Alcohol Disorders Research Articles

Development and cross-validation of a veterans mental health risk factor screen.

VA primary care patients are routinely screened for current symptoms of PTSD, depression, and alcohol disorders, but many who screen positive do not engage in care. In addition to stigma about mental disorders and a high value on autonomy, some veterans may not seek care because of uncertainty about whether they need treatment to recover. A screen for mental health risk could provide an alternative motivation for patients to engage in care. Data from samples of veterans and traumatic injury survivors were analyzed to identify mental health risk factors that are characteristics of individuals or stressors or of post-trauma, post-deployment, or post-military service resources, experiences, or responses. Twelve risk factors were strongly related to PTSD (r > .50): current PTSD, depression, dissociation, negative thinking, and emotional lability symptoms, life stress, relationship stress, social constraints, and deployment experiences of a difficult environment, concerns about life and family, perceived threat, and moral injury. Items assessing each of these risk factors were selected and their validity to prospectively predict PTSD and/or depression 6 months later was assessed in a new sample of 232 VA primary care patients. Twelve items assessing dissociation, emotional lability, life stress, and moral injury correctly classified 86% of those who later had elevated PTSD and/or depression symptoms (sensitivity) and 75% of those whose later symptoms were not elevated (specificity). Performance was also very good for 110 veterans who identified as members of ethnic/racial minorities. Mental health status was prospectively predicted in VA primary care patients with high accuracy using a screen that is brief, easy to administer, score, and interpret, and fits well into VA's integrated primary care. When care is readily accessible, appealing to veterans, and not perceived as stigmatizing, information about mental health risk may result in higher rates of engagement than information about current mental disorder status.

Hepatic artery disorders associated with alcoholism.

We aimed to characterize the relationship between severe chronic alcoholism and hepatic arterial wall disorders in humans. We obtained hepatic arteries from 165 patients undergoing liver transplantation who were placed into two etiological groups: an Alcoholism group and a Non-alcoholism group. We compared the age, sex, lipid profile, and histologic characteristics of the hepatic arteries (normal, reduction in luminal diameter of ≤10%, or atherosclerosis) of the participants in the two groups using multifactor analyses. The Alcoholism group comprised 58 men and 40 women and the Non-alcoholism group comprised 63 men and 4 women. The mean ages of the groups were 52.5 ± 9.6 years and 44.2 ± 13.8 years, respectively. There were no circulating lipid abnormalities in any of the participants. In women, arterial disorders were found at a younger age than in men. Hepatic arterial disorders were more frequent in the non-alcoholic participants, and women with alcoholism showed less arterial narrowing. The heavy consumption of alcoholic beverages is associated with a lower incidence of atherosclerosis of the hepatic artery in humans.

Sedative drug-use in Denmark, 2000 to 2019: a nationwide drug utilization study.

To describe trends in and characteristics of sedative drug use from 2000 through 2019 in relation to the introduction of central regulations and new drugs. In this descriptive study, we used individual prescription data on the entire Danish population from the Danish National Prescription Registry to calculate yearly incidence and prevalence of use of benzodiazepines, benzodiazepine-related drugs (Z-drugs), melatonin, olanzapine, low-dose quetiapine, mianserin/mirtazapine, pregabalin, and promethazine from 2000 through 2019. From the Danish National Patient Registry, we obtained data on drug users' psychiatric and somatic comorbidity. The use of benzodiazepines and Z-drugs declined gradually from 2000 through 2019, whereas the newer alternatives, melatonin, low-dose quetiapine, pregabalin and promethazine, increased in use, while the use of olanzapine and mianserin/mirtazapine was relatively stable. This development was seen in both men and women and across all age groups except for hypnotic benzodiazepines which showed a steep increase in the oldest age group from 2010. For all sedative drugs depression, anxiety, alcohol and misuse disorder, pain and cancer were the most prevalent comorbidities. During our study period, the number of individuals without any of the selected diagnoses increased. In Denmark different central regulations have influenced prescription practice toward more restrictive use of Z-drugs and benzodiazepines, except for hypnotic benzodiazepine prescriptions increased after the introduction of special palliative care. An increase in use of newer sedative drugs, however, indicates that the regulations do not remove the need for sedative drugs in the population.

Alcohol Consumption, Physical Activity, and CAD Risk Factors in Firefighters

Introduction: Firefighting is a physically and psychologically stressful occupation, where firefighters often resort to alcohol use as a coping strategy. Firefighters are particularly vulnerable to alcohol misuse and alcohol disorders, negatively affecting their health, well-being and, possibly, work performance. Therefore, this study investigated the prevalence of alcohol consumption and its relationship with the participants’ sociodemographic characteristics, weekly physical activity, and coronary artery disease (CAD) risk factors. Methods: This study used a quantitative, cross-sectional and descriptive design. A total of 124 full-time firefighters, males and females, were conveniently recruited from the City of Cape Town Fire and Rescue Service, South Africa, between September to November, 2020. Firefighters were then separated according to sex, age, ethnicity, and CAD risk factors. Mann-Whitney U and Kruskal-Wallis H were used to determine the statistical differences between groups, Kendall’s Tau was used to assess the correlation between ordinal and continuous variables, and Chi-square to assess the association between categorical variables. A p-value of less than 0.05 was used to indicate statistical significance. Results: In the present study, 72.6% (n = 90) of firefighters reported consuming alcohol, of which 75.5% (n = 74) were male and 61.5% (n = 16) were female. Of this total, 40.0% (n = 44) reported that they consumed a variety of alcoholic beverages, 32.2% (n = 36) consumed beers mainly, 14.4% (n = 16) consumed spirits mainly, and 13.3% (n = 15) consumed wines mainly. In addition, 21.1% (n = 19) were categorised as moderate drinkers and 10% (n = 9) as heavy drinkers. The overall volume of alcohol consumption was significantly different between sexes and ethnicities (p <0.05). In addition, the volume of alcohol consumption was significantly associated with sex, ethnicity, total low-intensity physical activity minutes, diastolic blood pressure, and hypertension (p = 0.005). Sex (p = 0.021) and ethnicity (p = 0.042) were significantly associated with alcohol type. The volume of alcohol consumption was a significant predictor of total low-intensity physical activity, as well as systolic (p = 0.048) and diastolic blood pressures (p = 0.036). Conclusion: The majority of firefighters consumed alcohol, preferred a variety of alcoholic beverages and were classified as light drinkers. Younger male firefighters consumed more alcohol than females and were more likely to be categorized as heavy drinkers. Alcohol consumption was significantly associated with sex, ethnicity, physical activity, and hypertension. Educational programs to mitigate alcohol consumption should be implemented as a preventative measure in the fire service, especially among young male firefighters.

Measuring Architecture in Recovery Homes: Recovery Home Architecture Scale

ABSTRACT Background: The settings where we live shape our daily experiences and interactions. Social environment and physical setting characteristics may be particularly important in communal living services, such as recovery homes for alcohol and drug disorders. Objectives: This paper describes the measurement and mobilization of architectural characteristics in one type of recovery home, sober living houses (SLHs). The Recovery Home Architecture Scale (RHAS) is a 25-item measure comprised of six subscales designed to assess architecture in SLHs. Results: Using a sample of 528 individuals residing in 41 houses, we found the RHAS had good interrater reliability, factor structure, and internal consistency. The measure also showed modest construct validity. The RHAS was not associated with length of stay (LOS) but did interact with a measure of the social environment that predicted LOS, the Recovery Home Environment Scale (RHES). Conclusions: Future studies should include a more diverse sample of SLHs and assess how house management, recovery capital, and other factors work in concert with architecture.

The transition to parenthood, opportunity to drink, drinking, and alcohol use disorder

BackgroundThis study used life histories from a setting of near universal marriage and childbearing (Nepal) to identify associations between both marital transitions and the transition into parenthood and alcohol use and disorder (AUD). MethodsA retrospective, cross-sectional survey using life history calendars documented lifetime marital and childbearing histories of 4876 men and 5742 women aged 15–59 in 2016–18. The clinically validated, Nepal-specific Composite International Diagnostic Interview assessed first alcohol use opportunity, use, and disorder. ResultsBeing never married increased the odds of having the opportunity to drink for men (OR=1.30, 95% CI=1.14 – 1.48, p < 0.001) and women (OR=1.24, 95% CI=1.08 – 1.43, p = 0.003) compared to being married. While men were never married, widowed, or divorced they were at a greater risk of developing AUD. The transition to parenthood significantly increased the odds of AUD onset for men (OR=1.71, 95% CI=1.12 – 2.61, p = 0.013), independent of marital transitions. For women in this setting, becoming divorced increased the odds of having their first drink (OR=1.77, 95% CI=1.14 – 2.75, p = 0.011). Giving birth to a first child also increased the odds of first opportunity to drink for women (OR=1.30, 95% CI=1.07 – 1.57, p = 0.008). ConclusionsWe found associations between marital transitions and AUD that are consistent with findings worldwide. In this setting of near universal childbearing, the transition into fatherhood increased the odds of postpartum AUD among men.

Clusters of conditions among US service members diagnosed with mild TBI from 2017 through 2019.

Many US Military Service Members (SMs) newly diagnosed with mild Traumatic Brain Injury (mTBI) may exhibit a range of symptoms and comorbidities, making for a complex patient profile that challenges clinicians and healthcare administrators. This study used clustering techniques to determine if conditions co-occurred as clusters among those newly injured with mTBI and up to one year post-injury. We measured the co-occurrence of 41 conditions among SMs diagnosed with mTBI within the acute phase, one or three months post-mTBI diagnosis, and chronic phase, one year post-mTBI diagnosis. Conditions were identified from the literature, clinical subject matter experts, and mTBI care guidelines. The presence of conditions were based on medical encounters recorded within the military health care data system. Through a two-step approach, we identified clusters. Principal component analysis (PCA) determined the optimal number of clusters, and hierarchical cluster analyses (HCA) identified the composition of clusters. Further, we explored how the composition of these clusters changed over time. Of the 42,018 SMs with mTBI, 23,478 (55.9%) had at least one condition of interest one-month post-injury, 26,831 (63.9%) three months post-injury, and 29,860 (71.1%) one year post injury. Across these three periods, six clusters were identified. One cluster included vision, cognitive, ear, and sleep disorders that occurred one month, three months, and one year post-injury. Another subgroup included psychological conditions such as anxiety, depression, PTSD, and other emotional symptoms that co-occurred in the acute and chronic phases post-injury. Nausea and vomiting symptoms clustered with cervicogenic symptoms one month post-injury, but later shifted to other clusters. Vestibular disorders clustered with sleep disorders and headache disorders one-month post-injury and included numbness and neuropathic pain one year post-injury. Substance abuse symptoms, alcohol disorders, and suicidal attempt clustered one year post-injury in a fifth cluster. Speech disorders co-occurred with headache disorders one month and one year post-injury to form a sixth cluster. PCA and HCA identified six distinct subgroups among newly diagnosed mTBI patients during the acute and chronic phases post-injury. These subgroups may help clinicians better understand the complex profile of SMs newly diagnosed with mTBI.

Convergence Between the Child Behavior Checklist Sleep Items, Actigraphy and Other Sleep Measures Among Children of Parents with Alcoholic Disorders and Controls.

The Child Behavior Checklist (CBCL) is a widely used instrument of children psychosocial functioning. CBCL sleep items have been used in both clinical settings and research. To date, few empirical studies have examined the relationships between CBCL sleep items and other sleep measures such as actigraphy and validated sleep questionnaires. This study extends the literature by examining these relationships in a group of children of parents with an alcohol use disorder (COAs) and matched controls. Two hundred and forty-eight children aged 8-12 (48% COAs; 50% girls; Mean age =10.37 (Standard deviation = 1.47)), participated in this study. Data presented here were taken from Time 1 of a larger prospective study designed to understand the relationship between sleep and alcohol use. All participants were naïve to alcohol and other illicit drugs. Parents completed the Achenbach CBCL and the Pediatric Sleep Questionnaire (PSQ). Participants wore an actigraph watch on their non-dominant wrists for one week and filled out the Youth Self-Report (YSR). Multiple regression analyses showed that CBCL sleep items (eg, "trouble sleeping") correlated with related actigraphy (eg, shorter total sleep time and longer sleep onset latency) and Pediatrics Sleep Questionnaire (PSQ) items (eg, sleep difficulties and daytime sleepiness). Logistic regression analyses indicated that CBCL items (eg, "trouble sleeping) predicted similar items in the Youth Self Report (YSR) (eg, trouble sleeping). Structural equation modeling analyses showed that the latent variable "CBCL sleep" correlated significantly with the latent variables of actigraphy (r = -0.54, p < 0.001), PSQ (r = 0.93, p < 0.001) and YSR (r = 0.38, p < 0.01). These associations were largely the same for COAs and controls. CBCL items were significantly associated with actigraphy variables, a validated sleep measure (PSQ) and youth report of sleep for both COAs and non-COAs.

Rüdin's 1916 Monograph: On the Inheritance and Primary Origin of Dementia Praecox.

In 1916, Ernst Rüdin published the first modern family study in the history of psychiatric genetics, the major goal of which was to test whether the pattern of risk in the siblings of dementia praecox (DP) probands followed Mendelian expectations. He utilized systematic ascertainment of probands and multisourced diagnostic assessments of probands and relatives, applying the narrow Kraepelinian concept of DP. In a novel step, he collaborated closely with a statistical geneticist-Wilhelm Weinberg-and applied his sibling, proband, and age correction methods. In his key sample-701 sibships when neither parent had DP-the morbid risk for DP in siblings was 4.48%, much lower than 25% expected for a recessive disorder. Risk for DP was increased by alcoholism or other mental disorders in parents. Other non-DP psychoses were common in both siblings and parents of DP probands. Rüdin discussed several alternative genetic models for DP including a 2-locus recessive, incomplete penetrance, and an oligogenic model. The high rates of other psychoses and psychopathic personalities in relatives might arise, he suggested, because these disorders shared genetic risks with DP. Rüdin established that DP, when carefully studied, ran in families, did not have a simple Mendelian genetic transmission pattern, and appeared likely to be genetically related to other non-DP psychotic disorders and perhaps some kinds of psychopathic personalities. This study, the most important in Rüdin's career, should be viewed in the context of his later extensive support of and collaboration with Nazi eugenic policies.

Neuropeptide Y Detection Using an Aptamer-Modifed Microelectrode Together with Methylene Blue As a Redox Probe

Neuroscience research has been growing fast over the last few years. Particularly the knowledge about neurotransmitters has increased over the past 50 years, impacting the understanding of many neurological disorders, including depression, schizophrenia, Parkinson's disease, and Alzheimer's disease. Still, there is a lack of knowledge about neuropeptides' liberation and action, and most of their function is assumed by indirect measurements. Neuropeptides are classified as non-electroactive molecules, making them difficult to track; consequently, the design of an analytical technique for their measurements is imperative. Neuropeptide Y (NPY) is the most abundant neuropeptide in the brain. It is associated with a wide range of biological processes and conditions, including depression, anxiety, obesity, alcoholism, mood changes, feeding behavior, and post-traumatic stress disorder (PTSD), among others. Currently, there is no method for NPY measurement in high temporal and spatial resolution in the brain. Therefore, we proposed the design of a biological sensor to understand the mechanism in which NPY is involved. This research is focused on electrochemical methods to detect and measure NPY based on an affinity-mediated strategy. An aptamer, a short single-stranded DNA with high affinity by NPY, was attached to a Pt surface of a microelectrode, taking advantage of the affinity between Pt and a thiol group in the aptamer structure. Then, to amplify the electrochemical signal, a redox molecule such as methylene blue (MB) was conjugated to the aptamer to allow rapid measurements of NPY levels in real-time. Real-time techniques such as cyclic voltammetry and square wave voltammetry (SWV) were explored to detect NPY in artificial Cerebrospinal Fluid (aCSF). Due to MB having a characteristic signal in both techniques, we successfully measured NPY concentration in aCSF (pH = 7.4). A change in current was observed as the NPY molecules interacted with the aptamer affecting the MB electrochemical signal and producing a "signal-off" sensor. These results allow us to obtain a calibration curve that will be used as an initial platform to perform Fast Scan Cyclic Voltammetry (FSCV) measurements to increase the time resolution in our measurements.

Sex-specific disparities in predictive factors of smoking cessation among smokers at high cardiovascular risk. Findings from a nationwide smoking cessation services cohort

Abstract Background Tobacco use is a major risk factor for cardiovascular diseases (CVD), but smoking cessation (SC) reduces or even cancels the risk of CVD for both sex. Using data from the French national “Consultations de Dépendance Tabagique” (CDTnet) cohort, we aimed to determine the predictive factors of SC in men and women smokers at high cardiovascular (CV) risk (i.e. with a CV disease or risk factor). Material and methods Retrospective study from the French SC services CDT-net database. Inclusion criteria were age ≥18 years, and ≥1 CV risk factor (BMI ≥25 kg/m2, hypercholesterolemia, diabetes, arterial hypertension) or CVD (history of stroke, myocardial infarction or angina pectoris, peripheral arterial disease (PAD)). Smoking abstinence (≥28 consecutive days) was self-reported and confirmed by exhaled carbon monoxide &amp;lt;10 ppm. Logistic regression assessed the association between SC and sociodemographic factors, medical characteristics and patients' smoking profile. Results Among the 246,364 subjects in the database, 15% (36,864) fulfilled the inclusion criteria. One month-abstinence was lower in women (52.6% (n=8,102) vs 55% (n=11,848) in men, p&amp;lt;0.001). For both sex, smokers with the lowest abstinence rates were those with respiratory diseases (47% among women vs. 50% among men respectively), depression history (48% vs. 48%), anxiety or depression symptoms (49% vs 50%) use of anxiolytics/antidepressants, use of opioid substitution treatment, use of cannabis (42% vs 41%) and benefit less than 3 follow-up visits (36% vs 41%). Factors positively associated with SC in both sex were age &amp;gt;65 years, having a degree, being employed, coming by self-initiation or by one's relatives, being overweight, having previous quit attempts, presenting with low nicotine dependence and being confident in achieving abstinence. Factors negatively associated with abstinence only in women but not in men was alcohol disorder. Finally, factors negatively associated with abstinence only in men but not in women were PAD, and tobacco-related cancers. Conclusion Our results from a large nationwide database suggest the relevance of differentiated management according to sex in smokers at high CV risk, given the major sex-specific disparities in factors associated with abstinence rates. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): This work was supported by IReSP and INCa through a call for doctoral grants launched in 2019.

S1449 Prior Bariatric Surgery and Labor/Delivery and Pregnancy Complications

S1449 Prior Bariatric Surgery and Labor/Delivery and Pregnancy Complications

Misalignment of Reward Response With Healthful Behavior: An Underappreciated Driver of Population Health Deficits and Health Disparities?

Socioeconomic status-related (SES-related) health disparities are worsening across resource-rich environments, despite increased knowledge about health determinants and inducements for healthful behavior change. We ask whether insights from addiction science and evolutionary biology may assist understanding and counteracting SES-related health disparities. It is known that a mismatch between evolved traits and behaviors that conserve energy drives many health deficits. We posit that this energy mismatch is one manifestation of a more expansive mismatch in levels of reward activation, between environments more versus less manipulated by human activity. This larger mismatch explains why SES-related health disparities arise not only from overeating and excessive sedentism, but also from alcohol, nicotine, other substances, and mood disorders. Lower SES persons are more likely to have lower baseline reward activation, which leads to higher prioritization of reward elevating activities, and at the same time are less likely to act on knowledge about unhealthfulness of behaviors.

Possibilities for implementing of anti-fibrotic and anti-inflammatory effects of metabolic therapy in acute alcoholic disorders under experimental conditions

The aim of the work was to study antifibrotic and anti-inflammatory effects of metabolic therapy and mechanisms of regeneration in acute alcoholic liver damage (AALD) in rats under experimental conditions. Materials and methods. The experiment involved 66 white non-linear male rats with a mass of 120–130 g, which were divided into 5 groups: 1 – intact animals (n = 10); 2 – animals with AALD (n = 20), 3 – animals (n = 12) with AALD and intraperitoneally injected with Corvitin, 4 – animals (n = 12) with AALD and injected with Glutargin, 5 – аnimals with AALD (n = 12) and injected with Corvitin and Glutargin. The pro-inflammatory cytokines and cell cycle phases were analyzed. Results. The level of IGF-1 was significantly 24.1 % higher in group 2 compared to the control. In animals of group 3, the level of IGF-1 was 20.2 % decreased compared with group 2. The level of IGF-1 was significantly 9.7 % decreased in group 5 animals compared with group 2. There was a 31.6% increase in the level of TGF-β in animals of group 2 in comparison with the control ones. The level of TGF-β was 22.8 % decreased in group 3 compared with group 2. In group 5 animals, the value was 12.0 % lower than in group 2. The percentage of cell nuclei in the presynthetic phase in group 2 rats was 8.3 % higher than in controls. In animals of group 2, the number of cell nuclei in the phase of DNA synthesis were 33.3 % larger than in group 1. The rate of DNA fragmentation in AALD exceeded the corresponding value in control group by 27.5 %. Conclusions. AALD was accompanied by an increase in the serum IGF-1 and TGF-β in animals. The administration of corvitin decreased the level of IGF-1 in rats with AALD, and the use of glutargine mainly decreased the level of TGF-β. Combined use of the drugs did not show significant effectiveness. Compensatory regeneration mechanisms were activated in AALD processes and apoptotic cell death was evidenced by the increased indicators of nuclear DNA fragmentation.

Maturing out of alcohol and cannabis co-use: A test of patterns and personality predictors.

Reductions in substance involvement into adulthood are thought to represent a normative maturing out of substance use. However, patterns and predictors of maturing out of alcohol and cannabis co-use remain largely unstudied. Therefore, the current study tested developmental trajectories of alcohol and cannabis use from late adolescence into adulthood and whether late adolescent personality traits predicted trajectory class membership. Data come from a longitudinal study of family history of alcohol disorder (N=458). Age bands were created to model trajectories of drinking quantity, negative alcohol consequences, and cannabis use frequency from late adolescence (age 18-22) to young adulthood (age 23-28) and adulthood (age 29-36). Participants reported on their sensation seeking, conscientiousness, and neuroticism during late adolescence and their typical drinking quantity, negative alcohol consequences, and cannabis use frequency at each age band. Three trajectory classes were derived from an initial Parallel Process Growth Mixture Model: (1) low-risk maturing out of alcohol-only use, (2) high-risk maturing out of co-use, and (3) high-risk switchers who increased their cannabis use into adulthood. Late adolescent sensation seeking was associated with higher odds of being in both co-use trajectories, whereas a lack of conscientiousness was associated with higher odds of being a co-use switcher. We identified heterogeneity in trajectories of co-use, which suggests that a lack of maturing out of alcohol involvement may be accompanied by increased cannabis use. Moreover, late adolescent personality traits may predispose individuals toward riskier developmental trajectories of substance use into adulthood.

Parent and Adolescent Reports of Parental Monitoring and Sources of Parental Knowledge are Linked to Cannabis Use and Symptom Development in Adolescents.

Greater discrepancies between parent and adolescent reports of parenting behaviors are associated with poorer adolescent functioning. The present research aims to build from the existing literature by examining unique parent and adolescent perceptions of parental monitoring and distinct sources of parental knowledge (i.e, parental solicitation, parental control, child disclosure) and their association with adolescent cannabis and alcohol use and disorder symptoms using cross-sectional data. Parent-adolescent dyads (N = 132) were recruited from the community and the family court system. Adolescents were ages 12 to 18 (40.2% female; 68.2% White, 18.2% Hispanic). Parents and adolescents completed a questionnaire assessing the four domains of parenting behaviors. Adolescents' substance-use behaviors and related disorder symptoms were assessed via adolescent self-report and semi-structured interviews. Parental ratings of distinct parenting behaviors were higher (more favorable) than their child's reports, as shown in prior studies. Parent-reported parenting behaviors were uniquely related to cannabis use, over and above adolescent reports and the adolescent's age. With regard to report discrepancies, interactive effects of parent and adolescent perceptions of parental control were not statistically significant in our analysis after correcting for multiple tests. While most research relating parental monitoring to adolescent cannabis use relies solely on adolescent perceptions, our study suggests a unique role of parent perceptions for cannabis use and disorder symptoms, respectively. Findings support the importance of considering unique parent and adolescent perceptions of what parents know, as well as how they know it, to understand early cannabis use and problem development.

General Demographics and Behavioral Patterns of Visitors Using a Self-help Website for Identification of and Intervention in Alcoholism and Common Mental Disorders in Suriname: Descriptive Study.

BackgroundDigital health applications have been shown to be an accepted means to provide mental health information and advice in various high- and middle-income countries. Started in 2015, ehealth.sr was the first website to offer preventive information, self-tests, and unguided digital self-help for depression, anxiety symptoms, and problematic alcohol use in Suriname, an upper middle-income country in South America.ObjectiveThis study aimed to assess the general demographics and behavioral patterns of the visitors of ehealth.sr, as well as to evaluate different promotional channels to attract the target audience to the website.MethodsData collection for this study took place between August 2015 and December 2020. Conventional promotion channels such as newspaper and radio advertisements as well as social media advertisements were used to attract users to the website. The number of visits and activity on the website was registered using Google analytics and the website’s internal activity log.ResultsOn average, about 115 unique visitors accessed the website per month. The average number of visits to the website increased notably when social media advertisement campaigns were conducted (266 per month in 2018) compared to when traditional advertisements campaigns through papers, radio, and television were used (34 per month in 2019). Of the 1908 new visitors, 1418 (74.32%) were female. On average, visitors accessed 2 (SD 0.3) pages of the website and a session lasted 2.6 (SD 0.9) minutes. The most popular pages for intervention on the website were those for the mood or anxiety screening (731/942, 77.6%) as opposed to those for alcohol screening (211/942, 22.4%). People aged <45 years (on average, 2.2 pages per session for 3.2 minutes) made more use of the website than people aged ≥45 years (on average, 1.7 pages per session for 2 minutes).ConclusionsPromotion via social media led to more visitors to the website than newspaper or radio advertisements. Younger age groups and females visited the website more often. The pages on preventive information and brief self-tests were visited more frequently than the self-help modules. In general, user adherence to the website in terms of the average session duration and number of viewed pages per session is low and is a key point of concern for the successful implementation of digital mental health websites.

Observational Study of the Association between Hyponatremia and Rhabdomyolysis in Patients Presenting to Hospital.

Hyponatremia may be a risk factor for rhabdomyolysis, but the association is not well defined and may be confounded by other variables. The aims of this study were to determine the prevalence and strength of the association between hyponatremia and rhabdomyolysis and to profile patients with hyponatremia. In a cross-sectional study of 870 adults admitted to hospital with rhabdomyolysis and a median peak creatine kinase of 4064 U/L (interquartile range, 1921–12,002 U/L), glucose-corrected serum sodium levels at presentation showed a U-shape relationship to log peak creatine kinase. The prevalence of mild (130–134 mmol/L), moderate (125–129 mmol/L), and severe (<125 mmol/L) hyponatremia was 9.4%, 2.5%, and 2.1%, respectively. We excluded patients with hypernatremia and used multivariable linear regression for analysis (n = 809). Using normal Na+ (135–145 mmol/L) as the reference category, we estimated that a drop in Na+ moving from one Na+ category to the next was associated with a 25% higher creatine kinase after adjusting for age, alcohol, illicit drugs, diabetes, and psychotic disorders. Multifactorial causes of rhabdomyolysis were more common than single causes. The prevalence of psychotic and alcohol use disorders was higher in the study population compared to the general population, corresponding with greater exposure to psychotropic medications and illicit drugs associated with hyponatremia and rhabdomyolysis. In conclusion, we found an association between hyponatremia and the severity of rhabdomyolysis, even after allowing for confounders.

Attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco), estimation of harmfulness and knowledge of these substances, and continuing education: A pilot cross-sectional study

To investigate attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco). The attitudes were assessed thanks to the Attitude to Mental Illness Questionnaire (AMIQ) for heroin, alcohol and tobacco-related disorders in three independent groups of pharmacists. Estimation of substance-related harmfulness, knowledge of substance-related disorders and activities/needs for continuing education on substance-related disorders were also recorded. Thirty-five pharmacists were included (heroin: 11, alcohol: 10 and tobacco: 14). AMIQ scores for heroin-related disorder were negative and lower than for alcohol (P<0.01) and tobacco (P<0.001). AMIQ scores for alcohol-related disorder were lower than for tobacco (P<0.05). The estimation of heroin-related harmfulness was higher than for alcohol and tobacco (P<0.001). The estimations of knowledge of substance-related disorders were lower for opioid and alcohol than for tobacco (P<0.001). AMIQ scores and the needs for continuing education on each associated addiction showed a positive relation (P<0.01). Pharmacists had a negative attitude toward heroin and alcohol-related disorders. A positive attitude toward patients with a substance-related disorder was associated with a need for continuing education. Efforts should be made to change attitudes and to promote continuing education on heroin and alcohol-related disorders.

Increased Risk for Substance Use-Related Problems in Mild Intellectual Disability: A Population-Based Cohort Study

IntroductionIntellectual disability (ID) has been linked to substance use-related problems (SUP). However, previous research is limited by the small sample sizes, lack of general population comparison and have not accounted for familial confoundings. The role of other psychiatric comorbidities also remains unknown.ObjectivesTo examine the risk of SUP in individuals with mild-ID and assess whether the associations depend on other psychiatric comorbidities, controlling for potential familial confounding.MethodsPopulation-based cohort study of individuals born in Sweden 1973-2003. We identified 19,078 individuals with mild-ID, 953,900 reference individuals from the general population, and 20,722 full-siblings of individuals with mild-ID. Conditional logistic regression models were used to compare individuals with mild-ID to the general population and their full-siblings regarding the risk of SUP, including alcohol and substance use disorders, alcohol and substance-related somatic diseases, substance-related crime, and substance-related death. Analyses were repeated stratified by the presence of psychiatric comorbidities.ResultsIndividuals with mild-ID had increased risks of any SUP (adjusted OR [95%CI]: 1.41 [1.35, 1.47]), compared to the general population, including alcohol-related somatic diseases (3.27 [1.92, 5.59]), alcohol (2.05 [1.91, 2.22]) and drug-use disorder (1.79 [1.69, 1.91]), and alcohol (1.36 [1.19, 1.49]) and drug-related crime (1.27 [1.19, 1.36]). The risk of SUP for individuals with mild ID was particularly elevated with comorbid mood (3.74 [3.47, 4.04]), anxiety (3.30 [3.09, 3.53]) and attention-deficit/hyperactivity disorders (2.61 [2.44, 2.80]). Increased risk of SUP remained significant when controlling for familial confounding.ConclusionsIndividuals with mild-ID, especially those with other psychiatric comorbidities, are at increased risks of SUP.DisclosureNo significant relationships.