Macau SAR
| | - Abao Xing
- Faculty of Applied Sciences, Macao Polytechnic University, Macau, Macau SAR
| | - Yuyang Sha
- Faculty of Applied Sciences, Macao Polytechnic University, Macau, Macau SAR
| | - Gang Luo
- Faculty of Applied Sciences, Macao Polytechnic University, Macau, Macau SAR
| | - Weiyu Meng
- Faculty of Applied Sciences, Macao Polytechnic University, Macau, Macau SAR
| | - Junfeng Li
- Department of Radiology, Changzhi Medical College, Changzhi, China
- Changzhi Key Lab of Functional Imaging for Brain Diseases, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Miao Zhou
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yangxi Huang
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ling Shing Wong
- Faculty of Health and Life Sciences, INTI International University, Nilai, Malaysia
| | - Cuicui Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Kefeng Li
- Faculty of Applied Sciences, Macao Polytechnic University, Macau, Macau SAR.
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Guiraud J, van den Brink W. Sodium oxybate: A comprehensive review of efficacy and safety in the treatment of alcohol withdrawal syndrome and alcohol dependence. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 178:213-281. [PMID: 39523055 DOI: 10.1016/bs.irn.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Alcohol dependence (AD) significantly impacts public health, affecting 3.4% of people aged 18-64 and contributing to around 12% of overall mortality. Individuals with AD have a markedly reduced life expectancy, dying up to 28 years earlier than the general population. Current treatments for AD show limited efficacy, with many patients not responding to these interventions, highlighting the need for new therapeutic options with novel mechanisms of action. Sodium oxybate (SMO), the sodium salt of GHB, is one such candidate, pharmacologically similar to alcohol; it acts on several neurotransmitters including GABA, potentially mitigating withdrawal symptoms and craving for alcohol. SMO has been clinically used in Italy and Austria since the 1990s, approved for treating alcohol withdrawal syndrome (AWS) and for maintaining abstinence in AD patients. Several randomized clinical trials (RCTs) and meta-analyses showed evidence of SMO to be effective and safe in these indications. For AWS, SMO was more effective than placebo and as effective as benzodiazepines in reducing withdrawal symptoms. For maintaining abstinence, SMO significantly improved continuous abstinence duration and abstinence rate compared to placebo. Comprehensive clinical data indicate that SMO is well-tolerated, with main adverse effects being mild, such as dizziness and vertigo, and serious adverse events being rare. The effectiveness and safety of SMO, coupled with its approval in two EU countries affirm its potential as a treatment option for AD, particularly in severe cases. Further RCTs, especially with stratification by severity of dependence, are suggested to refine our understanding of its efficacy across different patient subgroups.
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Affiliation(s)
- Julien Guiraud
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Vergio, Clichy, France.
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Balla J, Hagger MS. Protection motivation theory and health behaviour: conceptual review, discussion of limitations, and recommendations for best practice and future research. Health Psychol Rev 2024:1-27. [PMID: 39420632 DOI: 10.1080/17437199.2024.2413011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 10/01/2024] [Indexed: 10/19/2024]
Abstract
Protection motivation theory is a pre-eminent health behaviour theory purposed to predict participation in health protection and risk behaviours. It has been widely applied across multiple behaviours, populations and contexts. In this conceptual review, we summarise research applying the theory and identify shortcomings and evidence gaps that limit reported inferences and impede theory and intervention development. Accordingly, we provide recommendations for best practices and suggestions for future research to resolve these limitations. Limitations identified include a dearth of comprehensive theory tests, sparse evidence of theory sufficiency, a lack of studies including additional constructs, overuse of correlational and cross-sectional research designs, a paucity of intervention studies and tests of theory-consistent mechanisms of action, few tests intrapersonal and environmental moderators of theory effects and measurement concerns. We provide recommendations to address these limitations including conducting comprehensive theory tests in support of nomological validity; incorporating past behaviour and other constructs to establish theory sufficiency and extend its scope; adopting cross-lagged panel and factorial experimental research designs to test directional effects, permit better causal inference and test mechanisms of action; testing effects of moderators to identify conditions that may affect theory applicability and developing measurement standards for study constructs and adopting non-self-report behaviour measures.
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Affiliation(s)
- Jessica Balla
- Department of Psychological Sciences, University of California, Merced, CA, USA
| | - Martin S Hagger
- Department of Psychological Sciences, University of California, Merced, CA, USA
- Health Sciences Research Institute, University of California, Merced, CA, USA
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- School of Applied Psychology, Griffith University, Brisbane, Australia
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4
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Avitabile E, Gratacós-Ginès J, Pérez-Guasch M, Belén Rubio A, Herms Q, Cervera M, Nadal R, Carol M, Fabrellas N, Bruguera P, Llorente A, Ortega L, Lligoña A, Nuño L, Freixa N, Pons MT, Díaz A, Bataller R, Ginès P, López-Pelayo H, Pose E. Liver fibrosis screening increases alcohol abstinence. JHEP Rep 2024; 6:101165. [PMID: 39380719 PMCID: PMC11459648 DOI: 10.1016/j.jhepr.2024.101165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 10/10/2024] Open
Abstract
Background & Aims Individuals with alcohol use disorder (AUD) are at risk of liver disease. There is scarce information on the effectiveness of screening for liver fibrosis on alcohol consumption. Thus, we evaluated the efficacy of a screening program for liver fibrosis on alcohol consumption in individuals with AUD. Methods We performed a prospective interventional study in the Hospital Clinic of Barcelona. The screening cohort included individuals with AUD from the addiction unit who underwent screening for liver fibrosis with transient elastography and counselling on lifestyle habits in the liver unit. The control cohort included individuals with similar characteristics who attended the same unit in a previous period but did not undergo screening. Effects on alcohol consumption were evaluated at 6 months, after clinical follow-up, with clinical assessment by addiction specialists and urine ethyl glucuronide monitoring. Results In the screening cohort, 149/334 (45%) individuals were abstinent at 6 months (68% confirmed with urine ethyl glucuronide). Alcohol abstinence was higher in the screening cohort than in the control cohort (40/137 [29%], p = 0.002). Factors associated with alcohol abstinence in the multivariate analysis of the two combined cohorts (n = 471) were: receiving AUD medications (odds ratio [OR] 1.72, 95% CI 1.11-2.67), absence of illicit drug use (OR 0.50, 95% CI 0.31-0.80) and participating in the screening program (OR 1.77, 95% CI 1.14-2.74). In the screening cohort, 40 (12%) individuals had increased liver stiffness (≥8 kPa), which was associated with obesity (p = 0.03), arterial hypertension (p = 0.03), gamma-glutamyltransferase (p <0.001) and platelet levels (p = 0.001). Conclusions This study shows that an integrated screening program for liver fibrosis associated with counselling on alcohol consumption in individuals with AUD allows for early diagnosis of alcohol-associated liver disease and is associated with alcohol abstinence. Impact and implications Individuals with high alcohol consumption are at higher risk of liver disease compared to the general population. The potential beneficial effects of screening for liver disease in this population have scarcely been studied. We show that a screening program for liver fibrosis together with a lifestyle counselling intervention favoured alcohol abstinence among individuals with alcohol use disorder attending an addiction unit at 6 months, compared to a matched cohort who did not undergo screening. These findings suggest that screening programs for liver fibrosis have a therapeutic role in individuals with alcohol use disorder, supporting the implementation of these programs in addiction units.
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Affiliation(s)
- Emma Avitabile
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Jordi Gratacós-Ginès
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Martina Pérez-Guasch
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ana Belén Rubio
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Queralt Herms
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Marta Cervera
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ruth Nadal
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Carol
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Pol Bruguera
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Health and Addictions Research Group Addictions Unit, Psychiatry and Psychology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ana Llorente
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Health and Addictions Research Group Addictions Unit, Psychiatry and Psychology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Lluisa Ortega
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Health and Addictions Research Group Addictions Unit, Psychiatry and Psychology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Anna Lligoña
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Health and Addictions Research Group Addictions Unit, Psychiatry and Psychology Service, Hospital Clinic of Barcelona, Barcelona, Spain
- Red de investigación de atención primaria en adicciones (RIAPAD), Barcelona, Spain
| | - Laura Nuño
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Health and Addictions Research Group Addictions Unit, Psychiatry and Psychology Service, Hospital Clinic of Barcelona, Barcelona, Spain
- Red de investigación de atención primaria en adicciones (RIAPAD), Barcelona, Spain
| | - Neus Freixa
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Health and Addictions Research Group Addictions Unit, Psychiatry and Psychology Service, Hospital Clinic of Barcelona, Barcelona, Spain
- Red de investigación de atención primaria en adicciones (RIAPAD), Barcelona, Spain
| | - María Teresa Pons
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Health and Addictions Research Group Addictions Unit, Psychiatry and Psychology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alba Díaz
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ramon Bataller
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Pere Ginès
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Hugo López-Pelayo
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Health and Addictions Research Group Addictions Unit, Psychiatry and Psychology Service, Hospital Clinic of Barcelona, Barcelona, Spain
- Red de investigación de atención primaria en adicciones (RIAPAD), Barcelona, Spain
| | - Elisa Pose
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain
- Institut d’Investigacións Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas, Madrid, Spain
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Evon DM, Yao J, Zimmer C, Muir AJ, Hendershot CS, Proeschold-Bell RJ. Psychological processes and alcohol reduction in patients with chronic hepatitis C: Results from the HepART trial. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1541-1551. [PMID: 38923876 DOI: 10.1111/acer.15400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/04/2024] [Accepted: 05/15/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND There is a lack of randomized controlled trials of behavioral interventions and process-level research related to alcohol reduction among patients with chronic liver disease (e.g., hepatitis C viral (HCV) infection). We conducted a process-level, secondary analysis of the Hepatitis C-Alcohol Reduction Treatment (HepART) trial to investigate the association between change in psychological processes posited by the Integrated Behavioral Model (IBM) and change in World Health Organization (WHO) drinking risk levels. METHODS Patients with HCV who consume alcohol were recruited from hepatology clinics and received provider-delivered SBIRT (Screening, Brief Intervention, Referral to Treatment) or SBIRT+ 6 months of co-located alcohol counseling. Treatment arms were combined for this analysis because no between-group differences were found. At baseline and 6 months, the timeline followback method was used to determine alcohol risk levels according to the 2000 WHO risk categories (based on average grams of alcohol per day). Changes in alcohol consumption and WHO risk levels were quantified and regressed on change in individual psychological processes (e.g., readiness, self-efficacy, motives, attitudes, and strategies) from baseline to 6 months. RESULTS At the baseline assessment, 162 participants were classified as abstinent (5%), low (47%), moderate (16%), high (19%), or very high (13%) WHO risk levels. At 6 months, 38% remained at the same risk level and 48% decreased by at least one level. In univariate analyses, changes in 7 of 12 psychological processes were associated with change in risk levels. Adjusted multivariate analyses demonstrated that change in four processes were significantly associated with change in risk levels, including SOCRATES Taking Steps, Ambivalence, and Recognition scores and alcohol reduction strategies. CONCLUSIONS These findings demonstrate significant reductions in quantitative indices of alcohol consumption following opportunistic alcohol interventions in patients with HCV. However, results provided mixed support for associations between change in IBM psychological processes and alcohol consumption.
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Affiliation(s)
- Donna M Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jia Yao
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Catherine Zimmer
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew J Muir
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Christian S Hendershot
- Department of Psychiatry and Bowles, Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rae Jean Proeschold-Bell
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Bratu ML, Sandesc D, Anghel T, Dehelean L, Bondrescu M, Bratosin F, Tudor R. Quality of Life Assessment Using the WHOQOL-BREF Survey in Hospitalized Patients with Alcohol Use Disorder from Romania. Diseases 2024; 12:158. [PMID: 39057129 PMCID: PMC11276466 DOI: 10.3390/diseases12070158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/08/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
This cross-sectional analysis aimed to assess the quality of life (QoL) among hospitalized patients with alcohol use disorder (AUD) in Romania, utilizing the WHOQOL survey. Conducted from January to December 2023 in the Psychiatry Clinic of the "Pius Brinzeu" Emergency Clinical Hospital in Timisoara, this study engaged 70 participants, adhering to ethical standards outlined in the Declaration of Helsinki. Employing the WHOQOL-BREF instrument, the research hypothesized that AUD patients would show significantly lower QoL scores across its domains compared to general population norms. The study focused on identifying the QoL domains most impacted by AUD, exploring correlations between QoL scores and AUD background characteristics, and pinpointing intervention areas for patient care improvement. Participants were predominantly males (88.57%) with a middle-aged average of 55.51 years. Educational backgrounds varied, with a notable percentage having attended college (44.29%) or university (17.14%). Regarding marital status, 41.43% were married. Comorbidities were present in 52.86% of the sample, with hypertension being the most common (34.29%). Results showed mean QoL scores in the physical (61.84 ± 16.05), psychological (64.11 ± 17.16), social (60.48 ± 24.85), and environmental (68.44 ± 17.34) domains, revealing a significant diversity in satisfaction levels across these areas. Statistical analyses highlighted marital status as significantly associated with a better QoL in the physical domain, with married, co-habiting, and divorced participants reporting higher scores compared to single ones. In conclusion, while AUD significantly affects the QoL of hospitalized patients in Romania, marital status emerges as a critical factor in mitigating these effects, particularly in the physical domain of QoL. These findings underscore the complexity of AUD's impact on QoL and the importance of considering sociodemographic factors in patient care practices and interventions. The study contributes valuable insights into the nuanced relationship between AUD and QoL, proposing a foundation for enhancing care outcomes for AUD patients in Romania.
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Affiliation(s)
- Melania Lavinia Bratu
- Center for Neuropsychology and Behavioral Medicine, Department of Psychology, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Center for Cognitive Research in Neuropsychiatric Pathology, Department of Neurosciences, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (L.D.); (M.B.)
| | - Dorel Sandesc
- Department of Anesthesia and Intensive Care, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Teodora Anghel
- Department of Neurosciences-Psychiatry, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Liana Dehelean
- Center for Cognitive Research in Neuropsychiatric Pathology, Department of Neurosciences, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (L.D.); (M.B.)
- Department of Neurosciences-Psychiatry, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Mariana Bondrescu
- Center for Cognitive Research in Neuropsychiatric Pathology, Department of Neurosciences, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (L.D.); (M.B.)
- Department of Neurosciences-Psychiatry, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Raluca Tudor
- Second Discipline of Neurology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
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Yoo JJ, Lee DH, Chang Y, Jo H, Cho YY, Lee S, Kim LY, Jang JY. Trends in alcohol use and alcoholic liver disease in South Korea: a nationwide cohort study. BMC Public Health 2024; 24:1841. [PMID: 38987717 PMCID: PMC11234741 DOI: 10.1186/s12889-024-19321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND There is a lack of national-level research on alcohol consumption and the epidemiology of alcoholic liver disease (ALD) in South Korea. This study aims to address the critical public health issue of ALD by focusing on its trends, incidence, and outcomes, using nationwide claims data. METHODS Utilizing National Health Insurance Service data from 2011 to 2017, we calculated the population's overall drinking amount and the incidence of ALD based on ICD-10 diagnosis codes. RESULTS From 2011 to 2017 in South Korea, social drinking increased from 15.7% to 16.5%, notably rising among women. High-risk drinking remained around 16.4%, decreasing in men aged 20-39 but not decreased in men aged 40-59 and steadily increased in women aged 20-59. The prevalence of ALD in high-risk drinkers (0.97%) was significantly higher than in social drinkers (0.16%). A 3-year follow-up revealed ALD incidence of 1.90% for high-risk drinkers and 0.31% for social drinkers. Women high-risk drinkers had a higher ALD risk ratio (6.08) than men (4.18). The economic burden of ALD was substantial, leading to higher healthcare costs and increased hospitalization. Progression rates to liver cirrhosis and hepatocellular carcinoma (HCC) in ALD patients were 23.3% and 2.8%, respectively, with no gender difference in cirrhosis progression. CONCLUSIONS The study revealed a concerning rise in alcohol consumption among South Korean women and emphasizes the heightened health risks and economic burdens associated with high-risk drinking, especially concerning ALD and its complications.
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Affiliation(s)
- Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Dong Hyeon Lee
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Young Chang
- Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, 59 Daesagwan-Ro, Yongsan-Gu, Seoul, 04401, Republic of Korea
| | - Hoongil Jo
- Department of Internal Medicine, Wonkwang University School of Medicine & Hospital, Iksan, South Korea
| | - Young Youn Cho
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Sangheun Lee
- Department of Internal Medicine, Catholic Kwandong University College of Medicine, Gangneung, South Korea
| | - Log Young Kim
- Department of Big DATA Strategy, National Health Insurance Service, 32, Geongang-Ro, Wonju-si, 26464, Republic of Korea.
| | - Jae Young Jang
- Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, 59 Daesagwan-Ro, Yongsan-Gu, Seoul, 04401, Republic of Korea.
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Belnap MA, McManus KR, Grodin EN, Ray LA. Endpoints for Pharmacotherapy Trials for Alcohol Use Disorder. Pharmaceut Med 2024; 38:291-302. [PMID: 38967906 PMCID: PMC11272707 DOI: 10.1007/s40290-024-00526-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 07/06/2024]
Abstract
Alcohol use disorder (AUD) is a debilitating disorder, yet currently approved pharmacotherapies to treat AUD are under-utilized. The three medications approved by the US Food and Drug Administration (FDA) for the indication of AUD are disulfiram, acamprosate, and naltrexone. The current landscape of pharmacotherapies for AUD suggests opportunities for improvement. Clinical trials investigating novel pharmacotherapies for AUD traditionally use abstinence-based drinking outcomes or no heavy drinking days as trial endpoints to determine the efficacy of pharmacotherapies. These outcomes are typically measured through patient self-report endorsements of their drinking. Apart from these traditional outcomes, there have been recent developments in novel endpoints for AUD pharmacotherapies. These novel endpoints include utilizing the World Health Organization (WHO) risk drinking level reductions to promote a harm-reduction endpoint rather than an abstinence-based endpoint. Additionally, in contrast to patient self-report measurements, biological markers of alcohol use may serve as objective endpoints in AUD pharmacotherapy trials. Lastly, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) definition of recovery from AUD and patient-oriented outcomes offer new frameworks to consider endpoints associated with more than alcohol consumption itself, such as the provider-patient experiences with novel pharmacotherapies. These recent developments in new endpoints for AUD pharmacotherapies offer promising future opportunities for pharmacotherapy development, so long as validity and reliability measures are demonstrated for the endpoints. A greater breadth of endpoint utilization may better capture the complexity of AUD symptomatology.
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Affiliation(s)
- Malia A Belnap
- Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kaitlin R McManus
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Erica N Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA.
- Brain Research Institute, University of California, Los Angeles, Los Angeles, CA, USA.
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9
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Reid AE, Cho GY, Carey KB, Witkiewitz K. World Health Organization Risk Drinking Levels Among Mandated College Students: Associations With Alcohol Use, Mental Health, and Academic Performance. J Stud Alcohol Drugs 2024; 85:522-527. [PMID: 38363070 PMCID: PMC11289866 DOI: 10.15288/jsad.23-00074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 02/02/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE World Health Organization (WHO) risk drinking levels (i.e., low, moderate, high, or very high risk) have been used as a drinking-reduction endpoint in clinical trials. Yet, prior work has not attempted to quantify reductions in WHO risk levels among mandated students, who may also benefit from reduced drinking. We sought to validate WHO risk drinking levels in differentiating students' alcohol-related outcomes, depressive symptoms, and academic performance. Defining risk via typical drinks per drinking day versus drinks per day was compared, and gender differences were examined. METHOD Baseline data were drawn from three intervention trials for students mandated to intervention and who were not abstinent (N = 1,436). Sex-specific WHO risk levels were generated and dummy coded, with low risk as the reference. Regression models examined associations of risk levels with positive Alcohol Use Disorders Identification Test (AUDIT) scores, peak drinking, consequences, depressive symptoms, and grade point average. RESULTS Defining WHO risk via drinks per drinking day evenly dispersed students across categories, whereas drinks per day categorized most students as low risk. More women than men were classified as very high risk across definitions. Students classified as low risk differed from those classified as moderate, high, and very high risk in screening positive on the AUDIT, peak drinking, and consequences. WHO risk levels did not differentiate depressive symptoms. Differences in grade point average were inconsistent across risk definitions. CONCLUSIONS WHO risk drinking levels differentiated alcohol use and consequences and, therefore, hold promise for clinical use and for quantifying drinking reductions among mandated college students.
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Affiliation(s)
- Allecia E. Reid
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, Amherst, Massachusetts
| | - Grace Y. Cho
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, Amherst, Massachusetts
| | - Kate B. Carey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico
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10
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Richards DK, Tuchman FR, Hallgren KA, Kranzler HR, Aubin HJ, O’Malley SS, Mann K, Aldridge A, Anton RF, Witkiewitz K. Reductions in World Health Organization Risk Drinking Level Are Associated With Reductions in Alcohol Use Disorder Diagnosis and Criteria: Evidence From an Alcohol Pharmacotherapy Trial. J Addict Med 2024; 18:418-424. [PMID: 38606854 PMCID: PMC11290995 DOI: 10.1097/adm.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVES This study aimed to evaluate the validity of World Health Organization (WHO) risk drinking level reductions as meaningful endpoints for clinical practice and research. This study examined whether such reductions were associated with a lower likelihood of a current alcohol use disorder (AUD) diagnosis and fewer AUD criteria. METHODS We conducted a secondary data analysis to address these objectives using data from a multisite randomized controlled trial of gabapentin enacarbil extended release in treating moderate to severe AUD among adults (N = 346). Participants received gabapentin enacarbil extended release or placebo for 6 months. The timeline follow-back was used to assess WHO risk drinking level reductions, and the Mini-International Neuropsychiatric Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD diagnosis and criteria at baseline (past year) and end of treatment (past month). RESULTS Most participants (80.1%) achieved at least a 1-level reduction in the WHO risk drinking levels from baseline to end of treatment, and nearly half of participants (49.8%) achieved at least a 2-level reduction. At least a 1-level reduction or at least a 2-level reduction in WHO risk drinking level predicted lower odds of an active AUD diagnosis (1-level: odds ratio, 0.74 [95% confidence interval (CI), 0.66-0.84]; 2-level: odds ratio, 0.71 [95% CI, 0.64-0.79]) and fewer AUD criteria (1-level: B , -1.66 [95% CI, -2.35 to -0.98]; 2-level: B , -1.76 [95% CI, -2.31 to -1.21]) at end of treatment. CONCLUSIONS World Health Organization risk drinking level reductions correlate with Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD diagnosis and criteria, providing further evidence for their use as endpoints in alcohol intervention trials, which has potential implications for broadening the base of AUD treatment.
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Affiliation(s)
- Dylan K. Richards
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, USA
| | - Felicia R. Tuchman
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kevin A. Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Henry R. Kranzler
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania and VISN4 MIRECC, Crescenz VAMC, Philadelphia, PA, USA
| | - Henri-Jean Aubin
- French Institute of Health and Medical Research, Paris, Île-de-France, FRAN
| | - Stephanie S. O’Malley
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Karl Mann
- Zentralinstitut für Seelische Gesundheit (ZI), Mannheim, Baden-Württemberg, DE
| | - Arnie Aldridge
- Behavioral Health Financing, Economics and Evaluation Department, Research Triangle Institute International (RTI), Durham, NC, USA
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
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11
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Ares-Blanco S, López-Rodríguez JA, Polentinos-Castro E, Del Cura-González I. Effect of GP visits in the compliance of preventive services: a cross-sectional study in Europe. BMC PRIMARY CARE 2024; 25:165. [PMID: 38750446 PMCID: PMC11094967 DOI: 10.1186/s12875-024-02400-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/23/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Performing cardiovascular and cancer screenings in target populations can reduce mortality. Visiting a General Practitioner (GP) once a year is related to an increased likelihood of preventive care. The aim of this study was to analyse the influence of visiting a GP in the last year on the delivery of preventive services based on sex and household income. METHODS Cross-sectional study using data collected from the European Health Interview Survey 2013-2015 of individuals aged 40-74 years from 29 European countries. The variables included: sociodemographic factors (age, sex, and household income (HHI) quintiles [HHI 1: lowest income, HHI 5: more affluent]), lifestyle factors, comorbidities, and preventive care services (cardiometabolic, influenza vaccination, and cancer screening). Descriptive statistics, bivariate analyses and multilevel models (level 1: citizen, level 2: country) were performed. RESULTS 242,212 subjects were included, 53.7% were female. The proportion of subjects who received any cardiometabolic screening (92.4%) was greater than cancer screening (colorectal cancer: 44.1%, gynaecologic cancer: 40.0%) and influenza vaccination. Individuals who visited a GP in the last year were more prone to receive preventive care services (cardiometabolic screening: adjusted OR (aOR): 7.78, 95% CI: 7.43-8.15; colorectal screening aOR: 1.87, 95% CI: 1.80-1.95; mammography aOR: 1.76, 95% CI: 1.69-1.83 and Pap smear test: aOR: 1.89, 95% CI:1.85-1.94). Among those who visited a GP in the last year, the highest ratios of cardiometabolic screening and cancer screening benefited those who were more affluent. Women underwent more blood pressure measurements than men regardless of the HHI. Men were more likely to undergo influenza vaccination than women regardless of the HHI. The highest differences between countries were observed for influenza vaccination, with a median odds ratio (MOR) of 6.36 (under 65 years with comorbidities) and 4.30 (over 65 years with comorbidities), followed by colorectal cancer screening with an MOR of 2.26. CONCLUSIONS Greater adherence to preventive services was linked to individuals who had visited a GP at least once in the past year. Disparities were evident among those with lower household incomes who visited a GP. The most significant variability among countries was observed in influenza vaccination and colorectal cancer screening.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.
- Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain.
| | - Juan A López-Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- General Ricardos Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Elena Polentinos-Castro
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Isabel Del Cura-González
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
- Aging Research Center, Karolinksa Instituted, Stockholm, Sweden
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12
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Cook WK, Kerr WC, Zhu Y, Bright S, Buckley C, Kilian C, Lasserre AM, Llamosas-Falcón L, Mulia N, Rehm J, Probst C. Alcoholic beverage types consumed by population subgroups in the United States: Implications for alcohol policy to address health disparities. Drug Alcohol Rev 2024; 43:946-955. [PMID: 38316528 PMCID: PMC11052671 DOI: 10.1111/dar.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/20/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION We aimed to identify alcoholic beverage types more likely to be consumed by demographic subgroups with greater alcohol-related health risk than others, mainly individuals with low socio-economic status, racial/ethnic minority status and high drinking levels. METHODS Fractional logit modelling was performed using a nationally representative sample of US adult drinkers (analytic N = 37,657) from the National Epidemiologic Survey on Alcohol and Related Conditions Waves 2 (2004-2005) and 3 (2012-2013). The outcomes were the proportions of pure alcohol consumed as beer, wine, liquor and coolers (defined as wine-/malt-/liquor-based coolers, hard lemonade, hard cider and any prepackaged cocktails of alcohol and mixer). RESULTS Adults with lower education and low or medium income were more likely to drink beer, liquor and coolers, while those with a 4-year college/advanced degree and those with high income preferred wine. Excepting Asian adults, racial/ethnic minority adults were more likely to drink beer (Hispanics) and liquor (Blacks), compared with White adults. High- or very-high-level drinkers were more likely to consume liquor and beer and less likely to consume wine (and coolers), compared with low-level drinkers. High-level and very-high-level drinkers, who were less than 10% of all drinkers, consumed over half of the total volume of beer, liquor and coolers consumed by all adults. DISCUSSION AND CONCLUSIONS Individuals with low socio-economic status, racial/ethnic minority status or high drinking level prefer liquor and beer. As alcohol taxes, sales and marketing practices all are beverage-specific, targeted approaches to reduce consumption of these beverages, particularly among individuals with these profiles, are warranted.
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Affiliation(s)
- Won Kim Cook
- Alcohol Research Group, Public Health Institute, Emerville, USA
| | - William C. Kerr
- Alcohol Research Group, Public Health Institute, Emerville, USA
| | - Yachen Zhu
- Alcohol Research Group, Public Health Institute, Emerville, USA
| | - Sophie Bright
- School of Health and Related Research, Faculty of Medicine, Dentistry & Health, University of Sheffield, Shefield, UK
| | - Charlotte Buckley
- Department of Automatic Control and Systems Engineering, University of Sheffield, Shefield, UK
| | - Carolin Kilian
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
| | - Aurelie M. Lasserre
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Laura Llamosas-Falcón
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emerville, USA
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
| | - Charlotte Probst
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Canada
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13
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Tardelli VS. Commentary on Amin-Esmaeili et al.: Non-abstinence outcomes in stimulant clinical trials-Why deny improvement? Addiction 2024; 119:844-845. [PMID: 38476049 DOI: 10.1111/add.16481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Vítor S Tardelli
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
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14
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Rodríguez-Agudo R, González-Recio I, Serrano-Maciá M, Bravo M, Petrov P, Blaya D, Herranz JM, Mercado-Gómez M, Rejano-Gordillo CM, Lachiondo-Ortega S, Gil-Pitarch C, Azkargorta M, Van Liempd SM, Martinez-Cruz LA, Simão A, Elortza F, Martín C, Nevzorova YA, Cubero FJ, Delgado TC, Argemi J, Bataller R, Schoonjans K, Banales JM, Castro RE, Sancho-Bru P, Avila MA, Julve J, Jover R, Mabe J, Simon J, Goikoetxea-Usandizaga N, Martínez-Chantar ML. Anti-miR-873-5p improves alcohol-related liver disease by enhancing hepatic deacetylation via SIRT1. JHEP Rep 2024; 6:100918. [PMID: 38192540 PMCID: PMC10772393 DOI: 10.1016/j.jhepr.2023.100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 01/10/2024] Open
Abstract
Background & Aims Current therapies for the treatment of alcohol-related liver disease (ALD) have proven largely ineffective. Patients relapse and the disease progresses even after liver transplantation. Altered epigenetic mechanisms are characteristic of alcohol metabolism given excessive acetate and NAD depletion and play an important role in liver injury. In this regard, novel therapeutic approaches based on epigenetic modulators are increasingly proposed. MicroRNAs, epigenetic modulators acting at the post-transcriptional level, appear to be promising new targets for the treatment of ALD. Methods MiR-873-5p levels were measured in 23 liver tissue from Patients with ALD, and GNMT levels during ALD were confirmed using expression databases (transcriptome n = 62, proteome n = 68). High-resolution proteomics and metabolomics in mice following the Gao-binge model were used to investigate miR-873-5p expression in ALD. Hepatocytes exposed to 50 mM alcohol for 12 h were used to study toxicity. The effect of anti-miR-873-5p in the treatment outcomes of ALD was investigated. Results The analysis of human and preclinical ALD samples revealed increased expression of miR-873-5p in the liver. Interestingly, there was an inverse correlation with NNMT, suggesting a novel mechanism for NAD depletion and aberrant acetylation during ALD progression. High-resolution proteomics and metabolomics identified miR-873-5p as a key regulator of NAD metabolism and SIRT1 deacetylase activity. Anti-miR-873-5p reduced NNMT activity, fuelled the NAD salvage pathway, restored the acetylome, and modulated the levels of NF-κB and FXR, two known SIRT1 substrates, thereby protecting the liver from apoptotic and inflammatory processes, and improving bile acid homeostasis. Conclusions These data indicate that targeting miR-873-5p, a repressor of GNMT previously associated with NAFLD and acetaminophen-induced liver failure. is a novel and attractive approach to treating alcohol-induced hepatoxicity. Impact and implications The role of miR-873-5p has not been explicitly examined in the progression of ALD, a pathology with no therapeutic options. In this study, inhibiting miR-873-5p exerted hepatoprotective effects against ALD through rescued SIRT1 activity and consequently restored bile acid homeostasis and attenuated the inflammatory response. Targeting hepatic miR-873-5p may represent a novel therapeutic approach for the treatment of ALD.
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Affiliation(s)
- Rubén Rodríguez-Agudo
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - Irene González-Recio
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - Marina Serrano-Maciá
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - Miren Bravo
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - Petar Petrov
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Experimental Hepatology Joint Research Unit, IIS Hospital La Fe and Department of Biochemistry and Molecular Biology, University of Valencia, Valencia, Spain
| | - Delia Blaya
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Liver Cell Plasticity and Tissue Repair Lab, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Jose María Herranz
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain
| | - María Mercado-Gómez
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - Claudia María Rejano-Gordillo
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - Sofía Lachiondo-Ortega
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - Clàudia Gil-Pitarch
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - Mikel Azkargorta
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Proteomics Platform, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
| | - Sebastiaan Martijn Van Liempd
- Metabolomics Platform, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Spain
| | - Luis Alfonso Martinez-Cruz
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - A.L. Simão
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Félix Elortza
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Proteomics Platform, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
| | - César Martín
- Biofisika Institute (UPV/EHU, CSIC) and Department of Biochemistry and Molecular Biology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Yulia A. Nevzorova
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Department of Immunology, Ophthalmology and ENT Complutense University School of Medicine Madrid Spain, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Department of Internal Medicine III, University Hospital RWTH Aachen, Germany
| | - Francisco Javier Cubero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Department of Immunology, Ophthalmology and ENT Complutense University School of Medicine Madrid Spain, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Teresa C. Delgado
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - Josepmaria Argemi
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Instituto de Investigaciones Sanitarias de Navarra-IdiSNA, Pamplona, Spain
| | - Ramón Bataller
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Liver Research Center, Pittsburgh, Pennsylvania, USA
| | - Kristina Schoonjans
- Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jesús M. Banales
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), Ikerbasque, San Sebastian, Spain
- Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Rui E. Castro
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Pau Sancho-Bru
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Liver Cell Plasticity and Tissue Repair Lab, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Matías A. Avila
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
- Hepatology Program, Cima-University of Navarra, Pamplona, Spain
| | - Josep Julve
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain
| | - Ramiro Jover
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
- Experimental Hepatology Joint Research Unit, IIS Hospital La Fe and Department of Biochemistry and Molecular Biology, University of Valencia, Valencia, Spain
| | - Jon Mabe
- Business Department, IK4-Tekniker, Eibar, Spain
| | - Jorge Simon
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - Naroa Goikoetxea-Usandizaga
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
| | - María L. Martínez-Chantar
- Liver Disease Lab, Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Derio, Bizkaia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Carlos III National Health Institute, Madrid, Spain
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15
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Barbosa C, Dowd WN, Karriker-Jaffe KJ, Zarkin G. Modeling the impact of a long-term horizon and multiple treatment episodes on estimates of the cost-effectiveness of alcohol treatment in the United States. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2121-2137. [PMID: 38226759 PMCID: PMC10792252 DOI: 10.1111/acer.15186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Most clinical studies of alcohol use disorder (AUD) treatment have short follow-up periods, underestimating the full benefits of alcohol treatment. Furthermore, clinical studies only consider one treatment cycle and do not account for the need for multiple episodes to treat a chronic recurrent condition. METHODS A validated microsimulation model of the long-term drinking patterns of people with AUD in the United States simulated 10,000 individuals resembling those from a large clinical trial. The model was used to assess the impact of (1) 1-year, 5-year, and lifetime horizon on alcohol treatment cost-effectiveness estimates and (2) no, one, two, four, and unlimited additional treatment episodes on alcohol treatment cost-effectiveness estimates. Model outcomes included healthcare costs, crime costs, labor market productivity, life expectancy, quality-adjusted life years (QALYs), alcohol-related hospitalizations, and deaths. Cost-effectiveness analyses were conducted for two perspectives: a healthcare perspective that included costs from hospitalization and AUD treatment, and a broader societal perspective that also included crime costs and productivity. RESULTS The incremental cost per additional QALY gained for alcohol treatment compared with no treatment decreased from $55,590 after 1 year to $78 when healthcare costs and QALYs were tracked over the lifetime, that is, treatment became more cost effective. Treatment was cost saving for any time frame when the impacts on crime and labor productivity were also accounted for in a societal perspective. Access to multiple treatment episodes dominated (i.e., it was more effective and less costly) than no-treatment and one-episode scenarios. From a healthcare perspective, incremental costs per additional QALY for increasing from a maximum of two to four treatment episodes was $499 and from four to unlimited episodes was $5049. The unlimited treatment scenario dominated all others from a societal perspective. Results were robust in sensitivity analyses. CONCLUSIONS A long-term perspective and multiple episodes of alcohol treatment improve cost-effectiveness estimates. When societal impacts are included, alcohol treatment is cost saving. Results support the value of alcohol treatment.
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Affiliation(s)
| | - William N Dowd
- RTI International, Research Triangle Park, NC, United
States
| | | | - Gary Zarkin
- RTI International, Research Triangle Park, NC, United
States
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16
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Han J, Keedy S, de Wit H. Stimulant-like subjective effects of alcohol are not related to resting-state connectivity in healthy men. Cereb Cortex 2023; 33:9478-9488. [PMID: 37339883 PMCID: PMC10656944 DOI: 10.1093/cercor/bhad218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023] Open
Abstract
Individual differences in subjective, stimulant-like effects of alcohol are associated with the risk of developing alcohol use disorder. Specifically, individuals who experience more pronounced stimulant-like effects from alcohol are more likely to continue and escalate their usage. The neural basis for these individual differences in subjective response is not yet known. Using a within-subject design, 27 healthy male social drinkers completed three fMRI scans after ingesting a placebo, 0.4 and 0.8 g/kg alcohol, in a randomized order under double-blind conditions. Subjective stimulant effects of alcohol were assessed at regular intervals during each session. Seed-based and regional homogeneity analyses were conducted to evaluate changes in resting-state functional connectivity in relation to the stimulant effect of alcohol. Results indicated that 0.4 g/kg alcohol increased the connectivity to thalamus, and 0.8 g/kg alcohol decreased the connectivity to ventral anterior insula, primarily from the superior parietal lobule. Both doses reduced regional homogeneity in the superior parietal lobule but without an exact overlap with clusters showing connectivity changes in the seed-based analyses. The self-reported stimulant effect of alcohol was not significantly related to changes in seed-based connectivity or regional homogeneity. These findings suggest that alcohol-induced stimulation effects are not related to these indices of neural activity.
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Affiliation(s)
- Jiaxu Han
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, United States
| | - Sarah Keedy
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, United States
| | - Harriet de Wit
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, United States
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17
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Schouten MJE, ten Have M, Tuithof M, de Graaf R, Dekker JJM, Goudriaan AE, Blankers M. Alcohol use as a predictor of the course of major depressive disorder: a prospective population-based study. Epidemiol Psychiatr Sci 2023; 32:e14. [PMID: 36847267 PMCID: PMC9971850 DOI: 10.1017/s2045796023000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
AIMS There are indications that problematic alcohol use may negatively impact the course of major depressive disorder (MDD). However, most studies on alcohol use and adverse MDD outcomes are conducted amongst MDD populations with (severe) alcohol use disorder in psychiatric treatment settings. Therefore, it remains unclear whether these results can be generalised to the general population. In light of this, we examined the longitudinal relationship between alcohol use and MDD persistence after a 3-year follow-up amongst people with MDD from the general population. METHODS Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a psychiatric epidemiological prospective study comprising four waves amongst the adult Dutch general population (n = 6.646). The study sample (n = 642) consisted of those with 12-month MDD who participated at the follow-up wave. The outcome was 12-month MDD persistence after the 3-year follow-up, which was assessed via the Composite International Diagnostic Interview version 3.0. Weekly alcohol consumption was operationalised as non-drinking (0 drinks), low-risk drinking (⩽7 drinks; reference), at-risk drinking (women 8-13 drinks, men 8-20 drinks) and high-risk drinking (women ⩾14, men ⩾21 drinks). We performed univariate and multiple logistic regression analyses, which were adjusted for various socio-demographic and health-related factors. RESULTS The majority (67.4%) of the MDD sample were female, while the mean age was 47.1 years. Amongst these, 23.8% were non-drinkers, 52.0% were low-risk drinkers and 14.3% and 9.4% were at-risk and high-risk drinkers, respectively. Around one-quarter of the sample (23.6%) met the criteria for a persistent MDD after 3-year follow-up. No statistically significant association was found between alcohol use and MDD persistence, either for the crude model or the adjusted models. In comparison to low-risk drinking, the full adjusted model showed no statistically significant associations between MDD persistence and non-drinking (odds ratio (OR) = 1.15, p = 0.620), at-risk drinking (OR = 1.25, p = 0.423), or high-risk drinking (OR = 0.74, p = 0.501). CONCLUSIONS Contrary to our expectations, our findings showed that alcohol use was not a predictor of MDD persistence after 3-year follow-up amongst people with MDD from the general population.
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Affiliation(s)
- Maria J. E. Schouten
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, the Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands, Amsterdam Public Health research institute, Amsterdam, the Netherlands
- Author for correspondence: Maria J. E. Schouten, E-mail:
| | - Margreet ten Have
- Trimbos Institute – Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Marlous Tuithof
- Trimbos Institute – Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Ron de Graaf
- Trimbos Institute – Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Jack J. M. Dekker
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, the Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Anna E. Goudriaan
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, the Netherlands
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, and Amsterdam Institute for Addiction Research, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, the Netherlands
- Trimbos Institute – Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, and Amsterdam Institute for Addiction Research, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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18
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Li K, Hou L, Tan Y, Huang Y, Shi J, Han J, Yan J, Guan Y. Iron metabolism patterns in non-anemic patients with myasthenia gravis: A cross-sectional and follow-up study. Front Neurol 2022; 13:1060204. [PMID: 36504650 PMCID: PMC9729274 DOI: 10.3389/fneur.2022.1060204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background and purpose Iron metabolism in myasthenia gravis (MG) and factors associated with it are explored by few published studies. Therefore, this study aimed to compare iron metabolism patterns between patients with MG and healthy individuals as well as between the same group of patients before and after immunotherapy, and to identify predictors of iron metabolism disorders in MG. Materials and methods For this study, 105 patients and healthy individuals were included at baseline, after which paired parametric and non-parametric tests were adopted to compare their iron metabolism patterns, and multivariate binary logistic regression was used to identify predictors of iron metabolism disorders. Patients with MG were then followed up for 12 ± 3 months to explore alterations in their iron metabolism patterns after starting immunotherapy with the help of paired tests. Results Non-anemic immunotherapy-naive patients with MG had significantly lower serum iron (SI) and transferrin saturation (TS) levels than healthy individuals. Premenopausal female was significantly associated with SI < 65 μg/dL and iron deficiency in these patients. However, iron metabolism parameters did not significantly alter after around 12 months of immunotherapy in patients with MG. Conclusion Iron inadequacy was present in patients with MG, particularly premenopausal female patients, and it would hardly improve after immunotherapy. Given the significant role of iron in human body, it should be given more attention in patients with MG.
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Affiliation(s)
- Ke Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li'an Hou
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Tan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangyu Huang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiayu Shi
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhua Han
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingwen Yan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Yuzhou Guan
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Goldman-Mellor S, Kaplan MS, Qin P. Mortality Risk Following Nonfatal Injuries With Alcohol Use Disorder Involvement: A One-Year Follow-Up of Emergency Department Patients Using Linked Administrative Data. J Stud Alcohol Drugs 2022; 83:879-887. [PMID: 36484585 PMCID: PMC9756401 DOI: 10.15288/jsad.21-00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/21/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Patient presentations to the emergency department (ED) for alcohol-involved injury represent a growing public health burden, but their characteristics and sequelae remain understudied. This study examined mortality rates among ED patients presenting with alcohol-involved injuries and assessed how mortality varied by injury intent and other characteristics. METHOD This retrospective cohort study used statewide, longitudinally linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED in 2009-2012 with a nonfatal injury that involved comorbid diagnosis of alcohol use disorder (AUD; n = 261,222; 59.3% male). Injury intent was defined using International Classification of Diseases, 9th Revision, Clinical Modification external cause-of-injury codes. Cox regression was used to investigate factors associated with 12-month all-cause mortality rates. Age-, sex-, and race/ethnicity-adjusted standardized mortality ratios (SMRs) were calculated using statewide mortality data. RESULTS Most ED injury visits involving an AUD diagnosis were coded as unintentional (75.9%). Following the index ED visit, all-cause mortality among AUD-involved injury patients was 5,205 per 100,000 person-years, five times higher than the demographically matched population (SMR = 5.3; 95% confidence interval [5.2, 5.4]). Adjusted Cox regression models indicated that patients whose index injury was unintentional, and whose AUD was for acute intoxication, had significantly higher mortality. Most deaths among unintentionally injured patients were from natural causes, whereas external-cause deaths were relatively more common in the other patient groups. CONCLUSIONS AUD-involved injury presentations to the ED in California are common and associated with high patient mortality burden, which varies by injury intent. Interventions are needed to reduce excess mortality in these patients.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, California
| | - Mark S. Kaplan
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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20
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Lespine LF, Bramness JG, Pignon B, Vaiva G, Thomas P, Roelandt JL, Benradia I, Amad A, Geoffroy PA, Rolland B. Gender-related associations between psychiatric disorders and alcohol use disorder: Findings from the french "Mental health in the general population" survey. Arch Womens Ment Health 2022; 25:895-902. [PMID: 36083520 DOI: 10.1007/s00737-022-01253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
Women with alcohol use disorder (AUD) might be particularly vulnerable to psychiatric comorbidities. However, population surveys have yielded disparate findings. We used data from the French Mental Health in the General Population survey to investigate gender-related risks of psychiatric comorbidities associated with AUD. A cross-sectional survey based on face-to-face interviews, including the Mini International Neuropsychiatric Interview, was conducted among 38,717 subjects. Logistic regression models were used to assess risks of psychiatric comorbidities associated with AUD. After adjustment for socio-demographics and other psychiatric disorders, both women and men with AUD were at higher risk of comorbid depressive disorder (odds ratio [OR] = 2.6, 95% confidence interval [CI]: 2.0-3.4 in women, and OR = 2.0, 95% CI: 1.7-2.4 in men), bipolar I disorder (2.5; 1.4-4.4 in women vs. 2.6; 1.9-3.4 in men), and psychotic disorder (1.6; 1.01-2.5 in women vs. 1.8; 1.4-2.3 in men). Women with AUD exhibited an increased risk of comorbid panic disorder (OR = 1.6, 95% CI: 1.1-2.2) while the increased risk of post-traumatic stress disorder (PTSD) was significant in men only (OR = 2.6, 95% CI: 1.6-4.2). The increased risk of comorbid substance use disorder (SUD) was more elevated in women, compared to men (12.9; 8.1-18.1 vs. 4.8; 4.0-5.8 in men). Most of psychiatric conditions were over-represented in both women and men with AUD, relative to controls. Gender-specific findings were that women with AUD had an increased risk of comorbid SUD or panic disorder, while men had a significantly higher risk of comorbid PTSD.
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Affiliation(s)
- Louis-Ferdinand Lespine
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, Centre Hospitalier Le Vinatier, 95 Bd Pinel, 69500, Bron, France.
- UCBL1, INSERM, U1028, CNRS, UMR5292, CRNL, PSYR2, Lyon, France.
| | - Jørgen G Bramness
- Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Baptiste Pignon
- DMU IMPACT, Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux Universitaires « H. Mondor», Fondation FondaMental, Créteil, France
| | - Guillaume Vaiva
- Lille Neuroscience & Cognition (LilNCog), Université Lille, Inserm, CHU Lille, U1172, 59000, Lille, France
| | - Pierre Thomas
- Centre National de Ressources & Résilience Pour Les Psychotraumatismes (Cn2r Lille Paris), 59000, Lille, France
| | - Jean-Luc Roelandt
- Centre Collaborateur de L'Organisation Mondiale de La Santé Pour La Recherche Et La Formation en Santé Mentale, EPSM Lille Métropole, 211 rue Roger Salengro, 59 260, Hellemmes, France
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
| | - Imane Benradia
- Centre Collaborateur de L'Organisation Mondiale de La Santé Pour La Recherche Et La Formation en Santé Mentale, EPSM Lille Métropole, 211 rue Roger Salengro, 59 260, Hellemmes, France
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
| | - Ali Amad
- Centre National de Ressources & Résilience Pour Les Psychotraumatismes (Cn2r Lille Paris), 59000, Lille, France
| | - Pierre-Alexis Geoffroy
- Service de Psychiatrie Et dAddictologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Bichat, Paris, France
- Université de Paris, Inserm, 75019, NeuroDiderot, Paris, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, Centre Hospitalier Le Vinatier, 95 Bd Pinel, 69500, Bron, France
- UCBL1, INSERM, U1028, CNRS, UMR5292, CRNL, PSYR2, Lyon, France
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21
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Goldman-Mellor S, Olfson M, Schoenbaum M. Acute injury mortality and all-cause mortality following emergency department presentation for alcohol use disorder. Drug Alcohol Depend 2022; 236:109472. [PMID: 35490593 PMCID: PMC10492647 DOI: 10.1016/j.drugalcdep.2022.109472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Alcohol-related morbidity and mortality have increased substantially in the U.S. Understanding the population health implications of these concerning trends, including by identifying clinical subgroups of alcohol users at increased risk for potentially preventable acute causes of mortality, is of critical importance. METHODS This retrospective cohort study used statewide, all-payer, longitudinally-linked ED patient record and mortality data from California. Participants comprised all residents presenting to a licensed ED at least once in 2009-2011 with a diagnosis of alcohol use disorder (AUD). Participants were followed for one year after index ED visit to assess acute injury (unintentional poisoning, suicide, homicide, motor vehicle crash, and fall- or fire-related injury) and all-cause mortality rates per 100,000 person-years. Age-, sex-, race/ethnicity-adjusted standardized mortality rates (SMRs) for acute injury causes of death were determined using statewide mortality data. RESULTS Among 437,855 patients with index non-fatal ED visits for AUD, the 12-month acute injury mortality rate was 608.6 per 100,000 (SMR=8.0; 95% CI=7.7, 8.3), and all-cause mortality was 5700.7 per 100,000 (SMR=6.5; 95% CI=6.4, 6.6). Unintentional poisoning accounted for 46.5%, and suicide for 19.7%, of acute-injury deaths. Acute injury deaths comprised 71.7% of all-cause mortality among patients aged 10-24 years, but much lower proportions among older patients. Female AUD patients had lower rates for all mortality outcomes. CONCLUSIONS Emergency department patients with a recognized AUD comprise a population at persistently elevated risk for mortality. Age-related AUD patient differences in common causes of death, including drug overdose and suicide, can inform the structure of future clinical interventions.
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Affiliation(s)
- Sidra Goldman-Mellor
- University of California, Merced, Merced, CA 95343, USA; School of Social Sciences, Humanities, and Arts, Merced, CA 95343, USA; Department of Public Health, Merced, Merced, CA 95343, USA.
| | - Mark Olfson
- Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Michael Schoenbaum
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA.
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22
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Pirino BE, Martin CR, Carpenter BA, Curtis GR, Curran-Alfaro CM, Samels SB, Barker JM, Karkhanis AN, Barson JR. Sex-related differences in pattern of ethanol drinking under the intermittent-access model and its impact on exploratory and anxiety-like behavior in Long-Evans rats. Alcohol Clin Exp Res 2022; 46:1282-1293. [PMID: 35491472 PMCID: PMC9357056 DOI: 10.1111/acer.14853] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND While men in the United States consume more alcohol than women, rates of drinking are converging. Nevertheless, females remain underrepresented in preclinical alcohol research. Here, we examined rats' sex-related differences in patterns of ethanol (EtOH) drinking and the effects of this drinking on exploratory and anxiety-like behavior. METHODS Adult male and female Long-Evans rats were given 20% ethanol under the intermittent-access two-bottle-choice paradigm. Their intake was measured daily for the first 7 weeks. During the eighth week, intake was measured over the 24 h of daily access. During the ninth week, they, along with EtOH-naive controls, were tested prior to daily access in a novel chamber, light-dark box, and hole board apparatus. During the tenth week, blood ethanol concentration (BEC) was assessed after 30 to 40 min of access. RESULTS Females overall demonstrated higher ethanol intake and preference across all access weeks than males, although only half of females drank significantly more than males. Across 24 h of daily access, both sexes had their highest intake in the first 30 min and their lowest in the middle of the light phase of the light/dark cycle. Despite their greater ethanol intake, females did not show significantly different BECs than males. In behavioral tests, females showed less vertical time in a novel activity chamber, more movement between chambers in a light-dark box, and more nose pokes in a hole-board apparatus than males. While a history of ethanol drinking led to a trend for lower vertical time in the activity chamber and greater chamber entries in the light-dark box, the effects were not sex-dependent. CONCLUSIONS These results suggest that female and male rats could both be tested for acute effects of ethanol after 30 min of daily access, but that nuanced considerations are needed in the design of these experiments and the interpretation of their findings.
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Affiliation(s)
- Breanne E Pirino
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Cydney R Martin
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Brody A Carpenter
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Genevieve R Curtis
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Christina M Curran-Alfaro
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Shanna B Samels
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Jacqueline M Barker
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Anushree N Karkhanis
- Department of Psychology, Binghamton University - SUNY, Binghamton, New York, USA
| | - Jessica R Barson
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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Emerging roles of Sirtuins in alleviating alcoholic liver Disease: A comprehensive review. Int Immunopharmacol 2022; 108:108712. [PMID: 35397391 DOI: 10.1016/j.intimp.2022.108712] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 12/11/2022]
Abstract
Sirtuins (SIRTs), a NAD+ family of dependent deacetylases, are involved in the regulation of various human diseases. Recently, accumulating evidence has uncovered number of substrates and crucial roles of SIRTs in the pathogenesis of alcoholic liver disease (ALD). However, systematic reports are still lacking, so this review provides a comprehensive profile of the crucial physiological functions of SIRTs and its role in attenuating ALD, including alcoholic liver steatosis, steatohepatitis, and fibrosis. SIRTs play beneficial roles in energy/lipid metabolism, oxidative stress, inflammatory response, mitochondrial homeostasis, autophagy and necroptosis of ALD via regulating multiple signaling transduction pathways such as AMPK, LKB1, SREBP1, Lipin1, PGC-1α, PPARα/γ, FoxO1/3a, Nrf2/p62, mTOR, TFEB, RIPK1/3, HMGB1, NFATc4, NF-κB, TLR4, NLRP3, P2X7R, MAPK, TGF1β/Smads and Wnt/β-catenin. In addition, the mechanism and clinical application of natural/ synthetic SIRTs agonists in ALD are summarized, which provide a new idea for the treatment of ALD and basic foundation for further studies into target drugs.
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Si Y, Wang L, Zhao M. Anti-saccade as a Tool to Evaluate Neurocognitive Impairment in Alcohol Use Disorder. Front Psychiatry 2022; 13:823848. [PMID: 35573351 PMCID: PMC9094713 DOI: 10.3389/fpsyt.2022.823848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
It has been widely shown that chronic alcohol use leads to cognitive dysfunctions, especially inhibitory control. In an extension of the traditional approach, this research field has benefited from the emergence of innovative measures, among which is an anti-saccade, allowing direct and sensitive measure of the eye movements indexing attention bias to alcohol-related cues and the capability of inhibiting the reflexive saccades to the cues. During the past decade, there are numerous reports showing that drinkers make more unwanted reflexive saccades and longer latency in the anti-saccade task. These increased errors are usually explained by the deficits in inhibitory control. It has been demonstrated that inhibitory control on eye movement may be one of the earliest biomarkers of the onset of alcohol-related cognitive impairments. This review summarizes how an anti-saccade task can be used as a tool to investigate and assess the cognitive dysfunctions and the early detection of relapsing risk of alcohol dependence.
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Affiliation(s)
- Yuqi Si
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihui Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China
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Nesoff ED, Gutkind S, Sirota S, McKowen AL, Veldhuis CB. Mental health and economic stressors associated with high-risk drinking and increased alcohol consumption early in the COVID-19 pandemic in the United States. Prev Med 2021; 153:106854. [PMID: 34695505 PMCID: PMC8548050 DOI: 10.1016/j.ypmed.2021.106854] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Abstract
Physical distancing measures to curb COVID-19 transmission introduced mental health and economic stressors, possibly impacting problematic drinking. This cross-sectional study examines mental health and economic stressors early in the COVID-19 pandemic which may be associated with heavy alcohol use and increased alcohol use. We administered an online survey of U.S. adults via social media April 5 to May 5, 2020. High-risk drinking was defined by WHO risk drinking levels, a daily average of ≥4 drinks for men and ≥3 drinks for women. Participants reported retrospective assessments of increased alcohol use if their past-week alcohol consumption exceeded their past-year average weekly alcohol consumption. We used logistic regression to assess possible covariates of high-risk drinking and increased alcohol use. Among 2175 participants, 10% (n = 222) reported high-risk drinking, and 36% (n = 775) reported increased alcohol consumption. In multivariable analysis, high-risk drinking was significantly associated with household job loss (OR = 1.41, 95%CI = (1.06, 1.88)) and depressive symptoms (OR = 1.05, 95% CI = (1.02, 1.07)), and women had higher odds of high-risk drinking than men (OR = 2.37, 95% CI = (1.32, 4.69)). Previous mental health diagnosis was not significantly associated with high-risk drinking during the pandemic (OR = 1.31, 95% CI = (0.98, 1.76)) in univariable analysis. High-risk drinkers were almost six times as likely to report retrospective assessments of increased alcohol consumption, controlling for mental health and economic stressors (OR = 5.97, 95% CI = (4.35, 8.32)). Findings suggest a need for targeted interventions to address the complex mental health and economic stressors that may increase alcohol consumption and high-risk drinking during and after the pandemic.
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Affiliation(s)
- Elizabeth D Nesoff
- University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics, 423 Guardian Dr, Philadelphia, PA 19104, USA.
| | - Sarah Gutkind
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W168th St, New York, NY 10032, USA
| | - Safiya Sirota
- Columbia University Mailman School of Public Health, Department of Biostatistics, 722 W168th St, New York, NY 10032, USA
| | - Anna Laura McKowen
- Teachers College, Columbia University, 525 W120th St, New York, NY 10027, USA
| | - Cindy B Veldhuis
- Columbia University School of Nursing, 560 W168th St, New York, NY 10032, USA
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Nieto SJ, Grodin EN, Aguirre CG, Izquierdo A, Ray LA. Translational opportunities in animal and human models to study alcohol use disorder. Transl Psychiatry 2021; 11:496. [PMID: 34588417 PMCID: PMC8481537 DOI: 10.1038/s41398-021-01615-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/20/2021] [Accepted: 09/03/2021] [Indexed: 12/16/2022] Open
Abstract
Animal and human laboratory paradigms offer invaluable approaches to study the complex etiologies and mechanisms of alcohol use disorder (AUD). We contend that human laboratory models provide a "bridge" between preclinical and clinical studies of AUD by allowing for well-controlled experimental manipulations in humans with AUD. As such, examining the consilience between experimental models in animals and humans in the laboratory provides unique opportunities to refine the translational utility of such models. The overall goal of the present review is to provide a systematic description and contrast of commonly used animal paradigms for the study of AUD, as well as their human laboratory analogs if applicable. While there is a wide breadth of animal species in AUD research, the paradigms discussed in this review rely predominately on rodent research. The overarching goal of this effort is to provide critical analysis of these animal models and to link them to human laboratory models of AUD. By systematically contrasting preclinical and controlled human laboratory models, we seek to identify opportunities to enhance their translational value through forward and reverse translation. We provide future directions to reconcile differences between animal and human work and to improve translational research for AUD.
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Affiliation(s)
- Steven J. Nieto
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA
| | - Erica N. Grodin
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA
| | - Claudia G. Aguirre
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA
| | - Alicia Izquierdo
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA
| | - Lara A. Ray
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA
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Affiliation(s)
- Ned H Kalin
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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