Daily Alcohol Consumption Research Articles

Prospective changes in alcohol use among hazardous drinkers in the absence of treatment.

Gaining a better understanding of the natural course of hazardous alcohol consumption could inform the development of brief interventions to encourage self-change. In the current study, hazardous drinkers (based on Alcohol Use Disorders Identification Test score) were recruited using advertisements to participate in a 2-year multiwave prospective study. Participants (n = 206) provided self-reports every six months during the study, including reports of daily alcohol consumption. The current investigation focuses on self-initiated change in participants' frequency of heavy drinking days (i.e., ≥ 5/4 drinks per day for men/women), as predicted by a number of demographic (e.g., age) and psychosocial (e.g., guilt-proneness) variables. Latent growth curve models of the change in percent heavy drinking days over the 2-year period provided an excellent fit to the observed data and indicated a significant decline in percent heavy drinking days over time. Reductions in heavy drinking frequency were predicted by younger age and higher guilt-proneness. The identification of these predictors of reductions in heavy drinking frequency provides information to guide future work investigating self-change among hazardous drinkers.

Exploring knowledge, attitudes, and practices related to alcohol in Mongolia: a national population-based survey

BackgroundThe leading cause of mortality in Mongolia is Non-Communicable Disease. Alcohol is recognised by the World Health Organization as one of the four major disease drivers and so, in order to better understand and triangulate recent national burden-of-disease surveys and to inform policy responses to alcohol consumption in Mongolia, a national Knowledge, Attitudes and Practices survey was conducted. Focusing on Non-Communicable Diseases and their risk factors, this publication explores the alcohol-related findings of this national survey.MethodsA door-to-door, household-based questionnaire was conducted on 3450 people from across Mongolia. Participants were recruited using a multi-stage random cluster sampling technique, and eligibility was granted to permanent residents of households who were aged between 15 and 64 years. A nationally representative sample size was calculated, based on methodologies aligned with the WHO STEPwise approach to Surveillance.ResultsApproximately 50% of males and 30% of females were found to be current drinkers of alcohol. Moreover, nine in ten respondents agreed that heavy episodic drinking of alcohol is common among Mongolians, and the harms of daily alcohol consumption were generally perceived to be high. Indeed, 90% of respondents regarded daily alcohol consumption as either ‘harmful’ or ‘very harmful’. Interestingly, morning drinking, suggestive of problematic drinking, was highest in rural men and was associated with lower-levels of education and unemployment.ConclusionThis research suggests that Mongolia faces an epidemiological challenge in addressing the burden of alcohol use and related problems. Males, rural populations and those aged 25-34 years exhibited the highest levels of risky drinking practices, while urban populations exhibit higher levels of general alcohol consumption. These findings suggest a focus and context for public health measures addressing alcohol-related harm in Mongolia.

The effects of capping the alcohol consumption distribution and relative risk functions on the estimated number of deaths attributable to alcohol consumption in the European Union in 2004

BackgroundWhen calculating the number of deaths attributable to alcohol consumption (i.e., the number of deaths that would not have occurred if everyone was a lifetime abstainer), alcohol consumption is most often modelled using a capped exposure distribution so that the maximum average daily consumption is 150 grams of pure alcohol. However, the effect of capping the exposure distribution on the estimated number of alcohol-attributable deaths has yet to be systematically evaluated. Thus, the aim of this article is to estimate the number of alcohol-attributable deaths by means of a capped and an uncapped gamma distribution and capped and uncapped relative risk functions using data from the European Union (EU) for 2004.MethodsSex- and disease-specific alcohol relative risks were obtained from the ongoing Global Burden of Disease, Comparative Risk Assessment Study. Adult per capita consumption estimates were obtained from the Global Information System on Alcohol and Health. Data on the prevalence of current drinkers, former drinkers, and lifetime abstainers by sex and age were obtained from various population surveys. Alcohol-attributable deaths were calculated using Alcohol-Attributable Fractions that were calculated using capped (at 150 grams of alcohol) and uncapped alcohol consumption distributions and capped and uncapped relative risk functions.ResultsAlcohol-attributable mortality in the EU may have been underestimated by 25.5% for men and 8.0% for women when using the capped alcohol consumption distribution and relative risk functions, amounting to the potential underestimation of over 23,000 and 1,100 deaths in 2004 in men and women respectively. Capping of the relative risk functions leads to an estimated 9,994 and 468 fewer deaths for men and for women respectively when using an uncapped gamma distribution to model alcohol consumption, accounting for slightly less than half of the potential underestimation.ConclusionsAlthough the distribution of drinkers in the population and the exact shape of the relative risk functions at large average daily alcohol consumption levels are not known, the findings of our study stress the importance of conducting further research to focus on exposure and risk in very heavy drinkers.

A Reply to Roerecke & Rehm: Continuing Questions about Alcohol and Health Benefits

I am grateful for the opportunity for further debate and to reiterate my view that (i) Roerecke & Rehm 1 conducted a technically excellent meta-analysis on a largely poor literature and (ii) that plausible arguments remain against there being health benefits from moderate drinking. Given the fundamental significance of the issue for alcohol policy, I suggest that it is important to keep the shortcomings of this literature in clear view—as well as some other awkward findings for the health benefit hypothesis. I checked through their list of included studies and accept they were adequate for gaining an estimate of average daily alcohol consumption. I further agree that if measures of heavy episodic drinking had been employed in more than a couple of studies then the appearance of health benefits might have been even more pronounced. However, significant problems remain. They note that ‘most’ of their studies controlled for age and smoking status and ‘some’ also controlled for physical activity. Naimi et al. 2 identified some 27 risk factors (e.g. nutrition, physical exercise, body weight, diabetes) that differentiated abstainers significantly from moderate drinkers, and so there is still some room for improvement here. Roerecke & Rehm 3 acknowledge that many of their studies created bias by including former drinkers in the abstainer reference group 4, and they attempted to adjust for this in the analysis. However, there is another potential form of abstainer bias to deal with: the inclusion of occasional drinkers in the abstainer reference group. The idea here is that as people become more frail with age they are inclined not only to give up drinking, but also to cut down 5. If they are included with abstainers this could make moderate drinkers look good by comparison 4. Occasional drinkers may also be more healthy than abstainers for reasons unrelated to their drinking which could cause bias from another direction 6: many studies combine occasional with moderate drinkers, thus also making the latter look good when compared with abstainers. Finally, how adequate is it to estimate average alcohol consumption on the basis of only 2 weeks drinking, which was the minimum criterion used for study inclusion? Drinking patterns are highly variable, and assessments over only a few days can fail to catch occasional heavy drinkers and exaggerate the number of abstainers (e.g. Rehm et al. 7). In summary, I still think this literature is characterized accurately as having many shortcomings. Roerecke & Rehm 3 did not address the additional concern regarding other, less plausible health benefits associated with moderate drinking, such as a reduced risk of liver cirrhosis morbidity for men 8. A recent review paper identified studies claiming health benefits from moderate drinking for: Alzheimer's, asthma, the common cold, depression, gallstones, deafness, urinary tract symptoms, osteoporosis, obesity, arthritis, various cancers and hip fracture—to mention a few 9. Does this mean that alcohol is a universal panacea or are, perhaps, systematic biases at work? Some relevant and interesting new data suggest that even life-time abstainers may be biased towards being less healthy than light or moderate drinkers. Ng Fat & Shelton 10 examined a group of young adults who elected to be abstinent and compared them with their drinking peers, and found them to be significantly more likely to have poor health as well as low income. Somewhat older data from Scandinavia suggest that individuals who abstain completely for ideological reasons are much healthier than other abstainers—and just as healthy as moderate drinkers 11. If these findings make one inclined to throw up hands in despair of finding a watertight reference group, this may be a useful reality check. This is an area of research in need of both continued improvement and a little caution when it comes to interpretation. None.

Alcohol Consumption and CD4 T-Cell Count Response Among Persons Initiating Antiretroviral Therapy

We evaluated the longitudinal association of alcohol use with immunologic response to combination antiretroviral therapy (ART) among HIV-infected individuals. This was a prospective cohort study of individuals initiating ART. Participants underwent an Audio Computer-Assisted Self-interview querying drug and alcohol use within 6 months of treatment. Immunologic response to ART was defined by CD4 T-cell count (CD4). Primary independent variables were self-reported number of drinks consumed per drinking day (quantity) and days of alcohol consumption in a typical week (frequency). We used linear mixed effects models to quantify the association between CD4 T-cell count and alcohol quantity and frequency and Cox proportional hazards models to estimate the relative hazard of an increase in 100, 150, and 200 CD4 cells per cubic millimeter per additional drink per drinking day. Analyses were stratified by sex. Viral suppression was examined as a time-varying covariate. Between 2000 and 2008, 1107 individuals were eligible for inclusion in this study. There was no statistically significant difference in CD4 T-cell count by average drinks per drinking day at any frequency of alcohol use irrespective of sex or viral suppression. Similarly, we found no difference in the hazard ratio for drinks per drinking day within the categories of drinking frequency for time to CD4 T-cell count increase of 100, 150, and 200 cells per cubic millimeter, respectively. Among individuals initiating ART, the benefits of therapy and viral suppression on the immune system outweigh detrimental effects of alcohol, reinforcing the importance of initiating ART and ensuring adequate adherence to therapy.

A Dutch panel study on the relation between structure of everyday life, daily hassles, and alcohol consumption

BackgroundA widely held assumption within the general public is that one way in which people cope with their daily hassles is by drinking alcohol. Although the idea of drinking to compensate for daily hassles is intuit, empirical evidence is actually rather scarce. This study aimed to test whether structure of everyday life results in more daily hassles and has a protective effect regarding alcohol consumption (as predicted by classic role theory) or – in case the relation between daily hassles and alcohol consumption is positive (as predicted by tension reduction theories) – daily hassles would decrease the protective effect of having a more structured everyday life.MethodsA general population panel study (N = 2,440; 47% women; age: M = 52 years, SD = 17), measuring structure of everyday life and daily hassles (T1; 90% response rate) as well as alcohol consumption (T2; 85% response rate).ResultsIn line with classic role theory – structure of everyday life was positively associated with daily hassles and had a negative effect on alcohol consumption. Daily hassles was not associated with alcohol consumption.ConclusionsDaily hassles did not mediate the relationship between structure of everyday life and alcohol consumption.

Exploring the mechanisms of alcohol-related damage in oral mucosa – is oxidative stress associated with the increase in cell proliferation in rat tongue epithelium?

Context: Alcohol consumption has been related to a cell proliferation increase in oral epithelium but its mechanism remains unclear.Objective: The aim of this study was to investigate whether oxidative stress parameters are implicated in the induction of cell proliferation in rat tongue epithelium after different times of chronic alcohol consumption.Materials and methods: Cell proliferation was assessed in tongue epithelium using AgNOR (argyrophilic proteins related to active nucleolar organizer regions) quantification. Oxidative stress parameters [lipid peroxidation, protein carbonyls, superoxide dismutase activity and catalase (CAT) activity and immunocontent] and Nrf2 immunocontent were quantified in tongue homogenates.Results and discussion: Mean AgNOR numbers (mAgNOR) per nucleus was 2.22 ± 0.30 in ventral tongue epithelium after 120 days of alcohol consumption (vs. 1.87 ± 0.18 for control animals and 1.91 ± 0.23 for animals treated with alcohol for 60 days) indicating cell proliferation increase (p < 0.05, ANOVA followed by Tukey post hoc). Interestingly, 60 days of alcohol consumption induced changes in oxidative stress parameters, but no alteration in cell proliferation. Vitamin E co-treatment was conduced in order to evaluate its possible protective effects. The 120 day Tween + vitamin E + alcohol treatment induced an increase in mAgNORs when compared to the Tween + vitamin E treated group (respectively 2.10 ± 0.30 vs. 1.77 ± 0.11, p < 0.05, ANOVA followed by Tukey post hoc), showing that vitamin E co-treatment had no protective effects. In addition, an inverse association was observed between CAT activity and AgNORs quantity (R = −0.32; p < 0.05, Person’s correlation) as well as the possible involvement of Nrf2 in alcohol-related damage.Conclusions: Our findings suggest that the increase in cell proliferation associated with alcohol-related damage has no direct relation with an imbalance in oxidative parameters. In contrast, our results indicate that hydrogen peroxide may be implicated in cellular signaling during proliferation in the oral mucosa.

Ratio of IL 10 over IL 12 is a Novel Surrogate to Evaluate the Severity of Non Alcoholic Steatohepatitis (NASH) - A Prospective Clinical Pilot Study

Purpose: Non alcoholic steatohepatitis (NASH) is a growing global epidemic progressing to cirrhosis, liver failure, HCC, warrants liver transplant. The natural history is still not well defined, inflammatory cytokines, intrahepatic immune traffic, degree of apoptosis and path of fibrogenesis are the sequel of the disease process. This study evaluates a novel inflammatory cytokine (IL 10 and IL 12) ratio to predict NAFLD to NASH and its severity index. Methods: Ninety (n=90) patients, mean age of 45 (28-54) were divided into Group A (n=30) BMI (mean) <25% with normal lipids, healthy control. Group B with NAFLD (n=30) BMI >29% with NAFLD (hepatic steatosis, Waist/Hip ratio > 0.9, high lipids, HOMA>1.8, mean normal ALT, AST, RBP4,2.5, Leptin, Adiponectin, TNF alpha, serum NASH score <0.8, mean fibrotic score < 0.1, mean IL 10/IL 12 ratio < 1.0. Group C with NASH (n=30), BMI>30, W/H ratio > 1.1, high lipids, HOMA> 2.2, high AST, ALT, RBP>4.5, high leptin, low adiponectin, high TNF alpha, IL10/IL12 ratio> 4.5. Serums NASH score > 0.6, fibrotic score over 0.2. Liver biopsy in NASH group, macrovascular fat 18/30(60%), balloning 12/30(40%), Mallory body 7/30(23%), METAVIR score F2 12/30(40%), F3 9/30(30%), F4 3/30(10%). Exclusion Criteria: Diabetes, viral hepatitis, autoimmune liver disease, alcoholic liver disease with daily alcohol consumption over 20 gm, steatogenic medications including herbs and HIV. Results: See Table.Table: ResultsConclusion: IL 10/12 ratio correlated with the progression of NAFLD to NASH.IL 10/12 ratio >4.5 has NASH with high steatosis, fibrotic score. Larger study will establish the predictive index of IL10/IL 12 NASH in the severity and prognosis. Alcoholic hepatitis should be considered in the multivariate analysis.

Influence of daily alcohol consumption on serum adiponectin levels in men

BackgroundThe risk of cardiovascular diseases is lower among moderate alcohol drinkers than among both nondrinkers and heavy drinkers. However, factors that can account for the U-shaped or J-shaped relationship between daily alcohol consumption and incident cardiovascular diseases remain obscure. PurposeThe present cross-sectional study investigated the relationship between alcohol consumption and serum adiponectin levels. MethodTotal adiponectin was measured in 527 males participating in health check-up programs (age range 40–86 years, mean 60.5 years). Based on questionnaire responses, alcohol intake was categorized into three groups: none or occasional (A1); <50 g/day and ≥3 days/week (A2); and ≥50 g/day and ≥3 days/week (A3). ResultsNo significant differences in adiponectin levels were observed among the three alcohol consumption groups of subjects without the metabolic syndrome (MetS). In subjects with the MetS, the adiponectin level was significantly higher in the A2 (moderate drinker) group than in both the A1 and A3 groups. MetS subjects in group A2 had higher HDL-C levels than those in A1, but levels in group A3 were not significantly different from those in group A2. ConclusionAn increased adiponectin level in moderate alcohol drinkers who have MetS may contribute to the U-shaped relationship between alcohol consumption and risk of cardiovascular events, in addition to the involvement of HDL-C.

Increased intimate partner violence in users of Mexican public health services: fact or improved registry?

ObjectiveTo explore the prevalence trends in intimate partner violence (IPV) for the years 2003 and 2006 in Mexico, identifying factors associated with the severity of violence.MethodThe 2006 National Survey on...

Early identification and brief intervention for risky drinkers: an experience with general practitioners in Florence, Italy

Successful implementation of early identification and brief intervention (EIBI) was implemented in Italy from 2005–2007 in the city of Florence and its environs. Twenty-five general practitioners (GPs) identified risky drinkers among their clients and followed them for 12 months. Follow-up included visits to the GP’ so ffice with educational interventions aimed at reducing or stopping drinking. The GPs recorded alcohol consumption, drinking patterns, and conducted blood tests. A computer system was created to collect data centrally. At the end of the study, 2869 clients were enrolled (average daily alcohol consumption, 15.05 g). Three hundred and eight were risky drinkers (10.7%) (42.64 g alcohol on average per day). Of these, 40.6% had at least one abnormal blood test. Although fewer risky drinkers presented for follow-up (n = 126), their decrease of alcohol consumption was relevant at the second visit (37.61 g). Based on this experience, a one-day educational program for GPs on the issue of alcohol and alcohol-related problems was initiated in Florence, starting in 2010. The program focused on health information as well as communication skills, education, rehabilitation, and prevention. Two education groups were implemented in 2010. Forty-six GPs were asked their opinion on BI prior to participating in the educational program via an Italian version of the Brief Intervention Questionnaire. About 90% of participating GPs thought they needed to be better prepared to identify risky drinkers and to implement BI. About 60% found it difficult or somehow difficult to address the issue of drinking with patients. Thirty percent of GPs drank alcoholic beverages daily or nearly daily, and 22.5% smoked cigarettes.

Alcohol Consumption and the Risk of Hypertension in Men and Women: A Systematic Review and Meta‐Analysis

Heavy alcohol intake increases the risk of hypertension, but the relationship between light to moderate alcohol consumption and incident hypertension remains controversial. The authors sought to analyze the dose-response relationship between average daily alcohol consumption and the risk of hypertension via systematic review and meta-analysis. Electronic databases were searched for prospective control studies examining quantitative measurement of alcohol consumption and biological measurement of outcome. The primary endpoint was the risk of developing hypertension based on alcohol consumption. The level of alcohol consumption from each study was assigned to categorical groups based on the midpoint of their alcohol consumption classes to make possible the comparison of heterogeneous classification of alcohol intake. A total of 16 prospective studies (33,904 men and 193,752 women) were included in the analysis. Compared with nondrinkers, men with alcohol consumption with <10 g/d and 11 to 20 g/d had a trend toward increased risk of hypertension (relative risk [RR], 1.03; 95% confidence interval [CI], 0.94-1.13; P=.51) and (RR, 1.15; 95% CI, 0.99-1.33; P=.06), respectively, whereas a significantly increased risk of hypertension was found with heavy alcohol consumption of 31 to 40 g/d (RR, 1.77; 95% CI, 1.39-2.26; P<.001) and >50 g/d (RR, 1.61; 95% CI, 1.38-1.87; P<.001). Among women, the meta-analysis indicated protective effects at <10 g/d (RR, 0.87; 95% CI, 0.82-0.92; P<.001) and a trend toward decreased risk of hypertension with alcohol consumption 11 to 20 g/d (RR, 0.9; 95% CI, 0.87-1.04; P=.17), whereas a significantly increased risk of hypertension was indicated with heavy alcohol consumption of 21 to 30 g/d (RR, 1.16; 95% CI, 0.91-1.46; P=.23) and 31 to 40 g/d (RR, 1.19; 95% CI, 1.07-1.32; P=.002). In men, heavy alcohol consumption is associated with increased risk of hypertension, whereas there is a trend toward increased risk of hypertension with low and moderate alcohol consumption. The relationship between alcohol consumption and hypertension is J-shaped in women. Limiting alcohol intake should be advised for both men and women.

Long-term daily access to alcohol alters dopamine-related synthesis and signaling proteins in the rat striatum

Chronic alcohol exposure can adversely affect neuronal morphology, synaptic architecture and associated neuroplasticity. However, the effects of moderate levels of long-term alcohol intake on the brain are a matter of debate. The current study used 2-DE (two-dimensional gel electrophoresis) proteomics to examine proteomic changes in the striatum of male Wistar rats after 8months of continuous access to a standard off-the-shelf beer in their home cages. Alcohol intake under group-housed conditions during this time was around 3–4g/kg/day, a level below that known to induce physical dependence in rats. After 8months of access rats were euthanased and 2-DE proteomic analysis of the striatum was conducted. A total of 28 striatal proteins were significantly altered in the beer drinking rats relative to controls. Strikingly, many of these were dopamine (DA)-related proteins, including tyrosine hydroxylase (an enzyme of DA biosynthesis), pyridoxal phosphate phosphatase (a co-enzyme in DA biosynthesis), DA and cAMP regulating phosphoprotein (a regulator of DA receptors and transporters), protein phosphatase 1 (a signaling protein) and nitric oxide synthase (which modulates DA uptake). Selected protein expression changes were verified using Western blotting. We conclude that long-term moderate alcohol consumption is associated with substantial alterations in the rat striatal proteome, particularly with regard to dopaminergic signaling pathways. This provides potentially important evidence of major neuroadaptations in dopamine systems with daily alcohol consumption at relatively modest levels.

Alcohol and illicit drug use among potential HIV vaccine efficacy trial volunteers along Lake Victoria, Uganda

Background HIV has adversely affected fishing communities (FC), with prevalence ranging between 25-30% on Lake Victoria. To better characterize the HIV prevalence among FC and explore potential for HIV vaccine efficacy trials, we conducted a pilot study on HIV prevalence, sexual risk behavior, alcohol and drug use in these communities. Methods A cross-sectional HIV prevalence survey was conducted in 8 FC over 3 months. Census and mapping to determine the average population size in each community were conducted prior to the study. After obtaining informed consent, 2,200 individuals aged 18-49 years from randomly selected households were tested for HIV and responded to questionnaires on sexual behavior, alcohol consumption and drug use. Results Fifty three percent (53.0%) had consumed alcohol in the past three months with males consuming more alcohol than females [59.0% vs. 46.8%, p<0.01].19.2% of alcohol consumers also used illicit drugs [p<0.01]. Alcohol consumption in the previous 3 months was highest among Catholics [p<0.01], those with no formal education [p=0.01], sex workers (100%), loaders/off loaders (79%), bar owners (69.7%), construction workers (66.7%), bar attendants (66.1%) and fishermen [(61.0%), p<0.01]. Daily alcohol consumption was highest among older participants (35-49years) and sex workers [p<0.01]. Alcohol consumption before sex (43.0%) was highest among youths (25-34 years), sex workers, bar owners and attendants [p<0.01]. HIV prevalence was higher amongst alcohol consumers [63.4% vs. 36.6%, p<0.01], with daily and weekly consumers having a higher prevalence [73.0% vs. 27.0%, p=0.05]. Illicit drugs like cocaine, Miraa/Khat were used by 13.8% of participants, mostly amongst sex workers [(33%), p<0.01]. Illicit drugs were used mainly on a daily basis [(44.6%), p<0.01]. Conclusion Alcohol and illicit drug use is prevalent in FC and associated with higher prevalence of HIV infection. Efforts towards controlling alcohol and illicit drug use might help control HIV in these communities

Influence of mild-to-moderate alcohol consumption on cardiovascular diseases in men from the general population

Background and methodsThere is controversy about the association between mild-to-moderate alcohol consumption and a reduced risk of cardiovascular diseases. The relationships between daily alcohol consumption and the incidence of acute myocardial infarction (MI) or ischemic stroke (IS) were examined in men in a community-based, prospective cohort study (n = 8014, age 40–80 years, mean age = 64.1 years). Alcohol consumption was categorized into 3 groups (A1, none or occasional; A2, ≤25 g/day; A3, >25 g/day as ethanol) at baseline. ResultsDuring the mean follow-up of 5.5 years, 53 MIs and 186 ISs occurred. On Cox regression analysis adjusted for age, hypertension, diabetes, dyslipidemia, smoking index, and body mass index (BMI), the hazard ratio (HR) for incident MI was significantly lower in the A2 group than in the A1 group (HR = 0.49, p = 0.043). The HR for incident MI in the A3 group tended to be lower than in the A1 group (HR = 0.53, p = 0.10). In obese subjects, while a significantly lower HR for incident MI in the A2 group was retained (HR = 0.29, p = 0.049), no significant difference in the HR of the A3 group compared with the A1 group was found. No significant differences were found in the IS-free curve among the 3 groups of alcohol consumption. ConclusionsAlcohol consumption may have a protective effect on the onset of MI but not on IS in the general population. A U-shaped relation between alcohol consumption and incident MI was found in obese subjects. An appropriate limit for daily alcohol consumption, depending on the risk of ischemic heart disease, may need to be established.

Stability of acetaldehyde-derived DNA adduct in vitro

Acetaldehyde (AA) derived from alcoholic beverages is a confirmed carcinogen for esophageal and head and neck cancers. AA forms various DNA adducts and is thought to play a crucial role in carcinogenesis. Transient DNA adducts are usually repaired, but the stability of AA-derived DNA adducts has not been elucidated. We investigated the stability of N2-ethylidene-2′-deoxyguanosine (N2-ethylidene-dG), a major AA-derived DNA adduct, in cultured cells. First, to determine the optimal concentration of AA for detecting N2-ethylidene-dG in cell culture, a dose–response study was performed using HL60 cells of the human promyelocytic leukemia cell line. An AA concentration ⩾0.01% (1.8mM) was required to detect N2-ethylidene-dG in vitro. We next examined the stability of N2-ethylidene-dG. After a 1 or 2h exposure to 0.01% of AA in a tightly sealed bottle, N2-ethylidene-dG content was measured by sensitive liquid chromatography tandem mass spectrometry immediately, 24h, and 48h after exposure. After the 1h exposure, the mean (± SD) N2-ethylidene-dG contents were 12.1±1.28, 8.20±0.64, and 6.70±0.52 adducts per 107 bases at each postexposure time. After the 2h exposure, N2-ethylidene-dG content increased to 21.4±7.50, 10.5±3.61, and 9.83±3.90 adducts per 107 bases at each postexposure time. The half-life of this adduct was calculated as ∼35h in independent experiments. These results indicate that AA exposure from daily alcohol consumption may cause DNA damage and may increase the risk of alcohol-related carcinogenesis.

Relationships of Alcohol Use and Alcohol Problems to Probable Anxiety and Mood Disorder

We examine the effects of alcohol consumption and problem drinking on probable anxiety and mood disorder (AMD). Data were taken from the 2000–2006 CAMH Monitor (N = 15,653) general population survey of Ontario adults. Scoring 4+ on the 12-item General Health Questionnaire defined probable AMD, as suggested by recent research. Logistic regression showed that respondents with alcohol problems had significantly increased odds of probable AMD, but those reporting moderate daily alcohol consumption (up to 2 drinks) had decreased odds of probable AMD compared to abstainers. These data replicate other recent research in suggesting that the relationship between alcohol and adverse psychological states, such as psychological distress and probable anxiety and mood disorder, may not be monotonic. Several ways in which selection bias could account for these findings are discussed, as well as other possible causative mechanisms.

Highlights in basic autonomic neurosciences: Autonomic control of the counter-regulatory response and glucose homeostasis

Glucose homeostasis is of major importance to normal physiological function. Aberrations of glucose homeostasis occur in Type I and Type II diabetes because of loss of insulin production and loss of sensitivity to insulin, respectively. Treatment with insulin or oral hypoglycaemic agents helps restore normoglycaemia and prevents some of the complications of hyperglycaemia such as cardiovascular disease, neuropathy, nephropathy and retinopathy. As a consequence of treatment, patients often experience hypoglycaemia as a result of amismatch between daily insulin requirements, food intake, exercise and alcohol consumption. Exposure to recurrent hypoglycaemia frequently leads to a loss of the signs and symptoms of hypoglycaemia, a phenomenon known as hypoglycaemia unawareness. This can result in severe hypoglycaemia. In normal individuals, induction of hypoglycaemia results in activation of the glucose counterregulatory response, which raises blood glucose levels. The counterregulatory response comprises a reduction in endogenous insulin production by the pancreatic β-cells, increased production of glucagon by the pancreatic α-cells, release of adrenaline from the adrenalmedullary chromaffin cells and stimulation of appetite. Sustained hypoglycaemia also activates cortisol and growth hormone production. Recurrent hypoglycaemia results in the failure of the brain either to detect hypoglycaemia or to elicit these counterregulatory responses, such that a hypoglycaemic episode may be fatal. An additional problem in Type 1 diabetes is that the glucagon-secreting isletα-cells may be damaged concomitantly with the β-cells, depriving Type 1 patients of a major mechanism for increasing blood glucose levels during hypoglycemia. Therefore, in these patients restoration of normoglycaemia is strongly dependent on adrenaline secretion, a response which is seriously impaired by antecedent hypoglycemia. Several articles have been published recently which review the central nervous system neurocircuitry, glucose-sensing neurons and autonomic effector pathways that help to restore normoglycaemia but which becomes impaired upon exposure to antecedent hypoglycaemia.

Health behaviors among short- and long- term ex-smokers: Results from the Thai National Health Examination Survey IV, 2009

BackgroundAlthough numerous studies have shown the health behaviors of ex-smokers to be better than those in regular smokers, the differences in health behaviors among ex-smokers at varying durations of cessation have not been investigated. This study aims to examine the relationship between different durations of smoking cessation and health behaviors. MethodsData on dietary intake, alcohol consumption, physical activity, and smoking behavior from the Thai National Health Examination Survey IV for subjects aged 15–98years (n=19 371) were included in the analysis. Trends between health behaviors among regular smokers, ex-smokers with different durations of smoking (<1year, 1–10years, >10years), and never smokers were tested. Logistic regression models adjusted for sex, age, and economic status were used. ResultsThe prevalences of regular smoking, ex-smoking, and never smoking were 22.3%, 12% , and 65.7%, respectively. A trend was found for consumption of fruit, beans and meats, dairy and soy milk, whole-grain products, nutritional supplements, and eating habits. Average daily alcohol consumption (g) was lowest among ex-smokers who had quit for>10years ex-smokers (16.4) followed by 1–10years ex-smokers (27.2), and <1year ex-smokers (33.7). ConclusionA longer duration of smoking cessation correlated with better health behaviors.

Urban Movement and Alcohol Intake Strongly Predict Defaulting from Tuberculosis Treatment: An Operational Study

BackgroundHigh levels of defaulting from treatment challenge tuberculosis control in many African cities. We assessed defaulting from tuberculosis treatment in an African urban setting.MethodsAn observational study among adult patients with smear-positive pulmonary tuberculosis receiving treatment at urban primary care clinics in Kampala, Uganda. Defaulting was defined as having missed two consecutive monthly clinic visits while not being reported to have died or continued treatment elsewhere. Defaulting patients were actively followed-up and interviewed. We assessed proportions of patients abandoning treatment with and without the information obtained through active follow-up and we examined associated factors through multivariable logistic regression.ResultsBetween April 2007 and April 2008, 270 adults aged ≥15 years were included; 54 patients (20%) were recorded as treatment defaulters. On active follow-up vital status was established of 28/54 (52%) patients. Of these, 19 (68%) had completely stopped treatment, one (4%) had died and eight (29%) had continued treatment elsewhere. Extrapolating this to all defaulters meant that 14% rather than 20% of all patients had truly abandoned treatment. Daily consumption of alcohol, recorded at the start of treatment, predicted defaulting (adjusted odds ratio [ORadj] 4.4, 95%CI 1.8–13.5), as did change of residence during treatment (ORadj 8.7, 95%CI 1.8–41.5); 32% of patients abandoning treatment had changed residence.ConclusionsA high proportion of tuberculosis patients in primary care clinics in Kampala abandon treatment. Assessing change of residence during scheduled clinic appointments may serve as an early warning signal that the patient may default and needs adherence counseling.