CAGE Questionnaire Research Articles

Alcohol use and abuse in training conscripts of the Hellenic navy

ObjectivesAlcohol abuse and addiction are big current problems of the developed world having multivariate causality and multiple effects. Alcohol abuse in young people is a matter of central importance due to its wide range long lasting effects, especially so in Greece where the problem has only recently started growing. The Hellenic Navy is interested in the complications of alcohol abuse in training conscripts. Because young conscripts will be placed in demanding positions, but also because in Greece the military service is obligatory and represents an important period for the socialization of young men.MethodsIn the present study, levels of alcohol use and abuse were measured in a sample of 650 male training conscripts of the Hellenic Navy. The tools used are: (a) two questionnaires measuring frequency and quantity of alcohol consumption and psychosocial variables, (b) the CAGE test, which is a questionnaire measuring hidden alcoholism.Results38,1% conscripts were characterized problematic drinkers according the adolescents criteria. Additional psychological complications were related to alcohol use. Using the stricter criterion for adults (plus psychological complications) 8.9% were found to be problematic drinkers. The use of CAGE questionnaire which is measuring hidden alcoholism, identified 16% of the total sample as hidden alcoholics.DiscussionThe findings regarding unregular levels of alcohol use and abuse are presented as well as their relation to psychosocial complications and to demographic characteristics. The results are discussed in the light of Creek and international bibliography.

Fast Alcohol Consumption Evaluation: A Screening Instrument Adapted for French General Practitioners

To meet the needs of French general practitioners (GPs), we created a short (5 questions) interview/screening test for alcohol-related problems that is similar to AUDIT in terms of (1) test values and (2) identification of 3 groups: (a) abstainers and low-risk drinkers; (b) heavy drinkers; and (c) alcohol abusers or showing dependence. Nine questions (from AUDIT, CAGE, TWEAK, Five-shot Questionnaire) were given systematically to their patients (aged 18 or more) by 41 volunteer GPs. Before the consultation, patients confidentially completed the AUDIT questionnaire in the waiting room. After the consultation, an addiction specialist evaluated each patient's alcohol consumption and DSM-IV criteria for alcohol abuse and dependence and these were used as gold standards. The analysis included 564 patient records and used stepwise logistic regression to select 7 questions, from which a second selection resulted in a 5-item questionnaire. These questions are: AUDIT questions 1 (Frequency) and 2 (Usual quantity), CAGE questions 2 (Annoyed) and 4 (Eye-opener), and TWEAK question 5 (Black-out), with each question scored 0 to 4. High levels of sensitivity and specificity were obtained for each diagnosis (sensitivity 75%-87.8%; specificity 74%-95.8%). FACE is an appropriate screening method for French general practitioners.

Training primary care clinicians in maintenance care for moderated alcohol use.

To evaluate whether training primary care clinicians in maintenance care for patients who have changed their drinking influences practice behavior. We randomized 15 physician and 3 mid-level clinicians in 2 primary care offices in a 2:1 design. The 12 intervention clinicians received a total of 2 (1/4) hours of training in the maintenance care of alcohol problems in remission, a booster session, study materials and chart-based prompts at eligible patients' visits. Six controls provided usual care. Screening forms in the waiting rooms identified eligible patients, defined as those who endorsed: 1 or more items on the CAGE questionnaire or that they had an alcohol problem in the past; that they have "made a change in their drinking and are trying to keep it that way"; and that they drank <15 (men) or <10 (women) drinks per week in the past month. Exit interviews with patients evaluated the clinician's actions during the visit. Of the 164 patients, 62% saw intervention clinicians. Compared with patients of control clinicians, intervention patients were more likely to report that their clinician asked about their alcohol history (odds ratio, 2.8; 95% confidence interval, 1.3, 5.8). Intervention clinicians who asked about the alcohol history were more likely to assess prior and planned alcohol treatment, assist through offers for prescriptions and treatment referral, and receive higher satisfaction ratings for the visit. Systemic prompts and training in the maintenance care of alcohol use disorders in remission might increase primary care clinicians' inquiries about the alcohol history as well as appropriate assessment and intervention after an initial inquiry.

The diagnostic usefulness of AUDIT and AUDIT-C for detecting hazardous drinkers in the elderly

We compare the diagnostic usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and the AUDIT alcohol consumption questions (AUDIT-C) for detecting hazardous drinkers between the populations over and less than 65 years in primary care settings. To assess weekly alcohol intake an interview on quantity-frequency was administered to 602 patients. Hazardous drinking was defined as a level of consumption of 280g of alcohol per week for men and 168g for women. The participants received AUDIT, AUDIT-C and CAGE questionnaires. Gamma-glutamyltransferase (GGT), mean corpuscular volume (MCV), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were also determined. Average weekly alcohol intake among the population aged 65 and older was 83g, and 10% were hazardous drinkers. In this age group, the sensitivities of AUDIT and AUDIT-C for detecting this type of drinkers were 67% and 100%, whereas specificities were 95% and 81% respectively. In the younger patient group, the sensitivities were 84% and 100% and the specificities 95% and 79% respectively. In conclusion, both AUDIT and AUDIT-C perform well at detecting hazardous drinkers in the group older than 65 years and that their sensitivities and specificities are comparable to those in younger ages.

Predictors of Aversive Alcohol Consequences in a Military Sample

The purpose of this study was to identify predictors of risky alcohol use and alcohol-related consequences among postdeployment soldiers. Demobilizing soldiers completed an assessment packet that included questions about demographic factors, relationships, stress, and alcohol-related consequences. Significant predictors of greater alcohol-related consequences, as assessed with the CAGE questionnaire, included fewer years of formal education, male gender, not being in an intimate relationship, racial/ethnic minority status, enlisted rank, having been deployed to the continental United States, and greater stress, whereas significant predictors of drinking and driving included male gender, not being in an intimate relationship, and greater stress. Identifying the predictors of alcohol consequences that occur upon demobilization may aid in determining which soldiers are at risk for such consequences before deployment and may help to maintain military readiness.

Psychological distress among female spouses of male at-risk drinkers

The consequences of alcoholism on the mental health of spouses of lifetime at-risk drinkers are only known from studies on alcoholics already in treatment. A retrospective analysis was conducted using data from a Quebec community health survey. The purpose of this study was twofold. First, our goal was to ascertain the mental health of female spouses living with a male lifetime at-risk drinker. Secondly, we wanted to examine the relationship between male lifetime at-risk drinkers (aged 30–54 years) and the psychological distress of their nondrinking female spouses. Lifetime at-risk drinking, for the purposes of this study, was defined as having at least two positive answers to the CAGE questionnaire. Couples wherein both spouses were deemed not at-risk for problem drinking by the CAGE instrument (0 or 1 positive answer) formed the control group. Psychological distress was measured using the Indice de Détresse Psychologique de l'Enquête Santé Québec (Préville, M., Boyer, R., Potvin, L., Perrreault, C., & Légaré, G. (1992). La détresse psychologique: détermination de la fiabilité et de la validité de la mesure utilisée dans l'enquête Santé Québec. Cahier de recherches #7, Montréal, Santé Québec.). It measures symptoms of anxiety, depression, aggressivity, and cognitive impairments. Scores of ≥22 (out of 100) were indicative of a high level of psychological distress. This study confirmed higher levels of psychological distress in female spouses of male lifetime at-risk drinkers in the general population. An exploratory study examined the association between the psychological distress of female spouses and each of the following nine independent variables: male partner lifetime at-risk drinker, stressful life events, job situation, socioeconomic status, perceived health status, presence of children less than 15 years, length of the marital relationship, presence of a confidant, and availability of social support. Lifetime at-risk drinking is a risk factor for the spouse's psychological distress. An examination of the demographic characteristics related to alcohol intake in male lifetime at-risk drinkers is also described in this study.

Alcoholism: Study boosts evidence on linkage regions associated with alcoholism

Multiple studies are reporting linkage to regions on chromosomes 2 and 4 for alcoholism phenotypes. The linkage appears to be robust to both sample ascertainment and phenotype measurement. In a recent paper, Wilhelmsen et al1 reported linkage to regions on chromosomes 2 and 4 for quantitative phenotypes related to alcoholism. Using families from a sample selected for heavy smoking, linkage analyses were conducted for the total score on a commonly used screening instrument for alcoholism (the CAGE questionnaire) as well as measures of the quantity and frequency of drinking. Three different measures all resulted in peaks on chromosome 2 at 43 cM, with the LOD scores ranging between 2.0 and 3.4. This region on chromosome 2 has been linked with alcohol dependence in a report by the Collaborative Study on the Genetics of Alcoholism (COGA) group2 and is near a linkage peak reported in an analysis of heavy drinkers from the Framingham Heart Study.3

Patients’ characteristics and outcomes of palliative care inpatient consults at a comprehensive cancer center

8524 Background: There is limited information about the characteristics and outcomes of inpatient palliative care consults in cancer centers. Two mobile teams (MT) each with a physician, fellow, and a nurse, provide consultation to hospitalized patients (pts) with complex symptoms. Methods: We analyzed the pts characteristics and outcomes during a two-month period. The charts were reviewed for demographics, cancer data, reason for consultation, symptoms, interventions, and outcomes. Results: Sixty-one pts were analyzed. Pain was the main reason for a consult request in 46 pts (75%), delirium in 10 (16%), anxiety in 4 (7%) and constipation in 5 (8 %). Some pts had more than one reason. 56(92%) pts had metastatic disease, diagnosis for ≤1 year in 26 (42%) and ≤2 years in 44 (72%) (Median =17 months). The Edmonton Symptom Assessment Scale (ESAS), 0–10, is summarized in the table. We uncovered new issues at consultation, such as 20 pts (38%) screened positive for alcoholism with CAGE questionnaire and the 34 pts (56%) had clinical delirium. Features of opioids toxicity such as constipation (N=43;70%), confusion (N=35;57%) (Mean MMSE = 23 ± 5), hallucinations (N=21;34%), myoclonus (N=16;26%) and miosis (N=18;29%) were frequently identified. The MT interventions included imaging studies (23%), enema (43%), laxatives (49%), neuroleptics (54%), metoclopramide (39%), corticosteroids (25%). Half (N=30;50%) of the pts had opioid rotation and/or had counseling (N=27;46%). One out of two pts (N=30;49%) required transfer to the palliative care unit. Conclusions: Most pts had previously undiagnosed opioid toxicity, delirium, and other symptoms. Opioid toxicity occurred secondary to rapid opioid escalation, possibly linked to chemical coping, and psychosocial distress. The outcome of these pts improved by opioid rotation, adding laxatives, metoclopramide, neuroleptics, and steroids. [Table: see text] No significant financial relationships to disclose.

Readiness to Change in Primary Care Patients Who Screened Positive for Alcohol Misuse

Readiness to change drinking may influence the content or effectiveness of brief alcohol counseling. This study was designed to assess readiness to change and its relationship to alcohol misuse severity among primary care patients whose screening questionnaire was positive for alcohol misuse. This study was a cross-sectional analysis of data collected from 2 consecutive mailed questionnaires. Male outpatients at 7 Veterans Affairs (VA) general medicine clinics were eligible if they returned both questionnaires, screened positive for alcohol misuse (augmented CAGE Questionnaire > or =1 point), responded to 3 readiness-to-change questions, and completed the Alcohol Use Disorders Identification Test (AUDIT). A validated algorithm based on 3 standardized questions categorized participants into 3 readiness groups (precontemplation, contemplation, action). Measures of alcohol misuse severity included AUDIT, CAGE, and the 3 consumption questions from the AUDIT (AUDIT-C). Analyses were descriptive; linear-by-linear associations between alcohol misuse severity and readiness were tested with chi2 statistics. Response rates to the first and second surveys were 59% and 55%, respectively. Of the 6,419 eligible outpatients who screened positive for alcohol misuse, 4,797 (75%) reported any readiness to change (contemplation 24%, action 51%). Among patients with AUDIT scores >8, more than 90% indicated that they drank more than they should and/or had contemplated drinking less. Greater readiness was significantly associated with greater alcohol misuse severity (P <.001 for all measures). Most primary care patients who screen positive for alcohol misuse indicate some readiness to change. Contrary to stereotypes of denial, those with greater alcohol misuse severity are more likely to report readiness to change.

General practitioners and alcohol use disorders: quantity without quality.

General medical practitioners are essential for the prevention, diagnosis, and management of alcohol use disorders. Studies to examine medical practice in this field, however, are very rare. A cross-sectional study involving 2010 patients seen by a sample of 145 general practitioners in the Auvergne region of central France was conducted on a given day in May 1998. The purpose of the study was to evaluate the prevalence of alcohol use disorders (using the DSM-IV diagnostic criteria for alcohol abuse or dependence and the CAGE questionnaire) and so to estimate the proportion of nonsomatic alcohol-related care dispensed. Sixteen percent of patients consulting their general practitioner had an alcohol problem, 27% of men and 5% of women. On average, a quarter of these patients had not been previously identified by the physician. Diagnosis seemed particularly difficult in women: 11% of women aged between 36 and 45 had an alcohol-related problem that went unidentified in 60% of cases. Care for alcohol-related health problems was therefore seriously inadequate. In one third of cases, patients with a diagnosed alcohol-related problem were not followed up by the physician for that problem. Two thirds received no medication, and in more than 80% of cases the physician did not refer to a specialist or prescribe admission to a specialized hospital ward. These results underline the diagnostic and therapeutic difficulties experienced by general practitioners. This study has led to the establishment of a pilot health care network for patients suffering from alcohol use disorders. This network involves voluntary doctors who have been trained and are better paid for their services. Care protocols have been established to which these practitioners have to adhere.

Alcohol misuse: Positive response. Alcohol Health Work for every acute hospital saves money and reduces repeat attendances

Alcohol misuse: Positive response. Alcohol Health Work for every acute hospital saves money and reduces repeat attendances

Are Commonly Ordered Lab Tests Useful Screens for Alcohol Disorders in Older Male Veterans Receiving Primary Care?

Although mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferases (ALT), and the AST/ALT ratio are sometimes used as markers of alcohol disorders, their utility has not been established in older persons. We determined the tests' performance characteristics for (1) at-risk drinking, (2) CAGE positivity, (3) at-risk drinking and CAGE positivity, and (4) a clinician-recorded diagnosis of alcohol abuse/dependence in a study of older male veterans receiving primary care. Participants (n = 587) included patients who had MCV, AST, and/or ALT data collected as part of routine care no more than 12 weeks before or after enrollment. MCV, AST, and ALT test results were obtained from the VA's database. At enrollment, the Timeline Followback and Alcohol Use Disorders Identification Test (AUDIT) were used to identify at-risk drinkers (>15 drinks per week or AUDIT score > 8), and the CAGE questionnaire was administered to identify participants with a history abuse/dependent drinking (CAGE score > 2). Participants' medical records were reviewed to identify subjects with a clinician-recorded diagnosis of alcohol abuse/dependence. The prevalence of abnormal test results for MCV (threshold value = > 98), AST (> 41), ALT (> 41), and the AST/ALT ratio (> 2) was 11%, 4%, 4%, and 5%, respectively. The occurrence of at-risk drinking, CAGE positivity, at-risk drinking and CAGE positivity, and a clinician-recorded diagnosis of alcohol abuse/dependence was 11%, 25%, 5%, and 9%, respectively. Test sensitivity ranged from 3.9% to 25.4% and specificity from 88.5% to 97.1%, whereas positive likelihood ratios varied from 0.72 to 4.01 and negative likelihood ratios from 0.82 to 1.04. Areas under the receiver operating characteristic curve were similar (range = 0.50–0.58) across tests. In conclusion, MCV, AST, ALT, and the AST/ALT ratio are not useful markers of alcohol disorders in older male veterans.

ALCOHOL USE DISORDERS IN PRIMARY CARE PATIENTS IN CAGLIARI, ITALY

To evaluate the number of subjects with possible alcohol use disorders (SPAUD) among primary care patients in Cagliari, Sardinia, Italy, by means of the self-administration of Alcohol use disorder identification test (AUDIT) and CAGE questionnaires. 939 patients waiting in 10 surgeries of primary care physicians were asked to take part in the study. A sample of 309 women and 197 men (total 506), aged between 18 and 65 years, agreed to participate and completed both questionnaires. SPAUD were defined as those achieving cut-off scores of 5 for AUDIT and/or 1 for CAGE. Seventy-nine (15.61%) patients were SPAUD, achieving a positive score in at least one questionnaire. Fifty-six (11.07%) and forty-six (9.09%) patients yielded positive results with AUDIT and CAGE, respectively. Twenty-three (4.55%) patients were positive at both AUDIT and CAGE. Significantly higher proportions of men than women were recorded among SPAUD. The results of the present survey indicate a high number of SPAUD in a sample of primary care settings in Cagliari, closely similar to the occurrence of alcohol use disorders estimated in several other community-based primary care clinics in Western Countries.

Religiousness, Current Substance Use, and Early Risk Indicators for Substance Abuse in Nursing Students

Nursing students have been targeted by the American Nurses' Association (ANA) for efforts focused on the prevention of substance abuse. This study surveyed 241 nursing students enrolled in their first year of nursing courses at seven faith-based colleges and universities. The purposes were to investigate the prevalence of current substance use and the number of early risk indicators for substance abuse and dependence among nursing students, and to examine the relationships among religiousness, current substance use, and early risk indicators for substance abuse. Efinger's Alcohol Risk Survey, the CAGE Questionnaire, and the Intrinsic/Extrinsic-Revised Scale were used to collect data. Twenty-four percent of respondents reported current substance use, 15% scored in the probable abuse/dependence category: those who were more religious tended to have lower prevalence rates of substance use as well as fewer numbers of early risk indicators.

Validation of the Primary Care Alcohol Severity Measure

Alcohol-related disorders are common in primary care settings; many primary care physicians are ill-equipped to manage patients with alcohol-related disorders. The objective of this prospective cohort study was to develop and validate a patient-based measure, the Primary Care Alcohol Severity Measure, to determine which primary care patients with alcohol-related disorders would benefit from referral to alcohol treatment services. Four Boston-area Department of Veterans Affairs ambulatory care clinics were chosen as study sites. Two hundred seventy-eight male patients, mean age 55.5 years, 89.9% Caucasian, 42.5% married, all with CAGE Questionnaire scores greater than or equal to 2 and drinking within past year, participated in the study. We developed a multidimensional, 30-item measure that contained 2 subscales that assessed 2 symptom clusters of alcohol-related disorders: Physical and Behavioral. Each subscale's score was higher (more severe) for patients with a current Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised diagnosis of alcohol dependence or abuse: P < .01 for the physical subscale and P < .0001 for the behavioral subscale. Patients with more physical symptoms had poorer physical and mental health status, whereas patients with more behavioral symptoms had poorer mental health status. Scores on the 2 subscales, along with age and history of prior treatment, predicted the use of alcohol treatment services in the following year: c = 0.90 in logistic regression. The Primary Care Alcohol Severity Measure is a valid measure of alcohol severity in primary care patients and predicts the use of alcohol treatment services. It is relatively brief and easy to use, requiring only standard medical history items and patient reports of behavioral symptoms. It may be a useful tool to improve the quality of care for primary care patients with alcohol-related disorders.

Mental Disorders and Medical Care Utilization of VA Ambulatory Care Patients

In this article, the authors examine patterns of medical services use among the Department of Veterans Affairs (VA) ambulatory care patients who screened positive for posttraumatic stress, depression, or alcohol-related disorders. On the basis of research linking mental disorders with increased use of medical services, the authors hypothesize that even after controlling for age and medical disease comorbidity, patients in VA ambulatory care who screen positive for targeted mental disorders would be more likely to use VA medical services and have higher rates of such use than those who did not screen positive. Baseline data were obtained from the Veterans Health Study, a longitudinal investigation of veterans' health. Four Boston-area VA ambulatory care facilities were used as study sites. A random sample of 2425 participants (mean age = 62) was drawn from male VA ambulatory care patients screened for eligibility during specified periods. Screening measures were Center for Epidemiological Studies-Depression Scale for depression, Posttraumatic Stress Disorder Checklist for posttraumatic stress disorder, and CAGE Questionnaire for alcohol-related disorders with endorsement of prior year consumption for alcohol-related disorders. Prior medical services use was assessed by self-report. Although unadjusted analyses of medical services use revealed clear effects of the screening presence of mental disorders on most outcomes, after adjusting for age and medical comorbidity, almost all these effects were reduced, and some previously nonsignificant results became significant. Findings suggest that healthcare policy and risk adjustment predicated upon the presumed relationship between mental disorders in the aggregate and medical services use should reconsider the important contributions of age, comorbid medical disorders, and specific mental disorder diagnoses.

Validity of the CAGE questionnaire in schizophrenic patients with alcohol abuse and dependence

The objective of the study was to assess the sensitivity and the specificity of the CAGE questionnaire in 114 schizophrenic patients. The Composite International Diagnostic Interview was used to assess the DSM-III-R diagnosis of abuse of or dependence on alcohol. The CAGE questionnaire can be reliably used to assess alcohol use disorders in schizophrenic patients: with a cutoff score of 1 or more, the sensitivity of the CAGE questionnaire was 0.91 and the specificity was 0.83. With a cutoff score of 2 or more, the sensitivity of the CAGE questionnaire was 0.82 and the specificity was 0.94. The post test probabilities (PPV) were high (PPV 1 = 0.74; PPV 2 = 0.85) compared to the primary probability of alcoholism (29.8%).

Work–family conflicts and drinking behaviours among employed women and men

Objective To examine the relationship between work–family conflicts and drinking behaviours among women and men, and to discover whether the relationship remains the same after taking into account family structure and socio-economic status. Method Cross-sectional surveys were carried out by postal questionnaires in 2001 and 2002 among female and male municipal employees aged 40–60, of Helsinki, Finland; 4228 women and 1043 men participated, with a response rate of 66%. Dependent variables were heavy drinking—for men >12 standard portions per week and for women >9 portions per week; weekly binge drinking including 6 or more portions per occasion; and problem drinking, as measured by the CAGE questionnaire. Independent variables were work-to-family conflicts and family-to-work conflicts. Covariates were age, family structure, education, income, and occupational class. Results Work–family conflicts were strongly related to problem drinking among both women and men and also associated with heavy drinking among women. Taking family structure and socio-economic status into account did not markedly change the relationship between work–family conflicts and heavy drinking among women, but strengthened slightly the association with problem drinking among both women and men. Conclusions Work–family conflicts are particularly important issues in problem drinking among men and women and also in heavy drinking among women. Improving the balance between work and family may be a way to prevent problem drinking.

Quantification by Magnetic Resonance Imaging (MRI) and Consequences of Post-Transfusionnal Iron Overload in Long Bone Marrow Transplant Survivors.

Introduction The exact biological and clinical complications related to iron overload in adult non thallassemic patients receiving blood units (BU) are not well known. This is mainly due to the many confounding factors both in the evaluation of iron overload (mainly estimated by ferritin measurement) and its consequences on liver dysfunction (hepatitis, GVH) and cardiac or pancreatic function (toxicity, ageing).Patients and Methods We prospectively evaluated biological (glycemia, liver function) and clinical (cardiomyopathy, arythmia) consequences of post-transfusionnal iron overload, as sole risk factors, in a very closely selected population of long term BM transplant survivors. We quantified liver iron content (LIC) by MRI and studied the relationship between the number of BU, LIC and liver dysfunction. Exclusion criteria were extremely strict: transplant performed after 1999, any form of GVH, hepatitis B or C, alcoholism (CAGE Questionnaire), any presence of hepatotoxic drug, requirement of BU after the one year period following transplant, inflammation, neoplastic diseases or relapse, homozygous for HFE mutation.Results 104/150 adult patients transplanted before December 1999 were enrolled. 39/104 were excluded: GVH n=11, viral hepatitis n=3, alcoholism n=1, hepatotoxic drug n=4, active bleeding n=2, neoplastic disease or relapse n=11, chronic inflammation n=7. 65 patients were analyzed (34M,31F). Median age at transplant was 36. Median follow up was 9 years. The median number of BU received was 18 (0–77) (definitive evaluation in 60/65 patients). The median ferritin was 532 ng/ml (42–4023). 27/65 pts had AST and or ALT above normal value. Hyperlycemia was present in 11 cases. There was a significant correlation between the number of BU and the ferritin value (r= 0.81) (p<10–3) as well as between the number of BU and LIC (r=0.84)(p<10–3).38/65 patients had ferritin above normal value; among them, 31/32 cases had LIC above normal value, median 117 micromoles/gdw (30->300). The group with ferritin above normal value (n=38) differed significantly from the group with ferritin of normal range in terms of number of BU transfused (p<10 −3), level of AST(p<0.017) and ALT (p<0.009). However, the risk of occurrence of liver dysfunction (AST or ALT above normal) was slightly different between the normal ferritin (8/27) and high ferritin (19/38) groups (chi 2 non-significant). In addition, in the group having received more than 20 BU (n=24) compared to the group having received less than 20 BU (n=36), there was no significant difference in the risk of occurrence of liver dysfunction but there was a significant difference between these two groups in terms of ferritin (p<10–3)(t-test) and LIC results (p=0.013)(t-test). There was no significant difference regarding glycemia. No patients had clinical cardiac disease or were arythmic.Conclusion The magnitude of persistent iron overload in long BM transplant survivors correlates closely to the number of BU received and is well quantified by MRI. In this group having no cofactor of iron toxicity, our results suggest that the impact in the medium term of post transfusionnal iron overload on liver dysfunction, diabetes mellitus and cardiac disease is moderate.

The Alcohol Use Disorders Identification Test (AUDIT) as a Screening Tool for Excessive Drinking in Primary Care: Reliability and Validity of a French Version

Excessive drinking is a major problem in Western countries. AUDIT (Alcohol Use Disorders Identification Test) is a 10-item questionnaire developed as a transcultural screening tool to detect excessive alcohol consumption and dependence in primary health care settings. The aim of the study is to validate a French version of the Alcohol Use Disorders Identification Test (AUDIT). We conducted a validation cross-sectional study in three French-speaking areas (Paris, Geneva and Lausanne). We examined psychometric properties of AUDIT as its internal consistency, and its capacity to correctly diagnose alcohol abuse or dependence as defined by DSM-IV and to detect hazardous drinking (defined as alcohol intake >30 g pure ethanol per day for men and >20 g of pure ethanol per day for women). We calculated sensitivity, specificity, positive and negative predictive values and Receiver Operator Characteristic curves. Finally, we compared the ability of AUDIT to accurately detect "alcohol abuse/dependence" with that of CAGE and MAST. 1207 patients presenting to outpatient clinics (Switzerland, n = 580) or general practitioners' (France, n = 627) successively completed CAGE, MAST and AUDIT self-administered questionnaires, and were independently interviewed by a trained addiction specialist. AUDIT showed a good capacity to discriminate dependent patients (with AUDIT > or =13 for males, sensitivity 70.1%, specificity 95.2%, PPV 85.7%, NPV 94.7% and for females sensitivity 94.7%, specificity 98.2%, PPV 100%, NPV 99.8%); and hazardous drinkers (with AUDIT > or =7, for males sensitivity 83.5%, specificity 79.9%, PPV 55.0%, NPV 82.7% and with AUDIT > or =6 for females, sensitivity 81.2%, specificity 93.7%, PPV 64.0%, NPV 72.0%). AUDIT gives better results than MAST and CAGE for detecting "Alcohol abuse/dependence" as showed on the comparative ROC curves. The AUDIT questionnaire remains a good screening instrument for French-speaking primary care.