Alcoholic Research Articles

Couples, alcohol use and experience of intimate partner violence among young women in urban informal settlements in Durban, South Africa: A mixed methods study

Alcohol is recognized as a driver of intimate partner violence (IPV) perpetration and experience, but relatively little research has focused on the role of couples' drinking patterns, nor pathways between alcohol and violence. We draw on data collected among young (18–30 year old) people living in informal settlements who self-selected to enroll in an intervention trial to reduce IPV in Durban, South Africa to understand these dynamics. Between September 2015 and September 2016 quantitative data were collected from women, who reported on their own experiences of IPV and alcohol use, as well as their partner's own alcohol use. To contextualise and interpret the quantitative results, we use qualitative data from women and men (who were not in relationships with one another) to understand potential pathways through which alcohol use may shape conflict in relationships. All forms of IPV (physical and/or sexual, emotional and economic) were more common among women where either, they alone had problematic drinking levels, their partner was frequently drunk but they did not have problematic alcohol use, or they had problematic alcohol use and their partner was drunk frequently. Qualitative data suggested women and men in relationships rarely drank together. Three potential ways in which alcohol use increased conflict and IPV: disinhibition, with women and men more likely to get into arguments and speak ‘badly’ to one another; the impact of men's drinking on relationships, including economic provision and providing emotional support; and, the close association between alcohol consumption and infidelity, with women's public drinking being particularly stigmatized and male partner's seeing this as a challenge to their authority and control. Interventions addressing the alcohol-IPV nexus need to also address male patriarchal control and alcohol's close association with infidelity and the impact on finances, as well as reducing alcohol use.

W3 - Is the Whole Greater Than the Sum of Its Parts? Examining How Dosage of Intervention Components From the Sacramento Neighborhood Alcohol Prevention Project Affect Child Abuse and Neglect

W3 - Is the Whole Greater Than the Sum of Its Parts? Examining How Dosage of Intervention Components From the Sacramento Neighborhood Alcohol Prevention Project Affect Child Abuse and Neglect

Neurosteroid [3α,5α]3-hydroxypregnan-20-one inhibition of chemokine monocyte chemoattractant protein-1 in alcohol-preferring rat brain neurons, microglia, and astroglia.

Neuroimmune dysfunction in alcohol use disorder (AUD) is associated with activation of myeloid differentiation primary response 88 (MyD88)-dependent Toll-like receptors (TLR) resulting in overexpression of the chemokine monocyte chemoattractant protein-1 (MCP-1/CCL2). MCP-1 overexpression in the brain is linked to anxiety, higher alcohol intake, neuronal death, and activation of microglia observed in AUD. The neurosteroid [3α,5α][3-hydroxypregnan-20-one (3α,5α-THP) has been reported as an inhibitor of MyD88-dependent TLR activation and MCP-1 overexpression in mouse and human macrophages and the brain of alcohol-preferring (P) rats. We investigated how 3α,5α-THP regulates MCP-1 expression at the cellular level in P rat nucleus accumbens (NAc) and central amygdala (CeA). We focused on neurons, microglia, and astrocytes, examining the individual voxel density of MCP-1, neuronal marker NeuN, microglial marker IBA1, astrocytic marker GFAP, and their shared voxel density, defined as intersection. Ethanol-naïve male and female P rats were perfused 1 h after IP injections of 15 mg/kg of 3α,5α-THP, or vehicle. The NAc and CeA were imaged using confocal microscopy following double-immunofluorescence staining for MCP-1 with NeuN, IBA1, and GFAP, respectively. MCP-1 intersected with NeuN predominantly and IBA1/GFAP negligibly. 3α,5α-THP reduced MCP-1 expression in NeuN-labeled cells by 38.27 ± 28.09% in male and 56.11 ± 21.46% in female NAc, also 37.99 ± 19.53% in male and 54.96 ± 30.58% in female CeA. In females, 3α,5α-THP reduced the MCP-1 within IBA1 and GFAP-labeled voxels in the NAc and CeA. Conversely, in males, 3α,5α-THP did not significantly alter the MCP-1 within IBA1 in NAc or with GFAP in the CeA. Furthermore, 3α,5α-THP decreased levels of IBA1 in both regions and sexes with no impact on GFAP or NeuN levels. Secondary analysis performed on data normalized to % control values indicated that no significant sex differences were present. These data suggest that 3α,5α-THP inhibits neuronal MCP-1 expression and decreases the proliferation of microglia in P rats. These results increase our understanding of potential mechanisms for 3α,5α-THP modulation of ethanol consumption.

Withdrawal from chronic alcohol impairs the serotonin-mediated modulation of GABAergic transmission in the infralimbic cortex in male rats

The infralimbic cortex (IL) is part of the medial prefrontal cortex (mPFC), exerting top-down control over structures that are critically involved in the development of alcohol use disorder (AUD). Activity of the IL is tightly controlled by γ-aminobutyric acid (GABA) transmission, which is susceptible to chronic alcohol exposure and withdrawal. This inhibitory control is regulated by various neuromodulators, including 5-hydroxytryptamine (5-HT; serotonin). We used chronic intermittent ethanol vapor inhalation exposure, a model of AUD, in male Sprague-Dawley rats to induce alcohol dependence (Dep) followed by protracted withdrawal (WD; 2 weeks) and performed ex vivo electrophysiology using whole-cell patch clamp to study GABAergic transmission in layer V of IL pyramidal neurons. We found that WD increased frequencies of spontaneous inhibitory postsynaptic currents (sIPSCs), whereas miniature IPSCs (mIPSCs; recorded in the presence of tetrodotoxin) were unaffected by either Dep or WD. The application of 5-HT (50 μM) increased sIPSC frequencies and amplitudes in naive and Dep rats but reduced sIPSC frequencies in WD rats. Additionally, 5-HT2A receptor antagonist M100907 and 5-HT2C receptor antagonist SB242084 reduced basal GABA release in all groups to a similar extent. The blockage of either 5-HT2A or 5-HT2C receptors in WD rats restored the impaired response to 5-HT, which then resembled responses in naive rats. Our findings expand our understanding of synaptic inhibition in the IL in AUD, indicating that antagonism of 5-HT2A and 5-HT2C receptors may restore GABAergic control over IL pyramidal neurons. Significance statementImpairment in the serotonergic modulation of GABAergic inhibition in the medial prefrontal cortex contributes to alcohol use disorder (AUD). We used a well-established rat model of AUD and ex vivo whole-cell patch-clamp electrophysiology to characterize the serotonin modulation of GABAergic transmission in layer V infralimbic (IL) pyramidal neurons in ethanol-naive, ethanol-dependent (Dep), and ethanol-withdrawn (WD) male rats. We found increased basal inhibition following WD from chronic alcohol and altered serotonin modulation. Exogenous serotonin enhanced GABAergic transmission in naive and Dep rats but reduced it in WD rats. 5-HT2A and 5-HT2C receptor blockage in WD rats restored the typical serotonin-mediated enhancement of GABAergic inhibition. Our findings expand our understanding of synaptic inhibition in the infralimbic neurons in AUD.

Impact of hospital-administered extended-release naltrexone on readmission rates for patients with alcohol use disorder.

Alcohol use disorder (AUD) is a persistent public health concern, contributing significantly to mortality and morbidity. This study aims to evaluate the impact of in-hospital extended-release naltrexone (XR-NTX) administration on alcohol-related outcomes. This retrospective cohort study, conducted at an academic medical centre, included 141 adult patients with AUD who received XR-NTX between December 2020 and June 2021. Primary and secondary outcomes were assessed 90 days before and after XR-NTX administration to identify number of alcohol-related hospitalisations, emergency department (ED) visits and average length of hospital stay. Subgroup analyses assessed outcomes in high hospital utilisers and marginally housed or unhoused populations. There was a significant decrease in ED visits and length of hospital stay post XR-NTX and no significant difference in the number of rehospitalisations. Subgroup analysis showed significant reduction in hospital readmissions and ED visits among high hospital utilisers. Our sample was a predominantly middle-aged, male and white patient population. In-hospital initiation of XR-NTX for AUD was associated with a significant decrease in ED visits and length of hospital stay. While no significant impact on the number of hospitalisations was observed overall, there was a substantial reduction in hospital readmissions and ED visits among high utilisers. Our findings suggest the potential benefits of in-hospital XR-NTX, emphasising the need for further research to establish causal relationships, assess cost-effectiveness and explore effectiveness across diverse patient populations. Effective in-hospital interventions, such as XR-NTX, hold promise for improving patient outcomes and reducing the healthcare burden associated with AUD.

Telehealth Availability for Mental Health Care During and After the COVID-19 Public Health Emergency

Telehealth services expanded rapidly during the COVID-19 public health emergency (PHE). To evaluate changes in availability of telehealth services at outpatient mental health treatment facilities (MHTFs) throughout the US during and after the COVID-19 PHE. In this cohort study, callers posing as prospective clients contacted a random sample of 1404 MHTFs drawn from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Locator from December 2022 to March 2023 (wave 1 [W1]; during PHE). From September to November 2023 (wave 2 [W2]; after PHE), callers recontacted W1 participants. Analyses were conducted in January 2024. Callers inquired whether MHTFs offered telehealth (yes vs no), and, if yes, whether they offered (1) audio-only telehealth (vs audio and video); (2) telehealth for therapy, medication management, and/or diagnostic services; and (3) telehealth for comorbid alcohol use disorder (AUD). Sustainers (offered telehealth in both waves), late adopters (did not offer telehealth in W1 but did in W2), nonadopters (did not offer telehealth in W1 or W2), and discontinuers (offered telehealth in W1 but not W2) were all compared. During W2, 1001 MHTFs (86.1%) were successfully recontacted. A total of 713 (71.2%) were located in a metropolitan county, 151 (15.1%) were publicly operated, and 935 (93.4%) accepted Medicaid as payment. The percentage offering telehealth declined from 799 (81.6%) to 765 (79.0%) (odds ratio [OR], 0.84; 95% CI, 0.72-1.00; P < .05). Among MHTFs offering telehealth, a smaller percentage in W2 offered audio-only telehealth (369 [49.3%] vs 244 [34.1%]; OR, 0.53; 95% CI, 0.44-0.64; P < .001) and telehealth for comorbid AUD (559 [76.3%] vs 457 [66.5%]; OR, 0.62; 95% CI, 0.50-0.76; P < .001) compared with W1. In W2, MHTFs were more likely to report telehealth was only available under certain conditions for therapy (141 facilities [18.0%] vs 276 [36.4%]; OR, 2.62; 95% CI, 1.10-3.26; P < .001) and medication management (216 facilities [28.0%] vs 304 [41.3%]; OR, 1.81; 95% CI, 1.48-2.21; P < .001). A total of 684 MHTFs (72.0%) constituted sustainers, 94 (9.9%) were discontinuers, 106 (11.2%) were nonadopters, and 66 (7.0%) were late adopters. Compared with sustainers, discontinuers were less likely to be private for-profit (adjusted OR [aOR], 0.28; 95% CI, 0.11-0.68) or private not-for-profit (aOR, 0.26; 95% CI, 0.14-0.48) after adjustment for facility and area characteristics. Based on this longitudinal cohort study of 1001 MHTFs, telehealth availability has declined since the PHE end with respect to scope and modality of services, suggesting targeted policies may be necessary to sustain telehealth access.

An Observational Study of a Digital Substance Use and Recovery Program.

Digital substance use treatment programs present an opportunity to provide nonresidential care for people with problematic substance use. In June 2021, the provincial government in Ontario provided free access to Breaking Free Online (BFO), a digital behavioral change program for people with substance use disorders. An observational study was conducted with retrospective data to characterize clients' use and engagement patterns in BFO and examine changes in self-reported outcomes. In total, 6,370 individuals registered for BFO between June 2021 and October 2022, of whom 3,650 completed the intake assessment. Most of these clients were self-referred (64%), with 37% having been referred by health service providers. More than one-half of the clients (52%) resided in Ontario West or East regions. Support for addressing problematic alcohol use was the most requested program (40%). By October 2022, about 44% of the clients had completed between one and four of 12 program strategies. Analysis revealed significant changes in pre-post scores across four validated scales (p<0.001), indicating a decrease in anxiety and depression, an increase in quality of life, an improvement in recovery progression, and a decrease in severity of symptoms associated with substance use disorders. BFO clients with higher completion rates had the most improvement across the scales used; however, clients with lower and medium completion rates also had improvements. Because of the shame and stigma associated with substance use, digital supports with low barriers to entry can help support the autonomy, privacy, and preferences of individuals seeking help for problematic substance use.

Dazhu Hongjingtian injection attenuated alcohol-induced depressive symptoms by inhibiting hippocampus oxidative stress and inflammation through Nrf2/HO-1/NLRP3 signaling pathway

Ethnopharmacological relevanceAlcoholic depression, a disorder of the central nervous system, is characterized by alcohol abuse, which causes blood-brain barrier disruption and oxidative damage in the brain. The rhizome of Rhodiola crenulate, from which Dazhu Hongjingtian Injection (DZHJTI) is derived, has been traditionally employed in ethnopharmacology to treat neurological disorders due to its neuroprotective, anti-inflammatory, and antioxidant properties. However, the exact mechanism by which DZHJTI alleviates alcoholic depression remains unclear. Aim of the studyThis study aimed to investigate the antidepressant effects of DZHJTI and its underlying mechanisms in a mouse model of alcohol-induced depression. Materials and methodsA model of alcoholic depression was established using C57BL/6J mice, and the effects of DZHJTI on depression-like behaviors induced by alcohol exposure were assessed through behavioral experiments. Histopathological examination was conducted to observe nerve cell damage and microglial activation in the hippocampal region. Oxidative stress indices in the hippocampus, inflammatory factors, and serum levels of dopamine (DA) and 5-hydroxytryptamine (5-HT) were measured using ELISA. Expression of proteins related to the Nrf2/HO-1/NLRP3 signaling pathway was determined by Western blot analysis. ResultsDZHJTI attenuated depression-like behaviors, neuronal cell damage, oxidative stress levels, inflammatory responses, and microglial activation. It also restored levels of brain-derived neurotrophic factor, brain myelin basic protein, DA, and 5-HT in mice with chronic alcohol exposure. After DZHJTI treatment, the expressions of Nuclear Respiratory Factor 2 (Nrf2) and Heme Oxygenase-1 (HO-1) increased in the hippocampus, whereas the levels of NOD-like receptor thermal protein domain-associated protein 3 (NLRP3), apoptosis-associated speck-like protein containing CARD, cleaved caspase-1, interleukin (IL)-1β, and IL-18 decreased. ConclusionsDZHJTI ameliorates alcohol-induced depressive symptoms in mice through its antioxidant and anti-inflammatory effects, involving mechanisms associated with the Nrf2/HO-1/NLRP3 signaling pathway. This study highlights the potential of DZHJTI as a therapeutic option for alcohol-related depression and suggests the scope for future research to further elucidate its mechanisms and broader clinical applications.

Ventral tegmental area deep brain stimulation reverses ethanol-induced dopamine increase in the rat nucleus accumbens.

The neurophysiology of alcohol use disorder (AUD) is complex, but a major contributor to addictive phenotypes is the tendency for drugs of abuse to increase tonic extracellular dopamine (DA) levels in the nucleus accumbens (NAc). Repeated exposure to substances of abuse such as ethanol results in the overstimulation of the mesolimbic pathway, causing an excessive release of DA from the ventral tegmental area (VTA) to target regions such as the NAc. This heightened DA signaling is associated with the reinforcing effects of substances, leading to a strong desire for continued use. Recent work has postulated that high frequency deep brain stimulation (DBS) of the ventral tegmental area may reduce dopamine transmission to the nucleus accumbens following acute drug of abuse exposure, thereby mitigating the drug's addictive potential. We first demonstrate ethanol's ability to decrease phasic DA release over time and to increase tonic extracellular DA concentrations in the nucleus accumbens. Next, we demonstrate the capability for high frequency VTA DBS to reverse this ethanol-associated surge in tonic DA concentrations in the nucleus accumbens to levels not significantly different from baseline. This study suggests a promising new avenue for investigating the mechanisms of alcohol use disorder.

A commercial tobacco and alcohol use intervention for urban Native American youth

ObjectiveWesternized alcohol and commercial tobacco use prevention approaches for Native Americans have not been effective, or sustainable. The overall objective of this study examined the effect of the culturally based Urban Talking Circle (UTC) intervention versus standard education (SE) program for the prevention of alcohol and commercial tobacco use among urban Native American youth. DesignThe study employed a 2-condition quasi-experimental design and utilized convenience and snowball sampling methods for recruiting 100 urban Native American youth participants in two urban Native American community program locations in Florida. Study participants were randomized by their urban Native American community program location to one of the 2-conditions. These included the standard education (SE) program used within United States school systems (drug abuse resistance education) and the Urban Talking Circle (UTC) intervention, culturally tailored and developed for urban Native American youth from the culturally based Talking Circle Intervention for rural Native American Youth. The Native American Alcohol Measure for Youth (NAAMY) and Native Reliance Questionnaire were utilized to collect participants' data. Participants' data was analyzed using multivariate analysis of variance to determine differences between the scores on all measures at pre/post-intervention for the 2-conditions. ResultsStudy findings indicate that a culturally based intervention was more effective for the reduction of commercial tobacco and alcohol use than a non-culturally based intervention for urban Native American youth. ConclusionThe study findings emphasized that the utilization of the culturally tailored UTC intervention reduced involvement associated with alcohol and commercial tobacco use.

Discrimination experiences and problematic alcohol and cannabis use in young adulthood.

Limited research has examined how discrimination in young adulthood relates to substance use. We examined how multiple and specific types (e.g., race-based) of experiences of unfair treatment are related to problematic alcohol and cannabis use. We analyzed cross-sectional data from a diverse cohort of young adults (mean age 24.7) predominantly residing in southern California (n = 2303) to examine associations of multiple (count) and specific experiences (race-, sexual orientation-, gender-based) of perceived everyday discrimination with self-reported alcohol and cannabis use outcomes (consequences, use disorders, and solitary use). We also tested interactions between the three specific discrimination experiences and sociodemographic characteristics (e.g., race-based discrimination × race/ethnicity). In this diverse sample (e.g., 47% Latinx/o and 22% Asian; 22% sexual/gender diverse; 56% female) of young adults, about 46% reported up to four different discrimination experiences and 27% reported race-, 26% gender-, and 5% sexual orientation-based discrimination. Race- and gender-based discrimination and experiencing more types of discrimination were associated with worse cannabis use outcomes. Race-based discrimination was associated with fewer alcohol consequences and lower Alcohol Use Disorders Identification Test (AUDIT) scores. Associations with sexual orientation-based discrimination and the interactions were not significant. Findings build on limited research on associations of discrimination with cannabis use in young adults. More work is needed to understand the mechanisms by which discrimination influences drinking behaviors. This study advances the field by examining the unique contributions of specific and multiple types of discrimination experiences in young adulthood, a critical developmental period in which substance use peaks.

Factors Associated with Mild Cognitive Impairment in Community-Dwelling Elderly Individuals: A Re-evaluation of Systematic Reviews

&amp;lt;i&amp;gt;Objective &amp;lt;/i&amp;gt;This study aims to re-evaluate systematic reviews on factors associated with mild cognitive impairment (MCI) in community-dwelling elderly individuals to inform prevention and intervention strategies in community settings. &amp;lt;i&amp;gt;Methods &amp;lt;/i&amp;gt;Comprehensive searches were conducted across multiple databases, including CNKI, Wanfang Data, VIP Journal Integration Platform, PubMed, Scopus, Web of Science, and Cochrane Library, to identify systematic reviews on factors contributing to MCI in community-dwelling elderly individuals. Dual reviewers screened the literature, and the methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). Relevant factors were summarized and analyzed. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt; Eleven systematic reviews were included in the analysis. Of these, two were classified as high quality, two as low quality, and the remaining seven as very low quality. Protective factors against MCI included the consumption of tea, fish, and shellfish, physical exercise, and social participation. Risk factors encompassed a history of chronic diseases, depression, sleep disorders, smoking, and alcohol consumption. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt; The methodological quality of systematic reviews on factors associated with MCI in community-dwelling elderly individuals is generally low. MCI is closely linked to various aspects of physiological health, psychological health, dietary nutrition, and lifestyle behaviors. It is crucial to focus on high-risk groups, particularly the elderly and females, as well as individuals experiencing subjective cognitive decline, and conduct psychological screenings and assessments of dietary quality. These factors may serve as early indicators for MCI in community-dwelling elderly individuals.

The Effects of Acute and Chronic Alcohol Administration and Withdrawal on Bone Microstructure, Mechanical Strength, and Remodeling Protein Expression and Their Relation to an Antioxidant and FGF23 In Vivo.

Alcohol's detrimental effects on bone health are well established, yet some literature suggests moderate consumption may offer benefits. With alcohol use on the rise, we investigate the impact of acute and chronic alcohol administration, along with withdrawal, on male Wistar rat femurs. We observed a transient cortical thickness increase with acute alcohol (AA) compared to chronic exposure (CA) but no significant changes in trabecular parameters or mechanical properties. High osteocalcin and osteopontin expression levels were noted in AA, alongside elevated RANKL expression. Conversely, CA showed low TRAP levels. FGF23 expression significantly increased during alcohol withdrawal (AW), while GPX decreased after chronic exposure but rose during withdrawal. Although mechanical strength changes were insignificant, biochemical shifts suggest alcohol exposure promotes bone resorption, reduces antioxidant protection, and potentially hampers active vitamin D and phosphate reabsorption via FGF23 upregulation.

The risks for major psychiatric disorders in the siblings of probands with major depressive disorder.

Using a case-controlled study including siblings of major depression (MD) and control probands, born 1970-1990 and followed through 2018, we sought to clarify the degree to which the familial liability to MD is reflected in its clinical features, and the pattern of psychiatric disorders at elevated risk in the siblings of MD probands. The study population included full-siblings of 197,309 MD and matched 197,309 control probands. The proband-sibling tetrachoric correlation of for MD was +0.20. Both linear and quadratic effects of younger AAO and number of episodes significantly increased the risk of MD in siblings. Male sex, anxiety disorder, alcohol use disorder (AUD), inpatient treatment, psychotic symptoms, severity, and antidepressant prescription in MD probands increased the risk of MD in siblings. Cox proportional hazard models (hazard ratios, 95% CI) revealed a significantly increased risk of attention deficit hyperactivity disorder (1.82, 1.76-1.88), generalized anxiety disorder (1.79, 1.74-1.85), bipolar disorder (1.78, 1.70-1.85), MD (1.74, 1.72-1.76), obsessive-compulsive disorder (1.72, 1.65-1.80), phobic anxiety disorder (1.71, 1.65-1.76), and panic disorder (1.68, 1.64-1.72) in MD co-siblings. The HRs for AUD (1.64, 1.60-1.68), post-traumatic stress disorder (1.62, 1.59-1.66) were modestly lower, and the lowest was seen for schizophrenia (1.42, 1.30-1.54). The overall pattern of increased risk of these disorders was similar in reared-apart half-siblings and cousins of MD probands. Our findings suggest that MD is familial, and a range of important clinical factors predict its familial liability. The familial liability to MD, mostly due to genetic factors, is shared with a broad range of psychiatric disorders.

Late chronotype and associated health problems

Introduction: Chronotype reflects an individual's preference for activity and rest within a 24-hour period, governed by the internal circadian clock system located in the suprachiasmatic nuclei of the hypothalamus. There are three chronotypes: Morning, Evening, and Intermediate. The evening type is also called “night owls” or late chronotype. Night owls prefer to be active in the evening and sleep and wake up late. The misalignment between the sleep patterns in late chronotype and the social schedules puts the night owls in danger of physical and mental health issues. Purpose of work: The primary aim of this review is to provide a comprehensive overview of current knowledge on the impact of late chronotype on health. Methods and materials: A review of the literature available in the PubMed database, the following keywords and their combinations were searched: "chronotype", “mental health", "cancer", “late chronotype”, “circadian rhythm”, “type 2 diabetes”, “depression”. State of knowledge: Studies have confirmed that late chronotype is associated with a higher risk of type 2 diabetes, obesity, cancer, alcohol and cigarette addiction, and unhealthy eating habits. Furthermore, the evening chronotype is an independent risk factor for depression. It is also linked with anxiety, bipolar disorder, and schizophrenia. Summary: In this review, we have summarized the latest research on late chronotype, circadian misalignment, and their potential consequences on human health. Most studies on evening chronotype and related health issues are cross-sectional. Further longitudinal or experimental research is needed to examine the potential cause-and-effect relationships on this cause.

The Role of Biomarkers in HPV-Positive Head and Neck Squamous Cell Carcinoma: Towards Precision Medicine.

Head and neck cancer (HNC) represents a significant global health challenge, with squamous cell carcinomas (SCCs) accounting for approximately 90% of all HNC cases. These malignancies, collectively referred to as head and neck squamous cell carcinoma (HNSCC), originate from the mucosal epithelium lining the larynx, pharynx, and oral cavity. The primary risk factors associated with HNSCC in economically disadvantaged nations have been chronic alcohol consumption and tobacco use. However, in more affluent countries, the landscape of HNSCC has shifted with the identification of human papillomavirus (HPV) infection, particularly HPV-16, as a major risk factor, especially among nonsmokers. Understanding the evolving risk factors and the distinct biological behaviors of HPV-positive and HPV-negative HNSCC is critical for developing targeted treatment strategies and improving patient outcomes in this complex and diverse group of cancers. Accurate diagnosis of HPV-positive HNSCC is essential for developing a comprehensive model that integrates the molecular characteristics, immune microenvironment, and clinical outcomes. The aim of this comprehensive review was to summarize the current knowledge and advances in the identification of DNA, RNA, and protein biomarkers in bodily fluids and tissues that have introduced new possibilities for minimally or non-invasive cancer diagnosis, monitoring, and assessment of therapeutic responses.

Sexual Identity and Heavy Drinking Among Adults in Canada by Racially Minoritized Status and Income, 2015-2020.

Purpose: Our objective was to estimate inequities in heavy drinking between heterosexual, gay or lesbian, and bisexual or pansexual individuals, by sex/gender, and to determine whether this association is heterogeneous across racially minoritized status and income groups in Canadians aged 15 and older. Methods: We pooled three Canadian Community Health Survey cycles (2015-2020) and used separate modified Poisson regressions to explore the sex/gender-specific association between sexual identity and heavy drinking prevalence by racially minoritized status, and income, adjusted for survey cycle, age, marital status, and region. Results: With racially minoritized status, and income categories collapsed, heavy drinking was 1.3 times higher (95% confidence interval [CI] = 1.0-1.7) among bisexual or pansexual women compared with heterosexual women, with no differences among men. Among racially minoritized women, heavy drinking was 2.9 (95% CI = 1.3-6.4) times higher among bisexual or pansexual women and 1.9 (95% CI = 0.7-5.2) times higher among gay or lesbian women compared with heterosexual women. Among racially minoritized men, heavy drinking was 1.9 (95% CI = 0.9-4.0) times higher among gay men compared with heterosexual men. No differences were observed across sexual identity in White men or women. Bisexual or pansexual women reported increased heavy drinking relative to heterosexual women across income quintiles. Conclusion: Heavy drinking is distributed heterogeneously across sexual identity, sex/gender, racially minoritized status, and income. These results encourage equity-focused interventions to reduce heavy drinking among intersecting sociodemographic groups experiencing a greater burden of heavy drinking.

Association of Ultrasound Abdomen Findings with Liver Function Test and Alcohol Use Disorders Identification Test Scores in Cases of Alcohol Use Disorder

Introduction: There are three independent variables used in clinical practice to evaluate patients suffering from alcohol use disorder (AUD); these are Alcohol Use Disorders Identification Test (AUDIT), liver function tests (LFTs), and imaging findings on ultrasound of the abdomen. There is limited literature about the association of imaging findings with LFT and AUDIT scores in cases of AUD. Objective: The study was conducted to determine the association of ultrasound abdomen findings with LFTs and AUDIT scores in patients with AUD. Methods: This study was conducted using data from 439 patients of AUD (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) treated in the psychiatry department of a tertiary care hospital. The data hence obtained were subjected to statistical analysis. The ordinal data sets were compared using the Chi-square test, and P &lt; 0.05 was taken as statistically significant. Results: The ultrasonography (USG) findings of hepatic/portal system changes in patients of AUD show a significant association with the corresponding changes in AUDIT scores, serum bilirubin, and aspartate transaminase (AST) levels. The ultrasound findings were also significantly associated with total years of drinking and average drinking (in g) per day in the last 3 years. The USG findings did not show a significant statistical association between ALT (alanine transaminase) and serum gamma-glutamyl transferase levels. Conclusion: In patients with alcohol use disorder, USG abdomen findings correlate with the severity of dependence as indicated by years of drinking, average alcohol consumption per day for the last 3 years, AUDIT score (last 1 year), and markers of liver injury (serum bilirubin and AST). Combined use of clinical severity indicators (e.g., AUDIT), lab parameters, and USG abdomen can help in the early diagnosis of ALD.

Medication development for AUD: A systematic review of clinical trial methodology

Refining clinical trial methodology has become increasingly important as study design is shown to influence treatment efficacy. To maximize the efficiency of randomized clinical trials (RCTs), researchers aim to establish standardized practices. The goal of this systematic review is to describe methodological practices of clinical trials for alcohol use disorder (AUD) over the past 40 years. To achieve this goal, a PubMed search was conducted in April 2023 for RCTs on AUD medications published between July 2018 through April 2023. Resulting studies were combined with a previous search from 1985 through 2018. Inclusion criteria for the RCT studies were: (1) a randomized controlled trial, (2) double or single blinded, (3) placebo or active control condition, (4) alcohol use as the primary endpoint, (5) 4 or more weeks of treatment, and (6) 12 or more weeks of follow-up. In total, methodological data from 139 RCTs representing 19 medications and spanning the past four decades were summarized. Results indicated that the most common medications tested were naltrexone (k = 42), acamprosate (k = 24), and baclofen (k = 11). On average, participants were 74% male and consumed 226 drinks per month pre-randomization. The median length of treatment was 12 weeks (IQR = 12–16; min = 4 max = 52) and the median follow-up duration was 12.5 weeks (IQR: 12–26; min = 7 max = 104). There were two broad domains of outcomes (i.e., abstinence and heavy drinking), with most studies featuring outcomes from both domains (k = 87; 63%). Reporting practices were summarized by decade, revealing an increased enrollment of females, better reporting of race and ethnicity data, and less studies requiring pre-trial abstinence. This review summarizes the current state of the literature on randomized clinical trials for AUD including effect sizes for individual studies and summaries of key methodological features across this representative set of clinical trials.

The Effectiveness of a TPB Educational Program for Preventing Alcohol Use Among Adolescents

ABSTRACT In this pilot study, we assessed the effectiveness and acceptability of an educational program designed to prevent alcohol-related behaviors among high school students. The program was rooted in the Theory of Planned Behavior principles (TPB) and supplemented with life-skills teaching. A total of 352 participants were involved, representing 10 secondary schools in central Greece. Among these, 257 students (Mage: 14.51 ± 1.34 years) constituted the experimental group, while 95 were assigned to the control group. The experimental group received a 10-session program, one per week. The results revealed that the experimental group had a significant improvement on knowledge about alcohol, perceived behavioral control (PBC), and alcohol-related behavior between pre- and post-intervention measurements. Additionally, students expressed high levels of satisfaction with the program. These findings offer substantial evidence for the practicality and effectiveness of an alcohol prevention initiative that is rooted in theory and supported by life-skills education when implemented within a school environment.