Drinking Research Articles

Risk of self-harm in patients with eating disorders: English population-based national record-linkage study, 1999-2021.

Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders associated with high rates of self-harm (SH). This is the first national study in England to quantify this association in a hospital population. A retrospective cohort study using a linked national dataset of Hospital Episode Statistics for 1999-2021. The exposure cohort included individuals aged <35 years admitted to hospital with a diagnosis of AN or BN. The reference cohort included hospital controls. We calculated the rate ratio (RR) of SH in each cohort. The individuals in the two cohorts were matched on multiple socio-demographic indicators. The main outcome was a subsequent hospitalization or death record with an SH diagnosis. We identified 15,004 females and 1411 males with AN, and 6055 females and 741 males with BN. The RR with 95% confidence intervals (95%CI) for a subsequent admission with intentional self-harm after admission with AN was 4.9 (95%CI 4.7-5.1) in females and 4.8 (95%CI 3.9-5.8) in males. For BN it was 9.0 (95%CI 8.4-9.6) in females and 9.8 (95%CI 7.7-12.2) in males. There were strong associations between AN and BN and other SH. Women and men admitted to English hospitals with AN or BN have a very high risk of a subsequent admission with SH. For some SH behaviors, such as alcohol intoxication, the RR was >10-fold elevated. The magnitude of risk was higher for BN than for AN. Clinicians should be aware of the scale of risk increase. Providing those at risk with appropriate support is required. This study is the first national study in an English hospital population that confirms and quantifies the association between eating disorders and self-harm. We have found that both women and men admitted to hospital with anorexia nervosa or bulimia nervosa are at an increased risk of subsequent admission with self-harm. It is important that clinicians are aware of this increased risk to support those at highest risk of self-harm.

Possibilities of Diagnostic Research on Speech of People State of Alcohol Intoxication

Author aimed to highlight a number of issues arising before forensic expert while forensic research on phonograms containing oral speech of persons, regarding diagnosis of the unusual state of the speaker: in the state of alcohol intoxication and determination of the degree of influence of speaker’s intoxication state on possibility of conducting identification researches of the announcer while examination of video and sound recording. For achieving the goal, methods of scientific knowledge were used: observation, comparison, abstraction, analysis, synthesis, modeling, etc. Speech disorders have been observed in persons who are in a state of alcohol intoxication. Analysis of alcohol intoxication stages was carried out and their influence on the process of forming a person’s speech activity was determined. Patterns characteristic of the speech of people under influence of alcohol have been revealed. Variability specifics of voice formation and speech of a person under influence of alcohol were studied. Possibility of conducting identification researches based on physical parameters of oral speech, depending on degree of person intoxication was studied. Attention is focused on peculiarities of diagnosing speech of person who is in a state of mild, medium and severe degree of simple alcohol intoxication, and situational moments related to the speaker. As anatomical person speech apparatus creating individual picture of a speech signal characteristic of a certain person, as speech behavior, skills, individual experience, intelligence, etc., which influence creation of an individual image of speaker in an unusual state alcohol intoxication, are considered. Factors whose variability affects characteristics of a person’s voice in various states of alcohol intoxication have been studied.

371 Effect of Calcium Magnesium Carbonate And/Or Tylosin Phosphate Supplementation on Behavior, Rumination Activity, Feedlot Growth Performance and Carcass Characteristics in Yearling Beef Steers

Abstract The objective of this study was to evaluate the effects of calcium magnesium carbonate (CMC) and/or tylosin phosphate (TYL) supplementation on behavior, rumination activity, growth performance and carcass characteristics of yearling beef steers. Treatments were arranged in a 2 × 2 factorial including CMC and TYL. Beef steers (n = 156; 469 ± 18 kg) were randomly assigned to treatment pens (7 to 8 steers/pen) with pen (n = 20 pens total, 10 pens/main effect mean, and 5 pens/simple effect mean) as experimental unit. Cattle were transitioned from a 30% roughage diet to a 7% roughage finishing diet based on dry-rolled corn, dried distillers grains plus solubles, liquid supplement, and oat silage over the initial 20 d period. The CMC was included at 1.5% of the diet (DM basis) in replacement of dry-rolled corn and TYL was provided at 90 mg·animal·d-1. Behavior and rumination activity were monitored during a 24 h period on d 42. Data was collected on a pen-basis, every 10 min from 0800 h to 0750 h the next day and included minutes spent drinking (DR), eating (EA), active (AC), ruminating (RU), and resting (RE). Cattle were shipped for harvest on d 105 to a commercial beef abattoir. Growth performance was calculated on a carcass-adjusted basis (HCW/0.625). Data were analyzed as a randomized complete block design with fixed effects of CMC, TYL, or their interaction; block was a random effect. An interaction was observed between CMC and TYL for time spent DR (P = 0.03) and RU (P = 0.01). Control steers ruminated 28% longer compared with CMC/-TYL steers (P = 0.05) and 20% longer than -CMC/TYL steers (P = 0.05). The main effect of CMC tended to increase time spent EA by 19.3% (P = 0.06). Dry matter intake was decreased (P ≤ 0.02) by 4.57% when CMC was fed and increased by 1.96% when TYL was fed. However, no difference (P ≥ 0.26) was observed for G:F or gain efficiency in either treatment. No differences (P ≥ 0.28) were observed in any dietary net energy utilization outcomes in either main effect treatment. Carcass weight tended (P = 0.07) to be lighter with CMC supplementation compared with CON (432 vs 439 kg). Supplementation of TYL resulted in a 11.7% reduction (P = 0.04) in percentage of abscessed livers. No differences (P ≥ 0.12) were observed in DP, marbling, YG, or EBF in either main effect treatments. These results indicate that supplementation of CMC did not result in any appreciable improvements in growth, carcass or dietary net energy utilization performance, but TYL supplementation resulted in a positive effect on liver abscess prevalence.

The Effect of State Housing Policies on Eviction Filings and Judgments in the United States, 2001–2018

Housing instability is a significant problem in the United States, with a long literature documenting its impact on the social well-being of Americans. A relatively new line of research has illuminated the degree to which eviction is a substantial contributor to health risks, including “deaths of despair” from alcohol or drug-related accidental poisonings. Although eviction is a persistent threat in the United States, there is comparatively less research that is both longitudinal and that evaluates multiple policies simultaneously to guide decision makers about which policies are more or less effective at lowering eviction activity. In this study we test the association between housing policies and eviction processes for a large proportion of U.S. counties from 2001 to 2018 using a panel of state-level landlord–tenant laws and a panel of local housing-specific investments by the U.S. Department of Housing and Urban Development. We find evidence that some state and local policies are effective at reducing the number of eviction filings and the incidence of multiple filings to the same household, although there is less evidence that actual eviction judgments can be mitigated with these policies.

MECHANISMS OF NITROSATIVE STRESS AND DESTRUCTION OF THE ORGANIC MATRIX OF THE RAT MANDIBLE IN THE RECOVERY PERIOD AFTER ITS INCOMPLETE FRACTURE UNDER CONDITIONS OF CHRONIC ALCOHOL INTOXICATION

The mechanisms of nitrosative stress and depolymerization of biopolymers of the mandibular bone tissue after its incomplete fracture under conditions of chronic alcohol intoxication were investigated. The experiments were conducted on 20 white Wistar rats weighing 190-240 g, divided into 4 groups: Group 1 - intact animals, Group 2 - after reproduction of chronic alcohol intoxication, Group 3 - after modeling of mandibular fracture, Group 4 - after reproduction of mandibular fracture in the setting of chronic alcohol intoxication. The activity of total NO synthase, its constitutive and inducible isoforms, ornithine decarboxylase, concentrations of peroxynitrites of alkaline and alkaline-earth metals, free hydroxyproline, N-acetylneuraminic and hexuronic acids were determined in the homogenate of the standard mandible area by spectrophotometric method. It has been shown that the reproduction of chronic alcohol intoxication significantly increases the total and inducible NO synthase activity in the mandibular homogenate, accompanied by an increase in the concentration of the key marker of nitrosative stress – peroxynitrite. On the 14th day after the reconstruction of a mandibular fracture on the background of chronic alcohol intoxication, NO synthase activity and the content of peroxynitrites of alkaline and alkaline-earth metals in the bone homogenate exceed the results of groups with separate action of pathogenic factors. Under these conditions, the activity of the key enzyme of polyamine biosynthesis, ornithine decarboxylase, significantly decreases, and the depolymerization of bone biopolymers (collagen, glycoproteins, and proteoglycans) increases, which creates prerequisites for disruption of reparative processes in the fracture site.

Combination Treatment with Sonrotoclax (BGB-11417), a Second-Generation BCL2 Inhibitor, and Zanubrutinib, a Bruton Tyrosine Kinase (BTK) Inhibitor, Is Well Tolerated and Achieves Deep Responses in Patients with Treatment-Naïve Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (TN-CLL/SLL): Data from an Ongoing Phase 1/2 Study

Background: The combination of BCL2 and BTK inhibitors has shown synergistic activity. The combination of venetoclax, a BCL2 inhibitor, and ibrutinib, a BTK inhibitor, is an effective treatment for CLL/SLL. Sonrotoclax (BGB-11417) is a BH3 mimetic that binds and inhibits BCL2 with potency &amp;gt;10x that of venetoclax in biochemical assays. Zanubrutinib, a next-generation BTK inhibitor, has shown improved PFS with fewer cardiac adverse events (AEs) vs ibrutinib in a randomized study of patients with CLL/SLL (Brown et al. N Engl J Med. 2023). BGB-11417-101 (NCT04277637) is an ongoing, first-in-human, phase 1/1b dose-escalation/expansion study of patients with various B-cell malignancies. In a preliminary report, sonrotoclax, alone or in combination with zanubrutinib, was well tolerated at all doses tested up to 640 mg. This abstract describes the safety and efficacy data from patients with treatment-naïve (TN) CLL/SLL who received the combination of sonrotoclax and zanubrutinib. Methods:Patients received zanubrutinib (320 mg QD or 160 mg BID) 8-12 weeks before starting sonrotoclax using a ramp-up schedule starting from 1 mg to the intended target dosage of 160 mg or 320 mg QD (doubling weekly [W] or 30% increase every day 5 d/week [D]) to mitigate risk of tumor lysis syndrome (TLS). Patients were treated until progression, unacceptable toxicity, or could elect to stop. TLS was assessed per Howard (2011) criteria; mitigation included mandatory oral hydration and antihyperuricemics. Primary endpoint was safety (reported per CTCAEs v5.0); a secondary endpoint was ORR (per iwCLL 2008 criteria) and minimal residual disease assessed in blood by ERIC flow every 24 weeks (uMRD4; &amp;lt;1 CLL cell per 10,000 leukocytes, or &amp;lt;0.01%) was an exploratory endpoint. Results: As of May 21, 2023, 94 patients with TN-CLL/SLL were enrolled (sonrotoclax 160 mg QD, n=41 [26 W, 15 D] and 320 mg QD, n=53 [25 W, 28 D]); 15 patients were still receiving zanubrutinib monotherapy and 79 started sonrotoclax (160 mg, n=32 [25 W, 7 D] and 320 mg, n=47 [24 W, 23 D]). Median follow-up was 8.5 mo (range: 0.6-18.2) for all patients; 160 mg, 12.1 mo (range: 0.6-18.2); 320 mg, 7.0 mo (range: 1.1-14.6). No deaths have occurred, and all patients remain on study. Treatment-emergent AEs (TEAEs) occurring in ≥20% patients who received sonrotoclax plus zanubrutinib (n=79) are listed in theTable; TEAE frequencies were similar between the two sonrotoclax cohorts. Contusion, neutropenia, and low-grade gastrointestinal toxicity were the most common TEAEs; neutropenia was the most common grade ≥3 TEAE (n=13 [17%]). No cases of clinical or laboratory TLS occurred in either ramp-up schedule; no patient experienced atrial fibrillation. One TEAE (cryptococcal meningitis at 11 weeks treated with azoles) led to treatment discontinuation. Sonrotoclax dose holds occurred in 17 patients (22%) for a median duration of 11 days (range: 3-37) and three patients (4%) had dose reduction. The most common TEAEs resulting in dose holds were COVID-19 (n=9 [11%]) and diarrhea (n=3 [4%]). A total of 56 patients had a response assessment. The ORR was 100% (CR: 160 mg, n=9 [36%]; 320 mg, n=6 [19%]). Across all doses, rate of CR increased with time; overall median time to CR was 10.1 mo (range: 5.4, 17.1). No progression was reported in either cohort (Figure). Week 24 blood uMRD4 rates were 50% (n=12/24) in 160 mg and 65% (n=13/20) in 320 mg patients. Week 48 blood uMRD4 rates were 73% in 160 mg (n=11/15) and 100% (n=1/1) in 320 mg; no patient has lost uMRD4. Conclusion: Sonrotoclax (160 mg and 320 mg) in combination with zanubrutinib was well tolerated in patients with TN CLL/SLL. Only one patient discontinued treatment and three patients had dosage reductions. No TLS was seen with either ramp-up schedule. Acknowledging the short follow up, efficacy is encouraging with 100% ORR in assessed patients and no PFS events. High rates of blood uMRD4 occurred early. Based on these data, a phase 3 study assessing this combination is planned.

Role of alcohol in urgent ambulance contacts in 15-24-year-olds in Copenhagen: a descriptive population-based study

ObjectiveThe objective of this study is to estimate the proportion of alcohol-related ambulance contacts and to describe characteristics of these contacts in young people.DesignA descriptive population-based study with alcohol-related ambulance...

Psychoactive substance intoxication leading to general hospital admission in young and middle-aged people during and after the first lockdown

Incidence of hospitalisations related to psychoactive substance (H-PS) intoxication has been strongly decreased during the coronavirus disease 2019 (COVID-19) pandemic especially in young adult and French region of Nouvelle-Aquitaine was mostly concerned. This study aimed to describe (i) the incidence of H-PS in Bordeaux teaching hospital during and after the first 2020 lockdown in adults aged 18-29 years or 30+ then (ii) their characteristics specifically associated with the pandemic period by comparing 2020 with 2017-2019 baseline period. This historical cohort study was conducted in adults admitted to the Bordeaux teaching hospital with main or associated diagnosis codes of intoxication with benzodiazepine, methadone, buprenorphine, codeine, morphine, heroin, cocaine, ecstasy and alcohol. Data were collected locally through the discharge database. Incidence and characteristics of H-PS were described according to patients' age, in 2020 before (01/01-16/03), during (17/03-10/05), and after the first lockdown (11/05-31/07). Among the 5,824 stays included over the study period, PS most involved were alcohol and benzodiazepines. Compared to baseline, the decrease in H-PS's incidence was more important in young adults (-40%; nbaseline=450) in comparison to those aged 30+ (-18%; nbaseline=1,101) during the pandemic period, especially during the lockdown compared to 2017 (-59%; n2017=145 vs. -35%; n2017=166) with far decrease in alcohol and ecstasy intoxications. Seriousness of hospitalisation indications was increased regardless of age during the pandemic. Particularly in young adults, the proportion of suicides attempts increased during lockdown compared to the baseline period (almost 50% vs. 29%) and the period after lockdown was associated with 1.7 more-time road accident increased and 3 more-time fights compared with pre-lockdown period. The period following lockdown should be considered at risk H-PS due to accident. Recreational use of alcohol and ecstasy could be a target for minimize serious consequences associated to PS use in young adult.

Poisonings During the COVID-19 Pandemic: Attention to Children and Adolescents Admitted to the Referral Teaching Hospitals of Yazd and Taft Cities, Iran

Background: With the onset of the first wave of COVID-19 in Iran, along with the preventive quarantines, children who had to stay at home were in contact with drugs, alcohol, and disinfectants. This study compares the prevalence rates of poisoning for children and adolescents hospitalized during the first wave of COVID-19 to the previous year (pre-COVID-19 period in 2019). Methods: This analytic, cross-sectional study was conducted based on the administrative data obtained from the referral teaching hospital in Yazd and Taft cities, Iran. This study was conducted on children under the age of 15 years who were admitted to the hospital because of poisoning. The study was conducted from February 19, 2020, to February 18, 2021 (12 months during the COVID-19 pandemic) compared to 2019 as the reference period (pre-COVID-19). The data were analyzed by the SPSS software, version 20. Results: Multivariate regression analysis showed that by adjusting the effects of age and sex, the chance of alcohol poisoning (odd ratio [OR]=0.3, P=0.03), poisoning with oil and its derivatives (OR=0.33, P=0.05), and drugs-opioids poisoning in the period before the outbreak of COVID-19 was lower than during the outbreak of COVID-19. Additionally, the chance of poisoning with medications in the period before the outbreak of COVID-19 was 67% higher than during the outbreak of COVID-19 (OR=1.67, P=0.01). Conclusion: The results indicated a significant increase in poisoning with alcohol, drugs-opioids, oil, and its derivatives in children and adolescents in Yazd City, Iran, during the 12 months of the COVID-19 pandemic.

Alcohol Consumption and Helmet Use in Patients with Traumatic Brain Injury due to Motorcycle Accident

AbstractAlcohol consumption is an important risk factor for traumatic brain injury (TBI), and it has a great impact on its incidence and severity. However, studies suggest potential beneficial effects of alcohol during hospitalization and in the prognosis of moderate or severe TBI, with conflicting results. The objective of the present study was to associate alcohol consumption and helmet use in TBI patients, as well as the prognostic variables and patterns of injuries secondary to TBI. We analyzed 109 medical records of patients who suffered TBI due to a motorcycle accident. We evaluated data on alcohol consumption, helmet use, TBI severity, and tomographic findings on admission. The subjects with moderate or severe TBI were evaluated regarding hospitalization, mortality and prognosis variables. Patients who wore a helmet at the time of trauma had lower rates of skull fracture and extradural hematoma (EDH), but an increased incidence of subarachnoid hemorrhage (SAH). Furthermore, patients with moderate or severe TBI who were those under alcohol intoxication had a greater need for Intensive Care Unit (ICU) admission and a tendency to have a lower in-hospital mortality rate and a higher score on the Glasgow Prognostic Score (GPS). Thus, although the consumption of alcohol has an impact on the incidence and severity of TBI at admission, it seems to be related to a lower in-hospital mortality rate and a better prognosis. In addition, helmet use is essential to prevent injuries from direct head-to-shield impact, but no similar reduction in the incidence of injuries caused by indirect forces was observed.

Modern possibilities of diagnostic and therapeutic interventions for decompensated liver cirrhosis: the focus is on «gut — liver — brain». Clinical case

The relevance of the issue of management of patients with decompensated liver cirrhosis (LC) is stipulated by its medical and socio­economic importance not only in Ukraine, but worldwide due to the high prevalence of etiological factors, as well as the development of severe complications that lead to fatal consequences. Chronic alcohol intoxication is considered the most common cause of LC. The understanding of the etiopathogenetic mechanisms of liver damage and the development of complications is constantly updated, which requires the improvement of approaches to the treatment of such patients. An important role in modern diagnostic and therapeutic interventions is given to the «gut/intestinal microbiota — liver — brain» axis. Today there is evidence that intestinal microbiota indirectly affects intestinal permeability, production of nitric oxide, release of biologically active peptides from enteroendocrine cells, production of short chain fatty acids — the main metabolic product of bacteria that feed cells of the mucous membrane, affect cognitive functions and the activation of the immune system. intestinal system. Research in recent years has proven that it is the liver that takes the leading place in the «gut/intestinal microbiota — liver — brain» axis system. Today, the pathogenesis of alcoholic liver disease is also associated with the hypothesis of «leakage» of the intestine, since alcohol significantly increases its permeability. Special attention in the development of encephalopathy with an imbalance of the microbiome is paid to bacterial translocation into the submucosa due to the violation of the integrity of the tight contacts of epithelial cells, with subsequent stimulation of the release of inflammatory mediators by smooth cells and lymphocytes, which leads to the development of the inflammatory process, increased vascular permeability in the portal, hepatic and systemic networks circulation.&#x0D; The authors presented a clinical case of the use of modern possibilities of diagnostic and therapeutic interventions for decompensated liver cirrhosis of the of toxic etiology based on the global and domestic recommendations with a detailed discussion of patient care tactics.&#x0D;

PSI-6 Effect of Calcium Magnesium Carbonate And/or Tylosin Phosphate Supplementation on Behavior and Rumination Activity in Yearling Beef Steers Fed a Finishing Diet

Abstract The objective of this study was to evaluate the effects of CaMg(CO3)2 (MIN-AD, Papillon Agricultural Company, Easton, MD; MA) and or tylosin phosphate (Tylan, Elanco, Indianapolis, IN; TY) supplementation on 24-hour behavior and rumination activity of yearling beef steers fed a finishing diet. A 2 × 2 factorial arrangement of treatments was used resulting in 4 dietary treatments: no MA and no TY (-MA/-TY), MA and no TY (MA/-TY), no MA and TY (-MA/TY), or MA and TY (MA/TY). Beef steers (n = 158; 469 ± 18.0 kg) were randomly assigned to dietary treatments with pen (n = 20 pens total, 10 pens/main effect mean, and 5 pens/simple effect mean) serving as the experimental unit. The MA was included at 1.5% of the diet (DM basis) in replacement of dry-rolled corn and TY was provided at 90 mg·animal-1·d-1. Observation began at 0800 h and ended at 0750 h the following day, resulting in a 24-hour observation period. Observations were recorded on a pen basis, with number of animals/type of activity recorded every 10 minutes on d 42 on feed (22 d on finisher). Activity categories included number of animals drinking (DR), eating (EA), active (standing; AC), ruminating (RU), and resting (RE) per pen. Chewing (CHE) was determined as the sum of eating and ruminating activity. Data were analyzed as a randomized complete block design with the fixed effects of MA, TY, and their interaction; block (pen location) was considered a random effect. An interaction was noted between MA and TY for time spent drinking (P = 0.03) and ruminating (P = 0.01). Steers from -MA/TY spent more time drinking compared with the -MA/-TY and MA/TY steers; steers from MA/-TY were intermediate (P &amp;lt; 0.10). Steers from -MA/-TY ruminated 28% longer compared with MA/-TY steers (P = 0.05) and 20% longer than -MA/TY (P = 0.05), steers from MA/TY ruminated 16% longer than steers from MA/-TY (P = 0.05), while steers from -MA/TY were intermediate (P &amp;gt; 0.10). The main effect of MA tended to increase time spent eating by 19.3% (P = 0.06); however, no differences (P ≥ 0.28) were noted for the main effects of MA or TY for minutes/day spent chewing, resting, or active. These results indicate that supplementation of MA may alter feeding behavior, resulting in increased minutes/day spent eating. In addition, supplementation of TY and MA may result in increased water intake, and alter time spent ruminating per day.

Epidemiology and quality of care of acute intoxication in people over 65 years of age in Alicante, Spain

IntroductionThe objective of this study was to examine the epidemiology of acute poisonings in the emergency department (ED) of a tertiary center and to analyze the compliance level with quality indicators (QIs) in patients 65 years and older compared rest of adults. Materials and methodsThis was an observational and retrospective study that included diagnosed cases of acute poisoning in patients over 14 years old treated in the ED of a tertiary hospital. Demographic variables, type of toxic substances, and cause of poisoning were collected, along with 19 QIs and patient outcomes, with the main outcome variable being the degree of compliance with the QIs. ResultsA total of 1144 cases were recorded, with 10.4% (n = 119) being patients 65 years and older. Patients 65 years and older were more likely to be female (72.8% vs. 60.9%; p = 0.015), experience more accidental poisonings (37.6% vs. 25.7%; p = 0.006), and fewer intentional poisonings (35.0% vs. 49.6%; p = 0.003). There were fewer cases of alcohol poisoning (5% vs. 17.8%; <0.001), and no cases of illegal drug poisoning (p < 0.001) in this age group. Most QIs showed a high degree of compliance (>85%) in both patients 65 years and older and rest of adults. However, there were differences in the indication of oxygen therapy in cases of carbon monoxide poisoning (64.2% vs. 40.9%; p = 0.005). ConclusionsThe epidemiological profile of poisoning in patients 65 years and older differs from that of adult patients, with a similar degree of compliance with QIs. Based on the results obtained, there does not appear to be significant differences in the management of poisoned patients based on their age.

Proximity of alcohol outlets and presentation to hospital by young people after self-harm: A retrospective geospatial study using the integrated data infrastructure.

There is a well-established association between alcohol use, misuse, intoxication and self-harm, the latter of which is associated with suicide. This study aimed to better understand the association between proximity to alcohol outlets and the likelihood of young people presenting to hospital following self-harm. This was a nationwide retrospective geospatial study using data from the New Zealand Integrated Data Infrastructure using population-level data for 10-29-year-olds for the 2018 and 2017 calendar years. Presentations to hospital following self-harm were identified using the national minimum data set. Proximity to alcohol outlets was defined in road network distance (in kilometres) and ascertained using Integrated Data Infrastructure geospatial data. Alternative measures of proximity were employed in sensitivity analyses. Complete-case two-level random intercept logistic regression models were used to estimate the relationship between alcohol outlet proximity and hospital presentation for self-harm. Adjusted models included sex, age, ethnicity, area-level deprivation, urbanicity and distance to nearest medical facility. Analyses were also stratified by urbanicity. Of the 1,285,368 individuals (mean [standard deviation] age 20.0 [5.9] years), 7944 (0.6%) were admitted to hospital for self-harm. Overall, the odds of presenting to hospital for self-harm significantly decreased as the distance from the nearest alcohol outlet increased, including in adjusted models (adjusted odds ratio 0.980; 95% confidence interval = [0.969-0.992]); the association was robust to changes in the measure of alcohol proximity. The effect direction was consistent across all categorisations of urbanicity, but only statistically significant in large urban areas and rural areas. The findings of this study show a clear association between young people's access to alcohol outlets and presentation to hospital for self-harm and may provide a mandate for government policies and universal interventions to reduce young people's access to alcohol outlets. Further research regarding causative mechanisms is needed.

Delayed Diagnosis of Intracranial Trauma.

Introduction Trauma is one of the leading causes of death and hospitalization in the United States.Head trauma often results in significant morbidity and mortality.This study was undertaken to identify reasons for delay in diagnosis of intracranial trauma. Methods This retrospective study analyzed patients with intracranial trauma between 2016 and 2022, in which there was a delay of two days or more from the date of injury to the date of diagnosis. Results Among 809 patients with head trauma, 140 subjects were identified with delayed diagnosis of intracranial trauma (17.3%).The most common diagnoses were subdural hemorrhage (N = 82; 56%) and intraparenchymal hemorrhage (N = 33; 24%). The most common reasons for delay in diagnosis included patient delay in seeking care (N = 111; 79%), and delayed diagnosis during inpatient hospitalization (N = 16; 11%) (Chi-Square <0.0001) (Table 2). Among inpatients with delayed diagnosis, confounding issues included alcohol intoxication (N = 4; 3%), other injuries (N = 9; 6%), and mental health issues (N = 2; 1%). Conclusions Among patients with delayed diagnosis of intracranial trauma, the majority of delays in diagnosis were due to patient delay in seeking care.Future directions may include improved public education regarding trauma and the importance of seeking timely medical care.

Application to prevent pressure injury in elderly caregivers

Objective To develop and validate the content of a mobile application prototype on Pressure Injury (PI) Prevention for elderly caregivers. Methods Methodological study of prototype-type technological production in mobile application. The application development was guided by the Contextualized Instructional Design (CID) model. The content validation stage was carried out by seven teaching nurses of a technical course for elderly caregivers in a federal educational institution with the application of the Suitability Assessment of Materials (SAM) instrument. Data were analyzed using descriptive statistics. Results The prototype, which was named LPPrev, contains information about the concept, staging, causes of LP, and main affecting sites, in addition to reminders to reposition the elderly in bed; registration of nutritional information, oral hydration, body and intimate hygiene, and guidance on preventive care is also possible. The content evaluation obtained 96.6% of agreement between professors, being considered a material of superior quality. Conclusion LPPrev is an application prototype properly structured according to the categories evaluated by the SAM, with relevant information for caregivers of bedridden and dependent elderly, contributing to theoretical knowledge and fundamental care in the prevention of injury by pressure, being prepared to move on to the other stages of the DIC model.

The concept of personal responsibility in Bulgarian health and social legislation

Abstract Background In the context of scarce health care resources, national policies and legislation increasingly advocate patients’ personal responsibility for their ill health. This report aims at studying the concept of personal responsibility as a basis for resources prioritisation in Bulgarian health and social legislation. Methods Official normative documents were subjected to content and comparative analysis. Results Indirect personal responsibility can be found in the Bulgarian Health Act, Art.94 stating the duty of the patient to take care of his own health. Further, in the liver transplant algorithm of the Recipient Selection Ordinance, it is possible to distinguish a hidden criterion of patient's responsibility. One possible interpretation of Article 12 of the Code of Professional Ethics of Physicians in Bulgaria is the right of a physician to refuse medical care on the grounds of lack of trust due to patient's non-compliance with prescriptions. The latter correlates with the idea of prospective responsibility. Direct personal retrospective responsibility is imputed in the Health Insurance Act, Art. 111, where persons who themselves have damaged their health or in a state of alcoholic intoxication or drug abuse have damaged the health of others, must reimburse the costs of the NHIF. We also find clearly defined personal responsibility in the Social Security Code, Art. 46, according to which monetary compensation for temporary incapacity is not paid to insured persons who intentionally damage their health. There is no official data on the applicability of these legal norms. Conclusions Although in a less categorical form and not in relation to access to specific planned treatments, the idea of the personal responsibility is embodied in the Bulgarian legislation. It is necessary to accumulate further data on the applicability of these norms, as well as to study the views of patients, users of social services, professionals and general public. Key messages • Personal responsibility is gradually entering Bulgarian legislation as an official criterion for the allocation of social and health resources. • It is necessary to accumulate further data on the applicability of the prescribed legal norms, as well as to study the views of patients, users of social services, professionals and general public.

Pleiotropic effects of Metadoxil in the treatment of acute and chronic alcohol intoxications

This article presents a review of modern scientific data concerning the safety and efficacy of the use of Metadoxil at different stages of the treatment of alcohol use disorder (from acute alcohol intoxication to the alcohol withdrawal syndrome, to the post-withdrawal period and remission stabilization), as well as a review of the advantages of Metadoxil use in such patients, due to the neuro- and hepatoprotective effects of this medication. Authors also describe a clinical case from their own practice. In the aforementioned case, the use of Metadoxil as a part of combination therapy contributed not only to the stabilization of remission of the alcohol use disorder, but also to diminishing of symptoms of comorbid mental (obsessive-compulsive disorder) and somatic (alcoholic fatty liver disease) diseases.

Mazers and the drinking culture of late medieval England

ABSTRACT Mazers, drinking vessels often made of maple, were an important part of the material culture of medieval England from at least the first half of the twelfth century. They were significant for the range of meanings they brought to the consumption of drink. In some elite households, they had prestigious associations; elsewhere across society, they made important connections between families, in terms of inheritance and identity, and helped perpetuate memory and constitute memorial practices; as communal drinking vessels, they brought people together in common causes, in families, in gilds and chantries, even acting as a medium for conveying indulgences. They also marked a social distinction between those parts of society commonly drinking wine, who mainly used silver vessels, and those of lesser status, who more usually drank ale. The largest numbers were found in towns, and in monasteries, where the personal use of silver vessels by monks was discouraged.

Transcriptome changes in the nucleus of the solitary tract induced by repeated stress, alcohol dependence, or stress-induced drinking in dependent mice

Stress increases alcohol consumption in dependent animals and contributes to the development of alcohol use disorder. The nucleus of the solitary tract (NTS) is a critical brainstem region for integrating and relaying central and peripheral signals to regulate stress responses, but it is not known if it plays a role in alcohol dependence- or in stress-induced escalations in alcohol drinking in dependent mice. Here, we used RNA-sequencing and bioinformatics analyses to study molecular adaptations in the NTS of C57BL/6J male mice that underwent an ethanol drinking procedure that uses exposure to chronic intermittent ethanol (CIE) vapor, forced swim stress (FSS), or both conditions (CIE + FSS). Transcriptome profiling was performed at three different times after the last vapor cycle (0-hr, 72-hr, and 168-hr) to identify changes in gene expression associated with different stages of ethanol intoxication and withdrawal. In the CIE and CIE + FSS groups at 0-hr, there was upregulation of genes enriched for cellular response to type I interferon (IFN) and type I IFN- and cytokine-mediated signaling pathways, while the FSS group showed upregulation of neuronal genes. IFN signaling was the top gene network positively correlated with ethanol consumption levels in the CIE and CIE + FSS groups. Results from different analyses (differential gene expression, weighted gene coexpression network analysis, and rank-rank hypergeometric overlap) indicated that activation of type I IFN signaling would be expected to increase ethanol consumption. The CIE and CIE + FSS groups also shared an immune signature in the NTS as has been demonstrated in other brain regions after chronic ethanol exposure. A temporal-based clustering analysis revealed a unique expression pattern in the CIE + FSS group that suggests the interaction of these two stressors produces adaptations in synaptic and glial functions that may drive stress-induced drinking.