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Lewis H, Parker R, Ul-Haq Z, Lucas A, Cohen C, Vergis N, Thursz M. Healthcare interactions prior to first hospital admission with alcohol-related liver disease. Liver Int 2024. [PMID: 38771187 DOI: 10.1111/liv.15969] [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: 08/02/2023] [Revised: 04/12/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND AND AIMS To examine the healthcare contacts of patients in the year before an index admission to hospital with alcohol-related liver disease (ArLD) to identify where opportunities for earlier identification of alcohol use disorders (AUD) and ArLD and intervention may occur. METHODS A retrospective cohort study using the regional database encompassing NHS organisations across North West London (344 general practitioner [GP] practices, 4 acute hospital trusts and 2 mental health and community health trusts). Patients who had an index admission with ArLD were identified through healthcare coding and compared with a control cohort. Healthcare contacts, blood tests and AUD testing in the year preceding admission were measured. RESULTS The ArLD cohort had 1494 participants with an index hospital admission with ArLD. The control cohort included 4462 participants. In the year preceding an index admission with ArLD, 91% of participants had at least one contact with primary care with an average of 2.97 (SD 2.45) contacts; 80% (n = 1199/1494) attended ED, 68% attended an outpatient clinic, and 42% (n = 628/1494) had at least one inpatient admission. Only 9% of the ArLD (137/1494) had formal testing for AUD. Abnormal bilirubin and platelets were more common in the ArLD than the control cohort 25% (138/560) and 28% (231/837), respectively, v 1% (12/1228) and 1% (20/1784). CONCLUSIONS Prior to an index admission with ArLD patients have numerous interactions with all healthcare settings, indicating missed opportunities for early identification and treatment.
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Affiliation(s)
- Heather Lewis
- Liver Unit, Imperial College NHS Healthcare Trust, St Marys Hospital London, London, UK
| | - Richard Parker
- Leeds Liver Unit, St James's University Hospital, Leeds, UK
- Discover-NOW, Imperial College Health Partners, London, UK
| | - Zia Ul-Haq
- Discover-NOW, Imperial College Health Partners, London, UK
| | - Amanda Lucas
- Discover-NOW, Imperial College Health Partners, London, UK
| | - Carole Cohen
- Discover-NOW, Imperial College Health Partners, London, UK
| | - Nikhil Vergis
- Digestive Diseases Division, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Mark Thursz
- Digestive Diseases Division, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Pecorella G, De Rosa F, Licchelli M, Panese G, Carugno JT, Morciano A, Tinelli A. Postoperative cognitive disorders and delirium in gynecologic surgery: Which surgery and anesthetic techniques to use to reduce the risk? Int J Gynaecol Obstet 2024. [PMID: 38557928 DOI: 10.1002/ijgo.15464] [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: 04/17/2023] [Revised: 02/13/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024]
Abstract
Despite their general good health, an increasing proportion of elderly individuals require surgery due to an increase in average lifespan. However, because of their increased vulnerability, these patients need to be handled carefully to make sure that surgery does not cause more harm than good. Age-related postoperative cognitive disorders (POCD) and postoperative delirium (POD), two serious consequences that are marked by adverse neuropsychologic alterations after surgery, are particularly dangerous for the elderly. In the context of gynecologic procedures, POCD and POD are examined in this narrative review. The main question is how to limit the rates of POCD and POD in older women undergoing gynecologic procedures by maximizing the risk-benefit balance. Three crucial endpoints are considered: (1) surgical procedures to lower the rates of POCD and POD, (2) anesthetic techniques to lessen the occurrence and (3) the identification of individuals at high risk for post-surgery cognitive impairments. Risks associated with laparoscopic gynecologic procedures include the Trendelenburg posture and CO2 exposure during pneumoperitoneum, despite statistical similarities in POD and POCD frequency between laparoscopic and laparotomy techniques. Numerous risk factors are associated with surgical interventions, such as blood loss, length of operation, and position holding, all of which reduce the chance of complications when they are minimized. In order to emphasize the essential role that anesthesia and surgery play in patient care, anesthesiologists are vital in making sure that anesthesia is given as sparingly and quickly as feasible. In addition, people who are genetically predisposed to POCD may be more susceptible to the disorder. The significance of a thorough strategy combining surgical and anesthetic concerns is highlighted in this article, in order to maximize results for senior patients having gynecologic surgery.
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Affiliation(s)
- Giovanni Pecorella
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Filippo De Rosa
- Department of Anesthesia and Intensive Care, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Martina Licchelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Gaetano Panese
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Josè Tony Carugno
- Obstetrics and Gynecology Department, Minimally Invasive Gynecology Division, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Andrea Morciano
- Panico Pelvic Floor Center, Department of Gynecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
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3
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Balbinot P, Bottaro CL, Gandolfo N, Pellicano R, Testino G. Alcohol use disorder identification test renamed Glu-Glu Test in an area of north-west of Italy: preliminary descriptive results. Minerva Gastroenterol (Torino) 2023; 69:517-522. [PMID: 35904474 DOI: 10.23736/s2724-5985.22.03249-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND The first two causes of liver cirrhosis and hepatocellular carcinoma are alcoholic and dysmetabolic. In the early stages alcohol related liver disease (ALD) is silent. For this reason, more efforts should be made to identify early individuals with hazardous/harmful alcohol consumption (AC). Alcohol use disorder identification test (AUDIT) is a validated test. METHODS ASL3 (Ligurian Local Health Company 3) has included the AUDIT renamed Glu-Glu Test on its institutional website dedicated to citizens. The renaming was carried out to bring citizens closer to the test with greater ease, especially younger citizens. At the end of the compilation of the test, the calculator provides the citizen with his score: in relation to his possible risk band, provides him with the appropriate advice. In case of a score higher than 7, ultrasonography and elastography (2D-SWE) are proposed. RESULTS From December 15, 2021, to July 15, 2022, 270 asymptomatic subjects requested a medical examination autonomously, without the indication of a health worker. In 167 patients the score found hazardous AC, in 65 harmful AC and in 38 alcohol addiction. In case of hazardous AC, fibrosis grade 1-2 was evidenced in 16.7%, fibrosis grade 3 in 4.8% and fibrosis grade 4 in 3.6% of subjects. In case of harmful AC fibrosis grade 1-2 was evidenced in 37%, grade 3 in 9%, grade 4 in 6%. In this group an HCC nodule was diagnosed. In case of alcohol addiction, fibrosis grade 1-2 was evidenced in 73.6%, grade 3 in 10.5% and grade 4 in 10.5%. CONCLUSIONS This preliminary experience clearly tells us that it is possible to make an early diagnosis of fibrosis and HCC starting from the AC reported autonomously by citizens.
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Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3 Liguria, IRCCS San Martino University Hospital, Genoa, Italy
- Mutual-Self-Help, Community Programs and Caregiver Training Center, ASL3 Liguria, Genoa, Italy
| | | | | | | | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3 Liguria, IRCCS San Martino University Hospital, Genoa, Italy
- Mutual-Self-Help, Community Programs and Caregiver Training Center, ASL3 Liguria, Genoa, Italy
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4
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Montgomery C, Saini P, Schoetensack C, McCarthy M, Hanlon C, Owens L, Kullu C, van Ginneken N, Rice M, Young R. Improving access to treatment for alcohol dependence in primary care: A qualitative investigation of factors that facilitate and impede treatment access and completion. PLoS One 2023; 18:e0292220. [PMID: 37856500 PMCID: PMC10586622 DOI: 10.1371/journal.pone.0292220] [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: 05/09/2023] [Accepted: 09/16/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Timely intervention for people with alcohol dependence in primary care is needed. Primary care services have a key role in supporting adults with alcohol dependence and require appropriate provision of services. OBJECTIVE To examine the perceptions of both primary care practitioners and adults with alcohol dependence regarding service provision and to describe help seeking behaviours for adults with alcohol dependence. DESIGN AND SETTING Qualitative study consisting of semi-structured interviews with adults with alcohol dependence, healthcare professionals and staff members of specialist alcohol services who had previous or current experience in the management, treatment, or referral of adults with alcohol dependence in Northwest England. METHOD Interviews were conducted with ten adults with alcohol dependence and 15 staff. Data were analysed thematically, applying principles of constant comparison. RESULTS Three themes were identified following inductive thematic analysis. The first theme, point of access relates to current service provision being reactive rather than preventative, the stigma associated with alcohol dependence and a person's preparedness to change. The second theme identified was treatment process and pathways that highlights difficulties of engagement, mental health support, direct access and person-centred support. The third theme was follow-up care and discusses the opportunities and threats of transitional support or aftercare for alcohol dependence, signposting and peer support. CONCLUSION There are clear opportunities to support adults with alcohol dependence in primary care and the need to increase provision for timely intervention for alcohol related issues in primary care.
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Affiliation(s)
- Catharine Montgomery
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Pooja Saini
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Christine Schoetensack
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Molly McCarthy
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Claire Hanlon
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Lynn Owens
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, The Royal Liverpool and Broadgreen University Hospitals, Liverpool, United Kingdom
| | - Cecil Kullu
- Mersey Care NHS Foundation Trust, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Nadja van Ginneken
- Brownlow Health Central, Princes Park Health Centre, Liverpool, United Kingdom
| | - Melissa Rice
- UK Parliament, Houses of Parliament, Westminster, United Kingdom
| | - Ryan Young
- Brownlow Health Central, Princes Park Health Centre, Liverpool, United Kingdom
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Neufeld M, Bunova A, Fadeeva E, Nadezhdin A, Tetenova E, Vyshinsky K, Ferreira-Borges C, Yurasova E, Allenov A, Gornyi B, Ivanova E, Kalinina A, Kontsevaya A, Bryun E, Drapkina O, Gil A, Khalfin R, Koshkina E, Khaltourina D, Madyanova V, Rehm J. Translating and adapting the Alcohol Use Disorders Identification Test (AUDIT) for use in the Russian Federation: A multicentre pilot study to inform validation procedures. NORDIC STUDIES ON ALCOHOL AND DRUGS 2023; 40:536-553. [PMID: 37969901 PMCID: PMC10634389 DOI: 10.1177/14550725231183236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/05/2023] [Indexed: 11/17/2023] Open
Abstract
Aims: The Alcohol Use Disorders Identification Test (AUDIT) is one of the most widely used screening instruments worldwide. Although it was translated into many languages, not many country-specific adaptations exist, and a formal validation procedure of the Russian version has been carried out only recently. The present contribution documents the different steps taken to formally translate and adapt a Russian-specific version of the AUDIT (RUS-AUDIT). Methods: The AUDIT was translated into Russian following an established protocol, revised and adapted to the country context using an expert panel, and field-tested in an iterative approach, in line with WHO rules on instrument translation and adaptation A total of three pilot phases were carried out on 134 patients from primary healthcare (PHC) and 33 patients from specialised alcohol treatment facilities (narcology), guided by a specially established advisory board. Changes in each version were informed by the findings of the previous pilot phase and a thorough panel discussion. Results: Based on the findings of three different pilot phases, the RUS-AUDIT was developed as a paper-and-pencil interview for PHC professionals. Since various issues with representation and counting of standard drinks for the second test item arose, a special show card was developed to support the assessment. Preliminary AUDIT-C scores indicated that more than one-third of the screened women (34.2%) and about half of the screened men (50.9%) from PHC facilities have exceeded risk thresholds. Conclusions: The RUS-AUDIT was constructed as a feasible assessment tool for interviewers and patients. The large number of PHC patients who exceed the risk threshold has corroborated the need for formal validation and Russia-specific cut-off scores, considering the specific drinking patterns.
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Affiliation(s)
- Maria Neufeld
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Moscow, Russian Federation
| | - Anna Bunova
- National Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Eugenia Fadeeva
- National Research Centre on Addictions – branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Alexey Nadezhdin
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Moscow, Russian Federation
| | - Elena Tetenova
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Moscow, Russian Federation
| | - Konstantin Vyshinsky
- National Research Centre on Addictions – branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Carina Ferreira-Borges
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Moscow, Russian Federation
| | - Elena Yurasova
- WHO Country Office in the Russian Federation, Moscow, Russian Federation
| | - Andrey Allenov
- I.M. Sechenov First Moscow State Medical
University (Sechenov University), Moscow,
Russian Federation
| | - Boris Gornyi
- National Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Ekaterina Ivanova
- National Research Center for Therapy and
Preventive Medicine of the Ministry of Health
of the Russian Federation, Moscow, Russian Federation
| | - Anna Kalinina
- National Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Anna Kontsevaya
- National Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Evgeny Bryun
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Moscow, Russian Federation
| | - Oxana Drapkina
- National Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Artyom Gil
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Ruslan Khalfin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Evgenia Koshkina
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Moscow, Russian Federation
| | - Daria Khaltourina
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Viktoria Madyanova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
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6
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Ebrahimi A, Wiil UK, Baskaran R, Peimankar A, Andersen K, Nielsen AS. AUD-DSS: a decision support system for early detection of patients with alcohol use disorder. BMC Bioinformatics 2023; 24:329. [PMID: 37658294 PMCID: PMC10474761 DOI: 10.1186/s12859-023-05450-6] [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: 01/20/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) causes significant morbidity, mortality, and injuries. According to reports, approximately 5% of all registered deaths in Denmark could be due to AUD. The problem is compounded by the late identification of patients with AUD, a situation that can cause enormous problems, from psychological to physical to economic problems. Many individuals suffering from AUD never undergo specialist treatment during their addiction due to obstacles such as taboo and the poor performance of current screening tools. Therefore, there is a lack of rapid intervention. This can be mitigated by the early detection of patients with AUD. A clinical decision support system (DSS) powered by machine learning (ML) methods can be used to diagnose patients' AUD status earlier. METHODS This study proposes an effective AUD prediction model (AUDPM), which can be used in a DSS. The proposed model consists of four distinct components: (1) imputation to address missing values using the k-nearest neighbours approach, (2) recursive feature elimination with cross validation to select the most relevant subset of features, (3) a hybrid synthetic minority oversampling technique-edited nearest neighbour approach to remove noise and balance the distribution of the training data, and (4) an ML model for the early detection of patients with AUD. Two data sources, including a questionnaire and electronic health records of 2571 patients, were collected from Odense University Hospital in the Region of Southern Denmark for the AUD-Dataset. Then, the AUD-Dataset was used to build ML models. The results of different ML models, such as support vector machine, K-nearest neighbour, decision tree, random forest, and extreme gradient boosting, were compared. Finally, a combination of all these models in an ensemble learning approach was selected for the AUDPM. RESULTS The results revealed that the proposed ensemble AUDPM outperformed other single models and our previous study results, achieving 0.96, 0.94, 0.95, and 0.97 precision, recall, F1-score, and accuracy, respectively. In addition, we designed and developed an AUD-DSS prototype. CONCLUSION It was shown that our proposed AUDPM achieved high classification performance. In addition, we identified clinical factors related to the early detection of patients with AUD. The designed AUD-DSS is intended to be integrated into the existing Danish health care system to provide novel information to clinical staff if a patient shows signs of harmful alcohol use; in other words, it gives staff a good reason for having a conversation with patients for whom a conversation is relevant.
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Affiliation(s)
- Ali Ebrahimi
- SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark.
| | - Uffe Kock Wiil
- SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Ruben Baskaran
- SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Abdolrahman Peimankar
- SDU Health Informatics and Technology, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Kjeld Andersen
- Unit for Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit for Clinical Alcohol Research, Clinical Institute, University of Southern Denmark, Odense, Denmark
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Hu D, Primc N. Should responsibility be used as a tiebreaker in allocation of deceased donor organs for patients suffering from alcohol-related end-stage liver disease? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:243-255. [PMID: 36780062 PMCID: PMC10175331 DOI: 10.1007/s11019-023-10141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 05/13/2023]
Abstract
There is a long-standing debate concerning the eligibility of patients suffering from alcohol-related end-stage liver disease (ARESLD) for deceased donor liver transplantation. The question of retrospective and/or prospective responsibility has been at the center of the ethical discussion. Several authors argue that these patients should at least be regarded as partly responsible for their ARESLD. At the same time, the arguments for retrospective and/or prospective responsibility have been strongly criticized, such that no consensus has been reached. A third option was proposed as a form of compromise, namely that responsibility should only be used as a tiebreaker in liver allocation. The present study provides an ethical investigation of this third option. First, we will provide an overview of the main arguments that have been offered for and against the use of responsibility as an allocation criterion. Second, we will explore the concept of responsibility as a tiebreaker in detail and discuss several types of situations, in which responsibility could be used as a tiebreaker, as well as the main ethical challenges associated with them. As we will show, an ethical justified use of responsibility as a tiebreaker is limited to a very restricted number of cases and is associated with a number of ethical concerns. For this reason, waiting time should be preferred as a tiebreaker in liver allocation, even though the criterion of waiting time, too, raises a number of equity-related concerns.
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Affiliation(s)
- Diehua Hu
- Department of Philosophy, Central South University, 410075, Changsha, China
| | - Nadia Primc
- Institute of History and Ethics of Medicine, Medical Department, Heidelberg University, Im Neuenheimer Feld 327, 69120, Heidelberg, Germany.
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8
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Montgomery C, Schoetensack C, Saini P, Owens L, Van Ginneken N, Rice M, Young R, Jones A. Prevalence and incidence of alcohol dependence: cross-sectional primary care analysis in Liverpool, UK. BMJ Open 2023; 13:e071024. [PMID: 37076152 PMCID: PMC10123861 DOI: 10.1136/bmjopen-2022-071024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES Liverpool has high prevalence of alcohol use disorders (AUDs) compared with the rest of the UK. Early identification and referral in primary care would improve treatment for people with AUD. This study aimed to identify changes in prevalence and incidence of AUD in primary care in Liverpool, to identify local need for specialist services. DESIGN Cross-sectional retrospective analysis of electronic health records. SETTING National Health Service (NHS) Liverpool Clinical Commissioning Group (CCG) primary care. In total, 62 of the 86 general practitioner (GP) practices agreed to share their anonymised Egton Medical Information Systems (EMIS) data from 1 January 2017 to 31 December 2021. PARTICIPANTS Patients aged over 18 years with a SNOMED code for alcohol dependence (AD) or hazardous drinking (N=4936). Patients were excluded if they had requested that their data was not to be shared, and practices were excluded if they opted out (N=2) or did not respond to the data sharing request (N=22). PRIMARY AND SECONDARY OUTCOMES Prevalence and incidence of AUD diagnoses in primary care over the 5-year period; demographic profile of patients (sex, age, ethnicity, occupation); GP postcode; alcohol-related medications; and psychiatric and physical comorbidities. RESULTS There were significant decreases in incidence of AD and hazardous drinking diagnoses over the 5 years (p<0.001 in all cases). Prevalence showed less change over time. Diagnoses were significantly higher in more deprived areas (Indices of Multiple Deprivation decile 1 vs 2-10). Overall pharmacotherapy prescriptions were lower than national estimates. CONCLUSIONS There are low levels of identification of AUDs in primary care in Liverpool, and this is decreasing year on year. There was weak evidence to suggest patients in the most deprived areas are less likely to receive pharmacotherapy once diagnosed. Future research should seek to investigate practitioner and patient perspectives on barriers and facilitators to management of AUDs in primary care.
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Affiliation(s)
| | | | - Pooja Saini
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Lynn Owens
- Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, UK
| | | | | | - Ryan Young
- Brownlow General Practice, Liverpool, Liverpool, UK
| | - Andrew Jones
- School of Psychology, Liverpool John Moores University, Liverpool, UK
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9
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Rehm J, Shield KD, Bunova A, Ferreira‐Borges C, Franklin A, Gornyi B, Rovira P, Neufeld M. Prevalence of alcohol use disorders in primary health-care facilities in Russia in 2019. Addiction 2022; 117:1640-1646. [PMID: 35072306 PMCID: PMC9305418 DOI: 10.1111/add.15816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
AIMS To estimate prevalence of alcohol use disorders (AUD) and alcohol dependence (AD) for Russia in 2019, based on clients in primary health-care facilities. DESIGN Cross-sectional assessment of AUD and AD. Prevalence estimates were cross-validated using a treatment multiplier methodology. SETTING A total of 21 primary health-care facilities, including dispanserization units (population health preventive care settings). PARTICIPANTS A total of 2022 participants (986 women and 1036 men) 18 years of age and older. MEASUREMENTS Composite International Diagnostic Interview. FINDINGS The prevalence of AD and AUD was 7.0% [95% confidence interval (CI) = 5.9-8.1%] and 12.2% (95% CI = 10.8-13.6%), respectively. Marked sex differences were observed for the prevalence of AD (women: 2.8%; 95% CI = 1.7-3.8%; men: 12.2%; 95% CI = 10.3-14.1%) and AUD (women: 6.1%; 95% CI = 4.6-7.7%; men: 19.5%; 95% CI = 17.2-21.8%). Age patterns of AD and AUD prevalence were sex-specific. Among women, the prevalence of AUD and AD was highest in the youngest age group and decreased with age. Among men, the prevalence of AUD and AD was highest among men aged 45-59 years. Sensitivity analyses indicated that the prevalence of AD as estimated using a treatment multiplier (6.5%; 95% CI = 5.0-8.9%) was similar to the estimates of the main analysis. CONCLUSIONS Even though alcohol use has declined since 2003 in Russia, the prevalence of alcohol use disorders and alcohol dependence remains high at approximately 12 and 7%, respectively.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)TorontoOntarioCanada,Dalla Lana School of Public Health and Department of PsychiatryUniversity of TorontoTorontoOntarioCanada,Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany,Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental HealthTorontoOntarioCanada,Faculty of Medicine, Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada,Program on Substance Abuse and World Health Organization (WHO) CC, Public Health Agency of CataloniaBarcelonaSpain,I. M. Sechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - Kevin D. Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)TorontoOntarioCanada,Dalla Lana School of Public Health and Department of PsychiatryUniversity of TorontoTorontoOntarioCanada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental HealthTorontoOntarioCanada
| | - Anna Bunova
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian FederationMoscowRussia
| | - Carina Ferreira‐Borges
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable DiseasesMoscowRussia
| | - Ari Franklin
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)TorontoOntarioCanada
| | - Boris Gornyi
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian FederationMoscowRussia
| | - Pol Rovira
- Program on Substance Abuse and World Health Organization (WHO) CC, Public Health Agency of CataloniaBarcelonaSpain
| | - Maria Neufeld
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)TorontoOntarioCanada,Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany,World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable DiseasesMoscowRussia
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10
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Andreu M, Alcaraz N, Gual A, Segura L, Barrio P. Primary care provider expectations of addiction services and patients in Spain. Fam Pract 2022; 39:269-274. [PMID: 34089055 DOI: 10.1093/fampra/cmab053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary care (PC) is crucial in the care of substance use disorder (SUD) patients. However, the relationship between PC and addiction settings is complex and collaboration issues stand out. Available evidence suggests that integration of SUD and PC services can improve physical and mental health of SUD patients and reduce health expenses. OBJECTIVE To explore the experiences, views and attitudes of PC professionals towards the interaction between PC and SUD services. METHODS Twenty-seven GPs took part in three focus groups. The focus group sessions were audio-taped, transcribed verbatim and analysed using reflexive thematic analysis. Recurrent themes were identified. RESULTS Four main themes were devised: (1) Differences and specificities of SUD patients, (2) Interaction between providers of PC and addiction services, (3) Patient management (4) Addiction stigma. These main themes reflect the consideration that SUD patients are a specific group with specific care needs that yield specific challenges to GPs themselves. Improved training, availability of a shared medical record system, increased feedback between GP and addiction specialists and the efficiency of the circuit are to be considered the main priority for the majority of the participants. CONCLUSIONS An efficient and effective referral circuit, with increased feedback and shared medical records is considered key to GPs. Its implementation should keep in mind the specific features of both SUD patients and GPs.
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Affiliation(s)
- Magalí Andreu
- Grup de Recerca en Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Noelia Alcaraz
- Grup de Recerca en Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Antoni Gual
- Grup de Recerca en Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, Barcelona, España
| | - Lidia Segura
- Health and Social Security Department, Program on Substance Abuse, Autonomous Government of Catalonia, Spain
| | - Pablo Barrio
- Grup de Recerca en Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Universitari de Barcelona, Universitat de Barcelona, Barcelona, España
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11
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, and Campbell Family Mental Health Research Institute, Toronto, ON M5S 2S1, Canada; Institute of Medical Science, Dalla Lana School of Public Health, and Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Robin Room
- Centre for Alcohol Policy Research, Turning Point, Fitzroy, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
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12
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Petit B, Soudry-Faure A, Jeanjean L, Foucher J, Lalanne L, Carpentier M, Jonval L, Allard C, Ravier M, Mohamed AB, Meille V, Trojak B. Efficacy of repetitive transcranial magnetic stimulation (rTMS) for reducing consumption in patients with alcohol use disorders (ALCOSTIM): study protocol for a randomized controlled trial. Trials 2022; 23:33. [PMID: 35022086 PMCID: PMC8756711 DOI: 10.1186/s13063-021-05940-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/15/2021] [Indexed: 11/12/2022] Open
Abstract
Background The number of people with an alcohol use disorder (AUD) was recently estimated to be 63.5 million worldwide. The global burden of disease and injury attributable to alcohol is considerable: about 3 million deaths, namely one in 20, were caused by alcohol in 2015. At the same time, AUD remains seriously undertreated. In this context, alternative or adjunctive therapies such as brain stimulation could play an important role. The early results of studies using repetitive transcranial magnetic stimulation (rTMS) suggest that stimulations delivered to the dorsolateral prefrontal cortex significantly reduce cravings and improve decision-making processes in various addictive disorders. We therefore hypothesize that rTMS could lead to a decrease in alcohol consumption in patients with AUD. Methods/design We report the protocol of a randomized, double-blind, placebo-controlled, parallel-group trial to evaluate the efficacy of rTMS on alcohol reduction in individuals diagnosed with AUD. The study will be conducted in 2 centers in France. Altogether, 144 subjects older than 18 years and diagnosed with AUD will be randomized to receive 5 consecutive twice-daily sessions of either active or sham rTMS (10 Hz over the right DLPFC, 2000 pulses per day). The main outcomes of the study will be changes in alcohol consumption within the 4 weeks after the rTMS sessions. Secondary outcome measures will include changes in alcohol consumption within the 24 weeks, alcohol cravings, clinical and biological improvements, effects on mood and quality of life, and cognitive and safety assessments, and, for smokers, an assessment of the effects of rTMS on tobacco consumption. Discussion Several studies have observed a beneficial effect of rTMS on substance use disorders by reducing craving, impulsivity, and risk-taking behavior and suggest that rTMS may be a promising treatment in addiction. However, to date, no studies have included sufficiently large samples and sufficient follow-up to confirm this hypothesis. The results from this large randomized controlled trial will give a better overview of the therapeutic potential of rTMS in AUD. Trial registration ClinicalTrials.gov NCT04773691. Registered on 26 February 2021 https://clinicaltrials.gov/ct2/show/NCT04773691?term=trojak&draw=2&rank=5.
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Affiliation(s)
- Benjamin Petit
- Department of Addictology, University Hospital of Dijon, 14 rue Paul Gaffarel, B.P. 77908, 21079, Dijon Cedex, France. .,UFR des Sciences de Santé, Université de Bourgogne, Dijon, France.
| | - Agnès Soudry-Faure
- Unité de Soutien Méthodologique à la Recherche, Délégation à la Recherche et à l'Innovation (DRCI), University Hospital of Dijon, 1 boulevard Jeanne d'Arc BP 77 908, 21 079, Dijon Cedex, France
| | - Ludovic Jeanjean
- UMR CNRS 7357 iCube, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Université de Strasbourg, Strasbourg, France.,Centre de neuroModulation Non-Invasive de Strasbourg - CEMNIS, Hôpitaux Universitaires de Strasbourg, Hôpital Civil, 1 place de l'Hopital, BP426, 67091, Strasbourg Cedex, France
| | - Jack Foucher
- UMR CNRS 7357 iCube, FMTS (Fédération de Médecine Translationnelle de Strasbourg), Université de Strasbourg, Strasbourg, France.,Centre de neuroModulation Non-Invasive de Strasbourg - CEMNIS, Hôpitaux Universitaires de Strasbourg, Hôpital Civil, 1 place de l'Hopital, BP426, 67091, Strasbourg Cedex, France
| | - Laurence Lalanne
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000, Strasbourg, France.,Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000, Strasbourg, France.,Pôle Psychiatrie, Santé Mentale et Addictologie, Clinique de psychiatrie, Hôpitaux Universitaires de Strasbourg, 1 place de l'hôpital, BP 426, F-67091, Strasbourg Cedex, France
| | - Maud Carpentier
- Délégation à la Recherche et à l'Innovation (DRCI), University Hospital of Dijon, 1 boulevard Jeanne d'Arc - BP 77 908, 21079, Dijon Cedex, France
| | - Lysiane Jonval
- Unité de Soutien Méthodologique à la Recherche, Délégation à la Recherche et à l'Innovation (DRCI), University Hospital of Dijon, 1 boulevard Jeanne d'Arc BP 77 908, 21 079, Dijon Cedex, France
| | - Coralie Allard
- Department of Addictology, University Hospital of Dijon, 14 rue Paul Gaffarel, B.P. 77908, 21079, Dijon Cedex, France.,Délégation à la Recherche et à l'Innovation (DRCI), University Hospital of Dijon, 1 boulevard Jeanne d'Arc - BP 77 908, 21079, Dijon Cedex, France
| | - Mathilde Ravier
- Department of Addictology, University Hospital of Dijon, 14 rue Paul Gaffarel, B.P. 77908, 21079, Dijon Cedex, France
| | - Amine Ben Mohamed
- Délégation à la Recherche et à l'Innovation (DRCI), University Hospital of Dijon, 1 boulevard Jeanne d'Arc - BP 77 908, 21079, Dijon Cedex, France
| | - Vincent Meille
- Department of Addictology, University Hospital of Dijon, 14 rue Paul Gaffarel, B.P. 77908, 21079, Dijon Cedex, France
| | - Benoit Trojak
- Department of Addictology, University Hospital of Dijon, 14 rue Paul Gaffarel, B.P. 77908, 21079, Dijon Cedex, France.,UFR des Sciences de Santé, Université de Bourgogne, Dijon, France.,INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
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13
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Wiemker V, Bunova A, Neufeld M, Gornyi B, Yurasova E, Konigorski S, Kalinina A, Kontsevaya A, Ferreira-Borges C, Probst C. Pilot study to evaluate usability and acceptability of the ‘Animated Alcohol Assessment Tool’ in Russian primary healthcare. Digit Health 2022; 8:20552076211074491. [PMID: 35251679 PMCID: PMC8891874 DOI: 10.1177/20552076211074491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background and aims Accurate and user-friendly assessment tools quantifying alcohol consumption are a prerequisite to effective prevention and treatment programmes, including Screening and Brief Intervention. Digital tools offer new potential in this field. We developed the ‘Animated Alcohol Assessment Tool’ (AAA-Tool), a mobile app providing an interactive version of the World Health Organization's Alcohol Use Disorders Identification Test (AUDIT) that facilitates the description of individual alcohol consumption via culturally informed animation features. This pilot study evaluated the Russia-specific version of the Animated Alcohol Assessment Tool with regard to (1) its usability and acceptability in a primary healthcare setting, (2) the plausibility of its alcohol consumption assessment results and (3) the adequacy of its Russia-specific vessel and beverage selection. Methods Convenience samples of 55 patients (47% female) and 15 healthcare practitioners (80% female) in 2 Russian primary healthcare facilities self-administered the Animated Alcohol Assessment Tool and rated their experience on the Mobile Application Rating Scale – User Version. Usage data was automatically collected during app usage, and additional feedback on regional content was elicited in semi-structured interviews. Results On average, patients completed the Animated Alcohol Assessment Tool in 6:38 min (SD = 2.49, range = 3.00–17.16). User satisfaction was good, with all subscale Mobile Application Rating Scale – User Version scores averaging >3 out of 5 points. A majority of patients (53%) and practitioners (93%) would recommend the tool to ‘many people’ or ‘everyone’. Assessed alcohol consumption was plausible, with a low number (14%) of logically impossible entries. Most patients reported the Animated Alcohol Assessment Tool to reflect all vessels (78%) and all beverages (71%) they typically used. Conclusion High acceptability ratings by patients and healthcare practitioners, acceptable completion time, plausible alcohol usage assessment results and perceived adequacy of region-specific content underline the Animated Alcohol Assessment Tool's potential to provide a novel approach to alcohol assessment in primary healthcare. After its validation, the Animated Alcohol Assessment Tool might contribute to reducing alcohol-related harm by facilitating Screening and Brief Intervention implementation in Russia and beyond.
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Affiliation(s)
- Veronika Wiemker
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Anna Bunova
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Maria Neufeld
- WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), Moscow, Russian Federation
- Institute of Clinical Psychology and Psychotherapy, Dresden University of Technology, Dresden, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Boris Gornyi
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Elena Yurasova
- WHO Office in the Russian Federation, Moscow, Russian Federation
| | - Stefan Konigorski
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Anna Kalinina
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Anna Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Carina Ferreira-Borges
- WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), Moscow, Russian Federation
| | - Charlotte Probst
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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14
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Wu L, Zhang Y, Ren J. Epigenetic modification in alcohol use disorder and alcoholic cardiomyopathy: From pathophysiology to therapeutic opportunities. Metabolism 2021; 125:154909. [PMID: 34627873 DOI: 10.1016/j.metabol.2021.154909] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 02/07/2023]
Abstract
Alcohol consumption prompts detrimental psychological, pathophysiological and health issues, representing one of the major causes of death worldwide. Alcohol use disorder (AUD), which is characterized by compulsive alcohol intake and loss of control over alcohol usage, arises from a complex interplay between genetic and environmental factors. More importantly, long-term abuse of alcohol is often tied with unfavorable cardiac remodeling and contractile alterations, a cadre of cardiac responses collectively known as alcoholic cardiomyopathy (ACM). Recent evidence has denoted a pivotal role for ethanol-triggered epigenetic modifications, the interface between genome and environmental cues, in the organismal and cellular responses to ethanol exposure. To-date, three major epigenetic mechanisms (DNA methylation, histone modifications, and RNA-based mechanisms) have been identified for the onset and development of AUD and ACM. Importantly, these epigenetic changes induced by alcohol may be detectable in the blood, thus offering diagnostic, therapeutic, and prognostic promises of epigenetic markers for AUD and alcoholic complications. In addition, several epigenetic drugs have shown efficacies in the management of alcohol abuse, loss of control for alcohol usage, relapse, drinking-related anxiety and behavior in withdrawal. In this context, medications targeting epigenetic modifications may hold promises for pharmaceutical management of AUD and ACM.
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Affiliation(s)
- Lin Wu
- Department of Cardiology and Shanghai Institute of Cardiovascular Diseases, Fudan University Zhongshan Hospital, Shanghai 200032, China
| | - Yingmei Zhang
- Department of Cardiology and Shanghai Institute of Cardiovascular Diseases, Fudan University Zhongshan Hospital, Shanghai 200032, China
| | - Jun Ren
- Department of Cardiology and Shanghai Institute of Cardiovascular Diseases, Fudan University Zhongshan Hospital, Shanghai 200032, China; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA.
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15
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Rehm J, Neufeld M, Yurasova E, Bunova A, Gil A, Gornyi B, Breda J, Bryun E, Drapkina O, Fadeeva E, Kalinina A, Khaltourina D, Klimenko T, Kontsevaya A, Koshkina E, Martynova N, Nadezhdin A, Soshkina K, Tetenova E, Vujnovic M, Vyshinsky K, Ferreira-Borges C. Adaptation of and Protocol for the Validation of the Alcohol Use Disorders Identification Test (AUDIT) in the Russian Federation for Use in Primary Healthcare. Alcohol Alcohol 2021; 55:624-630. [PMID: 32728707 PMCID: PMC7576502 DOI: 10.1093/alcalc/agaa067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 01/10/2023] Open
Abstract
Aims To adapt and validate the Alcohol Use Disorders Identification Test (AUDIT) for use in the Russian Federation and countries with Russian-speaking populations by: Methods Systematic review of past use and validation of the Russian-language AUDIT. Interviews to be conducted with experts to identify problems encountered in the use of existing Russian-language AUDIT versions. A pilot study using a revised translation of the Russian-language AUDIT that incorporates country-specific drinking patterns in the Russian Federation. Results and Conclusions The systematic review identified over 60 different Russian-language AUDIT versions without systematic validation studies. The main difficulties encountered with the use of the AUDIT in the Russian Federation were related to the lack of: A revised version of the Russian-language AUDIT was created based on the pilot studies, and was validated in primary healthcare facilities in all regions in 2019/2020.
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Affiliation(s)
- Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer St. 46, Dresden 01187, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, Ontario M5T 1R8, Canada.,Institute of Medical Science (IMS), University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario M5S 1A8, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada.,Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya St., 8, b. 2, Moscow 119992, Russian Federation
| | - Maria Neufeld
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer St. 46, Dresden 01187, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.,WHO European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Elena Yurasova
- WHO Office in the Russian Federation, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Anna Bunova
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Artyom Gil
- Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya St., 8, b. 2, Moscow 119992, Russian Federation
| | - Boris Gornyi
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - João Breda
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Evgeniy Bryun
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Oxana Drapkina
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Eugenia Fadeeva
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Anna Kalinina
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Daria Khaltourina
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Dobrolyubov Street 11, Moscow 127254, Russian Federation
| | - Tatiana Klimenko
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Anna Kontsevaya
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Evgenia Koshkina
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Lublinskay Street 37/1, Moscow 109390, Russian Federation
| | - Natalya Martynova
- Department of Public Health and Communications, Ministry of Health of the Russian Federation, Rakhmanovsky Pereulok 3, Moscow 127051, Russian Federation
| | - Alexey Nadezhdin
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Lublinskay Street 37/1, Moscow 109390, Russian Federation
| | - Kristina Soshkina
- Department of Public Health and Communications, Ministry of Health of the Russian Federation, Rakhmanovsky Pereulok 3, Moscow 127051, Russian Federation
| | - Elena Tetenova
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Lublinskay Street 37/1, Moscow 109390, Russian Federation
| | - Melita Vujnovic
- WHO Office in the Russian Federation, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Konstantin Vyshinsky
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Carina Ferreira-Borges
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
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Neufeld M, Rehm J, Bunova A, Gil A, Gornyi B, Rovira, P, Manthey J, Yurasova E, Dolgova S, Idrisov B, Moskvicheva M, Nabiullina G, Shegaym O, Zhidkova I, Ziganshina Z, Ferreira-Borges C. Validation of a screening test for alcohol use, the Russian Federation. Bull World Health Organ 2021; 99:496-505. [PMID: 34248222 PMCID: PMC8243036 DOI: 10.2471/blt.20.273227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To validate a Russian-language version of the World Health Organization's Alcohol Use Disorders Identification Test (AUDIT). METHODS We invited 2173 patients from 21 rural and urban primary health-care centres in nine Russian regions to participate in the study (143 declined and eight were excluded). In a standardized interview, patients who had consumed alcohol in the past 12 months provided information on their sociodemographic characteristics and completed the Russian AUDIT, the Kessler Psychological Distress Scale and the Composite International Diagnostic Interview to identify problem drinking and alcohol use disorders. We assessed the feasibility of administering the test, its internal consistency and its ability to predict hazardous drinking and alcohol use disorders in primary health care in the Russian Federation. FINDINGS Of the 2022 patients included in the study, 1497 were current drinkers with Russian AUDIT scores. The test was internally consistent with good psychometric properties (Cronbach's α : 0.842) and accurately predicted alcohol use disorders and other outcomes (area under the curve > 75%). A three-item short form of the test correlated well with the full instrument and had similar predictive power (area under the curve > 80%). We determined sex-specific thresholds for all outcomes, as non-specific thresholds resulted in few women being identified. CONCLUSION With the validated Russian AUDIT, there is no longer a barrier to introducing screening and brief interventions into primary health care in the Russian Federation to supplement successful alcohol control policies.
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Affiliation(s)
- Maria Neufeld
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, 125009 Moscow, Russian Federation
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Anna Bunova
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Artyom Gil
- Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Boris Gornyi
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Pol Rovira,
- Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain
| | - Jakob Manthey
- Institute for Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany
| | - Elena Yurasova
- World Health Organization Office in the Russian Federation, Moscow, Russian Federation
| | | | - Bulat Idrisov
- Moscow Institute of Physics and Technology, Moscow, Russian Federation
| | - Marina Moskvicheva
- Department of Public Health and Healthcare, South Ural State Medical University, Chelyabinsk, Russian Federation
| | | | - Olga Shegaym
- Center for Medical Prevention, Tomsk, Russian Federation
| | - Irina Zhidkova
- Amur Regional Center for Preventive Medicine, Blagoveshchensk, Russian Federation
| | - Zukhra Ziganshina
- Institute of Management, Economics and Finance, Kazan Federal University, Kazan, Russian Federation
| | - Carina Ferreira-Borges
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, 125009 Moscow, Russian Federation
| | - & the 2019/2020 RUS-AUDIT Collaborators & the RUS-AUDIT Project Advisory Board
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, 125009 Moscow, Russian Federation
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
- Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain
- Institute for Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany
- World Health Organization Office in the Russian Federation, Moscow, Russian Federation
- Vologda City Policlinic, Vologda, Russian Federation
- Moscow Institute of Physics and Technology, Moscow, Russian Federation
- Department of Public Health and Healthcare, South Ural State Medical University, Chelyabinsk, Russian Federation
- Center for Medical Prevention, Astrakhan, Russian Federation
- Center for Medical Prevention, Tomsk, Russian Federation
- Amur Regional Center for Preventive Medicine, Blagoveshchensk, Russian Federation
- Institute of Management, Economics and Finance, Kazan Federal University, Kazan, Russian Federation
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17
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Birch JM, Critchlow N, Calman L, Petty R, Rosenberg G, Rumgay H, Vohra J. The Frequency and Content of Discussions About Alcohol Use in Primary Care and Application of the Chief Medical Officer's Low-Risk Drinking Guidelines: A Cross-Sectional Survey of General Practitioners and Practice Nurses in the UK. Alcohol Alcohol 2021; 56:433-442. [PMID: 33179022 DOI: 10.1093/alcalc/agaa120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/18/2020] [Accepted: 10/12/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To examine how often general practitioners (GPs) and practice nurses (PNs) working in primary care discuss alcohol with patients, what factors prompt discussions, how they approach patient discussions and whether the Chief Medical Officers' (CMO) revised low-risk drinking guidelines are appropriately advised. METHODS Cross-sectional survey with GPs and PNs working in primary care in the UK, conducted January-March 2017 (n = 2020). A vignette exercise examined what factors would prompt a discussion about alcohol, whether they would discuss before or after a patient reported exceeded the revised CMO guidelines (14 units per week) and whether the CMO drinking guidelines were appropriately advised. For all patients, participants were asked how often they discussed alcohol and how they approached the discussion (e.g. used screening tool). RESULTS The most common prompts to discuss alcohol in the vignette exercise were physical cues (44.7% of participants) or alcohol-related symptoms (23.8%). Most practitioners (70.1%) said they would wait until a patient was exceeding CMO guidelines before instigating discussion. Two-fifths (38.1%) appropriately advised the CMO guidelines in the vignette exercise, with PNs less likely to do so than GPs (odds ratio [OR] = 0.77, P = 0.03). Less than half (44.7%) reportedly asked about alcohol always/often with all patients, with PNs more likely to ask always/often than GPs (OR = 2.22, P < 0.001). Almost three-quarters said they would enquire by asking about units (70.3%), compared to using screening tools. CONCLUSION Further research is required to identify mechanisms to increase the frequency of discussions about alcohol and appropriate recommendation of the CMO drinking guidelines to patients.
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Affiliation(s)
- Jack M Birch
- MRC Epidemiology Unit, University of Cambridge School of Clinical, Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.,Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK.,Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Nathan Critchlow
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK.,Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK
| | - Lynn Calman
- Macmillan Survivorship Research Group, School of Health Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Robert Petty
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
| | - Gillian Rosenberg
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
| | - Harriet Rumgay
- Cancer Intelligence, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
| | - Jyotsna Vohra
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, EC20 1JQ, UK
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Agabio R, Balia S, Gessa GL, Pani PP. Use of Medications for the Treatment of Alcohol Dependence: A Retrospective Study Conducted in 2011-2012. Curr Drug Res Rev 2021; 13:154-164. [PMID: 33371866 DOI: 10.2174/2589977512666201228121820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/19/2020] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pharmacotherapy for Alcohol Dependence (AD) is underutilized. Barriers preventing the use of AD medications include high prices, lack of access to prescribing physicians, and a limited number of available medications. OBJECTIVE The study evaluated the use of AD medications in a sample of Italian outpatients who received these medications free of charge, had access to physicians during office hours, and for whom substitution therapy [gamma-hydroxybutyrate (GHB)] was available. We also evaluated the rate of patients who received a combination of non-pharmacological and pharmacological treatments among participants who were still drinking. METHODS SCID for AD and questionnaire were filled by to AD outpatients during a face-to-face interview. RESULTS & DISCUSSION 345 AD outpatients were interviewed: 58.8% were currently receiving at least one AD medication (GHB: 34.3%, disulfiram: 29.6%, acamprosate: 5.9%; naltrexone: 2.5%; more than one medication: 16.7%). Less than 30% of participants who were still drinking, received a combination of non-pharmacological and pharmacological treatments. Nonetheless, we found higher use of AD medications compared to previous studies conducted in other countries. This higher use of AD medications may be due to access to free medications, prescribing physicians' style, and a larger number of available medications. CONCLUSION Our results confirm the underutilization of AD medications, as less than 60% of AD outpatients received medications, and less than 30% of those who were still drinking, received a combination of non-pharmacological and pharmacological treatments. These findings may be useful in improving our knowledge of the barriers that prevent the use of AD medications in clinical practice.
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Affiliation(s)
- Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Sardinia, Italy
| | - Silvia Balia
- Department of Economics and Business, University of Cagliari and CRENoS, Sardinia, Italy
| | - Gian Luigi Gessa
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Sardinia, Italy
| | - Pier Paolo Pani
- Health Social Services, Public Health Trust Sardinia, Cagliari, Italy
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Frischknecht U, Hoffmann S, Steinhauser A, Lindemann C, Buchholz A, Manthey J, Schulte B, Rehm J, Kraus L, Verthein U, Reimer J, Kiefer F. [Screening for Problematic Alcohol Consumption - A Survey on Guideline Implementation in Transdisciplinary Health Care of a Model Region]. DAS GESUNDHEITSWESEN 2020; 84:43-51. [PMID: 33302318 DOI: 10.1055/a-1276-0475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM Recording the frequency of screenings for problematic alcohol consumption by professionals involved in the health care of respective patients. The German S3-guideline "screening, diagnosis and treatment of alcohol-related disorders" recommends the use of questionnaire-based screenings for all patients in all settings. METHODS Cross-sectional survey on screening frequency among general practitioners, gynecologists, psychiatrists, child- and adolescent therapists, psychotherapists, social workers and midwives. Logistic regression was used to explore how healthcare professionals' attributes were associated with the implementation of screenings. RESULTS With response rates of about 20%, health care professionals reported using screening instruments for an average of 6.9% of all patients during the previous four weeks. Most of the time, custom-made questions were used instead of the recommended instruments (AUDIT, AUDIT-C). Higher screening rates were reported for patients with newly diagnosed hypertension (21.2%), alcohol-related disorders (43.3%) and mental disorders (39.3%). Knowledge of the guideline was associated with implementation of screenings (OR=4.67; 95% KI 1.94-11.25, p<0.001). CONCLUSIONS Comprehensive screening for problematic alcohol use with questionnaire-based instruments in accordance with guidelines is far from being routinely implemented in the studied health care settings. Measures to increase the knowledge of the guidelines are necessary in order to increase the frequency of alcohol screening in health care.
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Affiliation(s)
- Ulrich Frischknecht
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim.,Katholische Hochschule NRW, Deutsches Institut für Sucht- und Präventionsforschung, Köln
| | - Sabine Hoffmann
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim
| | - Alisa Steinhauser
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim
| | - Christina Lindemann
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Angela Buchholz
- Institut für Medizinische Psychologie, Universitatsklinikum Hamburg-Eppendorf, Hamburg
| | - Jakob Manthey
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Dresden
| | - Bernd Schulte
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Jürgen Rehm
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Dresden.,Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health - Russell Street Site, Toronto.,Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto, Toronto.,WHO Collaborating Centre for Addiction and Mental Health , PAHO, Washington.,Epidemiological Research Unit, Technische Universität Dresden, Dresden.,Department of International Health Projects, Institute for Leadership and Health Management, I M Sechenov First Moscow State Medical University, Russian Federation, Moskva.,Graduate Department of Community Health and Institute of Medical Science, University of Toronto, Toronto
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest
| | - Uwe Verthein
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Jens Reimer
- Klinikverbund Bremen, Gesundheit Nord gGmbH Klinikverbund Bremen, Bremen
| | - Falk Kiefer
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim
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Frischknecht U, Hoffmann S, Steinhauser A, Lindemann C, Buchholz A, Manthey J, Schulte B, Rehm J, Kraus L, Verthein U, Reimer J, Kiefer F. Diagnostik und Behandlung alkoholbezogener Störungen – Versorgerbefragung zur Erarbeitung von Strategien der Leitlinienimplementierung. SUCHTTHERAPIE 2020. [DOI: 10.1055/a-1265-4687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Ziel der Studie Die Art und Häufigkeit durchgeführter Diagnostik, Kurzintervention und Behandlung bei PatientInnen mit bekanntem problematischen Alkoholkonsum und Alkoholkonsumstörungen durch Berufsgruppen der Gesundheitsversorgung soll erfasst werden. Diese Informationen dienen der Bedarfsabschätzung zur Entwicklung von Strategien zur weiteren Implementierung der S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“.
Methodik Schriftliche Befragung von FachärztInnen (hausärztlich allgemeinmedizinisch/internistische, gynäkologische, psychiatrische, pädiatrische, Kinder- und jugendpsychiatrische), PsychotherapeutInnen, SozialarbeiterInnen und Hebammen/Entbindungspflegern in einer Querschnittsstudie in der Modellregion Bremen.
Ergebnisse 34% der PatientInnen mit bekanntem problematischen Alkoholkonsum erhielten eine leitlinienkonforme Diagnostik, 39% eine spezifische Kurzintervention. Von den PatientInnen mit diagnostizierter alkoholbezogener Störung wurde bei 34% eine spezifische Behandlung in eigener Praxis durchgeführt und bei 37% eine Weiterbehandlung anderswo empfohlen. Validierte Instrumente zur Diagnostik alkoholbezogener Störungen fanden selten Anwendung. Kurzinterventionen beinhalteten meist informelle motivierende Gespräche. Als Postakutbehandlungen wurden überwiegend Suchtberatungen und Selbsthilfe und nur selten pharmakologische Rückfallprophylaxe durchgeführt.
Schlussfolgerungen Die Umsetzung strukturierter Diagnostik und Kurzinterventionen, sowie die zielgerichtete Empfehlung pharmakologischer Rückfallprophylaxe und ambulanter Angebote ist für eine leitliniengerechte Versorgung unzureichend. Sie sollten daher Gegenstand von Strategien zur weiteren Leitlinienimplementierung sein.
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Affiliation(s)
- Ulrich Frischknecht
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
- Katholische Hochschule NRW, Deutsches Institut für Sucht- und Präventionsforschung, Köln
| | - Sabine Hoffmann
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
| | - Alisa Steinhauser
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
| | - Christina Lindemann
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Angela Buchholz
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf; Hamburg
| | - Jakob Manthey
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden
| | - Bernd Schulte
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Jürgen Rehm
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto (UofT), PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto,Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Graduate Department of Community Health and Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Schweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
| | - Uwe Verthein
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Jens Reimer
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
- Gesundheit Nord, Bremen
| | - Falk Kiefer
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
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Rogal S, Youk A, Zhang H, Gellad WF, Fine MJ, Good CB, Chartier M, DiMartini A, Morgan T, Bataller R, Kraemer KL. Impact of Alcohol Use Disorder Treatment on Clinical Outcomes Among Patients With Cirrhosis. Hepatology 2020; 71:2080-2092. [PMID: 31758811 PMCID: PMC8032461 DOI: 10.1002/hep.31042] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/07/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Despite the significant medical and economic consequences of coexisting alcohol use disorder (AUD) in patients with cirrhosis, little is known about AUD treatment patterns and their impact on clinical outcomes in this population. We aimed to characterize the use of and outcomes associated with AUD treatment in patients with cirrhosis. APPROACH AND RESULTS This retrospective cohort study included Veterans with cirrhosis who received Veterans Health Administration care and had an index diagnosis of AUD between 2011 and 2015. We assessed the baseline factors associated with AUD treatment (pharmacotherapy or behavioral therapy) and clinical outcomes for 180 days following the first AUD diagnosis code within the study time frame. Among 93,612 Veterans with cirrhosis, we identified 35,682 with AUD, after excluding 2,671 who had prior diagnoses of AUD and recent treatment. Over 180 days following the index diagnosis of AUD, 5,088 (14%) received AUD treatment, including 4,461 (12%) who received behavioral therapy alone, 159 (0.4%) who received pharmacotherapy alone, and 468 (1%) who received both behavioral therapy and pharmacotherapy. In adjusted analyses, behavioral and/or pharmacotherapy-based AUD treatment was associated with a significant reduction in incident hepatic decompensation (6.5% vs. 11.6%, adjusted odds ratio [AOR], 0.63; 95% confidence interval [CI], 0.52, 0.76), a nonsignificant decrease in short-term all-cause mortality (2.6% vs. 3.9%, AOR, 0.79; 95% CI, 0.57, 1.08), and a significant decrease in long-term all-cause mortality (51% vs. 58%, AOR, 0.87; 95% CI, 0.80, 0.96). CONCLUSIONS Most Veterans with cirrhosis and coexisting AUD did not receive behavioral therapy or pharmacotherapy treatment for AUD over a 6-month follow-up. The reductions in hepatic decompensation and mortality suggest that future studies should focus on delivering evidence-based AUD treatments to patients with coexisting AUD and cirrhosis.
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Affiliation(s)
- Shari Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ada Youk
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hongwei Zhang
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Walid F. Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael J. Fine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Chester B. Good
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Center for High Value Pharmacy Initiatives, University of Pittsburgh Medical Center Health Plan, Pittsburgh, PA
| | - Maggie Chartier
- HIV, Hepatitis and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - Andrea DiMartini
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA
| | - Timothy Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA,Division of Gastroenterology, Department of Medicine, University of California, Irvine, California, USA
| | - Ramon Bataller
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kevin L. Kraemer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA,Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Roberts E, Clark G, Hotopf M, Drummond C. Estimating the Prevalence of Alcohol Dependence in Europe Using Routine Hospital Discharge Data: An Ecological Study. Alcohol Alcohol 2020; 55:96-103. [PMID: 31603459 DOI: 10.1093/alcalc/agz079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/15/2019] [Accepted: 08/29/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS This study aims to explore the feasibility of using routine hospital discharge data, at the level of countries within Europe, to estimate the general population prevalence of alcohol dependence (AD). METHODS We utilised the European Core Health Indicators data tool to extract the annual rate of hospital discharges due to any wholly attributable alcohol condition as defined by the ICD-10. For those counties with data available, we systematically searched Medline, EMBASE, PsychINFO and Google for studies reporting an estimate of the prevalence of AD from national cross-sectional surveys. We compared these prevalence estimates with those developed from prediction models based on hospital discharge data. RESULTS The rate of hospital discharges due to any condition from the F10 diagnostic category (mental and behavioural disorders due to alcohol) was moderately correlated with AD prevalence (r = 0.56), while the rate due to any condition from the K70 diagnostic category (alcoholic liver disease) was weakly correlated with AD prevalence (r = 0.21). Two-thirds of the estimates from cross-sectional surveys were not significantly different to those generated using the F10 discharge rate prediction model. CONCLUSIONS Country-level AD prevalence estimates generated using annual F10 hospital discharge rates are likely to provide information of some utility, particularly when limited other sources of information are available or when examining relative trends over time or between regions. There is, however, currently insufficient evidence to make a definitive recommendation to use hospital discharge data to estimate the absolute prevalence of AD per country in Europe.
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Affiliation(s)
- Emmert Roberts
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8AF, United Kingdom.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AB, United Kingdom
| | - Gayle Clark
- College of Social Work, University of South Carolina, 1512 Pendleton St Hamilton College, Columbia, South Carolina 29208, United States of America
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, 16 De Crespigny Park, London, SE5 8AB, United Kingdom
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8AF, United Kingdom
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Time to Get Help? Help-Seeking Process in Latin American Hospital Patients with Alcohol Use Disorder. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00157-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Manthey J, Lindemann C, Verthein U, Frischknecht U, Kraus L, Reimer J, Grün A, Kiefer F, Schulte B, Rehm J. [Provision of healthcare for people with risky alcohol use and severe alcohol use disorders in the state of Bremen, Germany: demand and guideline concordance?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:122-130. [PMID: 31828370 DOI: 10.1007/s00103-019-03072-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Early detection of risky alcohol use and severe alcohol use disorders (AUDs) is crucial to avoid adverse health consequences. The German "Guidelines on Screening, Diagnosis and Treatment of Alcohol Use Disorders" recommend to routinely screen patients for hazardous alcohol use and to subsequently conduct brief interventions, for example in primary healthcare. For severe AUDs, provision of withdrawal treatment is recommended in inpatient settings if complications are anticipated. OBJECTIVES To estimate the proportion of people with hazardous alcohol use or severe AUDs receiving healthcare as stipulated by the guidelines. MATERIALS AND METHODS The prevalence of hazardous use (female ≥12 g; male ≥24 g) and severe AUDs (female ≥60 g; male ≥90 g) was estimated using per capita consumption of pure alcohol. Treatment rates were estimated using survey data (for hazardous use) and inpatient admissions (for severe AUDs). All estimates refer to the adult population (15 years or older) of the federal state of Bremen for 2016. RESULTS Physicians screened 2.9% of all people with hazardous alcohol use and conducted brief interventions with 1.4%. Among people with severe AUDs, 7.1% received inpatient treatment. Among people with severe AUDs who required inpatient treatment, 14.1% received withdrawal treatment in inpatient settings. Treatment rates below average were registered among 21- to 39-year-olds. CONCLUSIONS In Bremen, provision of guideline-conform healthcare for hazardous alcohol use and severe AUDs is insufficient, especially among 21- to 39-year-olds.
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Affiliation(s)
- Jakob Manthey
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Chemnitzer Straße 46, 01187, Dresden, Deutschland. .,Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.
| | - Christina Lindemann
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Uwe Verthein
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Ulrich Frischknecht
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Deutschland.,Department for Public Health Sciences, Stockholm University, Stockholm, Schweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
| | - Jens Reimer
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.,Gesundheit Nord, Bremen, Deutschland
| | | | - Falk Kiefer
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Bernd Schulte
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Jürgen Rehm
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Chemnitzer Straße 46, 01187, Dresden, Deutschland.,Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Kanada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Kanada.,Department of Psychiatry, University of Toronto, Toronto, Kanada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moskau, Russland
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Rehm J, Heilig M, Gual A. ICD-11 for Alcohol Use Disorders: Not a Convincing Answer to the Challenges. Alcohol Clin Exp Res 2019; 43:2296-2300. [PMID: 31424579 PMCID: PMC6899584 DOI: 10.1111/acer.14182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy ResearchCentre for Addiction and Mental Health (CAMH)TorontoOntarioCanada
- Campbell Family Mental Health Research InstituteCAMHTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
- Institute of Clinical Psychology and PsychotherapyCenter for Clinical Epidemiology and Longitudinal StudiesTechnische Universität DresdenDresdenGermany
- Department of International Health ProjectsInstitute for Leadership and Health ManagementI. M. Sechenov First Moscow State Medical UniversityMoscowRussian Federation
| | - Markus Heilig
- Center for Social and Affective NeuroscienceDepartment of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
| | - Antoni Gual
- Addictions UnitPsychiatry DepartmentNeurosciences Institute, Hospital ClínicBarcelonaSpain
- IDIBAPS (Institut per a la Recerca Biomèdica Agustí Pi i Sunyer)BarcelonaSpain
- Red de Trastornos AdictivosInstituto Carlos IIIMadridSpain
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Carvalho AF, Heilig M, Perez A, Probst C, Rehm J. Alcohol use disorders. Lancet 2019; 394:781-792. [PMID: 31478502 DOI: 10.1016/s0140-6736(19)31775-1] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/30/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.
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Affiliation(s)
- Andre F Carvalho
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia.
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Angus C, Brown J, Beard E, Gillespie D, Buykx P, Kaner EFS, Michie S, Meier P. Socioeconomic inequalities in the delivery of brief interventions for smoking and excessive drinking: findings from a cross-sectional household survey in England. BMJ Open 2019; 9:e023448. [PMID: 31048422 PMCID: PMC6501949 DOI: 10.1136/bmjopen-2018-023448] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 01/24/2019] [Accepted: 02/18/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Brief interventions (BI) for smoking and risky drinking are effective and cost-effective policy approaches to reducing alcohol harm currently used in primary care in England; however, little is known about their contribution to health inequalities. This paper aims to investigate whether self-reported receipt of BI is associated with socioeconomic position (SEP) and whether this differs for smoking or alcohol. DESIGN Population survey of 8978 smokers or risky drinkers in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies. MEASURES Survey participants answered questions regarding whether they had received advice and support to cut down their drinking or smoking from a primary healthcare professional in the past 12 months as well as their SEP, demographic details, whether they smoke and their motivation to cut down their smoking and/or drinking. Respondents also completed the Alcohol Use Disorders Identification Test (AUDIT). Smokers were defined as those reporting any smoking in the past year. Risky drinkers were defined as those scoring eight or more on the AUDIT. RESULTS After adjusting for demographic factors and patterns in smoking and drinking, BI delivery was highest in lower socioeconomic groups. Smokers in the lowest social grade had 30% (95% CI 5% to 61%) greater odds of reporting receipt of a BI than those in the highest grade. The relationship for risky drinking appeared stronger, with those in the lowest social grade having 111% (95% CI 27% to 252%) greater odds of reporting BI receipt than the highest grade. Rates of BI delivery were eight times greater among smokers than risky drinkers (48.3% vs 6.1%). CONCLUSIONS Current delivery of BI for smoking and drinking in primary care in England may be contributing to a reduction in socioeconomic inequalities in health. This effect could be increased if intervention rates, particularly for drinking, were raised.
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Affiliation(s)
- Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jamie Brown
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Emma Beard
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Duncan Gillespie
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Penelope Buykx
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eileen F S Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Michie
- Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Petra Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Room R, Rehm J. Commentary on Degenhardt et al. (2019): Harm to others matters in substance use disorders, and so does discordance between the diagnostic systems. Addiction 2019; 114:553-554. [PMID: 30729599 DOI: 10.1111/add.14560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/10/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia.,Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Dauber H, Pogarell O, Kraus L, Braun B. Older adults in treatment for alcohol use disorders: service utilisation, patient characteristics and treatment outcomes. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2018; 13:40. [PMID: 30400930 PMCID: PMC6220462 DOI: 10.1186/s13011-018-0176-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022]
Abstract
Background In western countries demographic changes are leading to an ageing society. Consequently, the number of older adults with alcohol use disorders (AUDs) will rise and the demand of treatment is likely to increase. However, thus far not many older adults with an AUD are seeking treatment and little is known about the efficacy of treatment for older adults. The present study aimed at determining the proportion of older adults with an AUD in addiction treatment, particular characteristics and treatment outcomes of this clientele. Methods Using data of 10,860 patients with an AUD aged 60 and over that are documented within the national German addiction care system we conducted exploratory analyses with regard to prevalence, sociodemographic, disorder- and treatment-related variables. Results Overall, we found a low proportion of older patients in treatment due to AUDs, but highly positive treatment outcomes. With regard to sociodemographic and disorder-related characteristics, older females and late-onset patients in particular constitute a unique clientele. Conclusions The low service utilisation on the one hand but good treatment prognosis on the other emphasise the need to promote treatment seeking among older adults with AUDs. In this context, the special characteristics we found among older patients may contribute to better reach this population and to improve provisions of targeted treatment approaches.
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Affiliation(s)
- Hanna Dauber
- IFT Institut für Therapieforschung, Leopoldstr. 175, 80804, Munich, Germany. .,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Nußbaumstr. 7, 80336, Munich, Germany.
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Nußbaumstr. 7, 80336, Munich, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Leopoldstr. 175, 80804, Munich, Germany.,Department of Public Health Sciences, Stockholm University, 10691, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös-Loránd-University, Budapest, 1053, Hungary
| | - Barbara Braun
- IFT Institut für Therapieforschung, Leopoldstr. 175, 80804, Munich, Germany
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Women awaken faster than men after electroencephalogram-monitored propofol sedation for colonoscopy: A prospective observational study. Eur J Anaesthesiol 2018; 34:681-687. [PMID: 28873076 DOI: 10.1097/eja.0000000000000665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sedation for colonoscopy using intravenous propofol has become standard in many Western countries. OBJECTIVE Gender-specific differences have been shown for general anaesthesia in dentistry, but no such data existed for gastrointestinal endoscopy. DESIGN A prospective observational study. SETTING An academic teaching hospital of Hannover Medical School. PATIENTS A total of 219 patients (108 women and 111 men) scheduled for colonoscopy. INTERVENTION Propofol sedation using electroencephalogram monitoring during a constant level of sedation depth (D0 to D2) performed by trained nurses or physicians after a body-weight-adjusted loading dose. MAIN OUTCOME MEASURES The primary end-point was the presence of gender-specific differences in awakening time (time from end of sedation to eye-opening and complete orientation); secondary outcome parameters analysed were total dose of propofol, sedation-associated complications (bradycardia, hypotension, hypoxaemia and apnoea), patient cooperation and patient satisfaction. Multivariate analysis was performed to correct confounding factors such as age and BMI. RESULTS Women awakened significantly faster than men, with a time to eye-opening of 7.3 ± 3.7 versus 8.4 ± 3.4 min (P = 0.005) and time until complete orientation of 9.1 ± 3.9 versus 10.4 ± 13.7 min (P = 0.008). The propofol dosage was not significantly different, with some trend towards more propofol per kg body weight in women (3.98 ± 1.81 mg versus 3.72 ± 1.75 mg, P = 0.232). CONCLUSION The effect of gender aspects should be considered when propofol is used as sedation for gastrointestinal endoscopy. That includes adequate dosing for women as well as caution regarding potential overdosing of male patients. TRIAL REGISTRATION ClinicalTrials.gov (Identifier: NCT02687568).
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Iglesias K, Sporkert F, Daeppen JB, Gmel G, Baggio S. Comparison of self-reported measures of alcohol-related dependence among young Swiss men: a study protocol for a cross-sectional controlled sample. BMJ Open 2018; 8:e023632. [PMID: 30012797 PMCID: PMC6082486 DOI: 10.1136/bmjopen-2018-023632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Short screenings of alcohol-related dependence are needed for population-based assessments. A clinical interview constitutes a reliable diagnosis often seen as gold standard, but it is costly and time consuming and as such, not suitable for population-based assessments. Therefore, self-reported questionnaires are needed (eg, alcohol use disorder (AUD) as in the Diagnostic and Statistic Manual of Mental Disorders (DSM) 5), but their reliability is questionable. Recent studies called for more evidence-based measurements for population-based screening (eg, heavy alcohol use over time (HAU)). This study aims to test the reliability of different self-reported measures of alcohol use. METHODS AND ANALYSIS Based on stratified random selection, 280 participants will be recruited from the French-speaking subgroup of the Swiss National Science Foundation-supported Cohort Study on Substance Use and Risk Factors (C-SURF). This cohort is a population-based sample of young Swiss men in their mid-20s (n=2668). The sample size calculation is based on a proportion non-inferiority test (alpha=5%, power=80%, margin of equivalence=10%, difference in sensitivity between self-reported AUD and HAU=5%, correlation between AUD and HAU=0.35, and drop-outs=15%). Assessment will include a clinical interview as the gold standard of alcohol-related dependence, self-reported alcohol measures (HAU, AUD and drinking patterns), biomarkers as gold standards of chronic excessive drinking, and health outcomes. To assess the validity of the self-reported alcohol measures, sensitivity analyses will be run. The associations between alcohol-related measures and health outcomes will be tested. A non-response analysis will be run using the previous waves of the C-SURF study using logistic regressions. ETHICS AND DISSEMINATION The study protocol has been approved by the Human Research Ethics Committee of the Canton of Vaud, Switzerland (no. 2017-00776). The results will be submitted for publication in peer-reviewed journals and presented at national and international conferences.
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Affiliation(s)
- Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
- Center for the Understanding of Social Processes, University of Neuchâtel, Neuchâtel, Switzerland
| | - Frank Sporkert
- Forensic Toxicology and Chemistry Unit, Lausanne and Geneva Universities, Centre of Legal Medicine, Lausanne, Switzerland
| | | | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital, Lausanne, Switzerland
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of the West of England, Bristol, UK
| | - Stephanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Life Course and Social Inequality Research Center, University of Lausanne, Lausanne, Switzerland
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Optimizing the delivery of interventions for harmful alcohol use in primary healthcare: an update. Curr Opin Psychiatry 2018; 31:324-332. [PMID: 29846264 DOI: 10.1097/yco.0000000000000435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Alcohol is a leading risk factor for ill health and premature death. Regardless of poor levels of implementation achieved after more than 30 years of research and policy advice, alcohol screening and brief advice (SBA) remains one of the best policy options. This study updates the evidence by considering recent publications on SBA for heavy drinking and alcohol use disorder in primary healthcare at a timely moment, because researchers are, at present, debating future direction of research and policy in this field. RECENT FINDINGS Systematic literature search between 1 January 2016 and 31 December 2017 was conducted for new research on alcohol SBA in primary healthcare. In all, 63 articles were included. SUMMARY Primary healthcare-based SBA programmes are effective in reducing alcohol consumption among heavier drinkers. There is low implementation of these programmes in real practice. Academia is rethinking and debating future directions.
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Pan CH, Li MS, Yang TW, Huang MC, Su SS, Hung YN, Chen CC, Kuo CJ. Identification and medical utilization of incident cases of alcohol dependence: A population-based case-control study. Drug Alcohol Depend 2018; 188:216-223. [PMID: 29778776 DOI: 10.1016/j.drugalcdep.2018.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients with alcohol dependence (AD) often seek help from medical professionals due to alcohol-related diseases, but the overall distribution of medical specialties identifying new AD cases is unclear. We investigated how such cases were identified and how medical resources were utilized before the identification of AD in a nationwide cohort. METHODS We enrolled a population-based cohort (N = 1,000,000) using the National Health Insurance Research Database of Taiwan; 8181 cases with incident AD were retrieved between January 1, 2000, and December 31, 2010. For this nested case-control study, four controls were matched for age and sex with each case based on risk-set sampling. We measured various dimensions of medical utilization before AD was diagnosed, including department visited, physical comorbidity, and medication used. Conditional logistic regression was used for estimating the variables associated with AD. RESULTS Patients living in less urbanized areas who were unemployed were more likely to develop AD. The highest proportions (34.2%) of AD cases were identified in the internal medicine department, followed by the emergency (22.3%) and psychiatry (18.7%) departments. AD patients had a higher risk of comorbid chronic hepatic disease (adjusted RR = 2.72, p < 0.001) before identification of AD than controls. AD patients also had greater numbers of hospital admissions than controls, including non-psychiatric and psychiatric hospitalizations. Outpatient visit numbers were similar for AD patients and controls. CONCLUSIONS The findings indicate that clinicians providing care in diverse medical settings should be prepared to screen for unhealthy alcohol use and to mitigate its detrimental effects.
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Affiliation(s)
- Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Min-Shan Li
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Tien-Wey Yang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ming-Chyi Huang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sheng-Shiang Su
- Department of Computerized Center, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Ni Hung
- School of Gerontology Health Management and Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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Mierzecki A, Kłoda K, Guźmiński B, Morżak-Bożedajek A, Chełstowski K. Alcohol Drinking Pattern Is Associated with Demographic Features of Primary Health Care Patients in Poland: A Cross-Sectional Study. Med Sci Monit 2018; 24:2083-2090. [PMID: 29627844 PMCID: PMC5905354 DOI: 10.12659/msm.906776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Optimizing Delivery of Health Care Interventions (ODHIN) project focused on the implementation of screening and brief intervention for hazardous and harmful alcohol consumption in primary health care. The aim of the present study was to investigate whether alcohol drinking pattern is associated with demographic features of primary health care patients in Poland and if it is possible to identify groups at highest risk for hazardous and harmful drinking. MATERIAL AND METHODS The study enrolled 8805 adult (mean age 54.98±16.94, M/F - 3581/5224) patients reporting to 30 general practitioners working in 10 primary health care units located in urban and partially rural areas in Poland. The shortened, 3-item version of the Alcohol Use Disorders Identification Test (AUDIT-C) was the screening tool used. RESULTS Place of residence was significantly associated with higher odds of hazardous and harmful drinking diagnosis, referred to as AUDIT-C (+). Age and sex were significantly associated with AUDIT-C (+) and suspicion of alcohol dependence, referred to as AUDIT-C ³8 scores. Logistic regression revealed that males had 5-fold higher odds for hazardous and harmful drinking diagnosis and almost 28-fold higher odds for suspected alcohol dependence compared to females. CONCLUSIONS Demographic features are associated with drinking pattern of primary health patients in Poland. Young males and those inhabiting rural areas are at highest risk of being hazardous or harmful drinkers and of being alcohol dependent. There is a growing need for development of national guidelines to address the prevention of alcohol-related health problems by general practitioners.
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Affiliation(s)
- Artur Mierzecki
- Independent Laboratory of Family Physician Education, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Karolina Kłoda
- Independent Laboratory of Family Physician Education, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Bartosz Guźmiński
- Independent Laboratory of Family Physician Education, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Agnieszka Morżak-Bożedajek
- 1Independent Laboratory of Family Physician Education, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Kornel Chełstowski
- Department of Laboratory Diagnostics and Molecular Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
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The prevalence of alcohol dependence and its association with hypertension: a population-based cross-sectional study4 in Xuzhou city, China. BMC Public Health 2018; 18:364. [PMID: 29548314 PMCID: PMC5857079 DOI: 10.1186/s12889-018-5276-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 03/08/2018] [Indexed: 01/28/2023] Open
Abstract
Background To describe the prevalence of alcohol dependence and to explore the relationship between alcohol dependence and newly detected hypertension in China. Methods A multistage stratified cluster sampling method was used to obtain samples from February to June 2013. The Michigan Alcoholism Screening Test was used to estimate alcohol dependence level. A standard questionnaire measured other independent variables. Enumeration data were analyzed using chi-square; quantitative data were analyzed using t-tests. Spearman correlation analysis and multivariate logistic regression analysis were performed to identify the relationship between alcohol dependence and hypertension. Results The alcohol dependence rate was 11.56%; 22.02% of males (3854/17501) and 1.74% of females (324/18656) were classified as alcohol dependent. The newly detected hypertension rate was 9.46% (3422/36157). Significant associations were found between alcohol dependence levels and blood pressure (P < 0.01). Alcohol dependence was positively correlated with systolic blood pressure (r = 0.071, P < 0.01) and diastolic blood pressure (r = 0.077, P < 0.01) and was an independent risk factor for hypertension after adjusting for confounders (low alcohol dependence: odds ratio [OR] = 1.44, 95% confidence intervals [CI] = 1.14–1.81, P < 0.01; light alcohol dependence: OR = 1.35, 95% CI = 1.11–1.64, P < 0.01; medium alcohol dependence: OR = 1.83, 95% CI = 1.40–2.41, P < 0.01). Conclusion Alcohol dependence was high and associated with hypertension. Health education and precautions against alcoholism should be implemented in Xuzhou city.
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Abidi L, Oenema A, van den Akker M, van de Mheen D. Do general practitioners record alcohol abuse in the electronic medical records? A comparison of survey and medical record data. Curr Med Res Opin 2018; 34:567-572. [PMID: 29301406 DOI: 10.1080/03007995.2018.1424623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Primary care professionals are encouraged to screen patients for alcohol abuse. However, patients with alcohol abuse are often under-diagnosed as well as under-registered in medical records in general practices. This study aims to report on the registration rates of alcohol abuse diagnoses in general practices in comparison to patients' self-reported rates of alcohol use disorder. RESEARCH DESIGN AND METHODS Data of a total number of 2,349 patients were analyzed from the SMILE study, a large prospective cohort study conducted in The Netherlands. Two data collection strategies were combined: (1) Patient self-report data on alcohol consumption as well as other sociodemographic characteristics; (2) Medical record (ICPC codes) data of diagnoses of chronic and acute alcohol abuse of the same patients. GPs' registrations of diagnoses were compared with the self-report data using descriptive statistics. RESULTS Based on the results of the patient reported data, 179 (14.8%) male participants had an alcohol use disorder. Of the total number of female patients, 82 (7.2%) had an alcohol use disorder. One of the male and none of the female patients with an alcohol use disorder were registered as such by the GP. CONCLUSIONS This study found that 11.1% of the total patient sample reported an alcohol use disorder, of which a strikingly low number of patients were recorded as such by their GP. It is likely that low recognition due to barriers related to alcohol screening as well as registration avoidance due to the stigma around alcohol abuse play a role in low registration.
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Affiliation(s)
- L Abidi
- a Department of Health Promotion, School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - A Oenema
- a Department of Health Promotion, School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - M van den Akker
- b Department of Family Medicine, School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
- c Academic Center for General Practice/Department of Public Health and Primary Care , KU Leuven , Leuven , Belgium
| | - D van de Mheen
- a Department of Health Promotion, School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
- d Tranzo, School of Social and Behavioral Sciences , Tilburg University , Tilburg , The Netherlands
- e Erasmus Medical Centre , Rotterdam , the Netherlands
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Rehm J, Barbosa C. The cost-effectiveness of therapies to treat alcohol use disorders. Expert Rev Pharmacoecon Outcomes Res 2017; 18:43-49. [DOI: 10.1080/14737167.2018.1392241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J. Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - C. Barbosa
- Behavioral Health and Criminal Justice Division, RTI International, Chicago, IL, USA
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Rehm J, Anderson P, Prieto JAA, Armstrong I, Aubin HJ, Bachmann M, Bastus NB, Brotons C, Burton R, Cardoso M, Colom J, Duprez D, Gmel G, Gual A, Kraus L, Kreutz R, Liira H, Manthey J, Møller L, Okruhlica Ľ, Roerecke M, Scafato E, Schulte B, Segura-Garcia L, Shield KD, Sierra C, Vyshinskiy K, Wojnar M, Zarco J. Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union. BMC Med 2017; 15:173. [PMID: 28954635 PMCID: PMC5618725 DOI: 10.1186/s12916-017-0934-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 08/22/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. METHODS A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. RESULTS Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. CONCLUSIONS The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Peter Anderson
- Substance Use, Policy and Practice, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Alcohol and Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | | | - Iain Armstrong
- Health and Wellbeing Directorate, Public Health England, London, UK
| | - Henri-Jean Aubin
- CESP, University Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, France
| | | | | | - Carlos Brotons
- Sardenya Primary Health Care Center, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Robyn Burton
- Health and Wellbeing Directorate, Public Health England, London, UK
| | - Manuel Cardoso
- General Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD), Lisbon, Portugal
| | - Joan Colom
- Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Barcelona, Spain
| | - Daniel Duprez
- Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis, USA
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Implant Systems Group, National ICT Australia, Eveleigh, Australia
- Faculty of Engineering, University of New South Wales, Sydney, Australia
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany
- Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helena Liira
- General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia
- University of Helsinki, Department of General Practice, and Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Lars Møller
- Division of Noncommunicable Diseases through the Life Course, WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Emanuele Scafato
- National Observatory on Alcohol, National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
- Società Italiana di Alcologia (SIA), Italian Society of Alcohology, Bologna, Italy
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research, Hamburg University, Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany
| | - Lidia Segura-Garcia
- Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Barcelona, Spain
| | - Kevin David Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Cristina Sierra
- Hypertension and Vascular Risk Unit, Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Konstantin Vyshinskiy
- Research Institute on Addictions, Federal Medical Research Centre for Psychiatry and Narcology n.a. V. Serbsky, Moscow, Russia
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - José Zarco
- Drugs Intervention Group, semFYC, Ibiza Primary Health Care Center, Madrid, Spain
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PRANKE MDA, CORAL GP. ALCOHOL DEPENDENCE IN GASTROENTEROLOGY OUTPATIENT ON A PUBLIC HOSPITAL. ARQUIVOS DE GASTROENTEROLOGIA 2017; 54:338-343. [DOI: 10.1590/s0004-2803.201700000-40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/29/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT BACKGROUND: Alcoholism and alcoholic liver disease are both considered worldwide health problems. OBJECTIVE: The prevalence of alcohol dependence, the associated risk factors and the concordance between the prevalence found and the data collected during the medical visit were evaluated. METHODS: A prospective study evaluating gastroenterology outpatients at a public tertiary hospital was conducted. Two specific questionnaires to assess alcohol dependence were applied: Cut down, Annoyed by criticism, Guilty, Eye-opener (CAGE) and The Alcohol Use Disorder Identification Test (AUDIT). Data on comorbidities, clinical diagnosis and assessment of alcohol consumption by the attending physician were collected through medical records. RESULTS: One hundred and seventy eight patients were interviewed, of which 119 (66.9%) were women and 59 (33.1%) were men, with mean age of 57 years. Thirty-three (18.5%) of the 178 patients were considered alcohol-dependent by the CAGE questionnaire. Thirteen (7.3%) patients scored 8 points or more on the AUDIT questionnaire. The agreement (kappa) between these questionnaires was 0.37 (P<0.001). The most consumed drink was beer. The median daily consumption of dependent patients was 64 g. None of the patients were undergoing treatment in a specific treatment center, and 14/33 (42.4%) patients considered themselves alcoholics. Only in 17/33 (51.5%) there was information about alcoholism in their respective medical records. In the bivariate analysis, male gender (P<0.001), onset of alcohol consumption before the age of 15 (P=0.003), daily alcohol consumption in the last 12 months (P<0.001) and smoking (P<0.001) were identified as risk factors. After multivariate analysis, only male gender (P=0.009) and smoking (P=0.001) were associated with alcoholism. CONCLUSION: The present study demonstrated a high prevalence of alcohol dependence in the gastroenterology outpatient clinic, being predominantly associated with male gender and smoking. It is worth noting that approximately half of the dependents were not identified as such in the medical appointment, evidencing the importance of the diagnostic approach in the alcoholic outpatient.
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Rehm J, Room R. The cultural aspect: How to measure and interpret epidemiological data on alcohol-use disorders across cultures. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:330-341. [PMID: 32934495 PMCID: PMC7450835 DOI: 10.1177/1455072517704795] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/24/2017] [Indexed: 12/20/2022] Open
Abstract
Aims: To examine the cultural impact on the diagnosis of alcohol-use disorders using European countries as examples. Design: Narrative review. Results: There are strong cultural norms guiding heavy drinking occasions and loss of control. These norms not only indicate what drinking behaviour is acceptable, but also whether certain behaviours can be reported or not. As modern diagnostic systems are based on lists of mostly behavioural criteria, where alcohol-use disorders are defined by a positive answer on at least one, two or three of these criteria, culture will inevitably co-determine how many people will get a diagnosis. This explains the multifold differences in incidence and prevalence of alcohol-use disorders, even between countries where the average drinking levels are similar. Thus, the incidence and prevalence of alcohol-use disorders as assessed by surveys or rigorous application of standardised instruments must be judged as measuring social norms as well as the intended mental disorder. Conclusions: Current practice to measure alcohol-use disorders based on a list of culture-specific diagnostic criteria results in incomparability in the incidence, prevalence or disease burden between countries. For epidemiological purposes, a more grounded definition of diagnostic criteria seems necessary, which could probably be given by using heavy drinking over time.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, Canada University of Toronto, Canada
| | - Robin Room
- La Trobe University, Australia Stockholm
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Kuitunen‐Paul S, Rehm J, Lachenmeier DW, Kadrić F, Kuitunen PT, Wittchen H, Manthey J. Assessment of alcoholic standard drinks using the Munich composite international diagnostic interview (M-CIDI): An evaluation and subsequent revision. Int J Methods Psychiatr Res 2017; 26:e1563. [PMID: 28370786 PMCID: PMC6877198 DOI: 10.1002/mpr.1563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/05/2017] [Accepted: 02/24/2017] [Indexed: 01/16/2023] Open
Abstract
The quantity and frequency of alcohol consumption are crucial both in risk assessment as well as epidemiological and clinical research. Using the Munich Composite International Diagnostic Interview (M-CIDI), drinking amounts have been assessed in numerous large-scale studies. However, the accuracy of this assessment has rarely been evaluated. This study evaluates the relevance of drink categories and pouring sizes, and the factors used to convert actual drinks into standard drinks. We compare the M-CIDI to alternative drink assessment instruments and empirically validate drink categories using a general population sample (n = 3165 from Germany), primary care samples (n = 322 from Italy, n = 1189 from Germany), and a non-representative set of k = 22503 alcoholic beverages sold in Germany in 2010-2016. The M-CIDI supplement sheet displays more categories than other instruments (AUDIT, TLFB, WHO-CIDI). Beer, wine, and spirits represent the most prevalent categories in the samples. The suggested standard drink conversion factors were inconsistent for different pouring sizes of the same drink and, to a smaller extent, across drink categories. For the use in Germany and Italy, we propose the limiting of drink categories and pouring sizes, and a revision of the proposed standard drinks. We further suggest corresponding examinations and revisions in other cultures.
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Affiliation(s)
- Sören Kuitunen‐Paul
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
| | - Jürgen Rehm
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
- Social and Epidemiological Research DepartmentCenter for Addiction and Mental HealthTorontoCanada
- Addiction Policy, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
- Institute of Medical ScienceUniversity of Toronto, Faculty of Medicine, Medical Sciences BuildingTorontoCanada
- Department of PsychiatryUniversity of TorontoTorontoCanada
- WHO Collaborating Center for Mental Health and AddictionCenter for Addiction and Mental HealthTorontoCanada
| | - Dirk W. Lachenmeier
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
- Chemisches und Veterinäruntersuchungsamt (CVUA) KarlsruheKarlsruheGermany
| | - Firdeus Kadrić
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
| | - Paula T. Kuitunen
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
| | - Hans‐Ulrich Wittchen
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
- Center of Clinical Epidemiology and Longitudinal Studies (CELOS)Technische Universität DresdenDresdenGermany
| | - Jakob Manthey
- Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany
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Schwarzinger M, Thiébaut SP, Baillot S, Mallet V, Rehm J. Alcohol use disorders and associated chronic disease - a national retrospective cohort study from France. BMC Public Health 2017; 18:43. [PMID: 28732487 PMCID: PMC5521064 DOI: 10.1186/s12889-017-4587-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 07/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence on diseases caused by or associated with alcohol use disorders (AUDs) has been based on two meta-analyses including rather dated studies. The objective of this contribution was to estimate the risks of all-cause mortality and alcohol-attributable disease categories depending on a diagnosis of AUDs in a national sample for France. METHODS In a national retrospective cohort study on all inpatient acute and rehabilitation care patients in Metropolitan France 2008-2012 (N = 26,356,361), AUDs and other disease categories were identified from all discharge diagnoses according to standard definitions, and we relied on in-hospital death for mortality (57.4% of all deaths). RESULTS 704,803 (2.7%) patients identified with AUDs had a threefold higher risk of death (HR = 2.98; 95% CI: 2.96-3.00) and died on average 12.2 years younger (men: 10.4, 95% CI: 10.3-10.5; women: 13.7, 95% CI: 13.6-13.9). AUDs were associated with significantly higher risks of hospital admission for all alcohol-attributable disease categories: digestive diseases, cancers (exception: breast cancer), cardiovascular diseases, dementia, infectious diseases, and injuries. Elevated risks were highest for liver diseases that were associated with about two-third of deaths in patients with AUDs (men: 64.3%; women: 71.1%). CONCLUSIONS AUDs were associated with marked premature mortality and higher risks of alcohol-attributable disease categories. Our results support the urgent need of measures to reduce the burden of AUDs.
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Affiliation(s)
- Michaël Schwarzinger
- Translational Health Economics Network (THEN), 39 quai de Valmy, 75010 Paris, France
| | | | - Sylvain Baillot
- Translational Health Economics Network (THEN), 39 quai de Valmy, 75010 Paris, France
| | - Vincent Mallet
- Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, (UMR-S1016), CNRS (UMR 8104), Paris, France
- Institut Pasteur, Centre d’Immunologie Humaine (UMS20), Paris, France; Hepatology, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Cochin Port-Royal, Paris, France
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8 Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8 Canada
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
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Bradley KA, Ludman EJ, Chavez LJ, Bobb JF, Ruedebusch SJ, Achtmeyer CE, Merrill JO, Saxon AJ, Caldeiro RM, Greenberg DM, Lee AK, Richards JE, Thomas RM, Matson TE, Williams EC, Hawkins E, Lapham G, Kivlahan DR. Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial. Addict Sci Clin Pract 2017; 12:15. [PMID: 28514963 PMCID: PMC5436432 DOI: 10.1186/s13722-017-0080-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 04/28/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Most patients with alcohol use disorders (AUDs) never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE (CHOICE) trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication (TIDieR), results of recruitment, and baseline characteristics of the enrolled sample. METHODS The CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking (≥4 drinks/day for women; ≥5 for men) were recruited (2011-2014) into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and/or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs. RESULTS A total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 (range 22-75), and most met DSM-IV criteria for alcohol abuse (14%) or dependence (59%). Many participants also screened positive for tobacco use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco drug use disorders (19%). At baseline, participants had a median AUDIT score of 18 [Interquartile range (IQR) 14-24] and a median readiness to change drinking score of 5 (IQR 2.75-6.25) on a 1-10 Likert scale. CONCLUSION The CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking. Trial registration The trial is registered at clinicaltrial.gov (NCT01400581).
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Affiliation(s)
- Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Health Services, University of Washington, Seattle, WA USA
- Department of Medicine, University of Washington, Seattle, WA USA
| | - Evette Joy Ludman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Laura J. Chavez
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH USA
- Center for Innovation in Pediatric Practice, Nationwide Children’s Hospital, Columbus, OH USA
| | - Jennifer F. Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Susan J. Ruedebusch
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
| | - Carol E. Achtmeyer
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
| | | | - Andrew J. Saxon
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - Ryan M. Caldeiro
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Diane M. Greenberg
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
| | - Amy K. Lee
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Julie E. Richards
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Rachel M. Thomas
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
| | - Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Emily C. Williams
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Health Services, University of Washington, Seattle, WA USA
| | - Eric Hawkins
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | - Gwen Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466 USA
| | - Daniel R. Kivlahan
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA USA
- Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
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Epidemiology of alcohol dependence in UK primary care: Results from a large observational study using the Clinical Practice Research Datalink. PLoS One 2017; 12:e0174818. [PMID: 28362848 PMCID: PMC5376077 DOI: 10.1371/journal.pone.0174818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/15/2017] [Indexed: 12/17/2022] Open
Abstract
This study aims to investigate the incidence and annual presentation rates of alcohol dependence in general practice in the UK, and examine age-, gender-, socioeconomic-, and region-specific variation. We conducted a retrospective 'open' cohort study using the Clinical Practice Research Datalink (CPRD), an anonymised primary care database. Prior to data extraction, a case definition for alcohol dependence in CPRD was established using 47 Read codes, which included primary alcohol dependence and consequences of alcohol dependence. Directly standardised rates for incidence and annual presentation were calculated for each year between 1990 and 2013. Rates were compared by gender, age, UK home nation, and practice-level Index of Multiple Deprivation. The directly standardised annual incidence rates were 8.3 and 3.7 per 10,000 male and female patients, respectively. The estimated annual rates of presentation per 10,000 were 17.1 for males and 7.6 for females. Female to male rate ratios were: 0.40 (95% CI: 0.39-0.41) for incident cases; and 0.37 (95% CI: 0.36-0.39) for annual presentation. Rates were highest in those aged 35-54 for both measures and across genders, and lowest in those aged over 75 years. With England as the reference nation, Northern Ireland and Scotland had significantly higher rates for both measures. Patients from the most deprived areas had the highest incidence and annual presentation rates. There is unequal distribution of patients with severe alcohol dependence across population subgroups in general practice. Given the health and economic burden associated with dependent drinking, these data will be useful in informing future public health initiatives.
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Drug therapy for alcohol dependence in primary care in the UK: A Clinical Practice Research Datalink study. PLoS One 2017; 12:e0173272. [PMID: 28319159 PMCID: PMC5358741 DOI: 10.1371/journal.pone.0173272] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/17/2017] [Indexed: 12/11/2022] Open
Abstract
AIM To evaluate drug therapy for alcohol dependence in the 12 months after first diagnosis in UK primary care. DESIGN Open cohort study. SETTING General practices contributing data to the UK Clinical Practice Research Database. PARTICIPANTS 39,980 people with an incident diagnosis of alcohol dependence aged 16 years or older between 1 January 1990 and 31 December 2013. MAIN OUTCOME MEASURE Use of pharmacotherapy (acamprosate, disulfiram, naltrexone, baclofen and topiramate) to promote abstinence from alcohol or reduce drinking to safe levels in the first 12 months after a recorded diagnosis of alcohol dependence. FINDINGS Only 4,677 (11.7%) of the cohort received relevant pharmacotherapy in the 12 months following diagnosis. Of the 35,303 that did not receive pharmacotherapy, 3,255 (9.2%) received psychosocial support. The remaining 32,048 (80.2%) did not receive either mode of treatment in the first 12 months. Factors that independently reduced the likelihood of receiving pharmacotherapy included: being male (Odds Ratio [OR] 0.74; 95% CI 0.69 to 0.78); older (65-74 years: OR 0.61; 95% CI 0.49 to 0.77); being from a practice based in the most deprived quintile (OR 0.58; 95% CI 0.53 to 0.64); and being located in Northern Ireland (OR 0.78; 95% CI 0.67 to 0.91). The median duration to initiation of pharmacotherapy was 0.80 months (95% CI 0.70 to 1.00) for acamprosate and 0.60 months (95% CI 0.43 to 0.73) for disulfiram. Persistence analysis for those receiving acamprosate and disulfiram revealed that many patients never received a repeat prescription; persistence at 6 months was 27.7% for acomprosate and 33.2% for disulfiram. The median duration of therapy was 2.10 months (95% CI 1.87 to 2.53) for acamprosate and 3.13 months (95% CI 2.77 to 3.36) for disulfiram. CONCLUSION Drug therapy to promote abstinence in alcohol dependent patients was low, with the majority of patients receiving no therapy, either psychological or pharmacological. When drug therapy was prescribed, persistence was low with most patients receiving only one prescription. Our data show that treatment for alcohol dependence is haphazard, and there is an urgent need to explore strategies for improving clinical management of this patient group.
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Abstract
Taylor et al. (2014) raise an important issue concerning the detection of alcohol problems in older adults. The authors identify a number of age-related factors playing a role in the detection of alcohol problems, such as stigma, the concept of alcohol use disorder diagnoses and their standardized assessment, and drinking levels. They list a comprehensive review of tools for assessing alcohol problems among older adults, including laboratory tests, questionnaires, and interviews.
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Huynh C, Ferland F, Blanchette-Martin N, Ménard JM, Fleury MJ. Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders. Psychiatr Q 2016; 87:713-728. [PMID: 26875101 DOI: 10.1007/s11126-016-9422-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study assessed the characteristics of individuals with substance use disorders (ISUDs) according to their frequency of emergency department (ED) utilization, and examined which variables were associated with an increase in ED visits using Andersen's model. Data linkage of administrative databanks from three sources [addiction rehabilitation centre registry, physician billing systems, and hospital discharge databank] for 4526 ISUDs was performed. Predisposing, enabling and need factors associated with number of ED visits were determined using a negative binomial regression model and generalised estimating equations. The rate of ED utilization for this population was 9.6 %. Increased number of ED visits was associated with the following variables: older age, social fragmentation, number of consultations with general practitioners, number of consultations with psychiatrists, number of consultations with other types of physicians, alcohol abuse, drug abuse, schizophrenia, anxiety disorders, personality disorders, co-occurring substance dependence and mental disorders, co-occurring substance dependence and chronic physical disorders, and co-occurring mental health disorders and chronic physical disorders. By contrast, a diagnosis of substance dependence, co-occurring drug and alcohol abuse, and a co-occurring diagnosis of substance dependence with mental health and chronic physical disorders decreased ED visits. Efforts to reduce avoidable use of EDs should focus on chronic-disease management and other related strategies aimed at reinforcing services to ISUDs in the community, especially for ISUDs with a co-occurring diagnosis of either mental health disorders or chronic physical disorders.
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Affiliation(s)
- Christophe Huynh
- Centre de réadaptation en dépendance de Montréal - Institut universitaire, 950, rue de Louvain Est, Montreal, QC, H2M 2E8, Canada.
| | - Francine Ferland
- Centre de réadaptation en dépendance de Québec, 2525, chemin de la Canardière, Quebec, QC, G1J 2G3, Canada.,Centre de réadaptation en dépendance de Chaudière-Appalaches, 419, Dorimène-Desjardins, Lévis, QC, G6V 5V3, Canada
| | - Nadine Blanchette-Martin
- Centre de réadaptation en dépendance de Québec, 2525, chemin de la Canardière, Quebec, QC, G1J 2G3, Canada.,Centre de réadaptation en dépendance de Chaudière-Appalaches, 419, Dorimène-Desjardins, Lévis, QC, G6V 5V3, Canada
| | - Jean-Marc Ménard
- Centre de réadaptation en dépendance Domrémy-de-la-Mauricie-Centre-du-Québec, 440 rue des Forges, Trois-Rivières, QC, G9A 2H5, Canada
| | - Marie-Josée Fleury
- Centre de réadaptation en dépendance de Montréal - Institut universitaire, 950, rue de Louvain Est, Montreal, QC, H2M 2E8, Canada.,Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre, Quebec, Canada
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48
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Huỳnh C, Tremblay J, Fleury MJ. Typologies of Individuals Attending an Addiction Rehabilitation Center Based on Diagnosis of Mental Disorders. J Subst Abuse Treat 2016; 71:68-78. [DOI: 10.1016/j.jsat.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 09/08/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
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49
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Miquel L, Gual A, Vela E, Lligoña A, Bustins M, Colom J, Rehm J. Alcohol Consumption and Inpatient Health Service Utilization in a Cohort of Patients With Alcohol Dependence After 20 Years of Follow-up. Alcohol Alcohol 2016; 52:227-233. [DOI: 10.1093/alcalc/agw075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 11/13/2022] Open
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50
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Addolorato G, Mirijello A, Barrio P, Gual A. Treatment of alcohol use disorders in patients with alcoholic liver disease. J Hepatol 2016; 65:618-30. [PMID: 27155530 DOI: 10.1016/j.jhep.2016.04.029] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/24/2016] [Accepted: 04/25/2016] [Indexed: 12/18/2022]
Abstract
Alcohol use disorders (AUDs) is one of the leading causes of disease and disability in almost all European countries. Among the alcohol-related diseases, alcoholic liver disease (ALD) is the most common. At present, alcohol is the most frequent cause of liver cirrhosis in the Western world. The cornerstone of treatment for ALD is achieving total alcohol abstinence and preventing relapse; medical and surgical treatments for ALD are limited when drinking continues. This narrative review summarizes current treatments for AUDs with a particular emphasis to the treatment of AUDs in patients with ALD. Medical management, psychosocial and pharmacological interventions are analyzed, underlying limits and options in AUD patients. Finally, this review discusses the most appropriate setting for the management of AUD patients with advanced liver disease as well as the indications for liver transplantation in AUD patients.
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Affiliation(s)
- Giovanni Addolorato
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Italy.
| | - Antonio Mirijello
- Alcohol Use Disorders Unit, Department of Internal Medicine, Gastroenterology and Hepatology, Catholic University of Rome, Italy; Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, FG, Italy
| | - Pablo Barrio
- Department of Psychiatry, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain
| | - Antoni Gual
- Department of Psychiatry, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain.
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