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Balbinot P, Pellicano R, Testino G. Burden of caregiving of alcohol related liver disease patients: a possible role of training and caregiver groups frequency. Proposal of a method, preliminary results. Minerva Gastroenterol (Torino) 2023; 69:486-493. [PMID: 36255285 DOI: 10.23736/s2724-5985.22.03288-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND The patient with alcohol related liver disease (ALD) is an extremely complex patient who can be affected by various problems: alcohol use disorders (AUDs) (intoxication or withdrawal syndrome), psychopathological manifestations, hepatic encephalopathy (HE), family and social discomfort. Burden of caregiving for this type of patient is particularly severe. For this reason we propose our own working model. METHODS Thirty-one informal caregivers (ICs) of patients with ALD (28 females; mean age: 51±11) recruited in the period September-November 2021 followed prospectively were evaluated retrospectively. Those who completed all the steps (initial information/ training meeting), participation in support groups for caregivers and participation in self-help groups for AUD (club of alcoholics in treatment, anonymous family members, other realities) were selected (31/71: 43%). ICs underwent Zarit Burden Interview and a semi-structured interview. RESULTS From the semi-structured interview, emotional, organizational, but also constructive reflections emerge. Zarit Score (ZS) was found to be light or nil in the 13% (4/31), moderate in the 22.5% (7/31), severe in the 32% (10/31) and very serious in the 32% (10/31). The parameters that most influenced initial ZS are the presence of HE and primitive psychiatric comorbidity (PC). By dividing the caregivers into two groups (40) odds ratio is 2.4231 (95% CI: 0.4059-14.4637) in the presence of HE and odds ratio is 5.3846 (95% CI: 0.5666 to 51.1738) in the presence of PC. After the frequency to the caregiver groups (CGs) (at least 4) the ZS is significantly decreased (49.9±18 vs. 34±11; t=4.1966; P<0.0001) and this regardless of the presence of HE, PC or active alcohol consumption. CONCLUSIONS While waiting to increase the number of cases and to submit it to a more in-depth verification, we suggest to other health organizations to use and verify this organizational/ relational method for primary ICs, in an attempt to optimize the health and social health activity in a complex medical sector (ALD) in constant growth.
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Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 Liguria, Polyclinic San Martino Hospital, Genoa, Italy
- Centro Studi Mutual-self-help, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
| | | | - Gianni Testino
- Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 Liguria, Polyclinic San Martino Hospital, Genoa, Italy
- Centro Studi Mutual-self-help, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
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Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, University of Genoa, ASL3 Liguria, Genoa, Italy
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
| | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, University of Genoa, ASL3 Liguria, Genoa, Italy
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
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Testino G, Balbinot P, Pellicano R. Lifestyle and cancer. Minerva Gastroenterol (Torino) 2023; 69:580-581. [PMID: 37058145 DOI: 10.23736/s2724-5985.23.03348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3 Liguria, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy -
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy -
| | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3 Liguria, IRCCS San Martino University Hospital, University of Genoa, Genoa, Italy
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
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Testino G, Pellicano R, Balbinot P. Orthorexia, lifestyle and social media pressure: what to do? Minerva Gastroenterol (Torino) 2023; 69:581-582. [PMID: 37013387 DOI: 10.23736/s2724-5985.23.03393-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, University of Genoa, ASL3 Liguria, Genoa, Italy -
- Mutual-Self-Help, Community Programs and Caregiver Training Study Center, ASL3 Liguria, Genoa, Italy -
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, University of Genoa, ASL3 Liguria, Genoa, Italy
- Mutual-Self-Help, Community Programs and Caregiver Training Study Center, ASL3 Liguria, Genoa, Italy
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Balbinot P, Pellicano R, Patussi V, Caputo F, Testino G. Alcohol use disorders, self-help groups as a supplement to pharmacological and psychological therapy? A retrospective study in a population with alcohol related liver disease. Minerva Gastroenterol (Torino) 2023; 69:479-485. [PMID: 36255286 DOI: 10.23736/s2724-5985.22.03292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND According to the new criteria in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V), the prevalence of alcohol use disorders (AUDs) is 20-30% in men and 10-15% in women worldwide.2,3 The anticraving therapy/psychotherapy combination is currently used routinely in clinical practice. However, the results after one year are unsatisfactory. Meta-analytic studies found failure rates of 57 to 75%. These percentages vary in relation to the intensity and length of the treatment. In addition, the abstinence rates gradually decrease over time. In this study, the clinical outcome of alcohol related liver disease (ALD) patients who spontaneously attended self-help groups (SHGs) (club of alcoholics in treatment - multi-family community/ alcoholics anonymous) regularly versus those who did not want to start the path or did not complete it was evaluated. METHODS From January 2005 to December 2010, 1337 alcohol use disorder patients affected by compensated alcohol related liver disease, were prospectively followed and retrospectively assessed. Two hundred thirty-one patients were enrolled: 74 attended self-help groups assiduously, 27 attended sporadically and 130 refused participation in SHGs. RESULTS Constant attendance at SHGs compared to non-attendance allows for a significant increase (<0.0001) in the period of sobriety found in the median of distribution. Frequent attendance at SHGs is effectively "preventive," reducing the fraction of relapses by about 30%. The percentage of cases of cirrhosis is significantly different (P=0.0007) between those who have regularly attended SHG meetings (about 1% of patients) and those who have never attended or only occasionally (various percentages between 21 and 31% of patients); in both groups the incidence of new cases would seem to be 0.014 cases/ year. Similar difference in percentages regarding the onset of hepatocellular carcinomas (HCCs), although with a lower level of significance (P=0.017) among those who attended regularly, 4% of patients with an incidence of 0.006 cases/ year, compared to those who have never attended or only occasionally: over 14% of patients with an incidence of 0.022 cases/year. CONCLUSIONS This study suggests the importance of attending SHGs not only for the long-term achievement of alcoholic abstention, but also in positively influencing the course of alcohol-related diseases.
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Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, ASL3 Liguria, Genoa, Italy
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
| | | | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Translational Medicine, Center for the Study and Treatment of Alcohol-Related Diseases, University of Ferrara, Ferrara, Italy
- Department of Internal Medicine, Santissima Annunziata Hospital, University of Ferrara, Ferrara, Italy
| | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, ASL3 Liguria, Genoa, Italy
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Testino G, Scafato E, Patussi V, Balbinot P, Ghiselli A, Caputo F. Alcohol and cancer: a denied association the statement of the Italian society on alcohol (Società Italiana di Alcologia-SIA). Alcohol Alcohol 2023; 58:683-687. [PMID: 37779424 DOI: 10.1093/alcalc/agad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/03/2023] Open
Abstract
Alcohol consumption (AC) is carcinogenic to humans. The Italian Society on Alcohol (Società Italiana di Alcologia) defines excessive AC as anything greater than zero. It is not appropriate to associate AC with cardiovascular disease prevention. This is for prudence and to protect public health. It also asks to include information on alcohol labels that AC is associated with cancer.
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Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, ASL3 c/o Polyclinic San Martino Hospital, Genova, Italy
- Alcohological Regional Centre, ASL3, Genova, Italy
- Centro Studi "Auto-Mutuo-Aiuto, Programmi di Comunità, Formazione Caregiver", ASL3, Genova, Italy
- Società Italiana di Alcologia (SIA), Bologna, Italy
| | - Emanuele Scafato
- Società Italiana di Alcologia (SIA), Bologna, Italy
- Istituto Superiore di Sanità, Roma, Italy
| | - Valentino Patussi
- Società Italiana di Alcologia (SIA), Bologna, Italy
- SOD di Alcologia e Centro Alcologico Toscano, Ospedale Policlinico di Careggi, Firenze, Italy
| | - Patrizia Balbinot
- Unit of Addiction and Hepatology, ASL3 c/o Polyclinic San Martino Hospital, Genova, Italy
- Alcohological Regional Centre, ASL3, Genova, Italy
- Centro Studi "Auto-Mutuo-Aiuto, Programmi di Comunità, Formazione Caregiver", ASL3, Genova, Italy
- Società Italiana di Alcologia (SIA), Bologna, Italy
| | - Andrea Ghiselli
- President of the Italian Commission for the Review of Nutritional Guidelines 2018
| | - Fabio Caputo
- Società Italiana di Alcologia (SIA), Bologna, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Translational Medicine, Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, University of Ferrara, Ferrara, Italy
- Department of Translational Medicine, Center for the Study and Treatment of Alcohol-Related Diseases, University of Ferrara, Ferrara, Italy
- Department of Internal Medicine, Santissima Annunziata Hospital, University of Ferrara, Ferrara, Italy
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Testino G, Bottaro LC, Andorno E, Bandini F, Balbinot P, Beltramini S, Bottino S, Caltabellotta M, Caputo F, Caviglia E, Curone P, DI Biagio A, Gagliano C, Gandolfo N, Pestarino L, Rollero A, Romairone E, Sampietro L, Torre E, Zuccarelli S, Pellicano R. Hepatic encephalophaty: management and diagnostic therapeutic assistance path of Ligurian Local Health Company 3 (ASL3). Minerva Med 2023; 114:698-718. [PMID: 36952221 DOI: 10.23736/s0026-4806.22.08408-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Hepatic encephalophaty (HE) is a neuropsychiatric syndrome with a prevalence in the cirrhotic population ranging from 20 to 80%. HE is a cause of inappropriate hospitalization, caregiver burdening and increased social costs. There is need to create dedicated care pathways to better manage patients and support family caregivers. The data used for the preparation of this diagnostic therapeutic assistance path (DTAP) are based on a detailed analysis of the scientific literature published before June 30, 2022 (PubMed, Web of Science, Scopus, Google Scholar). Furthermore, in the process of developing this work, we consulted in particular the guidelines/ position papers of International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN), Italian Association for the Study of the Liver (AISF), European Association for the Study of the Liver (EASL), American Association for the Study of Liver Diseases (AASLD), Italian Society on Alcohol (Società Italiana di Alcologia [SIA]) and other relevant papers. DTAP was created based on the most recent recommendations of the international scientific literature. The present DTAP highlight the need for a multidisciplinary activity integrated with territorial medicine in close connection with caregivers. This guarantees improved therapeutic adherence, hospital readmission reduction, improved quality of life for patients and caregivers and a significant reduction in costs.
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Affiliation(s)
- Gianni Testino
- Addiction and Hepatology Unit/Alcohological Regional Centre and Study Centre "Self Help, Community Program and Caregiver Training" ASL3, Genoa, Italy -
| | | | - Enzo Andorno
- Liver Transplantation Unit, San Martino Polyclinic Hospital, Genoa, Italy
| | | | - Patrizia Balbinot
- Addiction and Hepatology Unit/Alcohological Regional Centre and Study Centre "Self Help, Community Program and Caregiver Training" ASL3, Genoa, Italy
| | | | | | | | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Internal Medicine, Santissima Annunziata Hospital, University of Ferrara, Ferrara, Italy
| | | | | | - Antonio DI Biagio
- Department of Health Sciences, Infectious Diseases Clinic, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | | | | | | | | | | | | | - Enrico Torre
- Unit of Endocrinology, Metabolic Diseases and Diabetology, ASL3 Liguria, Genoa, Italy
| | | | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
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Balbinot P, Pellicano R, Testino G. Male infertility and alcohol use disorder identification test. Minerva Endocrinol (Torino) 2023; 48:360-361. [PMID: 37724939 DOI: 10.23736/s2724-6507.22.03906-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3, IRCCS San Martino University Hospital, Genoa, Italy
- Centro Studi Centro Alcologico "Auto-Mutuo-Aiuto, Programmi di Comunità e Formazione Caregiver", ASL3 Liguria, Genoa, Italy
| | | | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3, IRCCS San Martino University Hospital, Genoa, Italy
- Centro Studi Centro Alcologico "Auto-Mutuo-Aiuto, Programmi di Comunità e Formazione Caregiver", ASL3 Liguria, Genoa, Italy
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Balbinot P, Pellicano R, Testino G. Alcohol, smoke, cannabis, new psychoactive substances, and non-prescribed drugs consumption among school student in an area of Nord-West of Italy. Minerva Gastroenterol (Torino) 2022; 68:421-425. [PMID: 35904475 DOI: 10.23736/s2724-5985.22.03253-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Alcohol and/or substance use disorders are known to be a significant phenomenon in the Western world. The aim of the present study was to evaluate the consumption of alcohol, cigarette smoking, cannabis, new psychoactive substances (NSP) / non prescribed drug (NPD) in a student population in the north-west of Italy (metropolitan area of Genoa). METHODS Fourteen comprehensive schools in the metropolitan area of Genoa (Italy) have requested to participate in the education for correct lifestyles meetings (from December 16, 2021, to May 30, 2022). Before each meeting, a meeting was held with the reference teachers: 3805 students aged 9 to 17 were involved. The group was divided by age group: 9-11, 12-13, 14-15 and 16-17 years. Before the lesson, the students were given a questionnaire relating to various topics related to lifestyle or resulting from an incorrect lifestyle (alcohol consumption, cigarette smoking, cannabis, NPS/NPD, psychological path). The questionnaire was anonymous and was approved by the teachers in the preparation phase of the meeting. RESULTS Logistic regression analysis found that cannabis use in the age of 14-15 increases the risk of consuming NPD/NPD by more than 26 times (odd ratio 26.3012; 95% CI 15.9656 to 43.3275; P<0.0001). In the age of 16-17, this risk increases approximately 14 times (odd ratio 14.0625; 95% CI 6.1729 to 32.0360; P<0.0001). In the age of 14-15 years, cannabis consumption, alcohol consumption >2 alcoholic units (AUs) on one occasion, NPD increases the probability of the need for a psychological path (cannabis: odds ratio 14.0254, 95% CI 10.9-17.9, P<0.0001; alcohol: odds ratio 3.68, 95% CI 3-4.4, P<0.0001; NPS/NPD: odds ratio 20.98, 16.4-38.4, P<0.0001). In the age of 14-15 and 16-17 years, respectively, 53% (95% CI 50-58%) and 68% (95% CI 66-71%) of students declared that they had neither the parents nor the psychologist of having used alcohol and/or substances. CONCLUSIONS These data should be useful to policy makers to implement prevention and health promotion policies through teaching (education for correct lifestyles) to be permanently included in school programs and to be recognized in the curricular path.
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Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology/Alcohological Regional Center, IRCCS San Martino University Hospital, ASL3 Liguria, University of Genoa, Genoa, Italy.,Mutual-Self-Help, Community Programs and Caregiver Training Study Center, ASL3 Liguria, Genoa, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Gianni Testino
- Unit of Addiction and Hepatology/Alcohological Regional Center, IRCCS San Martino University Hospital, ASL3 Liguria, University of Genoa, Genoa, Italy - .,Mutual-Self-Help, Community Programs and Caregiver Training Study Center, ASL3 Liguria, Genoa, Italy
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Balbinot P, Pellicano R, Testino G. Eating disorders treatment. A suggestion: overeaters anonymous. Minerva Gastroenterol (Torino) 2022; 68:485-486. [PMID: 36507831 DOI: 10.23736/s2724-5985.22.03233-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 Liguria, Genoa, Italy.,Centro Studi Mutual-self-help, community programs and caregiver training, ASL3 Liguria, Genoa, Italy
| | | | - Gianni Testino
- Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 Liguria, Genoa, Italy - .,Centro Studi Mutual-self-help, community programs and caregiver training, ASL3 Liguria, Genoa, Italy
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Balbinot P, Testino G, Pellicano R. The introduction of a self-help group facilitator in the Service of Hepato-alcohology: an innovative proposal. Minerva Gastroenterol (Torino) 2022; 68:486-487. [PMID: 33793156 DOI: 10.23736/s2724-5985.21.02851-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology, ASL3 Liguria, IRCCS San Martino University Hospital, Genoa, Italy
| | - Gianni Testino
- Unit of Addiction and Hepatology, ASL3 Liguria, IRCCS San Martino University Hospital, Genoa, Italy -
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13
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Testino G, Pellicano R, Balbinot P. Disordered Eating Behavior, Alcohol Use Disorder, and Bariatric Surgery. Obes Surg 2022; 32:1777-1778. [PMID: 35192132 DOI: 10.1007/s11695-022-05967-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Gianni Testino
- ASL3 c/o Polyclinic San Martino Hospital, Genova, Italy.
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Balbinot P, Bottaro LC, Pellicano R, Testino G. Local health company 3 Liguria (ASL3) introduces the GLU GLU test for alcohol use disorder identification (alcohol use disorder identification test). Minerva Gastroenterol (Torino) 2022; 68:234-235. [PMID: 35001608 DOI: 10.23736/s2724-5985.21.03116-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 Liguria c/o Polyclinic San Martino Hospital, Genova, Italy.,Centro Studi Mutual-self-help, community programs and caregiver training, ASL3 Liguria, Genova, Italy
| | - Luigi C Bottaro
- Centro Studi Mutual-self-help, community programs and caregiver training, ASL3 Liguria, Genova, Italy.,General Direction ASL3 Liguria, Genova, Italy
| | | | - Gianni Testino
- Unit of Addiction and Hepatology/Alcohological Regional Centre, ASL3 Liguria c/o Polyclinic San Martino Hospital, Genova, Italy - .,Centro Studi Mutual-self-help, community programs and caregiver training, ASL3 Liguria, Genova, Italy
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Testino G, Vignoli T, Patussi V, Allosio P, Amendola MF, Aricò S, Baselice A, Balbinot P, Campanile V, Fanucchi T, Greco G, Macciò L, Meneguzzi C, Mioni D, Palmieri VO, Parisi M, Renzetti D, Rossin R, Gandin C, Bottaro LC, Bernardi M, Addolorato G, Lungaro L, Zoli G, Scafato E, Caputo F. Alcohol-Related Liver Disease in the Covid-19 Era: Position Paper of the Italian Society on Alcohol (SIA). Dig Dis Sci 2022; 67:1975-1986. [PMID: 34142284 PMCID: PMC8210966 DOI: 10.1007/s10620-021-07006-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 04/14/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19), firstly reported in China last November 2019, became a global pandemic. It has been shown that periods of isolation may induce a spike in alcohol use disorder (AUD). In addition, alcohol-related liver disease (ALD) is the most common consequence of excessive alcohol consumption worldwide. Moreover, liver impairment has also been reported as a common manifestation of COVID-19. AIMS The aim of our position paper was to consider some critical issues regarding the management of ALD in patients with AUD in the era of COVID-19. METHODS A panel of experts of the Italian Society of Alcohology (SIA) met via "conference calls" during the lockdown period to draft the SIA's criteria for the management of ALD in patients with COVID-19 as follows: (a) liver injury in patients with ALD and COVID-19 infection; (b) toxicity to the liver of the drugs currently tested to treat COVID-19 and the pharmacological interaction between medications used to treat AUD and to treat COVID-19; (c) reorganization of the management of compensated and decompensated ALD and liver transplantation in the COVID-19 era. RESULTS AND CONCLUSIONS The COVID-19 pandemic has rapidly carried us toward a new governance scenario of AUD and ALD which necessarily requires an in-depth review of the management of these diseases with a new safe approach (management of out-patients and in-patients following new rules of safety, telemedicine, telehealth, call meetings with clinicians, nurses, patients, and caregivers) without losing the therapeutic efficacy of multidisciplinary treatment.
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Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Regional Centre On Alcohol, ASL3 San Martino Hospital, Genova, Italy
| | | | | | | | | | - Sarino Aricò
- Gastroenterology Unit, Mauriziano Hospital, Torino, Italy
| | | | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Regional Centre On Alcohol, ASL3 San Martino Hospital, Genova, Italy
| | | | | | | | | | | | | | - Vincenzo Ostilio Palmieri
- “Murri” Clinic of Internal Medicine, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | | | - Doda Renzetti
- Department of Internal Medicine, Mater Dei Hospital, Bari, Italy
| | | | - Claudia Gandin
- National Observatory On Alcohol, National Institute of Health, Roma, Italy
| | | | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Addolorato
- Alcohol Use Disorder and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lisa Lungaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giorgio Zoli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy ,Department of Internal Medicine, SS Annunziata Hospital, University of Ferrara, Via Vicini 2, 44042 Cento, FE Italy ,Centre for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Emanuele Scafato
- National Observatory On Alcohol, National Institute of Health, Roma, Italy
| | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy ,Department of Internal Medicine, SS Annunziata Hospital, University of Ferrara, Via Vicini 2, 44042 Cento, FE Italy ,Centre for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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16
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Testino G, Vignoli T, Patussi V, Allosio P, Amendola MF, Aricò S, Baselice A, Balbinot P, Campanile V, Fanucchi T, Macciò L, Meneguzzi C, Mioni D, Parisi M, Renzetti D, Rossin R, Gandin C, Bottaro LC, Caio G, Lungaro L, Zoli G, Scafato E, Caputo F. Alcohol use disorder in the COVID-19 era: Position paper of the Italian Society on Alcohol (SIA). Addict Biol 2022; 27:e13090. [PMID: 34532923 PMCID: PMC8646667 DOI: 10.1111/adb.13090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/11/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) first emerged in China in November 2019. Most governments have responded to the COVID‐19 pandemic by imposing a lockdown. Some evidence suggests that a period of isolation might have led to a spike in alcohol misuse, and in the case of patients with alcohol use disorder (AUD), social isolation can favour lapse and relapse. The aim of our position paper is to provide specialists in the alcohol addiction field, in psychopharmacology, gastroenterology and in internal medicine, with appropriate tools to better manage patients with AUD and COVID‐19,considering some important topics: (a) the susceptibility of AUD patients to infection; (b) the pharmacological interaction between medications used to treat AUD and to treat COVID‐19; (c) the reorganization of the Centre for Alcohol Addiction Treatment for the management of AUD patients in the COVID‐19 era (group activities, telemedicine, outpatients treatment, alcohol‐related liver disease and liver transplantation, collecting samples); (d) AUD and SARS‐CoV‐2 vaccination. Telemedicine/telehealth will undoubtedly be useful/practical tools even though it remains at an elementary level; the contribution of the family and of caregivers in the management of AUD patients will play a significant role; the multidisciplinary intervention involving experts in the treatment of AUD with specialists in the treatment of COVID‐19 disease will need implementation. Thus, the COVID‐19 pandemic is rapidly leading addiction specialists towards a new governance scenario of AUD, which necessarily needs an in‐depth reconsideration, focusing attention on a safe approach in combination with the efficacy of treatment.
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Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Regional Centre on Alcohol ASL3 San Martino Hospital Genoa Italy
| | - Teo Vignoli
- Unit of Addiction Treatment Lugo (Ravenna) Italy
| | | | | | | | - Sarino Aricò
- Gastroenterology Unit Mauriziano Hospital Torino Italy
| | | | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Regional Centre on Alcohol ASL3 San Martino Hospital Genoa Italy
| | | | | | | | | | | | | | - Doda Renzetti
- Department of Internal Medicine Mater Dei Hospital Bari Italy
| | | | - Claudia Gandin
- National Observatory on Alcohol National Institute of Health Rome Italy
| | | | - Giacomo Caio
- Centre for the Study and Treatment of Alcohol‐Related Diseases Department of Translational Medicine, University of Ferrara Ferrara Italy
| | - Lisa Lungaro
- Centre for the Study and Treatment of Alcohol‐Related Diseases Department of Translational Medicine, University of Ferrara Ferrara Italy
| | - Giorgio Zoli
- Centre for the Study and Treatment of Alcohol‐Related Diseases Department of Translational Medicine, University of Ferrara Ferrara Italy
- Department of Internal Medicine, SS Annunziata Hospital, Cento (Ferrara) University of Ferrara Ferrara Italy
| | - Emanuele Scafato
- National Observatory on Alcohol National Institute of Health Rome Italy
| | - Fabio Caputo
- Centre for the Study and Treatment of Alcohol‐Related Diseases Department of Translational Medicine, University of Ferrara Ferrara Italy
- Department of Internal Medicine, SS Annunziata Hospital, Cento (Ferrara) University of Ferrara Ferrara Italy
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17
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Abstract
Substance use disorders (SUDs) are often associated with alcohol use disorders (AUDs) and psychiatric comorbidities. In addition, they are often subjected to polytherapy. For these reasons SUDs patients are at greater risk of developing liver disease. In this concise review, liver damage from amphetamines, cannabinoids, cocaine and opioids is analyzed and the need to identify a possible associated alcohol use disorder is also suggested. Early identification of liver fibrosis is required in SUDs patients. Fibrosis is the most significant predictor of both prognosis and long-term survival. Its identification helps to promote the abstention from substances and alcohol. Active use of heroin, cocaine and synthetic substances is an absolute controindication for liver transplantation. In cases of remission and adherence to a significant care path, the patient is reevaluated. An addiction specialist should be present within the transplant team. If this is not present, a close collaboration with an addiction unit is mandatory.
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Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o San Martino Hospital, Genoa, Italy -
| | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o San Martino Hospital, Genoa, Italy
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18
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Testino G, Fagoonee S, Balbinot P, Pellicano R. Alcohol-related liver disease in patients admitted to intensive care unit: how to define alcohol consumption? Scand J Gastroenterol 2021; 56:559. [PMID: 33651962 DOI: 10.1080/00365521.2021.1891455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Centre; ASL3 c/o San Martino Hospital, Genova, Italy
| | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging, National Research Council, Molecular Biotechnology Center, Turin, Italy
| | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Centre; ASL3 c/o San Martino Hospital, Genova, Italy
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19
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Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology, IRCCS San Martino University Hospital, ASL3 Liguria, Genoa, Italy
| | - Gianni Testino
- Unit of Addiction and Hepatology, IRCCS San Martino University Hospital, ASL3 Liguria, Genoa, Italy -
| | - Fabio Caputo
- Unit of Internal Medicine, Cento Hospital, University of Ferrara, Ferrara, Italy
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20
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Testino G, Balbinot P. A comment on alcohol consumption and breast cancer risk. Minerva Endocrinol (Torino) 2021; 47:256-257. [PMID: 33829751 DOI: 10.23736/s2724-6507.21.03403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Centre -
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21
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Scafato E, Caputo F, Patussi V, Balbinot P, Addolorato G, Testino G. The undertreatment of alcohol-related liver diseases among people with alcohol use disorder. Eur Rev Med Pharmacol Sci 2021; 24:974-982. [PMID: 32017006 DOI: 10.26355/eurrev_202001_20083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Harmful and hazardous alcohol consumption is one of the most significant public health problems in Italy and Europe. Habitual excessive consumption and occasional excessive consumption, known as binge drinking, are the two main risk behaviours related to alcohol. Harmful drinking and alcohol dependence have strong social repercussions in terms of their social and economic impact and contribution to productivity losses. In addition, the terms alcohol abuse and alcohol dependence have been recently substituted by the only term of alcohol use disorder (AUD). The issues presented in this review demonstrate that excessive alcohol consumption is a growing public health concern and an appropriate national action plan is needed to increase the prevention of harmful and hazardous consumption and encourage patients to seek healthcare. To date, the main problem is the under-treatment of the population at risk, manifested as the time-lag between the onset of AUD and the first clinical detection. In order to address this, the Screening, Brief Intervention, and Referral to Treatment (SBIRT) strategy has been shared across countries in Europe and is supported by a Systematic Review of Reviews on SBIRT in primary healthcare. Unfortunately, there are still obstacles in the implementation of this approach. The main problem would appear to be general practitioners' difficulty in carrying out accurate and widespread screening, because they may minimize the problem. A more concerted effort in the training of healthcare professionals could address this by enabling the creation of renewed networks for the early identification of harmful and hazardous drinkers. These networks could prevent the occurrence of avoidable alcohol-related conditions, such as alcohol-related liver disease (ALD), while allowing for the timely implementation of evidence-based brief interventions.
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Affiliation(s)
- E Scafato
- National Observatory on Alcohol, National Institute of Health, Rome, Italy.
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22
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Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o IRCCS San Martino Hospital, Genoa, Italy -
| | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o IRCCS San Martino Hospital, Genoa, Italy
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23
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Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o IRCCS San Martino Hospital, Genoa, Italy -
| | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Centre, ASL3 c/o IRCCS San Martino Hospital, Genoa, Italy
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24
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Affiliation(s)
- Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3, San Martino Polyclinic Hospital, Genoa, Italy -
| | - Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3, San Martino Polyclinic Hospital, Genoa, Italy
| | - Silvia Leone
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3, San Martino Polyclinic Hospital, Genoa, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette-S. Giovanni Antica Sede Hospital, Turin, Italy
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25
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Balbinot P, Leone S, Testino G, Caputo F. Hospital readmission of patients with hepatic encephalopathy: Is the introduction of the formal caregiver useful in care management? Dig Liver Dis 2020; 52:358-359. [PMID: 31874833 DOI: 10.1016/j.dld.2019.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology, ASL3 Liguria c/o San Martino Hospital, Genova, Italy
| | - Silvia Leone
- Unit of Addiction and Hepatology, ASL3 Liguria c/o San Martino Hospital, Genova, Italy
| | - Gianni Testino
- Unit of Addiction and Hepatology, ASL3 Liguria c/o San Martino Hospital, Genova, Italy.
| | - Fabio Caputo
- Department of Internal Medicine, SS Annunziata Hospital, Cento, Ferrara, Italy; "G. Fontana" Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Science, University of Bologna, Italy
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26
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27
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Affiliation(s)
| | - Silvia Leone
- Unit of Addiction Medicine and Hepatology, Regional Alcohol Treatment Center, ASL3 Liguria, Genoa, Italy
| | | | - Patrizia Balbinot
- Unit of Addiction Medicine and Hepatology, Regional Alcohol Treatment Center, ASL3 Liguria, Genoa, Italy
| | | | - Gianni Testino
- Unit of Addiction Medicine and Hepatology, Regional Alcohol Treatment Center, ASL3 Liguria, Genoa, Italy -
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28
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Testino G, Balbinot P, Sampietro L, Bottaro LC. [Addiction disorders: a new management.]. Recenti Prog Med 2019; 110:230-235. [PMID: 31140455 DOI: 10.1701/3163.31445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Psychiatry and addiction disorders are closely linked, but the current epidemiological and clinical evidence impose us to effectively define the "dependence medicine" (DM) discipline, and to review its management. The need for change is also suggested indirectly by the new DSM-5 which proposes a partial overcoming of the term 'addiction' by introducing the definitions Substances Use Disorders (SUDs), Alcohol Use Disorders (AUDs), and disorders related to behavioral alterations (behavioral disorders): eating disorders, gambling, etc. These disorders can generate organic diseases, psychic, family and social problems. The onset of psycho-pathological diseases, in young poly-dependents, occurs in a high percentage of cases of SUDs and/or AUDs (40-70%); the constant increase of young poly-dependents requires us to avoid psychiatrization as a first approach. For these reasons we suggest a change of management in this field, underlining how the DM combines elements of public health, prevention, internal medicine, clinical pharmacology, neurology 'and even psychiatry'.
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Affiliation(s)
- Gianni Testino
- Centro Alcologico Regionale - Regione Liguria, ASL3 Liguria, Ospedale Policlinico San Martino, Genova
| | - Patrizia Balbinot
- Centro Alcologico Regionale - Regione Liguria, ASL3 Liguria, Ospedale Policlinico San Martino, Genova
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29
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30
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Pezzilli R, Caputo F, Testino G, Patussi V, Greco G, Macciò L, Rossin MR, Mioni D, Balbinot P, Gandin C, Zanesini F, Frulloni L, Aricò S, Bottaro LC, Pellicano R, Scafato E. Alcohol-related chronic exocrine pancreatic insufficiency: diagnosis and therapeutic management. A proposal for treatment by the Italian Association for the Study of the Pancreas (AISP) and the Italian Society of Alcohology (SIA). Minerva Med 2019; 110:425-438. [PMID: 30938130 DOI: 10.23736/s0026-4806.19.06043-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Current estimates of the prevalence of chronic pancreatitis, one of the most common causes of exocrine pancreatic insufficiency, are in the range of 3-10 per 100,000 people in many parts of the world. Alcohol consumption is a very important risk factor for exocrine pancreatic insufficiency and is involved in nearly half of all cases. The main hypothesis regarding the role of chronic alcohol consumption in pancreatitis is that there must be additional environmental or genetic risk factors involved for ongoing damage to occur. Treatment of patients with alcohol-related exocrine pancreatic insufficiency is complex, as the patient has two concomitant pathologies, alcohol-use disorder (AUD) and exocrine pancreatic insufficiency/chronic pancreatitis. Alcohol abstinence is the starting point for treatment, although even this along with the most advanced therapies allow only a slowdown in progression rather than restoration of function. This position paper of the Italian Association for the Study of the Pancreas and the Italian Society of Alcohology provides an overview of the pathogenesis of alcohol-related pancreatitis and discuss diagnostic issues. Treatment options for both exocrine pancreatic insufficiency/chronic pancreatitis (with a focus on pancreatic enzyme replacement therapy) and AUD (acamprosate, disulfiram, oral naltrexone, long-acting injectable naltrexone, sodium oxybate, nalmefene, baclofen, and psychosocial interventions) are also reviewed.
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Affiliation(s)
- Raffaele Pezzilli
- Pancreas Unit, Department of Gastroenterology, Polyclinic of Sant'Orsola, Bologna, Italy - .,Italian Association for the Study of the Pancreas, Rome, Italy -
| | - Fabio Caputo
- Department of Internal Medicine, SS. Annunziata Hospital, Cento, Ferrara, Italy.,G. Fontana Center for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Gianni Testino
- Regional Alcohol Center of Liguria Region, ASL3, San Martino Hospital, Genoa, Italy
| | | | - Giovanni Greco
- Department of Mental Health and Pathological Dependency, AUSL Romagna, SerT Ravenna, Ravenna, Italy
| | | | | | - Davide Mioni
- Casa di Cura Parco dei Tigli, Villa Di Teolo, Padua, Italy
| | - Patrizia Balbinot
- Regional Alcohol Center of Liguria Region, ASL3, San Martino Hospital, Genoa, Italy
| | - Claudia Gandin
- National Observatory on Alcohol, National Institute of Health, Rome, Italy
| | | | - Luca Frulloni
- Department of Medicine, Pancreas Institute, University of Verona, Verona, Italy
| | - Sarino Aricò
- Unit of Gastroenterology, Mauriziano Hospital, Turin, Italy
| | | | | | - Emanuele Scafato
- National Observatory on Alcohol, National Institute of Health, Rome, Italy
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31
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Affiliation(s)
- Gianni Testino
- Alcohological Regional Centre, Ligurian Region, ASL3 c/o San Martino Hospital, Genoa, Italy -
| | - Patrizia Balbinot
- Alcohological Regional Centre, Ligurian Region, ASL3 c/o San Martino Hospital, Genoa, Italy
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32
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Caputo F, Agabio R, Vignoli T, Patussi V, Fanucchi T, Cimarosti P, Meneguzzi C, Greco G, Rossin R, Parisi M, Mioni D, Arico' S, Palmieri VO, Zavan V, Allosio P, Balbinot P, Amendola MF, Macciò L, Renzetti D, Scafato E, Testino G. Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol. Intern Emerg Med 2019; 14:143-160. [PMID: 30187438 DOI: 10.1007/s11739-018-1933-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/22/2018] [Indexed: 02/07/2023]
Abstract
The chronic use of alcohol can lead to the onset of an alcohol use disorder (AUD). About 50% of subjects with an AUD may develop alcohol withdrawal syndrome (AWS) when they reduce or discontinue their alcohol consumption and, in 3-5% of them, convulsions and delirium tremens (DTs), representing life-threatening complications, may occur. Unfortunately, few physicians are adequately trained in identifying and treating AWS. The Italian Society on Alcohol has, therefore, implemented a task force of specialists to draw up recommendations for the treatment of AWS with the following main results: (1) while mild AWS may not require treatment, moderate and severe AWS need to be pharmacologically treated; (2) out-patient treatment is appropriate in patients with mild or moderate AWS, while patients with severe AWS need to be treated as in-patients; (3) benzodiazepines, BDZs are the "gold standard" for the treatment of AWS and DTs; (4) alpha-2-agonists, beta-blockers, and neuroleptics may be used in association when BDZs do not completely resolve specific persisting symptoms of AWS; (5) in the case of a refractory form of DTs, the use of anaesthetic drugs (propofol and phenobarbital) in an intensive care unit is appropriate; (6) alternatively to BDZs, sodium oxybate, clomethiazole, and tiapride approved in some European Countries for the treatment of AWS may be employed for the treatment of moderate AWS; (7) anti-convulsants are not sufficient to suppress AWS, and they may be used only in association with BDZs for the treatment of refractory forms of convulsions in the course of AWS.
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Affiliation(s)
- Fabio Caputo
- Unit of Internal Medicine, Department of Internal Medicine, SS Annunziata Hospital, Via Vicini 2, 44042, Cento, Ferrara, Italy.
- "G. Fontana" Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Roberta Agabio
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Teo Vignoli
- Unit of Addiction Treatment, Lugo, Ravenna, Italy
| | | | | | | | | | | | | | | | - Davide Mioni
- Nursing Home Parco dei Tigli, Teolo, Padova, Italy
| | - Sarino Arico'
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Vincenzo Ostilio Palmieri
- "Murri" Clinic of Internal Medicine, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | | | | | | | | | | | - Doda Renzetti
- Department of Internal Medicine, Mater Dei Hospital, Bari, Italy
| | - Emanuele Scafato
- National Observatory on Alcohol, National Institute of Health, Rome, Italy
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33
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Balbinot P, Testino G. Adolescenza e dipendenze: non solo chimica, ma anche "spiritualità". Gazz Med Ital - Arch Sci Med 2018. [DOI: 10.23736/s0393-3660.17.03607-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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34
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Affiliation(s)
- Patrizia Balbinot
- Alcohological Regional Center, Ligurian Region, ASL3 c/o IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Sharmila Fagoonee
- Institute for Biostructures and Bioimages, Center for Molecular Biotechnologies, Turin, Italy
| | | | - Gianni Testino
- Alcohological Regional Center, Ligurian Region, ASL3 c/o IRCCS San Martino Polyclinic Hospital, Genoa, Italy -
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35
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Testino G, Bottaro LC, Patussi V, Scafato E, Addolorato G, Leone S, Renzetti D, Balbinot P, Greco G, Fanucchi T, Schiappacasse G, Cardinale P, Allosio P, Pellicano R, Caputo F. Addiction disorders: a need for change. Proposal for a new management. Position paper of SIA, Italian Society on Alcohol. Minerva Med 2018; 109. [DOI: 10.23736/s0026-4806.18.05741-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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36
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Testino G, Bottaro LC, Balbinot P, Leone S, Pellicano R. Alcohol use disorders, cardiomyopathy and heart transplantation: a new management. Minerva Cardioangiol 2018; 66:744-746. [PMID: 29792019 DOI: 10.23736/s0026-4725.18.04725-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gianni Testino
- Alcohological Regional Center - Ligurian Region, ASL3 at San Martino Policlinic Hospital, Genoa, Italy -
| | | | - Patrizia Balbinot
- Alcohological Regional Center - Ligurian Region, ASL3 at San Martino Policlinic Hospital, Genoa, Italy
| | - Silvia Leone
- Alcohological Regional Center - Ligurian Region, ASL3 at San Martino Policlinic Hospital, Genoa, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology and Hepatology, Molinette Hospital, Turin, Italy
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37
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Affiliation(s)
- Gianni Testino
- Alcohological Regional Center of Liguria Region, ASL3, San Martino Polyclinic, Genoa, Italy -
| | - Silvia Leone
- Alcohological Regional Center of Liguria Region, ASL3, San Martino Polyclinic, Genoa, Italy
| | - Patrizia Balbinot
- Alcohological Regional Center of Liguria Region, ASL3, San Martino Polyclinic, Genoa, Italy
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Testino G, Balbinot P. Ethanol, flavonoid and prevention. Alexandria Journal of Medicine 2017. [DOI: 10.1016/j.ajme.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Gianni Testino
- Centro Alcologico Regionale – Regione Liguria, IRCCS AOU San Martino-IST, Genova, Italy
| | - Patrizia Balbinot
- Centro Alcologico Regionale – Regione Liguria, IRCCS AOU San Martino-IST, Genova, Italy
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Testino G, Patussi V, Balbinot P, Scafato E. [Alcohol and cancer: an undervalued problem in prevention programmes]. Epidemiol Prev 2016; 40:386. [PMID: 27919142 DOI: 10.19191/ep16.6.p386.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gianni Testino
- Centro alcologico regionale, Regione Liguria, IRCCS AOU San Martino-IST, Genova.,Collaborative Centre for Health Promotion, Research on Alcohol and Alcohol Related Health Problems, World Health Organization
| | - Valentino Patussi
- Collaborative Centre for Health Promotion, Research on Alcohol and Alcohol Related Health Problems, World Health Organization.,Centro alcologico regionale, Regione Toscana, AOU Careggi, Firenze
| | - Patrizia Balbinot
- Centro alcologico regionale, Regione Liguria, IRCCS AOU San Martino-IST, Genova.,Collaborative Centre for Health Promotion, Research on Alcohol and Alcohol Related Health Problems, World Health Organization
| | - Emanuele Scafato
- Collaborative Centre for Health Promotion, Research on Alcohol and Alcohol Related Health Problems, World Health Organization.,Istituto superiore di sanità, Roma
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