Improving assessment of alcohol treatment barriers among Latino and White adults with an alcohol use disorder: Development of the barriers to specialty alcohol treatment scale

INTRODUCTION

The present study's aims were two-fold. First, we sought to validate a novel measure to assess barriers to specialty alcohol treatment among White and Latino individuals with an alcohol use disorder (AUD): The Barriers to Specialty Alcohol Treatment (BSAT) scale. Second, we sought to demonstrate that the BSAT scale could be used to explain Latino-White disparities in barriers to alcohol treatment.

METHODS

In 2021, we recruited an online national sample of 1200 White and Latino adults with a recent AUD. Participants completed an online questionnaire that included the BSAT items. Confirmatory and exploratory factor analyses were conducted to validate the BSAT. Multiple group analyses across race/ethnicity and language were also performed using the final model.

RESULTS

The final model consisted of 36 items across 7 factors that reflect barriers related to low problem recognition, recovery goals, low perceived treatment efficacy, cultural factors, immigration-related concerns, low perceived social support, and logistical barriers. The final model's factor structure and factor loadings held up across race/ethnicity and language. The top endorsed barriers were low problem recognition, recovery goals, low perceived social support, logistical issues, and low perceived treatment efficacy. Compared to Whites, Latinos were more likely to report perceived lack of social support, logistical barriers, low perceived treatment efficacy, cultural barriers, and immigration-related concerns as barriers.

CONCLUSION

Findings provide empirical support for the validity of the BSAT scale, which offers improved measurement of specialty alcohol treatment barriers and can be used to explore Latino-White disparities in a future study.

O4-2 Evaluate the health-enhancing physical activity policy of Rio de Janeiro: ‘Programa Academia Carioca'

Issue and problem

In Brazil, 47% of people are insufficiently physically active (Guthold et al, 2018). According to the Global Physical Activity Observatory, 13.2% of deaths in Brazil are caused by inactivity. Besides, Ding et al (2016) estimated the direct health cost attributable to physical inactivity in this country at 1.6 billion US dollars. Rio de Janeiro (RJ) is one of the largest cities in Brazil, with a high mortality rate (54.1%) from non-communicable diseases (NCDs) and substantial health inequalities (SIM/MRJ, 2019). As a large city, it reproduces a worldwide trend, which associates economic growth and urbanization with an unhealthy lifestyle and epidemic levels of obesity and remarkable physical inactivity (WHO, 2014).

Problem description

The multifactorial context above described enables NCDs and challenges health protection systems. For this reason, the Municipal Health Department of RJ implemented since 2009 a Health-Enhancing Physical Activity (HEPA) policy: ‘Programa Academia Carioca' (PAC). This policy supports regular physical activity free of charge, in Primary Care Health Units (UAP). The Program combines the practice of physical activity associated with various educational and community activities. It includes Physical Education professionals who work in a multidisciplinary way. Therefore, this study aims to evaluate the implementation of this policy.

Results (effects/changes)

After 11 years, the PAC has 142,969 participants, 80% of whom have NCDs. Among its participants, blood pressure control was demonstrated in 90% of hypertensive patients; weight loss, and a 60% reduction in cardiovascular risk classification, and suspension of medication in 20% of users. Being part of the PAC resulted in greater use and understanding of the general services of UAP in 86% and 98% of participants, respectively. Detailed results are not available at that time but will be presented at the conference.

Lessons

The PAC showed to be a successful tool to enhance health through physical activity at UAP. The use of trained and specialized professionals plays a fundamental key to develop educational and community actions in vulnerable groups.

Main messages

The implementation of an ambitious and integrated HEPA policy, considering environmental and health factors, can produce more effective institutional responses to change this epidemiological scenario.

Therapeutic challenge in delusional disorder: a case report and literature review

Introduction

Delusional disorder (DD) is defined by the presence of one or more delusions, of at least one month’s duration, in the absence of prominent hallucinations or other symptoms of schizophrenia. Although functioning may not be markedly impaired, the delusion(s) or its ramifications may have a significant impact in the patient’s life. With a life-time prevalence of 0.18%, DD is still neglected in terms of approved treatment recommendations.

Objectives

We present the case of a patient diagnosed with DD and discuss the treatment of DD according to current evidence.

Methods

Relevant clinical information was extracted from the patient’s clinical process. A non-systematic review was made in Pubmed database with the terms “Delusional Disorder” and “Treatment”.

Results

Male, 76 years old, divorced, living alone, autonomous. First admitted at age 62 in our inpatient psychiatry ward for a persecutory delusion regarding his neighbors. He was discharged with the diagnosis of DD and started a follow-up in a mental health community team. He abandoned treatment and psychiatric consultation after 9 years. During 17 years he moved home more than 10 times due to a progressive dynamism of the delusion, leading to recent marked behavior changes towards his neighbors. He is again admitted in our inpatient psychiatry ward.

Conclusions

This case illustrates the impact that untreated DD can have on its patients. Although consensus using antipsychotics, there are still insufficient studies to make evidence-based recommendations to treat people with DD. Further research is needed in this sense.

Disclosure

No significant relationships.

Menstrual psychosis diagnosis: Does it still hold?

Introduction

Menstrual psychosis was first described in the 18th century. Brockington defined its characteristics: acute onset; brief duration with full recovery; confusion, stupor and mutism, delusions, hallucinations, or a manic syndrome and periodicity in temporal association with the menstrual cycle.

Objectives

Description of a clinical case of menstrual psychosis and review of the literature.

Methods

Description of a clinical case. Non systematic review of the literature, searching the terms “psychosis”; “menstrual”; “catamenial” in the databases Pubmed, Medline and Cochrane.

Results

Female, 39-year-old patient. No psychiatric history until the postpartum period of a traumatic vaginal birth, when she developed stupor and mutism which lasted for two days. During the following 2 years, she progressively presented with sadness, asthenia, anhedonia, insomnia and incapacity for self-care. She was prescribed paroxetine and olanzapine, with partial recovery. Subsequently, she had at least 6 episodes with about 3-day duration of asthenia, food refusal, insomnia, incapacity for self-care, disorganization of thought and behavior and mystical and persecutory delusions, coincident with the beginning of menstruation. She was hospitalized in two of them and received treatment with venlafaxine 75mg and paliperidone 6mg, with psychotic symptoms remission after a week.

Conclusions

This case presents the characteristics of menstrual psychosis. This is a rare condition, with only 30 reported cases worldwide. According to current classification systems, this condition fulfills diagnostic criteria for brief psychotic disorder. Nonetheless, studying in more detail this disorder could be interesting, with the goal of deepening the knowledge of the neurobiology of psychosis, particularly the effects of estrogen on this disorder.

Disclosure

No significant relationships.

Cost-effectiveness analysis comparing companion diagnostic tests for EGFR, ALK, and ROS1 versus next-generation sequencing (NGS) in advanced adenocarcinoma lung cancer patients

BACKGROUND

The treatment of choice for advanced non-small cell lung cancer is selected according to the presence of specific alterations. Patients should undergo molecular testing for relevant modifications and the mutational status of EGFR and translocation of ALK and ROS1 are commonly tested to offer the best intervention. In addition, the tests costs should also be taken in consideration. Therefore, this work was performed in order to evaluate the cost-effectiveness of a unique exam using NGS (next generation sequencing) versus other routinely used tests which involve RT-PCR and FISH.

METHODS

The target population was NSCLC, adenocarcinoma, and candidates to first-line therapy. Two strategies were undertaken, strategy 1 corresponded to sequential tests with EGFR RT-PCR, then FISH for ALK and ROS1. Strategy 2 differed from 1 in that ALK and ROS1 translocation testing were performed simultaneously by FISH. Strategy 3 considered single test next-generation sequencing, a platform that includes EGFR, ALK and ROS1 genes. A decision tree analysis was used to model genetic testing options. From the test results, a microsimulation model was nested to estimate survival outcomes and costs of therapeutic options.

RESULTS

The use of NGS added 24% extra true cases as well as extra costs attributed to the molecular testing. The ICER comparing NGS with sequential tests was US$ 3479.11/correct case detected. The NGS improved a slight gain in life years and QALYs.

CONCLUSION

Our results indicated that, although precise, the molecular diagnosis by NGS of patients with advanced stage NSCLC adenocarcinoma histology was not cost-effective in terms of quality-adjusted life years from the perspective of the Brazilian supplementary health system.

Cost-effectiveness of QuantiFERON-TB Gold In-Tube versus tuberculin skin test for diagnosis and treatment of Latent Tuberculosis Infection in primary health care workers in Brazil

Objectives

The goal of this study was to perform a cost-effectiveness analysis from the public health system perspective, comparing five strategies for Latent Tuberculosis Infection (LTBI) diagnosis in primary health care workers in Brazil.

Design

Analytical model for decision making, characterized by cost-effectiveness analysis.

Setting

Primary Care Level, considering primary health care workers in Brazil.

Participants

An analytical model for decision making, characterized by a tree of probabilities of events, was developed considering a hypothetical cohort of 10,000 primary health care workers, using the software TreeAge Pro^™ 2013 to simulate the clinical and economic impacts of new diagnostic technology (QuantiFERON^®-TB Gold in-Tube) versus the traditional tuberculin skin test.

Methods

This model simulated five diagnostic strategies for LTBI in primary health care workers (HCW) in Brazil: tuberculin skin testing using ≥5 mm cut-off, tuberculin skin testing ≥10 mm cut-off, QuantiFERON^®-TB Gold in-Tube, tuberculin skin testing using ≥5 mm cut-off confirmed by QuantiFERON^®-TB Gold In-Tube if TST positive, tuberculin skin testing using ≥10 mm cut-off confirmed by QuantiFERON^®-TB Gold In-Tube if TST positive.

Primary and secondary outcome measures

The outcome measures are the number of individuals correctly classified by the test and the number of Tuberculosis cases avoided.

Results

The most cost-effective strategy was the tuberculin skin test considering ≥10mm cut-off. The isolated use of the QuantiFERON^®-TB Gold In-Tube revealed the strategy of lower efficiency with incremental cost-effectiveness ratio (ICER) of US$ 146.05 for each HCW correctly classified by the test.

Conclusions

The tuberculin skin test using ≥10 mm cut-off was the most cost-effective strategy in the diagnosis of Latent Tuberculosis Infection in primary health care works in Brazil.

Women economic empowerment via cash transfer and microcredit programs is enough to decrease intimate partner violence? Evidence from a systematic review

Intimate partner violence (IPV) is a worldwide public health problem. Many proposals aiming to eliminate its occurrence include the empowerment of women through their socio-economic development. In this context, some studies suggested that microcredit programs (MP) and cash transfer programs (CTP) are initiatives that can also reduce the risk of IPV. Others pointed to an opposite effect. The objective of this study was to investigate the influence of women's economic empowerment in MP and CTP on the risk of physical, psychological and sexual violence through a systematic review. Papers/documents selection was conducted by two researchers according to the following criteria: published in English, Portuguese or Spanish; primary data; assessing the effect of MP or CTP on IPV; in heterosexual couples; on women beneficiaries of the intervention; using a comparator group eligible for an MP or CTP; and focusing on risk IPV as the outcomes. Our results showed that the impact of MP are mixed when it comes to physical and physical/sexual violence. Even so, the review suggests that the effect of MP on sexual violence is trivial or nonexistent. Regarding the impact of CTPs, the present study showed that the effects on physical, physical/sexual, psychological, and sexual violence were also heterogeneous. Women more empowered and with some autonomy could be at risk. Despite that, participation in the empowerment program should be encouraged for poor women and families. However, parallel interventions to lead with IPV should be addressed to the main actions to reduce the risk of increasing IPV prevalence in certain scenarios.

Estimated cost of asthma in outpatient treatment: a real-world study

OBJECTIVE

To estimate the cost of diagnosis and treatment of asthma.

METHODS

We used the perspective of society. We sequentially included for 12 months, in 2011-2012, 117 individuals over five years of age who were treated for asthma in the Pneumology and Allergy-Immunology Services of the Piquet Carneiro Polyclinic, Universidade do Estado do Rio de Janeiro. All of them were interviewed twice with a six-month interval for data collection, covering 12 months. The cost units were identified and valued according to defined methods. We carried out a sensitivity analysis and applied statistical methods with a significance level of 5% for cost comparisons between subgroups.

RESULTS

The study consisted of 108 patients, and 73.8% of them were women. Median age was 49.5 years. Rhinitis was present in 83.3% of the individuals, and more than half were overweight or obese. Mean family income was U$915.90/month (SD = 879.12). Most workers and students had absenteeism related to asthma. Total annual mean cost was U$1,291.20/patient (SD = 1,298.57). The cost related to isolated asthma was U$1,155.43/patient-year (SD = 1,305.58). Obese, severe, and uncontrolled asthmatic patients had higher costs than non-obese, non-severe, and controlled asthmatics, respectively. Severity and control level were independently associated with higher cost (p = 0.001 and 0.000, respectively). The direct cost accounted for 82.3% of the estimated total cost. The cost of medications for asthma accounted for 62.2% of the direct costs of asthma.

CONCLUSIONS

Asthma medications, environmental control measures, and long-term health leaves had the greatest potential impact on total cost variation. The results are an estimate of the cost of treating asthma at a secondary level in the Brazilian Unified Health System, assuming that the treatment used represents the ideal approach to the disease.

"Farmácia Popular do Brasil" Program: characterization and evolution between 2004 and 2012

The "Farmácia Popular do Brasil" Program (PFPB) aims to improve access to medicines, offering subsidized products. It is structured in an arrangement involving public and private sectors. The paper described the organization and expansion of the PFPB and examined the reference price (RP) of the medicines paid by the government, between 2004 and 2012. It is an exploratory study of quantitative and qualitative approach, developed from the literature review and analysis of public documents. Quantitative data were collected from the Ministry of Health and Electronic System of Citizens Information Services. The PFPB is organized in two delivery models: public owned facilities (Rede Própria) and accredited private retail pharmacies (Aqui Tem Farmácia Popular-ATFP). The ATFP has allowed its own expansion, from 2006. Antihypertensives, antidiabetics and antiasthmatics were exempt from copayment, since 2011. The expansion of the ATFP Program was significant, for facilities and covered municipalities, 750% and 528%, respectively. The RP was reduced by 33.6% on average (ranging from 23-52%) for medicines available since the beginning of the ATFP. The expansion was performed with the actions hitherto unprecedented, as copayment and accreditation of private retail pharmacies.

Cost-effectiveness analysis comparing companion diagnostic tests for EGFR, ALK and ROS-1 versus next-generation sequence (NGS) in advanced adenocarcinoma lung cancer patients

9068

Background: Success of a target therapy is directly correlated with the accuracy of its companion diagnostic test. Without a corresponding biomarker, target therapy may yield shorter survival, waste time, increase burdens and costs. As important as conducting cost-effectiveness studies for therapies, it is also valuable to compare different molecular tests. In lung cancer, the mutational status of EGFR and translocation of ALK and ROS-1 are commonly tested to offer the best intervention. Our objective is to evaluate the cost-effectiveness of a unique exam using NGS versus other routinely used tests such as the ones which involve RT-PCR and FISH. Methods: Target population is NSCLC, adenocarcinoma, and candidates to first-line therapy. Strategy 1: test EGFR mutation if EGFR test is negative, individual follow to FISH for ALK; if FISH is negative, follow to FISH for ROS-1. Strategy 2: differs from 1 since FISH for ALK and ROS are requested together. Strategy 3: all individuals are submitted to NGS (multicomplex platform which include EGFR, ALK, ROS-1 and other genes). Tests could also be classified as unknown due to the quality of tumor sample. Prevalence of biomarker, test accuracy and proportion of unknown results were used to calculate each decision tree branch. Sensitivity and specificity was obtained from literature review using Sanger as reference standard for RT-PCR tests and NGS. The study was analyzed from a healthcare-payer perspective based on Brazilian private sector. Costs were based on data from diagnostic companies, ANS and AMB-CBHPM 2016. Results: The use of NGS added 24% extra cases correct identified as well as extra costs (US$ 800.76; PPP 2015) attributed to the molecular testing. The ICER comparing NGS with sequential tests was US$ 3,381.82/correct case detected. Comparing strategy 2:1, the ICER was US$937.86/correct case detected. Conclusions: this study is part of an effort to integrate companion diagnostics discussions on precision medicine and covered drugs in the Brazilian health system. These findings can also subsidy cost-effectiveness studies that incorporates subsequent treatments and survival.

The medicine selection process in four large university hospitals in Brazil: Does the DTC have a role?

Knowledge about evidence-based medicine selection and the role of the Drug and Therapeutics Committee (DTC) is an important topic in the literature but is scarcely discussed in Brazil. Our objective, using a qualitative design, was to analyze the medicine selection process performed in four large university hospitals in the state of Rio de Janeiro. Information was collected from documents, interviews with key informants and direct observations. Two dimensions were analyzed: the structural and organizational aspects of the selection process and the criteria and methods used in medicine selection. The findings showed that the DTC was active in two hospitals. The structure for decision-making was weak. DTC members had little experience in evidence-based selection, and their everyday functions did not influence their participation in DTC activities. The methods used to evaluate evidence were inadequate. The uncritical adoption of new medicines in these complex hospital facilities may be hampering pharmaceutical services, with consequences for the entire health system. Although the qualitative approach considerably limits the extent to which the results can be extrapolated, we believe that our findings may be relevant to other university hospitals in the country.

Economic contraction, alcohol intoxication and suicide: analysis of the National Violent Death Reporting System

OBJECTIVES

Although there is a large and growing body of evidence concerning the impact of contracting economies on suicide mortality risk, far less is known about the role alcohol consumption plays in the complex relationship between economic conditions and suicide. The aims were to compare the postmortem alcohol intoxication rates among male and female suicide decedents before (2005-2007), during (2008-2009) and after (2010-2011) the economic contraction in the USA.

METHODS

Data from the restricted National Violent Death Reporting System (2005-2011) for male and female suicide decedents aged 20 years and older were analysed by Poisson regression analysis to test whether there was significant change in the fractions of suicide decedents who were acutely intoxicated at the time of death (defined as blood alcohol content ≥0.08 g/dL) prior, during and after the downturn.

RESULTS

The fraction of all suicide decedents with alcohol intoxication increased by 7% after the onset of the recession from 22.2% in 2005-2007 to 23.9% in 2008-2011. Compared with the years prior to the recession, male suicide decedents showed a 1.09-fold increased risk of alcohol intoxication within the first 2 years of the recession. Surprisingly, there was evidence of a lag effect among female suicide decedents, who had a 1.14-fold (95% CI 1.02 to 1.27) increased risk of intoxication in 2010-2011 compared with 2005-2007.

CONCLUSIONS

These findings suggest that acute alcohol intoxication in suicide interacts with economic conditions, becoming more prevalent during contractions.

Análise dos custos do procedimento PET-TC com 18 F-FDG na perspectiva do SUS provedor: estudo em uma unidade pública de saúde do Rio de Janeiro, Brasil

A tomografia de emissão de pósitrons (PET) é de uso recente no Brasil e há necessidade de se estimar os custos do procedimento, de forma a subsidiar estudos de avaliação econômica sobre a tecnologia. O trabalho analisou o processo de produção da PET-TC utilizando 18 F-FDG e estimou seus custos na perspectiva de um provedor público de serviços de saúde. Utilizou- se a técnica de microcustos, com identificação, quantificação e valoração de todos os insumos consumidos na produção do procedimento. As estimativas de custo consideraram a observação de 85 exames realizados no Instituto Nacional de Câncer, de março/julho de 2012. O caso de referência considerou pacientes oncológicos adultos, volume de produção de 5 exames/dia e uso de uma dose de 18 F-FDG por paciente. Os custos unitários do procedimento foram de R$ 3.150,30, na perspectiva salarial da carreira de Ciência & Tecnologia, e de R$ 2.927,19 na do Ministério da Saúde. O elemento de maior impacto nos custos correspondeu ao volume diário de produção dos exames. Foram explorados elementos que podem impactar no custo do exame nas instituições públicas de saúde.

Construct validity of the short inventory of problems among Spanish speaking Hispanics

OBJECTIVE

Research on ethnic health disparities requires the use of psychometrically sound instruments that are appropriate when applied to ethnically diverse populations. The Short Inventory of Problems (SIP) assesses alcohol-related consequences and is often used as a measure to evaluate intervention effectiveness in alcohol research; however, whether the psychometric properties of this instrument are comparable across language and ethnicity remains unclear.

METHOD

Multi-group confirmatory factor analysis (MGCFA) was used to test for the invariance of the measurement structure of the SIP across White Non-Hispanic English speaking (N=642), Hispanic English speaking (N=275), and Hispanic Spanish speaking (N=220) groups.

RESULTS

The MGCFA model in which factor loadings, measurement intercepts, and item residuals were constrained to be equal between English speakers and Spanish speakers exhibited a reasonable fit to the data, χ(2)(221)=1089.612 p<.001, TLI=.926; CFI=.922, RMSEA=.059 (90% CI=.055-.062). The ΔCFI supported strict factorial invariance, ΔCFI=.01, across groups; no significant group differences were found between factor loadings, measurement intercepts, or item residuals between English speakers and Spanish speakers.

CONCLUSIONS

This study extends the existing confirmatory factor analysis results of the SIP by providing additional data to inform the utility of the SIP among Hispanics. Strict factorial invariance between Spanish and English speakers is necessary to: conclude that the underlying constructs have the same meaning across groups; test for group differences in the latent variables across groups; and presume that group differences are attributable only to true differences between groups. Thus, the SIP is strongly supported for evaluating the effectiveness of alcohol treatment among Hispanics.

[Dispensing specialized component medicines in areas of the State of Rio de Janeiro]

The Specialized Pharmaceutical Services Component (CEAF) ensures the dispensing of high-cost medicines for the treatment of specific diseases. The fact that these medicines are mandatory though access is only through legal injunctions, suggests flaws in the management of pharmaceutical services. This paper analyzed adherence to Clinical Protocols and Therapeutic Guidelines (PCDT) in the dispensing of these CEAF medicines. Qualitative research was also conducted in facilities with different characteristics in the State of Rio de Janeiro. It was noted that the lack of adequate structure in the units studied, including trained personnel, compromises the dispensing CEAF medicines in all facilities. The CEAF dispensing procedure, heavily dependent on interaction between prescribers and dispensers, is not carried out as would be expected. It is possible that inadequate performance is also linked to flaws in the planning and organization of services. The results indicate barriers in adherence to PCDT by health professionals, prejudicing health system users and possibly leading them to access medicines by legal means. It is believed that characteristics of the investigated facilities are similar to others in Brazil, and the barriers identified may be the same, compromising healthcare.

Alcohol dependence in the 1990 US National Alcohol Survey: operationalizing and comparing two nosological systems

The criteria for alcohol dependence in both the ICD-10 and DSM-III-R nosologies were measured in a national general population survey, using 24 stem items and follow-ups. For current (12-month) dependence (at the criterion of 3+ components), the rate was 3.2% according to DSM-III-R criteria, and 5.4% according to ICD-10. The Kappa coefficient of agreement between the two systems for classification of individuals as currently dependent was 0.62, and for lifetime diagnosis the Kappa coefficient was 0.68. Prevalence for the individual components of each diagnosis and for the underlying items are given, and the contribution of each component to the overall dependence score is examined. Implications of the results for future epidemiological work with the two classifications are discussed.

Estimates of thyroid cancer incidence in Brazil: an approach using polynomial models

This study aimed to estimate thyroid cancer incidence in Brazil in 2006 using polynomial models that take age and birth cohort effects into account in the estimation process. Estimates were based on new cases of thyroid cancer in nine Brazilian cities (Manaus, Palmas, Natal, Recife, Cuiabá, Belo Horizonte, São Paulo, Porto Alegre, and Curitiba) and the Federal District from 1997 to 2001. We estimated 6,066 new cases, of which 1,065 in men and 5,001 in women. The incidence rates were, respectively, 1.16 and 5.27 per 100,000 inhabitants. Rates increased with age in both genders, especially after 30 years. The size and profile of rates according to age and gender indicate that the method yields plausible estimates.

[Non-invasive cerebral oximetry monitoring in percutaneous cardiac valvular implantations: two cases report]

Cerebral oximetry non-invasive technology is based on cerebral tissue oxygen saturation (StcO2) measure in microcirculation, through near-infrared spectroscopy (NIRS)). As a result, cerebral oximetry (StcO2) is a mixed oxygen saturation parameter between de-oxide and oxide hemoglobin witch estimates a value between arterial (SaO2) and jugular venous saturation (SvjO2) under physiologic conditions. Complementary to the arterial oxygen saturation measured by pulse oximetry, cerebral tissue oxygen saturation reflects regional cerebral metabolism and the balance of local cerebral oxygen supply and demand. In this article, the authors report two clinical cases, the first case of a 79 year old man, submitted to percutaneous aortic valve bioprothesis femoral implantation, complicated by a stroke event, expressed by cerebral hypoxia in StcO2 monitorization on the left hemisphere and clinical motor deficit evidence, and the second one a 73 year old man, ASA III, submitted to percutaneous aortic valve bioprosthesis subclavian implantation procedure, where no complications were decribed and haemodymic and StcO2 stability was noticed.Given the clinical evidence on the reported cases, StcO2 monitorization revealed to be a relevant and usefull tool, in order to identify cerebral tissue hypoxia in the first case, as well as reflecting the adequate balance of local cerebral oxygen supply and demand, in the later.

[An analysis of financial flows from the Brazilian Ministry of Health for research and development in 2003-2005 according to the National Agenda for Health Research Priorities]

This study mapped the application of financing in research and development in health (R&D/H) by the Brazilian Ministry of Health in 2003-2005, according to the National Agenda for Health Research Priorities, created in 2004. The analysis was based on data from a study aimed primarily at measuring these investment flows during the same period. The calculations included only direct financing with actual outlays in research, including payroll expenditures. The studies were categorized according to the 24 sub-agendas of the national priority agenda by two independent researchers, and disagreements were resolved by consensus. Research and development expenditures in health totaled 409.7 million reais, concentrated mainly in the following sub-agendas: transmissible diseases, the health industry complex, clinical research, pharmaceutical care, and non-communicable diseases (79% of the total). All 24 sub-agendas received some financing during the period. The study established a baseline for subsequent evaluations of this financing instrument's inductive capacity and the relationship between R&D/H investments and the population's health needs.

Tobacco use among the elderly: The first Brazilian National Survey (BNAS)

OBJECTIVE

This study describes the prevalence and pattern of tobacco use among the elderly in Brazil and establishes its association with socio-demographic characteristics, other substance use and depression.

METHOD

The analyses were performed in 400 individuals aged 60 years and over who participated in the first Brazilian national alcohol survey (BNAS) in 2000.

RESULTS

Nearly 60% of the sample had ever smoked, of them one in three were still smoking at the time of the interview. Most (94.3%) of the tobacco users were smoking everyday and 34.3% consuming more than 20 cigarettes a day. Only 1% of the former smokers had received support to quit. Over half of the current users (65%) would use free treatment to quit if it existed in Brazil, and just under half of them (47.4%) would consider quitting if cigarettes' price were higher. Currently, tobacco users were more likely to be men and alcohol abusers. Prevalence of depression was high regardless participant smoking status (33.0% among non-smokers, 34.7% among current smokers and 39.3% among former smokers). There was no significant association between smoking and depression.

CONCLUSION

This study found a disturbingly high proportion of tobacco users among the elderly in Brazil. According to the Global Burden of Disease project, tobacco has the highest mortality risk of all substance use categories, especially for the elderly. This study shows there is an urgent need to develop smoking cessation interventions targeted specifically to the elderly.

Alcohol consumption in late-life--the first Brazilian National Alcohol Survey (BNAS)

To investigate the alcohol consumption in later life in Brazil and its association with socio-demographic characteristics. This study was a cross-sectional analysis of nationally representative survey data. A multistage cluster sampling procedure was used to select 3007 individuals of 14 years of age and older from the Brazilian household population. In this study we analyzed data from all 400 participants who were over 60 years old. Alcohol Abuse and Dependence Syndrome was established according to DSM-IV and Risky Drinking was defined in two ways: heavy drinkers (>7 drinks/week) and as binge drinkers (>3 drinks/one occasion). Twelve percent of participants reported heavy drinking behavior while 10.4% and 2.9% were binge drinkers and alcohol dependent respectively. In the adjusted logistic regression only gender was associated with heavy drinking behavior. Males, the youngest and the wealthiest were more likely to report binge drinking behaviors. In conclusion, alcohol related-problems are common but under recognized among older adults. Health professionals should be aware that common definitions of alcohol abuse and dependence may not apply as readily to older people, who have had biological changes for alcohol tolerance and its effects on the Central Nervous System.

DUI-arrest characteristics among white and Mexican-American DUI offenders mandated for treatment

OBJECTIVE

To report cross-ethnic differences among white and Mexican-American DUI offenders on the characteristics of an arrest (index) that brought subjects to treatment.

METHOD

Subjects are 250 (223 male) whites and 249 (187 male) Mexican Americans consecutively admitted to five DUI offender programs in a Northern California county. Interviews averaged 1 hour in length and were conducted in the programs by trained interviewers. The response rate was 71% for whites and 84% for Mexican Americans.

RESULTS

At the time of the arrest, Mexican Americans were driving cars older than those driven by whites. A higher proportion of Mexican Americans than whites reported having consumed 10 or more drinks before the arrest. The most frequent locale for drinking before the arrest was "home or friends' home" for Mexican Americans and a "bar/tavern/club" for whites.

CONCLUSIONS

Cross-ethnic differences related to the circumstance of the arrest (car year) do not fully explain the higher rates of DUI arrest among Mexican Americans, compared with whites. Differences in drinking locale before arrest suggest that server intervention efforts may not be as effective in preventing DUI for Mexican Americans as they are for whites. Prevention interventions with Mexican Americans should center on the family, as a means to minimize drinking at home and decrease the large number of drinks consumed on a particular occasion by Mexican Americans.

Intimate partner violence, dependence symptoms and social consequences from drinking among white, black and Hispanic couples in the United States

This study estimates the association of intimate partner violence (IPV) and alcohol-dependence symptoms, social consequences from drinking, and drug use among white, black, and Hispanic couples. A probability sample of 555 white, 358 black, and 527 Hispanic couples in the U.S. household population was interviewed in 1995. The response rate was 85%. Bivariate analysis indicates that most problem status variables are associated with increased rates of male-to-female (MFPV) and female-to-male (FMPV) partner violence. Logistic regression analyses showed that predictors of MFPV and FMPV vary by ethnicity.

Intimate partner violence and drinking patterns among white, black, and Hispanic couples in the U.S

PURPOSE

Using reports from both partners, this study estimated prevalence rates of intimate partner violence (IPV) among white, black, and Hispanic couples in the U.S., and assessed the contribution of drinking patterns, psychosocial, and other sociodemographic factors to the risk of partner violence.

METHODS

A multistage area probability sample consisting of 555 white, 358 black, and 527 Hispanic couples in the U.S. household population was interviewed in 1995. Logistic regression analyses revealed that predictors of IPV vary by ethnicity.

RESULTS

Rates of male-to-female (MFPV) and female-to-male partner violence (FMPV) were highest among black couples (23% and 30%), followed by Hispanic (17% and 21%), and white couples (12% and 16%). Between 27 percent and 41 percent of the men, and 4 percent and 24 percent of the women were drinking at the time of the violent incident.

IMPLICATIONS

Black and Hispanic couples are at higher risk for IPV than white couples and should be targeted for prevention intervention. The interrelationships among IPV, alcohol consumption, and ethnicity are complex. These findings suggest that future attempts at modeling IPV should be ethnically sensitive and, ideally, include separate analyses of each ethnic group.

Couples' drinking patterns, intimate partner violence, and alcohol-related partnership problems

PURPOSE

Past research has revealed a strong correspondence between alcohol use and family dysfunction (e.g., Straus and Gelles in 1986 and 1990). Unfortunately, much of this research has relied on reports from only one family member.

METHODS

Here, we present the results from a recent, nationwide study of alcohol-consumption patterns, alcohol-related partnership problems, and intimate partner violence (IPV) based on reports from both romantic partners of 1,615 married and cohabiting couples.

RESULTS

Using the "drinking partnerships" construct developed by Roberts and Leonard in 1997, we found that despite considerable concordance between couple members' drinking behaviors, discrepant drinking patterns were strongly predictive of relational distress and the incidence of physical violence.

IMPLICATIONS

These findings suggest that the interaction between couple members' alcohol-related behaviors has crucial implication for the health and well-being of the entire family.

Alcohol-related intimate partner violence among white, black, and Hispanic couples in the United States

Intimate partner violence (IPV) is a major public health problem in the United States. Results from a 1995 national study indicated that 23 percent of the black couples, 11.5 percent of the white couples, and 17 percent of the Hispanic couples surveyed reported an incident of male-to-female partner violence in the 12 months preceding the survey. The rate of female-to-male partner violence was also high: 15 percent among white couples, 30 percent among black couples, and 21 percent among Hispanic couples. The higher prevalence of IPV among ethnic minorities, compared with whites, cannot be explained by any single factor, but seems to be related to risk factors associated with the individual, the type of relationship between partners, and factors in the environment. Alcohol plays an important part in IPV. The study found that 30 to 40 percent of the men and 27 to 34 percent of the women who perpetrated violence against their partners were drinking at the time of the event. Alcohol-related problems were associated with IPV among blacks and whites, but not among Hispanics. Alcohol's role in partner violence may be explained by people's expectations that alcohol will have a disinhibitory effect on behavior or by alcohol's direct physiological disinhibitory effect. It is also possible that people consciously use alcohol as an excuse for their violent behavior or that alcohol appears to be associated with violence because both heavier drinking and violence have common predictors, such as an impulsive personality.

Neighborhood poverty as a predictor of intimate partner violence among White, Black, and Hispanic couples in the United States: a multilevel analysis

PURPOSE

This study assessed the contribution of neighborhood poverty, measured at the census tract level, to the risk of male-to-female and female-to-male partner violence (MFPV, FMPV) among white, black, and Hispanic couples in the United States.

METHODS

As part of the 1995 National Alcohol Survey, a representative sample of married/cohabiting couples was obtained through a multistage, multicluster household probability sampling frame. The outcome variables, MFPV and FMPV, were measured through the Conflict Tactics Scale, Form R. Sociodemographic, psychosocial, and alcohol consumption covariates that were statistically significant through bivariate analysis were retained as individual-level predictors. Neighborhood poverty, indicating residence in a census tract where greater than 20% of the population lived below the Federal poverty line, was assessed by appending 1990 Census data to the primary data set. Multilevel logistic regression models were constructed, with separate analyses performed for each outcome (MFPV, FMPV) among the white, black, and Hispanic couples.

RESULTS

Couples residing in impoverished neighborhoods are at increased risk for both MFPV and FMPV. The association between residence in an impoverished neighborhood and MFPV was statistically significant for black couples (Odds Ratio [OR] 2.87; 95% Confidence Interval [CI] 1.36, 6.07). The association between residence in an impoverished neighborhood and FMPV was statistically significant for black couples and white couples.

CONCLUSIONS

Characteristics of the socioenvironment, such as neighborhood poverty, are associated with the risk of partner violence, particularly among black couples. Policies aimed at reducing community poverty may contribute to effective partner violence prevention strategies.

Drinking and DSM-IV alcohol and drug dependence among white and Mexican-American DUI offenders

OBJECTIVE

To report data on drinking patterns and DSM-IV alcohol and drug dependence among whites and Mexican Americans in treatment for driving under the influence of alcohol (DUI).

METHOD

Interviews were conducted with a sample of 250 whites and 250 Mexican Americans admitted to one of five DUI treatment programs in a Northern California county. Interviews averaged 1 hour in length and were conducted in the programs by trained interviewers. The response rate was 72% for whites and 83% for Mexican Americans.

RESULTS

Whites drink most frequently, followed by U.S.-born Mexican Americans and, finally, by Mexican Americans born in Mexico. However, rates of the amount of alcohol usually consumed are higher for Mexican Americans born in Mexico than for the other two groups. Prevalence rates of DSM-IV alcohol dependence are: 29% for whites, 27% for U.S.-born Mexican Americans and 9% for those born in Mexico. Prevalence rates of DSM-IV drug dependence are: 23% for whites, 24% for U.S.-born Mexican Americans and 6% for those born in Mexico.

CONCLUSIONS

Rates of alcohol and drug dependence in these DUI treatment programs are much higher than rates of dependence in the general population, independent of ethnicity. Patterns of alcohol consumption vary dramatically among whites, U.S.-born Mexican Americans and Mexican Americans born in Mexico. The large amounts of alcohol ingested per occasion by Mexican-born Mexican Americans is particularly noteworthy and may put them at more risk for DUI. However, drug use and drug dependence are higher among whites and U.S.-born Mexican Americans than among Mexican Americans born in Mexico.

Hispanics, Blacks and White driving under the influence of alcohol: results from the 1995 National Alcohol Survey

OBJECTIVE

To report nationwide survey data on patterns of driving under the influence of alcohol among Whites, Blacks and Hispanics.

METHOD

Data were obtained from a probability sample consisting of 1582 Blacks, 1585 Hispanics and 1636 Whites in the US household population. Interviews averaging 1 h in length were conducted in respondents' homes by trained interviewers.

RESULTS

Self-reported rates of driving a car after having drunk enough 'to be in trouble if stopped by the police' were highest among White and Hispanic men (22 and 21%, respectively), as were lifetime arrest rates for driving under the influence of alcohol (13% for White men, 19% for Hispanic men). Additionally, our analyses suggest that drinkers who drive under the influence of alcohol are more likely to be men (regardless of ethnicity), consume more alcohol, and be alcohol dependent than drinkers who do not engage in alcohol-impaired driving.

Alcohol-related problems and intimate partner violence among white, black, and Hispanic couples in the U.S

OBJECTIVES

This study analyzes gender and ethnic/racial differences in the prevalence of alcohol-related problems among white, black and Hispanic couples in the United States, and assesses their contribution to the risk of intimate partner violence (IPV).

METHODS

Our study population consisted of 1440 white, black, and Hispanic couples obtained through a multistage area household probability sample from the 1995 National Alcohol Survey. Alcohol-related problems (i.e., drinking consequences and alcohol dependence symptoms in the last 12 months) were assessed among respondents and their partners. Male-to-female and female-to-male partner violence (MFPV, FMPV) were measured separately using the Conflict Tactics Scale.

RESULTS AND CONCLUSIONS

Alcohol-related problems were more prevalent among men than women. Our bivariate analysis demonstrated a significant positive association between male alcohol-related problems and IPV across racial/ethnic groups, and a similar association between female alcohol-related problems and IPV for white and black couples. In the multivariate logistic regression analyses, however, many of these associations were attenuated. After controlling for sociodemographic and psychosocial covariates, male alcohol-related problems were no longer significantly associated with an increased risk of MFPV among white or Hispanic couples. Female alcohol-related problems predicted FMPV, but not MFPV, among white couples. Among black couples, however, male and female alcohol-related problems remained strong predictors of intimate partner violence.

SIGNIFICANCE

Alcohol-related problems are important predictors of intimate partner violence, and the exact association between problems and violence seems to be ethnic-specific. Alcohol-related problems, rather than level of alcohol consumption, may be the more relevant factor to consider in the alcohol-partner violence association. Future research is needed to explore the temporal relationships between the development of alcohol-related problems and the occurrence of partner violence.

The structure of DSM-IV alcohol dependence in a treatment sample of Mexican and Mexican American men

AIMS

To examine the symptom profile and factorial structure of DSM-IV alcohol dependence.

DESIGN

Subjects were interviewed in program facilities by trained interviewers using a standardized questionnaire. The response rate was 95% in Mexico and 90% in the United States.

SETTING

Two publicly funded inpatient facilities in Mexico and five in the United States. In Mexico the programs were located in Mexico City. In the United States the programs were located in Santa Clara County, California.

PARTICIPANTS

Three hundred and ninety-one Mexican and 212 Mexican American men in treatment for alcohol problems in Mexico and the United States.

MEASUREMENT

Dependence criteria were assessed with the Composite Diagnostic Interview-Substance Abuse Module (CIDI-SAM).

FINDINGS

The unidimensional structure of alcohol dependence fits the Mexican American data but not the Mexican data. However, when Mexican clients were divided according to place of interview (treatment program), the unidimensional structure fits one of the groups but not the other.

CONCLUSIONS

The test of unidimensionality must be seen as inconclusive with regard to the Mexican data. These results highlight the potential influence that client selection methods may have on study results, especially in cross-cultural projects.

Trends in situational norms and attitudes toward drinking among whites, blacks, and hispanics: 1984-1995

The purpose of this study was to explore trends in situational norms and attitudes toward drinking and to assess the associations of norms and attitudes with current drinking and frequent heavy drinking patterns among whites, blacks, and hispanics between 1984 and 1995. Data were obtained from two nationwide probability samples of US households. Results indicated that there were no broad trends in situational norms and attitudes toward drinking between 1984 and 1995 among whites, blacks, and hispanics in the US. The variations in norms and attitudes detected between 1984 and 1995 were ethnic and gender-specific. For all of the groups studied, situational norms and attitudes were highly predictive of both current drinking and frequent heavy drinking patterns.

The identification of alcohol dependence criteria in the general population

AIMS

To assess the criteria used to identify alcohol dependence in the general population.

DESIGN AND SETTING

Two independent probability surveys of the US household population 18 years of age and older were analyzed: the 1994 National Telephone Survey (NTS-94), which interviewed 637 respondents, and the 1988 National Household Interview Survey (NHIS-88) which interviewed 43,809 respondents in their homes.

PARTICIPANTS

The analyses of the NHIS-88 dataset focused on drinkers who consumed at least 12 drinks of alcohol in the 12 months prior to the survey interview (N = 22,102). The analyses of the NTS-94 dataset focused on drinkers who consumed at least one drink in the 12 months prior to the survey interview (N = 637).

MEASUREMENTS

Criteria for DSM-IV alcohol dependence were operationalized using 15 items from a standardized questionnaire.

FINDINGS

Analyses suggested that normal drinking behavior can be misidentified as dependence criteria. Results for men who drank up to two drinks per day suggest that if the dependence criteria were invalid, reductions in the prevalence of specific indicators of alcohol dependence would range from 0.3% to 5.2%. Correcting for the misidentification of alcohol dependence diagnosis would reduce the overall prevalence of alcohol dependence by 0.5%. Up to 7% of the men could have been diagnosed as alcohol-dependent and could have provided invalid reports.

CONCLUSIONS

The identification of alcohol dependence in general population samples must include careful probing of the nature of drinking-related behavior reported by respondents. This will decrease misidentification of dependence criteria, increasing the validity of dependence diagnosis in survey research.

Alcohol and AIDS-related sexual behavior among Hispanics: acculturation and gender differences

We examined the relationship of acculturation to alcohol use and risky sexual behavior among Hispanic men (N = 269) and women (N = 294). Data were obtained from a 1991/1992 general population survey on alcohol that included questions on sexual behavior. Guided by a conceptual/theoretical framework, we focused on gender and acculturation differences as we examined the relationship between sociodemographic characteristics, perception of AIDS-related risk, drinking and AIDS-related sexual behavior. Logistic regression analyses were performed separately for men and women to evaluate the predictive strength of acculturation, demographic factors, and alcohol consumption on risky sexual behavior. Results indicated that less acculturated Hispanic men drank more heavily and were more likely to engage in risky sexual behavior than those who were more acculturated. Although acculturated Hispanic women drank more than those who were less acculturated, less acculturated Hispanic women engaged in more risky sexual behavior. The data indicate the need for culturally sensitive AIDS-prevention programs that are linked with alcohol treatment services for men and that are targeted to different acculturation levels for men and women.

Rates of intimate partner violence in the United States

OBJECTIVES

Estimates of intimate partner violence in the United States based on representative samples have relied on data from one person per household or limited numbers of indicators from both partners. The purpose of this study was to estimate nationwide rates of intimate partner violence with data from both couple members by using a standardized survey instrument, the Conflict Tactics Scale.

METHODS

A multistage probability sampling design was used to conduct separate face-to-face interviews in respondents' homes with both members of 1635 representative couples living in the 48 contiguous states.

RESULTS

Both partners' reports were used to estimate the following lower- and upper-bound rates: 5.21% and 13.61% for male-to-female partner violence, 6.22% and 18.21% for female-to-male partner violence, and 7.84% to 21.48% for any partner-to-partner violence.

CONCLUSIONS

High rates of intimate partner violence in the United States corroborate previous claims that the amount of intimate partner violence is substantial.

Trends in alcohol consumption patterns among whites, blacks and Hispanics: 1984 and 1995

OBJECTIVE

To report national trends in alcohol consumption patterns among whites, blacks and Hispanics between 1984 and 1995, in relation to the recent decline in per capita consumption in the United States.

METHOD

Data were obtained from two nationwide probability samples of U.S. households, the first conducted in 1984 and the second in 1995. The 1984 sample consisted of 1,777 whites, 1,947 blacks and 1,453 Hispanics; the 1995 sample consisted of 1,636 whites, 1,582 blacks and 1,585 Hispanics. On both occasions, interviews averaging 1 hour in length were conducted in respondents' homes by trained interviewers.

RESULTS

Between 1984 and 1995, the rate of abstention remained stable among whites but increased among blacks and Hispanics. Frequent heavy drinking decreased among white men (from 20% to 12%), but remained stable among black (15% in both surveys) and Hispanic men (17% and 18%). Frequent heavy drinking decreased among white women (from 5% to 2%), but remained stable among black (5% in both surveys) and Hispanic women (2% and 3%). White men and women were two times more likely to be frequent heavy drinkers in 1984 than in 1995.

CONCLUSIONS

The reduction in per capita consumption in the U.S. is differentially influencing white, black and Hispanic ethnic groups. The stability of rates of frequent heavy drinking places blacks and Hispanics at a higher risk for problem development than whites. This finding is, therefore, a concern to public health professionals and others interested in the prevention of alcohol-related problems among ethnic groups in the United States.

Trends in alcohol-related problems among whites, blacks, and Hispanics: 1984-1995

The objective of this study was to report trends in alcohol problems among whites, blacks, and Hispanics between 1984 and 1995. Data were obtained from two nationwide probability samples of U.S. households, the first conducted in 1984 and the second in 1995. The 1984 sample consisted of 1777 whites, 1947 blacks, and 1453 Hispanics. The 1995 sample included 1636 whites, 1582 blacks, and 1585 Hispanics. On both occasions, interviews (average length, 1 hr) were conducted in respondents' homes by trained interviewers. The results indicate that between 1984 and 1995, alcohol problems were stable among white and black men and increased among Hispanic men. The rates of three or more alcohol problems for men of each ethnic group for 1984 and 1995 were: 12% and 11% for white men, 16% and 13% for black men, and 9% and 16% for Hispanic men, respectively. Problem prevalence was stable and relatively low among women in all three ethnic groups. Overall, the prevalence of alcohol problems continues to be high among men in the United States. Even though recent research has shown that rates of frequent heavy drinking among white men have declined, we found no corresponding decrease in problem prevalence. Rates of frequent heavy drinking and alcohol-related problems between 1984 and 1995 have remained especially high among black and Hispanic men, suggesting that men of these two ethnic groups should be specifically targeted for renewed prevention efforts.

Alcohol consumption among racial/ethnic minorities: theory and research

Ethnic minorities (e.g., Hispanics, blacks, Asian-Americans, and Native Americans) are still underrepresented in alcohol research in the United States. Furthermore, existing studies often do not take into consideration the variability that exists within each ethnic group, resulting in inaccurate generalizations. Studies among Hispanics have found substantial differences among Hispanic subgroups in drinking patterns and rates of alcohol-related problems. Moreover, no single variable can explain the observed patterns. Similarly, numerous factors have been shown to shape drinking patterns among blacks, including individual and environmental characteristics as well as historical and cultural factors. Different subgroups of Asian-Americans also vary substantially in their rates of drinking and heavy drinking, although their lifetime alcohol use is lower than the national average. Genetic and cultural factors, as well as stress and historic experiences, may influence drinking patterns of Asian-Americans. The widely differing drinking patterns among Native Americans also are likely shaped by a variety of influences.