Complete Abstinence Research Articles

Knowledge and attitudes regarding sexually transmitted infections among healthcare workers.

Healthcare workers have a fundamental role in providing care and education on sexually transmitted infections (STIs). However, their knowledge is often worryingly limited. This study aimed to assess the real knowledge and attitude regarding STIs among healthcare workers of the IRCCS Ospedale Policlinico San Martino, Genoa, Italy. The recruited subjects were asked to complete a 31-item questionnaire, divided into 3 sections: socio-demographic context, knowledge about STIs, and personal sexual behavior. We enrolled 140 subjects, employed as nurses (52.9%), physicians (12.9%), laboratory technicians (7.1%), or other workers (27.1%). Despite the generalized erroneous belief of having a good level of knowledge on the matter, only one-third of the subjects could correctly identify STIs among a list of diseases, and less than one-third correctly recognize all possible ways of transmission. Human immunodeficiency virus (HIV) was the most frequently recognized STI (97%), but only 39.2% of healthcare workers were correctly informed about the body fluids that can transmit the virus. Most participants (93.5%) correctly identified condoms as effective in preventing STIs but did not indicate complete abstinence as the only way to guarantee protection against STIs. Most participants were informed on the oncogenic potential of human papillomavirus (HPV) infections (82%), the usefulness of the Pap test (85.7%), and the existence of vaccines against some STIs (63.5%). Overall, healthcare workers have limited knowledge about STIs. Creating specific educational programs aimed at healthcare providers should become a priority.

Implications of Prenatal Cannabis Exposure on Childhood Neurodevelopmental Outcomes: A Summary of the Clinical Evidence.

Cannabis is commonly used by pregnant patients for alleviation of pregnancy-associated symptoms. Multiple national medical associations have recommended against prenatal cannabis use, yet misinformation regarding its safety and efficacy remains prevalent in public discourse. Effective and evidence-based patient counseling on prenatal cannabis use requires a thorough understanding of the existing data on fetal neurodevelopment. The aim of this study was to summarize the existing clinical literature on the impacts of intrauterine cannabis exposure on offspring neurodevelopment. Articles were identified via literature search in PubMed and OVID; relevant articles were reviewed. Limited data have shown associations between intrauterine cannabis exposure and (1) increased startles and difficulty with consolation in the neonatal period, (2) memory challenges, verbal reasoning challenges, and diminished academic performance during early childhood, and (3) inattention, hyperactivity, and aggression during early childhood. Further research with large and diverse samples that use objective measures of cannabis use across multiple time points in pregnancy is required to assess causation, the true extent of impacts, and dose-dependent effects. The existing clinical data regarding the impacts of prenatal cannabis use on fetal neurodevelopment are limited by important confounders like genetic predisposition, concomitant tobacco and other substance use during pregnancy, and low socioeconomic status. However, the theoretical and demonstrated associations between prenatal cannabis use and adverse neurodevelopmental outcomes are compelling enough to warrant complete abstinence during pregnancy, pending further research. Providers can utilize this summary to offer data-driven guidance on prenatal cannabis use for pregnant patients.

Sex differences in cigarette smoking following a mindfulness-based cessation randomized controlled trial

Some interventions for smoking cessation such as quit smoking aids show sex-specific effects on outcomes, but behavioral interventions such as mindfulness-based interventions (MBIs) for smoking cessation lack formal reporting of sex-intervention tests of interaction to date. To address this gap, we conducted a secondary analysis of a RCT dataset (N = 213), recruiting participants from California, to statistically test a sex-intervention interaction effect on complete 7-day point prevalence abstinence (PPA), proportion of days abstinent, and daily cigarettes smoked. Smoking was assessed using the timeline follow back method spanning the four weeks following a daily 14-day app-based intervention and a planned smoking quit date immediately following the intervention phase. All models adjusted for baseline nicotine dependence. The study groups had comparable sex proportions (MBI: 56 % female; control: 55 % female) and the ratio of outcome assessment completion by group was not dependent on sex. Adjusted analyses revealed a significant sex-intervention interaction effect for daily cigarettes smoked ([female coded 1]: two-way interaction effect IRR = 0.59, 95 % CI: 0.46–0.77, p < 0.0001; effect for female: IRR = 0.68, 95 % CI: 0.57–0.81, effect for male: IRR = 1.14, 95 % CI: 0.95–1.37), but not for complete 7-day PPA ([female coded 1] two-way interaction effect OR = 1.24, 95 % CI: 0.31–4.89, p = 0.76) or proportion of total days abstinent ([female coded 1] two-way interaction effect OR = 1.97, 95 % CI: 0.53–7.37, p = 0.31). Females, but not males, allocated to a daily app-based MBI with a quit plan and quit aid workbook smoked fewer cigarettes per day compared to females in the control group. Males, but not females, showed significantly less use of the MBI app compared to the control app.

Alcoholic Hepatitis: Diagnosis and Management Procedures

Over alcoholic consumption for a long-time is the most common cause of alcoholic hepatitis (AH) that has significant short-term and long-term morbidity and mortality due to chronic liver disease. Alcoholic hepatitis is the most elaborate indicator of alcoholic liver disease (ALD). It is a devastating acute condition of the disease that needs early detection, diagnosis, and proper treatment. It is characterized by inflammation, fibrosis, and ultimately cirrhosis for the continual excessive drinking. It is an acute hepatic inflammation associated with an injury of the liver with the clinical syndrome of acute jaundice and coagulopathy. If it is not treated appropriately, may transform to life-threatening acute liver failure, such as hepatocellular carcinoma (HCC) and liver cirrhosis. Complete alcohol abstinence is the cornerstone therapy for AH to decrease short-term mortality and most of the patients recover for at least six months after abstinence. This review paper tries to discuss the diagnosis and treatment procedures of the AH in brief for the benefit of the patients.

Smoking cessation prior to elective total joint arthroplasty results in sustained abstinence postoperatively.

Tobacco use is a well-documented modifiable risk factor for perioperative complications. To determine the tobacco abstinence rates of patients who made cessation efforts prior to a total joint arthroplasty (TJA) procedure. A retrospective evaluation was performed on 88 self-reported tobacco users who underwent TJA between 2014-2022 and had tobacco cessation dates within 3 mo of surgery. Eligible patients were contacted via phone survey to understand their tobacco use pattern, and patient reported outcomes. A total of 37 TJA patients participated. Our cohort was on average 61-years-old, 60% (n = 22) women, with an average body mass index of 30 kg/m2. The average follow-up time was 2.9 ± 1.9 years. A total of 73.0% (n = 27) of patients endorsed complete abstinence from tobacco use prior to surgery. Various cessation methods were used perioperatively including prescription therapy (13.5%), over the counter nicotine replacement (18.9%), cessation programs (5.4%). At final follow up, 43.2% (n = 16) of prior tobacco smokers reported complete abstinence. Patients who were able to maintain cessation postoperatively had improved Patient-Reported Outcomes Measurement Information System (PROMIS)-10 mental health scores (49 vs 58; P = 0.01), and hip dysfunction and osteoarthritis outcome score for joint replacement (HOOS. JR) scores (63 vs 82; P = 0.02). No patients in this cohort had a prosthetic joint infection or required revision surgery. We report a tobacco cessation rate of 43.2% in patients undergoing elective TJA nearly 3 years postoperatively. Patients undergoing TJA who were able to remain abstinent had improved PROMIS-10 mental health scores and HOOS. JR scores. The perioperative period provides clinicians a unique opportunity to assist active tobacco smokers with cessation efforts and improve postoperative outcomes.

The Food Addiction Clinical Treatment (FACT) Manual: A Harm Reduction Treatment Approach.

While the construct of food addiction has been controversial, there is growing evidence that certain foods can activate biobehavioral and neurological mechanisms consistent with addiction to other substances. Despite increased evidence and acceptance of certain foods as addictive substances amongst the scientific community, there is a paucity of interventions available that are uniquely suited for the treatment of this condition. Further, many of the addiction and disordered eating treatment models currently utilized for food addiction are seemingly at odds, with the former often recommending complete abstinence from trigger foods and the latter promoting intake of all foods in moderation. The Food Addiction Clinical Treatment (FACT) manual was created as an alternative using an empirically supported harm-reduction model specifically targeted to treat the addiction and disordered eating features of food addiction. The purpose of the current article is to expose readers to the key tenets of the FACT manual, demonstrate the feasibility of this intervention with a sample of participants with severe food addiction, and discuss future directions for the treatment of food addiction. Positive outcomes from this intervention provide preliminary evidence for the efficacy of FACT for the treatment of food addiction with minimal negative adverse effects. Future research using randomized control trials and longer follow-up is needed to validate the FACT manual as an empirically supported treatment for food addiction.

Alpha-Gal syndrome as a novel food allergy: a case report study

Introduction and importance: Alpha-Gal syndrome (AGS), a distinct form of mammalian meat allergy, presents unique characteristics that set it apart from typical IgE-mediated food hypersensitivities. AGS induces an allergic response typically 3–6 h post-ingestion of mammalian meat, such as beef, pork, or lamb. This prolonged reaction time differentiates AGS from other food allergies, which usually provoke a more immediate response. Case presentation: The authors present a case of a 35-year-old male patient who, unbeknownst to him, had been experiencing symptoms consistent with Alpha-Gal allergy for several years. His symptoms only subsided upon the complete elimination of mammalian meat from his diet. It was only then that the possibility of AGS was considered. Complete abstinence from mammalian meat, meat by-products, and other α-Gal containing foods is the most effective preventative strategy for AGS. No definitive cure for AGS has been established as of now. Treatment protocols for hypersensitivity reactions are contingent upon the severity of the reaction, with therapies ranging from antihistamine medications to the administration of epinephrine. Conclusion: There is considerable variability among AGS patients concerning the consumption of dairy products. Some individuals with AGS can safely consume dairy products without any adverse reactions, while others are advised to abstain due to potential allergenic responses. This variability in dairy tolerance among AGS patients warrants further investigation.

Reporting on Health Care and Social Service Provider Approaches to Promoting Alcohol Abstinence During Pregnancy

ABSTRACT Despite the known detrimental health effects of alcohol use during pregnancy, there are still health care (HCP) and social service providers (SSP) who do not promote complete abstinence. The purpose of this study was to explore the current practices of HCPs and SSPs when discussing alcohol use during pregnancy, and to understand their rationale for their specific recommendations. An online survey was completed by 1123 HCPs (n = 588) and SSPs (n = 535) that asked them to identify their approach to discussing alcohol and pregnancy. Participants had the option to further explain their current recommendations regarding alcohol use during pregnancy in an open-ended format. Open-ended responses were analyzed using a content analysis approach (n = 156). The majority of respondents recommend abstinence (83.9% of HCPs, n = 493; 78.4% of SSPs, n = 419), while 9.8% of HCPs (n = 57) and 2.2% of SSPs (n = 12) responded that low levels of consumption may be acceptable. HCPs may recommend low levels of consumption based on other international guidelines, limited evidence to suggest that one unit of alcohol is harmful, and as a harm reduction strategy. SSPs stated that they refer clients to HCPs for recommendations related to alcohol consumption, and that they prefer to provide information based on public health guidelines. This exploratory work may inform the development of resources to support HCPs and SSPs to recommend abstinence from alcohol throughout gestation.

Efficacy of bupropion and varenicline genetic markers in choosing pharmacological treatment for smoking cessation, and implications for combining drugs: A randomized controlled trial - GENTSMOKING.

Smoking cessation is the best strategy for reducing tobacco-related morbimortality. The goal of this randomized controlled trial was to test whether using the genetically favorable markers to choose a smoking cessation drug treatment (precision medicine) was superior to using the most effective drug (varenicline) in terms of abstinence rates. Additionally, combination therapy was tested when monotherapy failed. This partially blind, single-center study randomized (1:1) 361 participants into two major groups. In the genetic group (n=184), CYP2B6 rs2279343 (genotype AA) participants started treatment with bupropion, and CHRNA4 rs1044396 (genotype CT or TT) participants started treatment with varenicline; when genetic favorable to both, participants started treatment with bupropion, and when favorable to neither, on both drugs. In the control group (n=177), participants started treatment with varenicline, regardless of genetic markers. Drug treatment lasted 12 weeks. Efficacy endpoints were abstinence rates at Weeks 4, and Weeks 8-12, biochemically validated by carbon monoxide in exhaled air. Participants who did not achieve complete abstinence at Week 4, regardless of group, were given the choice to receive combination therapy. Abstinence rates were 42.9% (95% CI: 36-64) in the control group versus 30.4% (95% CI: 23-37) in the genetic group at Week 4 (p=0.01); and 74% (95% CI: 67-80) versus 52% (95% CI: 49-64) at Week 12 (p<0.001), respectively. The strategy of combining drugs after Week 4 increased abstinence rates in both groups and the significant difference between genetic and control groups was maintained. Results show that using these selected genetic markers was inferior to starting treatment with varenicline (control group), which is currently the most effective smoking cessation drug; moreover, the addition of bupropion in cases of varenicline monotherapy failure improves the efficacy rate until the end of treatment. NCT03362099.

Alcohol-related liver disease: A global perspective

Alcohol-associated liver disease (ALD) represents one of the deadliest yet preventable consequences of excessive alcohol use. It represents 5.1 % of the global burden of disease, mainly involving the productive-age population (15-44 years) and leading to an increased mortality risk from traffic road injuries, suicide, violence, cardiovascular disease, neoplasms, and liver disease, among others, accounting for 5.3 % of global deaths. Daily alcohol consumption, binge drinking (BD), and heavy episodic drinking (HED) are the patterns associated with a higher risk of developing ALD. The escalating global burden of ALD, even exceeding what was predicted, is the result of a complex interaction between the lack of public policies that regulate alcohol consumption, low awareness of the scope of the disease, late referral to specialists, underuse of available medications, insufficient funds allocated to ALD research, and non-predictable events such as the COVID-19 pandemic, where increases of up to 477 % in online alcohol sales were registered in the United States. Early diagnosis, referral, and treatment are pivotal to achieving the therapeutic goal in patients with alcohol use disorder (AUD) and ALD, where complete alcohol abstinence and prevention of alcohol relapse are expected to enhance overall survival. This can be achieved through a combination of cognitive behavioral, motivational enhancement and pharmacological therapy. Furthermore, the appropriate use of available pharmacological therapy and implementation of public policies that comprehensively address this disease will make a real difference.

Cannabinoids Hyperemesis Syndrome – An Urgent Call for Timely Diagnosis, Management, and Future Directions– A Case Report and Review of the Updated Literature

IntroductionCannabinoid Hyperemesis Syndrome (CHS) is distinguished by a pathognomonic cyclic pattern of hyperemesis characterized by recurring episodes of severe vomiting every few weeks to months, as well as obsessive thoughts and compulsive behavior, such as a proclivity to take frequent hot baths or showers. It is largely accepted as the most commonly used illicit drug in the United States, with estimates ranging from 42% to 46% lifetime consumption. Despite greater awareness of CHS, practitioners continue to lack comprehension, resulting in an unfortunate delay in patient identification and treatment.ObjectivesThe aim of this article is to bring attention to CHS in order to enable clinicians, and more specifically, addiction medicine specialists and psychiatrists, to diagnose it as quickly as possible and thus avoid unnecessary additional invasive examinations and investigations. This will save the patient’s time, prevent financial burdens and mental health stresses, and increase their overall quality of life.MethodsA thorough screening and data extraction of the relevant articles was conducted using PubMed, Cochrane, and Embase. Databases were used to search for articles on CHS published between January 2021 and September 2023, yielding relevant articles. Keywords used were “hyperemesis”, “cyclical vomiting,” “cannabis” and “cannabinoid”.ResultsWe present a case of 20-year-old teens who came to emergency with severe dehydration and vomiting of more than 40 episodes at home. He had multiple admissions for abdominal pain, nausea, and vomiting in the past and was evaluated and diagnosed with gastritis, PUD, and H. pylori infection. A more detailed medical history revealed a frequent use of cannabis over the past few years and symptoms manifestation and worsening is associated with the use of cannabis. After the complete cessation of cannabis, there have been no new symptomatic episodes reported in the patient and the patient is stable clinically.ConclusionsCannabinoid Hyperemesis Syndrome (CHS) is a serious health hazard that requires immediate discovery and treatment. Despite the widespread use of cannabis, CHS is often misdiagnosed, resulting in unnecessary medical treatments and complications for patients. Given their special knowledge of linking chronic cannabis use to this syndrome, this case report and literature review highlight the critical role of addiction medicine experts and psychiatrists in quickly detecting and treating CHS. Early detection and treatment, particularly complete cannabis abstinence, are critical in alleviating symptoms, minimizing recurrent hospitalizations, and ultimately improving patients’ overall quality of life.Disclosure of InterestNone Declared

Italian Guidelines for the diagnosis and treatment of Fetal Alcohol Spectrum Disorders: international diagnostic criteria - differences and similarities.

The umbrella term Fetal Alcohol Spectrum Disorders (FASD) brings together under its definition a heterogeneous continuum of disabilities linked by a common etiology and pathogenesis: exposure to alcohol during intrauterine life. Despite extensive research, definitive toxic thresholds remain elusive, underscoring the recommendation for complete alcohol abstinence during pregnancy and lactation. FASD poses diagnostic challenges due to its varied presentations and heterogeneous phenotype. Consequently, no singular diagnostic guideline exists, with multiple expert-driven diagnostic systems globally available. This review aims to synthesize recent and notable guidelines facilitating FASD diagnosis. While efforts were made to include the latest diagnostic systems, determining which scheme is best applied to each individual patient population necessitates clinician discretion. In Italy, the guidelines proposed by Hoyme, revised in 2016, are commonly utilized, yet comparative analysis among guidelines offers valuable insights into their historical context and diagnostic utility. Our discussion explores both similarities and discrepancies among systems for diagnosing FASD, shedding light on their evolution and practical application. The objective of our work was to compare in a practical and precise manner the various existing guidelines used globally regarding the diagnosis of FAS. Our review therefore proposes the diagnostic criteria used by the various working groups and compares them, trying to create a practical comparison between the various guidelines, identifying differences and similarities.

Alcoholic Hepatitis

Alcoholic hepatitis is a serious liver condition characterized by inflammation and liver damage caused by excessive alcohol consumption. This condition represents a significant health concern worldwide as it can progress to more severe liver diseases, including cirrhosis and liver failure. This abstract provides an overview of alcoholic hepatitis, including its causes, symptoms, diagnosis, and treatment. Long-term alcohol consumption is the primary cause of alcoholic hepatitis. When alcohol is metabolized in the liver, it generates toxic byproducts that can lead to inflammation and cellular damage. Over time, repeated episodes of damage can result in alcoholic hepatitis. Patients with this condition may present with various symptoms including jaundice, abdominal pain, nausea, vomiting, fever, and an enlarged liver. Diagnosis of alcoholic hepatitis typically involves a combination of medical history assessment, physical examination, blood tests, and imaging studies. Elevated levels of liver enzymes, such as AST and ALT, are common laboratory findings. A liver biopsy may be required to confirm the diagnosis and assess the extent of liver damage. Treatment of alcoholic hepatitis primarily focuses on alcohol cessation, which is essential to prevent further liver damage and improve the chances of recovery. Supportive care, such as nutritional supplementation and the management of complications, is also essential. Hospitalization may be necessary for severe cases. The prognosis varies depending on the severity of the condition and the patient's response to treatment. Complete abstinence from alcohol significantly improves the chances of recovery; however, some individuals may progress to advanced liver disease or even liver failure. Liver transplantation may be considered for those with end-stage liver disease. key words Alcoholic hepatitis Liver inflammation Excessive alcohol consumption Liver damage Cirrhosis Liver failure Symptoms Jaundice Abdominal pain Nausea Vomiting Fever Enlarged liver Diagnosis Liver enzymes AST (Aspartate Aminotransferase) ALT (Alanine Aminotransferase) Liver biopsy Treatment Alcohol cessation.

Comparison of Humor Style Preferences Between Successfully Recovering Individuals and Newcomers Participating in 12-Step Recovery Programs

Background: Humor has long been associated with potential benefits on physical and psychological health and well-being [1]. Identified and developed a tool to measure various functions, forms or styles of humor with either beneficial, adaptive expression or in detrimental, maladaptive operations. The purpose of this study was to explore these humor styles in a population of recovering individuals with substance use disorder attending 12-step recovery programs. Humor style preferences were compared between newer members (less than one year abstinence) versus established, successful members (more than five years abstinence). Methods: Demographics, including age and gender, number of months of complete abstinence and level of 12-step participation including having a sponsor or not, and weekly meeting attendance. The Humor Styles Questionnaire (HSQ) was self-administered, measuring affiliative, self-enhancing, aggressive and self-defeating humor style scores. Hypothesis 1: That adaptive humor expression (affiliative, self-enhancing styles) would be higher in the successfully recovering group. Hypothesis 2: That maladaptive humor expression (aggressive, self-defeating styles) would be higher in the newcomer group. Results: Self-defeating humor style was significantly higher in the newcomer group (p&lt;.05). There was no difference between groups of successfully recovering individuals and newcomers with affiliative, self-enhancing and aggressive styles of humor. Conclusion: Self-defeating humor, considered a maladaptive, negative style is a preferred style of humor early in the recovery. Contributing factors of the self-defeating preference in this group is more recent substance use and the negative consequences of behaviors related to its use. Successful, long term recovery with 12-step program involvement leads to a significant reduction in preference of self-defeating humor. The difference in humor styles may be reflective of improvement in self-esteem in those with long term abstinence.

Risk factors for self-reported alcohol consumption during pregnancy.

Fetal alcohol syndrome (FAS) is the most common preventable cause of impaired fetal development. The amount of alcohol consumed by expectant mothers varies by country. Studies on the prevalence of alcohol use among pregnant women in Slovakia and the risk factors linked to alcohol consumption during pregnancy are scarce. Similarly lacking are the data regarding pregnant women's awareness of the negative consequences of alcohol use during pregnancy. The study comprised women who gave birth at the 2nd Department of Gynecology and Obstetrics between July 1, 2023, and December 31, 2023. All respondents received an anonymous retrospective questionnaire following childbirth. The questionnaire investigated alcohol consumption throughout the year preceding conception as well as during each of the trimesters. The questionnaire also included questions on the woman's plans to become pregnant, her demographics, and her awareness of the hazards associated with alcohol consumption during pregnancy. Afilled-out questionnaire was obtained from 402 women. Of these, 51 women (12.8%) reported being completely abstinent before becoming pregnant. Complete abstinence before pregnancy was the greatest strongest protection against drinking during pregnancy (RR: 0.03). Among the 351 women who drank before pregnancy, 108 women (30.8%) continued to drink while pregnant, which constitutes 26.9% of all pregnant women. Risk factors of alcohol use during pregnancy included unplanned pregnancy (RR: 1.32), inadequate knowledge of the negative consequences of alcohol intake during pregnancy (71.9% vs 75.4%), and heavy drinking prior to pregnancy (RR: 2.55). In accordance with certain European data, the best means of protection against alcohol consumption during pregnancy include complete abstinence prior to conception, pregnancy planning, and high-quality education regarding the negative effects of alcohol during pregnancy (Tab. 4, Ref. 19). Text in PDF www.elis.sk Keywords: fetal alcohol syndrome spectrum, alcohol drinking in pregnancy, pregnancy planning, prenatal alcohol exposure, pregnancy.

ВОЗРАСТНЫКЕ АСПЕКТЫ ПОВЕДЕНЧЕСКИХ ФАКТОРОВ РИСКА У НАСЕЛЕНИЯ КУЗБАССА

Significance. Studying prevalence of behavioral risk factors, especially at the population level, is extremely relevant for public health and disease prevention. However, it is clear that prevention programs require different approaches for different age groups. The purpose of the study is to analyze age-specifics of behavioral risk factors in the population of Kuzbass. Material and methods. The study sample was formed based on the results of two epidemiological studies conducted in the Kemerovo region. Primary monitoring was carried out in 2015-2017 among 1270 men and women aged 35-70 (random sample). The sample of young people was formed based on the study of individual and contextual conditions for developing behavioral risk factors among students at the Institute of Food Science and Technologies of the Kemerovo State University. The study was conducted in 2022 among 626 students; a non-random sampling method was used to form the sample. Data on smoking, alcohol consumption and physical activity were collected through interviews. The level of physical activity in the adult sample was assessed using the International Physical Activity Questionnaire (IPAQ), and in the sample of people aged 18-29 - using the Global Physical Activity Questionnaire (GPAQ). Statistical calculations were performed in SPSS version 22 (IBM Corp. USA). The critical level of statistical significance was taken to be 0.05. Results. The proportion of young people who smoked equaled to 35.1% and was 2.4 time higher than the proportion of smokers aged 60 and older, and 1.4 time higher than those aged 40-59 (p &lt;0.001). Respondents aged 40-59 most often gave up smoking (23.2%, p&lt;0.001). People in the middle and older age groups smoked exclusively traditional cigarettes (99.1% and 100.0%, respectively); while among young people, this figure was only 37.8%. The majority of young people preferred to use electronic cigarettes (68.4%), while people aged 40-59 only mentioned them as an option in 6.5% of cases. Persons aged 18-29 were 1.2 times more likely to consume alcohol on a regular basis than respondents aged 40-59 and 2.1 times more likely than people aged 60 and older. Episodic alcohol consumption, as well as complete abstinence was typical of persons aged 60 and older. In the age group of 18-29 years, 75.9% of those surveyed drank beer; in the group of 40-59 years, this figure decreased 1.2 times, while in the group of 60+ it decreased 1.9 times (p&lt;0.001). Wine consumption had a similar trend: with age there was a decrease of 1.4 times and 1.6 times, respectively. The average MET/week was higher in the age group of 40-59 years and exceeded that in people aged 60 and older 1.4 times, and in people 18-29 years - 1.7 times (p&lt;0.001). The share of working physical activity is also higher in people of the middle and older age groups. Transport and recreational physical activity is more typical of respondents aged 18-29. Conclusion. Behavioral risk factors (tobacco and alcohol consumption, physical activity patterns) have a number of age and gender characteristics that should be taken into account to ensure successful disease prevention. Scope of application. Preventive medicine.

Safety and feasibility clinical trial of nucleus accumbens deep brain stimulation for treatment-refractory opioid use disorder.

There were more than 107,000 drug overdose deaths in the US in 2021, the most ever recorded. Despite advances in behavioral and pharmacological treatments, over 50% of those receiving treatment for opioid use disorder (OUD) experience drug use recurrence (relapse). Given the prevalence of OUD and other substance use disorders (SUDs), the high rate of drug use recurrence, and the number of drug overdose deaths, novel treatment strategies are desperately needed. The objective of this study was to evaluate the safety and feasibility of deep brain stimulation (DBS) targeting the nucleus accumbens (NAc)/ventral capsule (VC) and potential impact on outcomes in individuals with treatment-refractory OUD. A prospective, open-label, single-arm study was conducted among participants with longstanding treatment-refractory OUD (along with other co-occurring SUDs) who underwent DBS in the NAc/VC. The primary study endpoint was safety; secondary/exploratory outcomes included opioid and other substance use, substance craving, and emotional symptoms throughout follow-up and 18FDG-PET neuroimaging. Four male participants were enrolled and all tolerated DBS surgery well with no serious adverse events (AEs) and no device- or stimulation-related AEs. Two participants sustained complete substance abstinence for > 1150 and > 520 days, respectively, with significant post-DBS reductions in substance craving, anxiety, and depression. One participant experienced post-DBS drug use recurrences with reduced frequency and severity. The DBS system was explanted in one participant due to noncompliance with treatment requirements and the study protocol. 18FDG-PET neuroimaging revealed increased glucose metabolism in the frontal regions for the participants with sustained abstinence only. DBS of the NAc/VC was safe, feasible, and can potentially reduce substance use, craving, and emotional symptoms in those with treatment-refractory OUD. A randomized, sham-controlled trial in a larger cohort of patients is being initiated.

Narrowing the Patient-Physician Gap Based on Self-Reporting and Monthly Hepatologist Feedback for Patients With Alcohol-Related Liver Disease: Interventional Pilot Study Using a Journaling Smartphone App.

Screening and intervention for alcohol use disorders (AUDs) are recommended to improve the prognosis of patients with alcohol-related liver disease (ALD). Most patients' smartphone app diaries record drinking behavior for self-monitoring. A smartphone app can be expected to also be helpful for physicians because it can provide rich patient information to hepatologists, leading to suitable feedback. We conducted this prospective pilot study to assess the use of a smartphone app as a journaling tool and as a self-report-based feedback source for patients with ALD. The aims of this study were assessment of whether journaling (self-report) and self-report-based feedback can help patients maintain abstinence and improve liver function data. This pilot study used a newly developed smartphone journaling app for patients, with input data that physicians can review. After patients with ALD were screened for harmful alcohol use, some were invited to use the smartphone journaling app for 8 weeks. Their self-reported alcohol intake, symptoms, and laboratory data were recorded at entry, week 4, and week 8. Biomarkers for alcohol use included gamma glutamyl transferase (GGT), percentage of carbohydrate-deficient transferrin to transferrin (%CDT), and GGT-CDT (GGT-CDT= 0.8 × ln[GGT] + 1.3 × ln[%CDT]). At each visit, their recorded data were reviewed by a hepatologist to evaluate changes in alcohol consumption and laboratory data. The relation between those outcomes and app usage was also investigated. Of 14 patients agreeing to participate, 10 completed an 8-week follow-up, with diary input rates between 44% and 100% of the expected days. Of the 14 patients, 2 withdrew from clinical follow-up, and 2 additional patients never used the smartphone journaling app. Using the physician's view, a treating hepatologist gave feedback via comments to patients at each visit. Mean self-reported alcohol consumption dropped from baseline (100, SD 70 g) to week 4 (13, SD 25 g; P=.002) and remained lower at week 8 (13, SD 23 g; P=.007). During the study, 5 patients reported complete abstinence. No significant changes were found in mean GGT and mean %CDT alone, but the mean GGT-CDT combination dropped significantly from entry (5.2, SD 1.2) to the week 4 visit (4.8, SD 1.1; P=.02) and at week 8 (4.8, SD 1.0; P=.01). During the study period, decreases in mean total bilirubin (3.0, SD 2.4 mg/dL to 2.4, SD 1.9 mg/dL; P=.01) and increases in mean serum albumin (3.0, SD 0.9 g/dL to 3.3, SD 0.8 g/dL; P=.009) were recorded. These pilot study findings revealed that a short-term intervention with a smartphone journaling app used by both patients and treatment-administering hepatologists was associated with reduced drinking and improved liver function. UMIN CTR UMIN000045285; http://tinyurl.com/yvvk38tj.

Diversity among flexitarian consumers; stratifying meat reducers by their underlying motivations to move to a plant-based diet

Concerns surrounding environmental and health impacts of meat production and consumption have motivated consumers to reduce their intake of animal-based products, with many adopting a ‘flexitarian’ diet that involves reduction of animal-based products, without complete abstinence. The underlying motivations driving this dietary shift remain unclear.Two online studies investigated whether subgroups of flexitarian consumers could be identified through individual differences in psychological traits that were hypothesised to be related to flexitarianism. Consumer subgroups were compared on their self-reported meat consumption and factors important to their dietary choices.In Study 1, self-identified flexitarians (N = 353) completed questionnaires comprising validated items related to psychological aspects of food choices (e.g., food-neophobia, food-involvement, health-consciousness). Consumer segments were created based on clusters of differences in motivations to follow a flexitarian diet. Study 2 (N = 297) sought to validate these initial clusters in a naïve sample of self-identified flexitarians.In Study 1, consumers grouped into three distinct clusters defined as ‘health-driven’, ‘trend-cautious’, and ‘adventurous’ flexitarians. Differences in food choice motivations and the importance of reducing meat intake were observed between clusters, but not reflected in differences in meat consumption. In Study 2, four consumer segments were defined as ‘health-only’, ‘traditional trend-cautious’, ‘adventurous’ and ‘health-focused’ flexitarians. Again, differences in food motivations, health interest, justifications for meat consumption and the importance of reducing meat intake were observed between clusters, but not reflected in differences in meat consumption.We provide a novel description of the diverse motivations among flexitarian consumers to reduce animal-based product intake.

Non-abstinent recovery in alcohol use disorder is associated with greater regional cortical volumes than heavy drinking.

Harm-reduction (i.e., non-abstinent recovery) approaches to substance use treatment have garnered increasing attention. Reduced levels of alcohol consumption post-treatment have been associated with better psychosocial functioning and physical health, yet less is known regarding differences in brain structures associated with varying levels of alcohol consumption. This study investigated regional cortical volumes after alcohol use disorder (AUD) treatment among individuals who achieved complete abstinence and those who returned to lower and higher levels of consumption. Data were collected from individuals with AUD (n = 68) approximately 8 months after the initiation of treatment. Using risk drinking levels defined by the World Health Organization, participants were classified as abstaining (AB) or relapsing with low (RL) or higher (RH) levels. Data were also obtained from 34 age-matched light/non-drinking controls (LN). All participants completed a 1.5 T magnetic resonance imaging session and volumes for 34 bilateral cortical regions of interest were quantitated with FreeSurfer. Generalized linear models were used to examine group differences in cortical volume. All group findings are significant at an FDR-corrected value of 0.018. Adjusting for age and intracranial volume, significant group differences were found in 13/34 cortical regions. AB showed greater volumes than RL in 2/13 regions and RH in 6/13 regions. RH demonstrated significantly smaller volumes than LN in 12/13 ROIs, whereas RL differed from LN in 9/13 regions. RH and RL differed in only two cortical regions. Individuals who consumed low-risk levels of alcohol post-treatment exhibited regional cortical volumes more similar to abstainers than individuals who returned to higher-risk levels. This suggests that low-risk levels of alcohol consumption are associated with brain integrity that is comparable to that seen with complete abstinence. Given the previously demonstrated improvement in psychosocial and physical health with reduced levels of alcohol consumption post-treatment, harm reduction may be a beneficial and more attainable goal for some individuals with AUD who are seeking treatment.