Identification of harmful drinking in subjects who have had their driving license suspended due to alcohol use: a retrospective Italian study

OBJECTIVE

Early identification of Harmful Drinking (HD) is difficult, and underestimated. The aim of our retrospective study was to investigate the presence of HD in a population of subjects who had their driving license suspended due to driving under the influence of alcohol.

MATERIALS AND METHODS

We retrospectively recruited 979 subjects. During the first appointment (T0), clinical and laboratory characteristics of patients were evaluated, and the AUDIT questionnaire was administered. Two groups were then defined: Harmful Drinking (HD) and non-HD, and all subjects underwent a brief interview for 5-10 minutes before being assigned to a group.

RESULTS

95.9% of our sample were identified as non-HD, whereas 4.1% of them were HD; twenty-one (2.1%) of the HD underwent a control appointment (T1), and 17 (1.7%) of them were diagnosed with alcohol use disorder (AUD); there was a statistically significant reduction in mean daily alcohol intake (p<0.009), and in the mean values of the blood markers of HD between T0 and T1 in HD.

CONCLUSIONS

The present study shows that 4.1%, and 1.7% of subjects presented a diagnosis of HD and AUD, respectively, and their entry in a protocol of drinking monitoring proved beneficial in reducing alcohol intake. Thus, the implementation of strict surveillance of subjects found driving under the influence of alcohol involving a network of professional figures (from police forces to specialists in alcohol addiction treatment) may help to detect and to treat subjects with HD and AUD, and to monitor their alcohol use over time.

Results of process evaluation of the Unplugged school-based prevention program in Nigeria

Background

The UNODC with the collaboration of the Government implemented in Nigeria a large-scale project to promote healthy lifestyles in schools, families and communities. Within the project, the prevention program Unplugged was tested through a randomized controlled trial. This study aims to evaluate the implementation of the program in the intervention schools and the satisfaction of teachers and students.

Methods

32 schools were randomly extracted from a list of 60 schools provided by the Federal Ministry of Education. 16 schools were randomly allocated to intervention and implemented Unplugged. To monitor program implementation, the teachers filled a form reporting data on fidelity of implementation. To monitor satisfaction, teachers and students filled an anonymous form at the end of the program.

Results

69% of intervention schools participated in the process evaluation. The duration of the units was on average 55 min. The implementation rate was very high. All classes implemented six units whilst less than 10% did not implement the other six units. The highest rate of not implementing classes was observed for unit 11 and 12. The highest student interest as declared by the teachers was observed for Unit 1 and 8, the highest interactivity for Unit 9 and 8. Most teachers found the units easy to lead and referred an improvement of teaching skills, knowledge about substances, relationship with the students and class climate, and found very useful the Teacher Handbook. Ninety percent of students considered Unplugged useful for their choices, for 82% it improved the vision of themselves, for 95% their knowledge, for 80% the relationship with mates and for 77% the relationship with teachers. 97.5% of students would like to have a similar program next year.

Conclusions

Unplugged reached in Nigeria very good results in terms of implementation and satisfaction of teachers and students. Process evaluation is useful to improve the quality of prevention interventions.

Key messages

School based prevention interventions like Unplugged can be successfully implemented in low income countries, especially when supported by printed Handbook for teachers. Teachers and students participating in Unplugged perceived an improvement of class climate and relationship between teachers and students due to the program.

18F-FDG PET/CT in the post-operative monitoring of patients with adrenocortical carcinoma

CONTEXT

The role of (18)F-labeled 2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the post-operative monitoring of patients with adrenocortical carcinoma (ACC) is still unclear.

OBJECTIVE

To assess the accuracy of FDG PET/CT to diagnose ACC recurrence in a real world setting.

DESIGN AND METHODS

Retrospective evaluation of data of 57 patients with presumed ACC recurrence at CT scan who underwent FDG PET/CT within a median time of 20 days. We compared the results of either FDG PET/CT or CT with a gold standard confirmation of recurrence (positive histopathology report of removed/biopsied lesions or radiological progression of target lesions at follow-up) to assess their diagnostic performance at different body sites to correctly categorize target lesions. We also assessed whether FDG PET/CT findings may be useful to inform the management strategy.

RESULTS

In 48 patients with confirmed ACC recurrence, we found that FDG PET/CT had lower sensitivity than CT in diagnosing liver and lung recurrences of ACC. FDG PET/CT had higher specificity than CT in categorizing liver lesions. FDG PET/CT had a greater positive likelihood ratio than CT to identify liver and abdominal ACC recurrences. The management strategy was changed based on FDG PET/CT findings in 12 patients (21.1%).

CONCLUSIONS

The greater sensitivity of CT may be partly expected due the specific inclusion criteria of the study; however, the greater specificity of FDG PET/CT was particularly useful in ruling out suspected ACC recurrences found by CT. Thus, use of FDG PET/CT as a second-line test in the post-operative surveillance of ACC patients following CT finding of a potential recurrence may have a significant impact on patient management.

Personality Disorders in a Sample of Inpatients Alcoholics Entering Detoxification Treatment in Italy: Prevalence and Gender Differences

Introduction

Alcohol abuse and dependence are frequently associated with psychiatric disorders and Personality Disorders, with differences among genders. However, only few studies investigated gender differences in personality disorders among alcoholics.

Aims

The aim of our study is to investigate personality disorders in a sample of inpatient alcoholics applying Millon Clinical Multiaxial Inventory - III, and to describe gender differences in prevalence and comorbidity of personality disorders.

Methods

The study population consist of 206 alcohol dependent patients entering detoxification treatment in a specialized clinic in Italy. At enrollment, patients filled in the Millon Clinical Multiaxial Inventory - III for the assessment of personality disorders and the AUDIT Test for the evaluation of alcohol consumption.

Results

The sample consisted of 150 men and 56 women. According to Millon assessment, 25% percent of men vs 12% of women had one PDs, 16% vs 23% had two PDs, and 46% vs 48% had more than three PDs. A statistically significant higher proportion of women got high scores on Avoidant (21.4% vs 9.3%, p = 0.020), Self-Defeating (50.0% vs 24.0%, p < 0.001), and Borderline scale (42.9% vs 25.3%, p = 0.015). Associations among PD are sporadic among men whilst are very frequent among women. Depressive, Self-Defeating and Borderline PDs are frequently associated both to other PDs and among each other, suggesting a possible female pattern.

Conclusions

Borderline PD is confirmed to be more frequent among alcoholic women than among men. More studies are needed to clarify prevalence and associations of PDs, prognosis, and gender differences in alcoholics patients.

Is universal prevention against youths' substance misuse really universal? Gender-specific effects in the EU-Dap school-based prevention trial

BACKGROUND

Studies of effectiveness of school-based prevention of substance misuse have generally overlooked gender differences. The purpose of this work was to analyse gender differences in the effectiveness of a new European school-based curriculum for prevention of substance misuse among adolescents.

METHODS

The European Drug Abuse Prevention (EU-Dap) trial took place in seven European countries during the school year 2004-05. Schools were randomly assigned to either a control group or a 12-session standardised curriculum ("Unplugged") based on a comprehensive social influence model. The analytical sample consisted of 6359 students (3324 boys and 3035 girls). The use of cigarettes, alcohol and illicit drugs, adolescents' knowledge and opinions about substances, as well as social and personal skills were investigated through a self-completed anonymous questionnaire administered at enrollment and 3 months after the end of the programme. Adjusted Prevalence Odds Ratios were calculated as the measure of association between the intervention and behavioural outcomes using multilevel regression modelling.

RESULTS

At enrollment, boys were more likely than girls to have used cannabis and illicit drugs, whereas girls had a higher prevalence of cigarette smoking. At the follow-up survey, a significant association between the programme and a lower prevalence of all behavioural outcomes was found among boys, but not among girls. Age and self-esteem emerged as possible modifiers of these gender differences, but effects were not statistically significant.

CONCLUSIONS

Comprehensive social influence school curricula against substance misuse in adolescence may perform differently among girls and boys, owing to developmental and personality factors.

Quality of systematic reviews used in guidelines for oncology practice

BACKGROUND

Systematic reviews are an important tool for developing clinical recommendations. Those of high quality assure a good level of confidence on the strength of the recommendations.

METHODS

A QUOROM-based checklist was applied to the reviews cited in a sample of guidelines on breast and colon cancer prevention and therapy. The checklist provided a weight for each criterion and a total quality score. Each review was independently evaluated by two reviewers; disagreements were solved by consensus.

RESULTS

Eighty reviews (96%) were retrieved and evaluated; 36 focused on breast, and 44 on colorectal cancer. Twenty-three reviews (29%) did not match the definition of systematic review. In 17 (21%) the searching methods were unclear or described elsewhere. Forty (50%) were systematic. Not systematic, low and very low quality reviews accounted for 70% of the total. No review obtained the A+ class score; only 5 (6%) the A- and 7 (9%) the B+.

CONCLUSIONS

The results of this assessment provide a sober picture of the quality of the sources used to build guidelines. Oncologists should be aware that they could be relying on poor underlying documents. Writing groups should be aware of methodological problems, and should consult the existing manuals for the preparation of guidelines.

Methadone maintenance at different dosages for opioid dependence

BACKGROUND

Methadone maintenance treatment (MMT) is a long term opioid replacement therapy, recognised as effective in the management of opioid dependence. Even if MMT at high dosage is recommended as therapy for reducing illicit opioid use and promoting longer retention in treatment, at present day "the organisation and regulation of the methadone maintenance treatment varies widely".

OBJECTIVES

To evaluate the efficacy of different dosages of MMT for opioid dependence in modifying health and social outcomes and in promoting patients' familial, occupational and relational functioning.

SEARCH STRATEGY

The following sources were scanned: - MEDLINE (OVID 1966-2001)- EMBASE (1988-2001)- ERIC (1988-2001)- Psychinfo (1947-2001)- Cochrane Controlled Trials Register (CCTR) (1947-2001)- Register of the Cochrane Drug and Alcohol Group (CDAG) (1947-2001)The CDAG search strategy was applied together with a specific MESH strategy. Further studies were searched through: letters to the authors of selected trials or to experts in order to obtain unpublished data. check of references of relevant reviews.

SELECTION CRITERIA

Randomised Controlled Trials (RCT) and Controlled Prospective Studies (CPS) evaluating methadone maintenance at different dosages in the management of opioid dependence were included in the review. Non-randomised trials were included when proper adjustment for confounding factors was performed at the analysis stage.

DATA COLLECTION AND ANALYSIS

Extraction of data was performed separately by two reviewers. Discrepancies were resolved by a third reviewer. RevMan software was used for analysis. Quality assessments of the methodology of studies were carried out using CDAG checklist.

MAIN RESULTS

22 studies were excluded from the review. 21 studies were included; of them, 11 were RCTs with 2279 people randomised and 10 were CPSs with 3715 people followed-up.

OUTCOMES

Retention rate - RCTs: High vs low doses at shorter follow-ups: RR=1.36 [1.13,1.63], and at longer ones: RR=1.62 [0.95,2.77]. Opioid use (self reported), times/w - RCTs: high vs low doses WMD= -2.00 [-4.77,0.77] high vs middle doses WMD= -1.89[-3.43, -0.35] Opioid abstinence, (urine based) at >3-4 w - RCTs: high vs low ones: RR=1.59 [1.16,2.18] high vs middle doses RR=1.51[0.63,3.61] Cocaine abstinence (urine based) at >3-4 w - RCTs: high vs low doses RR=1.81 [1.15,2.85]Overdose mortality - CPSs: high dose vs low dose at 6 years follow up: RR=0.29 [0.02-5.34] high dose vs middle dose at 6 years follow up: RR=0.38 [0.02-9.34] middle dose vs low dose at 6 years follow up: RR=0.57 [0.06-5.06]

REVIEWER'S CONCLUSIONS

Methadone dosages ranging from 60 to 100 mg/day are more effective than lower dosages in retaining patients and in reducing use of heroin and cocaine during treatment. To find the optimal dose is a clinical ability, but clinician must consider these conclusions in treatment strategies.