Drinking Standards Research Articles

Road traffic injuries and alcohol use in the emergency department in Tanzania: a case-crossover study

Abstract
 Introduction: Alcohol is the leading risk factor for road traffic injury (RTI). Africa has the second-highest rate of alcohol dependence and the highest road traffic fatality rate. We describe the proportion of Tanzanian emergency department (ED) patients presenting with RTIs who are blood alcohol content (BAC) positive and determine the dose-response relationship between drinking and injury risk.Methods: Analysis of data from EDs in Tanzania from 2013 to 2014 was performed. Adults presenting to an ED within 6 hours of injury had BAC testing and were asked whether and how much alcohol was consumed prior to the injury. Data also included self-reported alcohol use during control periods 1 day and 1 week prior to the injury. Case-crossover analysis of injury risk used logistic regression to determine matched-pair odds ratios (ORs) and 95% confidence intervals (CIs).Results: Of 513 injury patients, 375 (73%) suffered RTIs. Overall, 29% of RTI patients were BAC-positive. Approximately 40% of those who reported using alcohol prior to RTI reported drinking more than 5 standard drinks. With any alcohol, drivers of both motorcycles and cars/trucks had increased odds of RTI (4.90 OR (CI 2.5-9.5) and 5.70 OR (CI 2.8-11.6) respectively). While the odds of RTI in car/truck drivers demonstrated a dose-dependent response, that in motorcyclists was highest after 3-4 drinks (5.60 OR, CI 2.22-14.10).Discussion: The RTI burden in Tanzania is high. Any alcohol can increase RTI risk. These findings should guide drunk-driving legislation.

Ultrasound evaluation of gastric emptying time of standardized high-calorie liquid meals in healthy adults: A double-blind cross-over randomized study

Commercially available high-calorie drinks containing fat and protein can be used as dietary supplements in surgical patients. According to preoperative fasting guidelines, high-calorie drinks are non-clear fluids and should not be consumed 6h before elective procedures. The aim of this study was to evaluate the gastric emptying time of commercially available high-calorie drink formulations in healthy adults using gastric ultrasound. 25 healthy adult volunteers were included in this double-blind, cross-over prospective study. On three study sessions, fasted volunteers ingested one of the three study products: a solution of 75g of glucose in 200ml of water, a fat-free liquid meal, and a nutritionally complete liquid meal with equal volume and energy content. Gastric ultrasound examinations were performed to evaluate the gastric contents qualitatively and the volume of the gastric contents was calculated from the cross-sectional area of the gastric antrum measured in right lateral position by using a validated model. Repeated gastric ultrasounds were performed at baseline and half-hourly after ingesting the products in supine and right lateral position until the criteria for an empty stomach were met. The glucose solution and the standard fat-free high-calorie drink with the same caloric content had a median gastric emptying time of 150min. The nutritionally complete liquid meal had a median gastric emptying time of 180min. Gastric emptying was complete in all participants before 6h had elapsed since ingesting the study products. High calorie liquid meals have a gastric emptying time longer than the recommended fasting time for clear fluids, but shorter than the recommended fasting time for solids in healthy adults.

Alcohol for seizure induction in the epilepsy monitoring unit

Rationale: Seizure induction techniques are used in the epilepsy monitoring unit (EMU) to increase diagnostic yield and reduce length of stay. There are insufficient data on the efficacy of alcohol as an induction technique. MethodsWe performed a retrospective cohort study using six years of EMU data at our institution. We compared cases who received alcohol for seizure induction to matched controls who did not. The groups were matched on the following variables: age, reason for admission, length of stay, number of antiseizure medications (ASM) at admission, whether ASMs were tapered during admission, and presence of interictal epileptiform discharges. We used both propensity score and exact matching strategies. We compared the likelihood of epileptic seizures and nonepileptic events in cases versus controls using Kaplan-Meier time-to-event analysis, as well as odds ratios for these outcomes occurring at any time during the admission. ResultsWe analyzed 256 cases who received alcohol (median dose 2.5 standard drinks) and 256 propensity score-matched controls. Cases who received alcohol were no more likely than controls to have an epileptic seizure (X2(1) = 0.01, p = 0.93) or nonepileptic event (X2(1) = 2.1, p = 0.14) in the first 48 h after alcohol administration. For the admission overall, cases were no more likely to have an epileptic seizure (OR 0.89, 95 % CI 0.61–1.28, p = 0.58), nonepileptic event (OR 0.97, CI 0.62–1.53, p = 1.00), nor require rescue benzodiazepine (OR 0.63, CI 0.35–1.12, p = 0.15). Stratified analyses revealed no increased risk of epileptic seizure in any subgroups. Sensitivity analysis using exact matching showed that results were robust to matching strategy. ConclusionsAlcohol was not an effective induction technique in the EMU. This finding has implications for counseling patients with epilepsy about the risks of drinking alcohol in moderation in their daily lives.

Characteristics of high- and low-risk drinkers who use online alcohol home delivery in Western Australia.

Variation in alcohol availability is an important driver of levels of consumption and harm, with recent increases in online alcohol home delivery use expanding availability. There is limited research on the impacts of these changes and the characteristics of consumers who use alcohol home delivery. This study presents findings from an online survey (n = 465) of Western Australian adults who had purchased alcohol for home delivery within the past 6 months. Analyses compared high-risk and low-risk drinkers on use of, and exposure to, alcohol home delivery. Compared to low-risk drinkers, high-risk drinkers were significantly more likely to make more frequent online purchases (odds ratio 5.42), utilise same day delivery (odds ratio 2.91) and purchase through specialised online-only retailers (odds ratio 2.69). High-risk drinkers also reported receiving deliveries while intoxicated more often (odds ratio 11.62), and ordering alcohol for delivery to continue a current drinking session (odds ratio 7.47). High-risk drinkers also received advertising for alcohol home delivery more frequently (odds ratio 1.60) than low-risk drinkers. High-risk drinkers also ordered larger quantities of alcohol than low-risk drinkers (M = 49 vs. 32 standard drinks). Findings from this study indicate that these services are popular with high-risk drinkers and potentially undermine other policy efforts to reduce drinking. Within Australia, stronger legislation (such as mandatory delay between order and delivery) and monitoring (e.g., test purchasing for compliance) are recommended.

Plasma phosphorylated tau 181 and modifiable risk factors for dementia in a large scale cohort of Australian older adults

AbstractBackgroundUp to 40% of dementia cases could be prevented by addressing modifiable risk factors. Alzheimer’s disease (AD), the most common form of dementia, is preceded by up to decades of silent pathological change providing an ideal window for early detection and intervention. In this study, our objective was to examine the associations between modifiable risk factors and plasma phosphorylated p‐tau 181, a hallmark biomarker of early AD.MethodParticipants were recruited from the Island Study Linking Ageing and Neurodegenerative Disease (ISLAND), a prospective public health initiative in Tasmania, Australia’s southernmost island state. ISLAND participants were invited to complete a set of surveys online: a questionnaire on dementia risk factor adherence, demographic surveys and cognitive tests via the Cambridge Neuropsychological Test Automated Battery (CANTAB); Paired Associates Learning (PAL) and Spatial Working Memory (SWM). At four clinics across the state, participants also provided blood samples for measurement of plasma phosphorylated p‐tau 181 and genotyping for APOE.ResultA total of 738 participants (mean age 65.41 years, mean education 17.36 years, 71.8% female, 26.4% ε4+) took part in the study. We found gender‐specific effects on cognition, whereby identifying as male was associated with significantly lower learning ability (PAL) whilst identifying as female was associated with significantly lower executive function (SWM). In multivariate linear models, increasing alcohol consumption (measured in standard drinks per week) was significantly associated with lower plasma p‐tau 181. In adjusted models, no other modifiable risk factors examined were associated with p‐tau 181. Increasing age, identifying as male and possessing at least one APOE ε4 allele were all associated with higher plasma concentrations of p‐tau 181ConclusionHigher alcohol consumption, higher age, identifying as male and having an APOE ε4 allele were all associated with lower plasma phosphorylated tau 181. This contributes to evidence that both modifiable and non‐modifiable dementia risk factors are related to the biological precedents of AD. These associations were related to gender and genetics, therefore a panel of modifiable and non‐modifiable variables should be included in screening or diagnostic testing for pre‐clinical AD. More research is needed regarding specific alcohol types and biomarkers of AD.

Daily associations between cannabis use and alcohol use among people who use cannabis for both medicinal and nonmedicinal reasons: Substitution or complementarity?

People who use cannabis for medicinal (vs. nonmedicinal) reasons report greater cannabis use and lower alcohol use, which may reflect a cannabis-alcohol substitution effect in this population. However, it is unclear whether cannabis is used as a substitute or complement to alcohol at the day level among people who use cannabis for both medicinal and nonmedicinal reasons. This study used ecological momentary assessment to examine this question. Participants (N = 66; 53.1% men; mean age 33 years) completed daily surveys assessing previous-day reasons for cannabis use (medicinal vs. nonmedicinal), cannabis consumption (both number of different types of cannabis used and grams of cannabis flower used), and number of standard drinks consumed. Multilevel models revealed that, in general, greater cannabis consumption on a given day was associated with greater same-day alcohol use. Further, days during which cannabis was used for medicinal (vs. exclusively nonmedicinal) reasons were associated with reduced consumption of both cannabis and alcohol. The day-level association between medicinal reasons for cannabis use and lower alcohol consumption was mediated by using fewer grams of cannabis on medicinal cannabis use days. Day-level cannabis-alcohol associations may be complementary rather than substitutive among people who use cannabis for both medicinal and nonmedicinal reasons, and lower (rather than greater) cannabis consumption on medicinal use days may explain the link between medicinal reasons for cannabis use and reduced alcohol use. Still, these individuals may use greater amounts of both cannabis and alcohol when using cannabis for exclusively nonmedicinal reasons. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sulforaphane as a potential modifier of calorie-induced inflammation: a double-blind, placebo-controlled, crossover trial

Background and aimsObservational data indicate that diets rich in fruits and vegetables have a positive effect on inflammatory status, improve metabolic resilience and may protect against the development of non-communicable diseases. Nevertheless, experimental evidence demonstrating a causal relationship between nutrient intake (especially whole foods) and changes in metabolic health is scarce. This study investigated the pleiotropic effects of sulforaphane from broccoli sprouts, compared to pea sprouts, on biomarkers of endothelial function, inflammation and metabolic stress in healthy participants subjected to a standardized caloric challenge.MethodsIn this double-blind, crossover, randomized, placebo-controlled trial 12 healthy participants were administered 16 g broccoli sprouts, or pea sprouts (placebo) followed by the standardized high-caloric drink PhenFlex given to disturb healthy homeostasis. Levels of inflammatory biomarkers and metabolic parameters were measured in plasma before and 2 h after the caloric overload.ResultsAdministration of broccoli sprouts promoted an increase in levels of CCL-2 induced by caloric load (p = 0.017). Other biomarkers (sICAM-1, sVCAM-1, hs-CRP, and IL-10) individually showed insignificant tendencies toward increase with administration of sulforaphane. Combining all studied biomarkers into the systemic low-grade inflammation score further confirmed upregulation of the inflammatory activity (p = 0.087) after sulforaphane. No significant effects on biomarkers of metabolic stress were detected.ConclusionThis study has demonstrated that sulforaphane facilitated development of a mild pro-inflammatory state during the caloric challenge, which could be suggestive of the onset of the hormetic response induced by this phytonutrient. The use of integrative outcomes measures such as the systemic low-grade inflammation score can be viewed as a more robust approach to study the subtle and pleiotropic effects of phytonutrients.Clinical trial registration:www.clinicaltrials.gov, identifier NCT05146804.

A computer-assisted telephone collaborative care intervention provided by lay providers for the treatment of comorbid depression and at-risk drinking: Analysis of a randomized controlled trial

IntroductionVirtual collaborative care for people with comorbid depression and at-risk drinking lacks strong evidence. Our aim was to assess the impact of 12 months of telephone collaborative care (tCC) versus enhanced usual care (eUC) on depression and drinking. MethodsWe performed a secondary analysis of the Primary care Assessment and Research of a Telephone intervention for Neuropsychiatric conditions with Education and Resources study (PARTNERs), a blinded randomized controlled trial. We examined 144 participants with comorbid depression and at-risk drinking, of which 129 were from the original sample whose data have been published, and 15 were studied since the original report had been published. PARTNERs compared eUC consisting of usual care plus assessment of symptoms at baseline, and 4, 8, and 12 months later vs. tCC consisting of eUC plus telephone-based coaching and symptom monitoring provided by a lay mental health technician to patients supervised by a psychiatrist. The study assessed depression response and remission using logistic regression; we assessed trajectory of drinking using Generalized-estimating equations (GEE). Baseline factors associated with likelihood of not exceeding number of drinks at 12 months were identified using decision trees. ResultstCC produced a faster decline in the number of drinks than eUC (Wald Χ2 = 9.47, p = 0.02). However, drinking and depression outcomes did not differ significantly between the two groups at the end of treatment. Higher alcohol consumption at baseline (≥18 standard drinks per week in the tCC group and ≥11 standard drinks per week in the eUC group) was associated with a higher likelihood of having at-risk drinking after 12 months of treatment. ConclusionsOur findings suggest that, compared to eUC, tCC may accelerate drinking reductions in patients with comorbid depression and at-risk drinking. Both treatments were equally effective at the end of treatment for both depression and drinking outcomes.

Development of a tool to estimate sugar and caloric contents in alcoholic beverages for a diabetes self-management program in Thailand

Diabetes self-management education and support (DSMES) is recommended as a standard of care for patients with diabetes worldwide. Alcohol consumption is one aspect mentioned within the DSMES program in Thailand where alcohol consumption is the highest among Southeast Asian countries. Many diabetes guidelines suggest limiting alcohol intake to not more than one standard drink per day for adult women and two for adult men if they cannot abstain from drinking. In practice, however, the conversion of alcohol consumption into standard drinks, and nutritional information about the calorie and sugar contents of alcoholic beverages, especially domestically produced spirits, are not commonly available in Thailand. By reviewing the diabetes guidelines internationally and the Thailand alcoholic beverage industry, a visual health education tool to help convert different alcoholic beverages into standard drinks and to provide the calorie and sugar content of alcoholic beverages was developed as a part of the DSMES program. It was finalized following pilot testing and focus group discussions with policymakers, healthcare providers, and type 2 diabetes patients. The personalized counseling tool, integrated with guidelines and culturally tailored to the Thai setting is distributed to counselors/educators. It is a potentially useful tool for patients to make informed choices for their self-management of diabetes.

Alcohol consumption and epigenetic age acceleration across human adulthood.

The alcohol-associated biological aging remains to be studied across adulthood. We conducted linear regression analyses to investigate the associations between alcohol consumption and two DNA methylation-based biological age acceleration metrics in 3823 Framingham Heart Study participants (24-92 years and 53.8% women) adjusting for covariates. We also investigated whether the two epigenetic aging metrics mediated the association of alcohol consumption with hypertension. We found that higher long-term average alcohol consumption was significantly associated with biological age acceleration assessed by GrimAge acceleration (GAA) and PhenoAge acceleration (PAA) in middle-aged (45-64 years, n = 1866) and older (65-92 years, n = 1267) participants while not in young participants (24-44 years, n = 690). For example, one additional standard drink of alcohol (~14 grams of ethanol per day) was associated with a 0.71 ± 0.15-year (p = 2.1e-6) and 0.60 ± 0.18-year (p = 7.5e-4) increase in PAA in middle-aged and older participants, respectively, but the association was not significant in young participants (p = 0.23). One additional standard serving of liquor (~14 grams of ethanol) was associated with a greater increase in GAA (0.82-year, p = 4.8e-4) and PAA (1.45-year, p = 7.4e-5) than beer (GAA: 0.45-year, p = 5.2e-4; PAA: 0.48-year, p = 0.02) and wine (GAA: 0.51-year, p = 0.02; PAA: 0.91-year, p = 0.008) in middle-aged participant group. We observed that up to 28% of the association between alcohol consumption and hypertension was mediated by GAA or PAA in the pooled sample. Our findings suggest that alcohol consumption is associated with greater biological aging quantified by epigenetic aging metrics, which may mediate the association of alcohol consumption with quantitative traits, such as hypertension.

Effects of prenatal alcohol exposure on infant lung function, wheeze, and respiratory infections in Australian children.

Prenatal alcohol exposure (PAE) is a known risk factor for a range of adverse outcomes, such as facial dysmorphism, adverse birth outcomes, and neurodevelopmental changes. Preclinical research shows that PAE also inhibits lung development, lowers surfactant protein expression, has detrimental effects on alveolar macrophages, and decreases both T and B cell numbers. However, clinical evidence of respiratory impacts from PAE is limited. This study explored whether lung function, wheeze, and incidence of respiratory infections differ in children with PAE compared with unexposed children. Data from the Barwon Infant Study (n = 1074) were examined. PAE data were extracted from maternal questionnaires at trimesters 1 and 2 (combined), and trimester 3, and included as "total standard drinks" during each trimester and total pregnancy intake, a binary yes/no for PAE, and binge drinking (>5 standard drinks in one session). Respiratory outcomes were parent-reported wheeze, lung function (measured by multiple breath washout), and parent report and medical record indicators of health service attendances for respiratory conditions. Linear and logistic regressions were performed to quantify relationships between PAE and respiratory outcomes, controlling for socioeconomic status, birthweight, sex, gestational age, and maternal smoking. Binge drinking was associated with increased health service attendance for respiratory condition(s) in the first 12 months of life (OR = 5.0, 95% CI (1.7, 20.7), p = 0.008). We did not find a relationship between binary PAE and binge drinking with lung function at 4 weeks of age or wheeze at 12 months. The number of standard drinks consumed in trimester two was associated with a lower lung clearance index (β = -0.011 turnovers, 95% CI (-0.0200, -0.0013), p = 0.03), and a small increase in functional residual capacity (β = 0.34 mL, 95% CI (0.02, 0.66), p = 0.04). We found an association between binge drinking and health service utilization for respiratory conditions in infancy, but no evidence that low-level PAE was associated with adverse respiratory outcomes.

Guidelines for alcohol consumption in the era of ‘no safe levels’ - where do we stand?

Abstract Background Despite claims that moderation consumption could improve health outcomes, namely cardiovascular health, the latest scientific evidence shows there is no safe amount of alcohol consumption. This study sought to determine the current definitions of standard drink and alcohol consumption guidelines across different nations. Methods Based on information from the WHO and the authors’ own judgment, a pool of countries with available data was created. In order to gather the required information, structured internet searches of relevant terms for each country were conducted. Results In 2015, a similar study was conducted but no actualizations were made afterwards. Currently, there has yet to be a standard drink definition agreed upon by every national government, and there are differences between what constitutes this standard drink. Countries have different guidelines for how much alcohol is safe to consume, and low-risk consumption guidelines vary considerably. There are also double standards for men and women. There are few governments that explicitly state that alcohol consumption should be zero. Conclusions National drinking recommendations and guidelines and standard drinking units differ considerably from country to country. It should be evaluated how this impacts public health since this is information available to the general public and can influence how citizens view what they should consume. Public dissemination of messages about so-called safe alcohol consumption levels, moderate alcohol consumption, or protective effects of alcohol consumption is against WHO recommendations, so state governments and national health institutes should consider this matter. Key messages • Countries do not have standardized public health definitions and messages concerning alcohol consumption. • Public health practitioners should update the content of alcohol guidelines accessible to the public to accommodate the latest scientific evidence.

Alcoholic drink produced by pea is a risk factor for incident knee surgery in patients with knee osteoarthritis.

The objective of this study is to investigate whether alcohol exposure and specific alcoholic drinks are independent risk factors for incident knee surgery in knee osteoarthritis (KOA) patients. We identified all patients who were clinically diagnosed as KOA between January 2010 and January 2018 in our outpatient department. Demographic, clinical, and radiographic data were collected from the database of our hospital. Next, we analyzed the association between alcohol consumption and incident knee surgery. A total of 4,341 KOA patients completed the current study and were included in the final analysis. Incident knee surgery for the purpose of treating osteoarthritis was observed in 242 patients. Incident knee surgery was significantly associated with age (OR [95%CI], 1.023 [1.009-1.039], P = 0.002), BMI (OR [95%CI], 1.086 [1.049-1.123], P < 0.001), baseline K-L grade 3 (OR [95%CI], 1.960 [1.331-2.886], P = 0.001), baseline K-L grade 4 (OR [95%CI], 1.966 [1.230-3.143], P = 0.005), 7.1-14 drinks per week (OR [95%CI], 2.013 [1.282-3.159], P = 0.002), >14 standard drinks per week (OR [95%CI], 2.556 [1.504-4.344], P = 0.001), and the most common alcoholic drink produced by pea (OR [95%CI], 3.133 [1.715-5.723], P < 0.001). KOA patients who consumed more than seven standard drinks per week were at substantial risk of incident knee surgery. In addition, alcoholic drink produced by pea is also an independent risk factor.

Link between depression and bone mineral density in Cooper Center Longitudinal Study: Indirect effects of vitamin D, inflammation, and physical activity

BackgroundTo examine the effect of depressive symptom severity on bone mineral density (BMD) and the potential mediators of the relationship. MethodThis study used data from n = 7273 participants in the Cooper Center Longitudinal Study at the Cooper Clinic in Dallas. Participants were included if they had data for all study variables, including left and right femoral neck (BMD), age, sex, body mass index, smoking status, antidepressant (SSRI/SNRI) use, standard alcoholic drinks consumed per week, and depressive symptom severity as measured with the Center for Epidemiological Studies-Depression (CESD)-10. To evaluate the effect of depressive symptoms on both L/R femur BMD, two multiple linear regression analyses were conducted. To examine effects of vitamin D, high sensitivity C-reactive protein (hs-CRP), and physical activity (MET units) on the relationship between depressive symptom severity and BMD, parallel mediation analyses were conducted. ResultsDepressive symptom severity (CES-D 10 score) significantly predicted both L/R BMD (L: β = −0.048, R: β = −0.047, both p ≤ .001). Only physical activity significantly mediated the relationship between depressive symptom severity and L/R BMD (L: β = −0.008, 95 % CI [−0.011, −0.005]; R: β = −0.007, 95 % CI [−0.010, −0.005]). LimitationsThe sample may not be generalizable to all patient populations. ConclusionDepressive symptom severity was inversely related to both L/R femur BMD in a large cohort of relatively healthy adults. Physical activity, but not vitamin D or hs-CRP, mediated this relationship. Future research might examine the effect of physical activity interventions both on depression and BMD. Impact statementWe certify that this work is both novel and confirmatory of recent clinical research (Lee et al., 2015; Amsterdam and Hooper, 1998; Hlis et al., 2018; Wainstein et al., 2016; Blair et al., 1989; Farrell et al., 2022; Ainsworth et al., 2011). We demonstrated a negative relationship between depression and BMD in a large cohort of adults and expanded on previous findings by demonstrating that physical activity acts as a mediator of this relationship. Physical activity is known to stimulate osteogenesis in osteoporotic patients, and this study further expands on its role in depressive symptoms in this population. Key points•This study of a large cohort of adults adds to the growing body of evidence associating depression severity with low bone mineral density.•Physical activity acts as a mediator on the negative relationship between bone mineral density and depression.

Application of the Weighted Arithmetic Water Quality Index in Assessing Groundwater Quality: A Case Study of the South Gujarat Region

Groundwater is a natural resource used for drinking, agriculture, and industry, apart from surface water. Its quality should be assessed regularly, and the condition of water resources should be maintained accordingly. The most common analytical method for describing and assessing the general water quality is the Water Quality Index (WQI). This study aims to assess the South Gujarat Region’s groundwater quality using the WQI. Various physicochemical parameters like pH, turbidity, total dissolved solids, total hardness, calcium, magnesium, chloride, sulphate, nitrate, fluorides, and total alkalinity are considered for the present study. The data period from 2018 to 2022 is considered for the same. The Weighted Arithmetic Water Quality Index Technique is used to evaluate these data. For checking the potability of the parameters within the acceptable limit, the Indian Standard Drinking Water Specification code (IS: 10050-2012) is adopted. According to the study mentioned above, a few wells’ groundwater quality has been found to be higher than the WQI value. It is also observed that four wells were found unsuitable for drinking purposes in 2018. It is noted that if the WQI value of groundwater is above 51, it is considered harmful to human health; therefore, it requires some kind of processing before use. This study will be beneficial to the policymakers for identifying and providing details about groundwater quality in the form of a specific value, i.e., WQI.

Liver stiffness in Fontan patients: the effect of respiration and food intake.

For several years, patients with single ventricle hearts have been palliated according to the Fontan principle. One well known long-term consequence in these patients is the Fontan-associated liver disease and fibrosis, which occurs due to the chronically increased Central Venous Pressure (CVP) after Fontan palliation. It carries an increased risk of liver cirrhosis and hepatocellular carcinoma over time. Liver elastography (LE) is a non-invasive, safe, and feasible ultrasound method to determine liver stiffness and the stage of liver fibrosis. Usually, this examination must be performed in a sober condition and strict inspiratory hold to optimize the results and may therefore be difficult to perform on children as a routine examination. However, the influence of food intake and respiration on these results in Fontan patients is unclear. To optimize the implementation for this examination especially in children, the effects of food intake and breathing maneuvers on liver stiffness in patients with Fontan circulation were investigated. For this prospective study, 25 Fontan patients (group 1) and 50 healthy volunteers (group 2) were examined. The two groups were additionally divided into two age categories (group 1a: 10-19 years; group 1b: 20-29 years; group 2a: 15-19 years; group 2b: 20-25 years). Liver stiffness was measured by liver elastography once before food intake (=T0, with 6 h of fasting). Subsequently the participants consumed a standardized chocolate drink (500 mL) with nutritional distribution corresponding to a standardized meal (600 kcal). Liver stiffness was then determined 15, 30, 45, 60, 90, 120, 150, and 180 min after ingestion. Each measurement of liver stiffness was performed during maximal inspiratory and expiratory holds. The study was reviewed and approved by the responsible ethics committee. In group 2 there was a significant increase in liver stiffness after food intake at T15, T30, and T45 during inspiration measurements (T0 = 4.0 kPa vs. T15 = 4.9 kPa, difference = 22.5%; T0 = 4.0 kPa vs. T30 = 4.9 kPa difference = 22.5%; T0 = 4.0 kPa vs. T45 = 4.3 kPa difference = 7.5%), as well as during expiration at T15 and T30 (T0 = 4.5 kPa vs. T15 = 5.1 kPa, difference = 14.7%; T0 = 4.5 kPa vs. T30 = 4.9 kPa difference = 7.8%). Whereas in Fontan patients (group 1) liver stiffness did not differ significantly at any time between fasting (T0) and postprandial values. The respiratory maneuvers in the healthy subjects (group 2) differed significantly only before food intake (T0) (group 2: insp = 3.97 kPa vs. exp. = 4.48 kPa difference = 11.3%). In the Fontan group (group 1), there was no significant difference between the respiratory phases at any point. The different age categories showed no significant difference in liver stiffness. With these results we could demonstrate for the first time that in Fontan patients the time of food intake (i.e., fasting) has no clinical significance for the values obtained in liver elastography. We could also demonstrate that the breathing maneuvers during the examination had only minimal clinical impact on the results of liver elastography in patients with normal circulation and no effect in patients with Fontan-circulation. Consequently, liver elastography for Fontan patients is reliable independently of food intake and breathing maneuvers and can also be performed on younger patients, who are unable to follow breathing commands or longer fasting periods, without any impairment of the results. These results should encourage a routine use of LE in the follow-up of Fontan patients.

Alcohol zero: the end, the beginning of the end, or just the end of the beginning?

Alcohol drinks, especially wine, have been described since 6,000 B.C. For many years in modern medicine, wine in moderation has been considered healthy for cardiovascular prevention, i.e., recommended by nutrition committees. Some regional guidelines still recommend one to two standard drinks per day. By the very recent (January 2023), World Health Organization and Canadian Guidance on alcohol emphasize that any alcoholic drink is hazardous to the health and the safe amount is zero. The risk starts with every single drop. It was also nicely summarized in the manuscript “Alcohol-dose question and the weakest link in a chemical interplay” (Explor Cardiol. 2023;1:15–25. doi: 10.37349/ec.2023.00003) especially from the standpoint of a researcher in the cardiovascular arena. The newest recommendations are based on observational studies and their meta-analysis, therefore establishing associations, pointing out that alcohol may somewhat prevent cardiovascular diseases and diabetes type 2, but with a significant increase in non-cardiovascular morbidity and mortality, especially cancers. Previous recommendations, therefore, may be obsolete as they were based on studies where abstainers from alcoholic beverages had inherent higher risks. The current controversy with conflicting guidelines for alcoholic beverage consumption in the era of precision medicine may stimulate more fundamental investigations up to genetic ones and find the cause-effect relations. In the era of precision medicine, it may come closer to discovering the causes of cancers and many other diseases, enabling predictions of reactions to alcoholic beverages by each person, not just in the population.

The Impacts of Selling Alcohol in Grocery Stores in Ontario, Canada: A Before-After Study.

From 2015 to 2019, the Government of Ontario expanded privatized sales of alcohol, licensing 450 grocery stores to sell beer, cider, and wine. The impacts of a nearby grocery store gaining an alcohol license on adults' alcohol use in Ontario are examined, including whether impacts differed by gender. Data from 2015-2019 Canadian Community Health Survey participants in Ontario (age ≥ 20 years), living within 1,000 m and 1,500 m of grocery stores that gained a license to sell alcohol and propensity-matched controls were included (1,000 m n = 14,052, 1,500 m n = 30,486). Alcohol use outcomes included past-7-day number of standard drinks consumed, near-daily drinking (≥4 days/week), and heavy drinking (5+ drinks in men/4+ in women, at least once/month). Gender-specific difference-in-differences (DiD) analyses compared changes in alcohol use before and after intervention in intervention and control populations. Decreases in past-7-day drinks, near-daily drinking, and heavy drinking were observed after intervention in both intervention and control populations. At the 1,000 m level, adjusted DiD analyses showed past-7-day drinking in women (risk ratio = 1.21, 95% CI [0.88, 1.60]) and heavy drinking in men (odds ratio = 1.38, 95% CI [0.92, 2.08]) had effect sizes above 1, a relative increase over controls, although confidence intervals crossed 1. Findings did not indicate significant differences in alcohol use in intervention relative to controls for other alcohol use measures and at 1,500 m. Findings suggest no association between a partial alcohol deregulation initiative in Ontario and alcohol use from 2015 to 2019. It is important to monitor the impacts on alcohol use over time as further alcohol deregulation plans in Ontario and other jurisdictions are considered.

Effect of a smartphone intervention as a secondary prevention for use among university students with unhealthy alcohol use: randomised controlled trial

ObjectiveTo estimate the effects of providing access to an alcohol intervention based on a smartphone.DesignRandomised controlled trial..SettingFour higher education institutions in Switzerland.Participants1770 students (≥18 years) who screened positive for unhealthy...

The effectiveness of alcohol label information for increasing knowledge and awareness: a rapid evidence review

BackgroundConsumers have difficulty understanding alcoholic units and low risk drinking guidelines (LRDG). Labelling may improve comprehension. The aims of this rapid evidence review were to establish the effectiveness of on-bottle labelling for (i) improving comprehension of health risks; (ii) improving comprehension of unit and/or standard drink information and/or LRDG, and (iii) reducing self-reported intentions to drink/actual drinking.MethodsElectronic database searches were carried out (January 2008-November 2018 inclusive). Papers were included if they were: published in English; from an Organization for Economic Co-operation and Development country; an experimental/quasi-experimental design. Papers were assessed for quality using the Effective Public Health Practice Project Quality Assessment tool. Ten papers were included. Most studies were moderate quality (n = 7).ResultsFive themes emerged: comprehension of health risks; self-reported drinking intentions; comprehension of unit/standard drink information and/or LRDG; outcome expectancies; and label attention. Labelling can improve awareness, particularly of health harms, but is unlikely to change behaviour. Improved comprehension was greatest for labels with unit information and LRDG.ConclusionsAlcohol labelling can be effective in improving people’s comprehension of the health risks involved in drinking alcohol enabling them to make informed consumption decisions, and perhaps thereby provide a route to changing behaviour. Thus, effective alcohol labelling is an intervention that can be added to the broader suite of policy options. That being said, the literature reviewed here suggests that the specific format of the label matters, so careful consideration must be given to the design and placement of labels.