Harmful Alcohol Use Research Articles

Non-Communicable Diseases (NCDs) A Global Burden in India: An Overview

Non-communicable diseases (NCDs) are a growing public health concern in India. These diseases have a high health-care demand and are costly, especially in low-resource settings. According to a WHO study, only 50% of chronic disease patients in developed countries follow treatment recommendations. The low compliance of patients with non-communicable diseases to treatment and medical advice is a major therapeutic challenge. The elderly is one of the most vulnerable and high-risk groups in terms of health. Physical inactivity, unhealthy diets, tobacco use, and harmful alcohol use are the main behavioural risk factors for NCDs. The objective of the study is to concentrate on the risk factors that contribute to non-communicable diseases like diabetes, hypertension, etc. and the necessary steps that must be taken before they have a negative effect on our health. Recommendation: A population-based strategy has been developed for the prevention, management, and screening of prevalent Non-Communicable Diseases (NCDs), such as diabetes, hypertension, and common malignancies. Increasing community awareness by use of print, electronic, and social media; promotion of a healthy lifestyle, and raising public awareness of NCDs.

Screening and Interventions for Cardiovascular Disease Prevention in the Limpopo Province, South Africa: Use of the Community Action Model.

The rise in non-communicable diseases (NCDs) has been attributed to economic growth in developing countries, shifts in societal norms, and behaviors such as dietary habits and physical activity. Up to 80% of NCDs could be prevented by eliminating shared risk factors, mainly tobacco use, unhealthy diets, physical inactivity, and the harmful use of alcohol. The South African government's national strategic plan to control NCDs, which includes cardiovascular disease (CVD) prevention, places a strong emphasis on the need to improve the prevention, detection, early intervention, and management of NCDs. In line with the above recommendations, this study aimed to screen rural communities using the non-laboratory INTERHEART Risk Score tool (NLIRS) and develop relevant and suitable intervention strategies for a patient at moderate risk of developing a heart attack. A quantitative research approach applying a household-based design was used to conduct this study and the community action model (CAM). The difference between pre-intervention and post-intervention results were analyzed using a t-test and Analysis of covariance (ANCOVA) with age, smoke, hypertension, and diabetes as the covariates. The study found a significant difference in proportions between pre and post-intervention for raised Systole (SBP), obesity by body mass index (BMI), and waist circumference (WC). In rural communities, using CAM to improve knowledge and behavioral practices of NCD risk factors is feasible and effective. This basket of interventions will assist community members in reducing their risk of developing metabolic syndromes as well as their risk of developing CVDs. Continued investment and research in CVD prevention interventions are required to improve health, reduce costs, and have long-term benefits for conflict-affected individuals and communities.

Falling treatment uptake in the hepatitis C care cascade is a growing threat to achieving elimination.

Most high-income countries are not on track to achieve the World Health Organization hepatitis C elimination targets. As elimination programmes assess growing proportions of patients in community-based pathways, rates of treatment uptake may fall. We aimed to identify factors associated with DAA treatment uptake and measure changes in their prevalence over time. We performed a time-to-treatment analysis on 2728 patients approved for hepatitis C Direct-Acting Antiviral treatment in the North Central London region between January 2016 and October 2019. We investigated the association between treatment uptake and factors including assessment/treatment setting (hospital, drug service or prison), patient age, gender, injection drug use, harmful alcohol use, cirrhosis status and previous treatment. The likelihood of treatment uptake was reduced by three independent risk factors. These included assessment setting: prison-based or drug-service pathways (aHR 0.29 or 0.81 vs. hospital outpatient pathway, 95% CI 0.21-0.40 and 0.70-0.94 respectively, p< .001); being UK-born (aHR 0.89 vs. non-UK born, 0.82-0.98, p= .01); and history of harmful alcohol use (aHR 0.84 vs. no history, 0.72-0.99, p= .04). The average number of these risk factors for not starting treatment per patient increased over time (R2 = 0.66 p< .001). Independent of these, there was an additional 5% reduction in rate of treatment initiation in each successive year of the programme (aHR 0.95, 0.91-0.99, p= .02). In conclusion, disengagement from care before treatment uptake was found to be a growing threat to elimination. Despite provision of community-based test-to-cure pathways, there are persistent barriers to treatment uptake and these are increasing over time.

Viral suppression and self-reported ART adherence after 3 years of universal testing and treatment in the HPTN 071 (PopART) community-randomised trial in Zambia and South Africa: a cross-sectional analysis

In 2014, UNAIDS set the target that 90% of individuals on antiretroviral therapy (ART) be virally suppressed. Here, we use data from the HPTN 071 (PopART) trial to report whether the introduction of universal testing and treatment has affected viral suppression or treatment adherence among individuals who self-reported they were taking ART, and identify risk factors for these outcomes. This was a cross-sectional study nested within the randomly selected population cohort of the PopART trial. The trial took place in 21 communities in Zambia and South Africa. Analyses included 3570 HIV-positive participants who were seen at the second follow-up visit in 2016-17 and who self-reported that they were currently taking ART. Viral suppression was defined as HIV RNA of less than 400 copies per mL from a blood sample collected during the cohort visit, and ART adherence was measured using self-reporting (reported as no missed pills in last 7 days). Prevalences of these outcomes were compared across three trial arms using a two-stage approach suitable for clustered data. Each arm consisted of seven communities, with one arm receiving a combination HIV prevention package including immediate ART initiation, one receiving a combination HIV prevention package excluding immediate ART initiation and one arm receving standard of care. Risk factors for each of the outcomes were assessed using logistic regression. Among the 3570 participants who self-reported that they were currently on ART, 416 (11·7%) of 3554 were not virally suppressed (16 were missing viral suppression status) and 345 (9·7%) of 3566 reported being non-adherent to ART (four were missing adherence status). The proportion not virally suppressed was higher in communities in South Africa (195 [16·4%] of 1191) than in Zambia (221 [9·4%] of 2363). There was no evidence that the prevalence of the outcomes differed between trial arms. There was evidence that men, younger individuals, individuals who reported participating in harmful alcohol use, and those who reported internalised stigma were more likely to be non-adherent, and not virally suppressed. The results assuaged concerns that early ART initiation in a universal testing and treatment setting could lead to reduced adherence and viral suppression. US National Institute of Allergy and Infectious Diseases (which is a part of the National Institutes of Health), the International Initiative for Impact Evaluation with support from the Bill &amp; Melinda Gates Foundation, US President's Emergency Plan for AIDS Relief, and Medical Research Council UK.

Gamma-glutamyltransferase predicts macrovesicular liver graft steatosis – an analysis of discarded liver allografts in Finland

Objective Liver-transplantation activity is limited by the shortage of grafts. Donor-liver macrovesicular steatosis predisposes to ischemia-reperfusion injury and is associated with reduced graft survival. The increasing prevalence of fatty-liver disease underlines the importance of identifying macrovesicular steatosis in potential donor livers. We analyzed liver grafts discarded for transplantation, and particularly the role of gamma-glutamyltransferase (GGT) in predicting graft steatosis. Methods One-hundred sixty rejected cadaveric-donor liver grafts were studied. Donor selection was based on clinical data, and macroscopic graft inspection. Discarded grafts were biopsied at procurement of non-liver organs. Results The most common reasons for discarding the graft were abnormal liver tests, ultrasound-verified steatosis and history of harmful alcohol use. GGT correlated moderately with macrovesicular steatosis (r = 0.52, p < 0.001), but poorly with microvesicular steatosis (r = 0.36, p < 0.001). Increased correlation between GGT and macrovesicular steatosis was observed among alcohol abusers (r = 0.67, p < 0.001). Area under the curve (AUC) of GGT for predicting >30% macrovesicular steatosis was 0.79 (95% CI 0.71–0.88), and for >60% steatosis, 0.79 (95% CI 0.68–0.90). The optimal GGT-cut off for detecting >30% and >60% macrovesicular steatosis were, respectively, 66 U/L (sensitivity 76% and specificity 68%) and 142 U/L (sensitivity 66% and specificity 83%). Among alcohol users, a GGT value >90 U/L showed 100% sensitivity for >60% macrovesicular steatosis. AUC for GGT in predicting fibrosis Stages 2–4 was 0.82 (95% CI 0.71–0.92, p < 0.001, optimal cut off 68, sensitivity 92%, specificity 61%). Conclusions Abnormal liver values, steatosis and harmful alcohol use were the main reasons for discarding liver-graft offers in Finland. GGT proved useful in predicting moderate and severe liver graft macrovesicular steatosis.

Syndemics of intimate partner violence among women in HIV endemic South Africa: geospatial analysis of nationally representative data

Despite some improvement in lowering HIV incidence, HIV-related challenges, such as intimate partner violence (IPV), remain unacceptably high among women in South Africa. For decades, researchers and activists have pointed to the complex and intertwined reality of the substance abuse, violence and AIDS (SAVA) syndemic that endangers women. However, more recent systematic review/meta-analysis evidence points to inconclusive association between IPV and alcohol use. Furthermore, much of the evidence is often non-population-based that focuses on the co-occurrence rather than synergistic SAVA interaction. In this study, using the latest data from the South Africa Demographic and Health Survey (SA-DHS), we identified geographic synergistic clustering of IPV associated with HIV and substance abuse in South Africa as a measure of population-level interactions among these factors. The SA-DHS is a nationally representative sample that includes wide-ranging data on health, social challenges and household geo-locations of 5,874 women who participated in the domestic violence module. First, geographical IPV, harmful alcohol use (as the substance abuse measure available in SA-DHS) and HIV clusters were identified using the Kulldorff spatial scan statistic in SaTScan. Second, synergistic interactions related to recent IPV (i.e. recent physical, sexual, emotional violence during the last 12 months) with harmful alcohol use and HIV challenge were measured using RERI [Relative excess risk due to interaction], AP [attributable proportion] and S [Synergy index]. In our results, we spatially identified geographical physical IPV syndemic interactions in parts of the Eastern Cape/Free State Provinces (RERI = 4.42 [95% CI: 2.34–6.51], AP = 0.56 [95% CI: 0.44–0.68], S = 2.77 [95% CI: 2.01–3.84], but not in other forms of IPV. Although IPV, based on decade old concept of SAVA syndemic, was less common/widespread than expected from the national scale population-based data, we identified population-level physical violence syndemic occurring in South Africa. Our study highlights the need to prioritize public health response targeting vulnerable populations residing in these high-risk areas of syndemic mechanisms linking these synergistic epidemics that women face in South Africa.

Feasibility of a Brief Intervention to Decrease Harmful Alcohol Use Among Methadone Maintenance Treatment Clients in Shanghai: A Randomized Controlled Trial.

In this study, we aimed to examine the prevalence of alcohol consumption among methadone maintenance treatment (MMT) clients in Shanghai and to determine whether a brief intervention (BI) affects drinking among them. A total of 837 clients from 14 local MMT clinics were invited to complete the Alcohol Use Disorders Identification Test (AUDIT). One hundred one were included in the study and randomly assigned to the BI group or the control group. Clients in the BI group received a BI and general health education, whereas clients in the control group received the general health education only. Baseline and postintervention assessments were conducted by using the AUDIT, the Drinking Attitude Questionnaire, the Depression Module of the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the General Well-Being Schedule. Two hundred fifty-nine (30.9%) reported drinking during the last year, and 103 (12.3%) met the criteria for harmful use. At the 3-month follow-up, the AUDIT scores of the 2 groups were significantly decreased, and the time effect was statistically significant ( F = 6.224, P = 0.018), but there was no group difference in AUDIT scores ( F = 1.953, P = 0.172). Both groups had a main time effect of time on the improvement of depression ( F = 8.044, P = 0.008), anxiety ( F = 9.650, P = 0.004), and general well-being ( F = 5.056, P = 0.033). However, there was no statistical difference between the 2 groups ( P > 0.05), and no statistical difference in the time ( F = 1.738, P = 0.198) and group ( F = 0.658, P = 0.424) effect of drinking attitude. Alcohol consumption is common among MMT clients in China. Brief intervention, in its current form, could not effectively help them reduce their alcohol consumption.

Toxic Habits and Well-Being Measures in Spanish Healthcare University Students during the COVID-19 Pandemic.

Background: Unhealthy lifestyles are strongly entrenched in healthcare universities and have sometimes been linked to stress or lack of sleep. This study investigated the prevalence of toxic habits (smoking, patterns of harmful alcohol use, and illicit drug use), stress levels, perceived health status, and sleep duration and assessed the connections between toxic habits and said well-being measures, as well as healthcare students’ perception of the influence of the COVID-19 pandemic on these health-related behaviors. Methods: In a cross-sectional study, healthcare students from Alfonso X University (Spain) completed a health survey composed of Alcohol Use Disorders Identification Test (AUDIT-C), Perceived Stress Scale (PSS-10), self-perceived health status, and the number of hours of sleep. Results: A total of 997 healthcare students completed the survey, of which 982 were analyzed. Being a smoker (32.2%) was associated with worse health status and insufficient sleep. Risk drinkers (33.2%) were associated with being female, and the consumption of cannabinoids (6.7%), with being male. These three toxic habits were related to each other. High levels of stress (28.2%) were correlated with worse ratings in the perception of health status (29.2%) and with insufficient sleep (45.8%), and all of them were associated with the female sex. Respectively, 49.3% and 44.2% of students recognized a worsening in their perception of stress and their sleep habits during the pandemic. Conclusion: Healthcare universities must carry out health promotion programs for stress management, sleep habits, and unhealthy lifestyles.

Comparing Tobacco and Alcohol Policies From a Health Systems Perspective: The Cases of the Philippines and Singapore.

Objective: To provide a comparative analysis of current tobacco and alcohol control laws and policies in the Philippines and Singapore Methods: We used a public health law framework that incorporates a systems approach using a scorecard to assess the progress of the Philippines and Singapore in tobacco and alcohol control according to SDG indicators, the WHO Framework Convention on Tobacco Control and the WHO Global Strategy to Reduce Harmful Use of Alcohol. We collected data from the scientific literature and government documents. Results: Despite health system differences, both the Philippines (73.5) and Singapore (86.5) scored high for tobacco control, but both countries received weak and moderate scores for alcohol control: the Philippines (34) and Singapore (52.5). Both countries have policy avenues to reinforce restrictions on marketing, improve corporate social responsibility programs, protect policies from the influence of the industry, and reinforce tobacco cessation and preventive measures against alcohol harms. Conclusion: Using a health system-based scorecard for policy surveillance in alcohol and tobacco control helped set policy benchmarks, showed the gaps and opportunities in these two countries, and identified avenues for strengthening current policies.

Hazardous or harmful alcohol use and reward processing in people with HIV.

The intersecting epidemics of HIV and hazardous or harmful alcohol use (HAU) can have significant detrimental consequences. Both HIV and HAU have independent negative influences on executive function. Dysfunction in reward processing may play a role in these co-occurring epidemics. In this cross-sectional case-control study, we investigated the association of HAU with reward processing amongst people with HIV (PWH). We investigated the function of the ventral-striatal reward system using a functional MRI (fMRI) monetary incentive delay (MID) task in a sample of 60 South African adults (mean age 32.7years): 42 living with HIV and on ART (21 with harmful alcohol use [HIV + HAU], 21 without [HIV-HAU]) and 18 healthy controls, matched for age, gender, and resident community. Education significantly influenced task performance, with those with a secondary level of education demonstrating a greater increase in reaction time (p = 0.048) and accuracy (p = 0.002) than those without. There were no significant differences in reward anticipation in the ventral striatum (VS) between HIV + HAU, HIV-HAU, and healthy controls when controlling for level of education. There were also no significant differences in reward outcome in the orbitofrontal cortex (OFC) between HIV + HAU, HIV-HAU, and healthy controls when controlling for level of education. In a sample of South African adults, we did not demonstrate significant differences in reward anticipation in the VS and reward outcome in the OFC in PWH, with and without HAU, and controls. Factors, such as task performance, education, and depression may have influenced our results. Further studies are needed to better delineate the potential links between HIV, HAU, and depression and reward system function.

Effects of Substitution of Higher-Alcohol Products with Lower-Alcohol Products on Population-Level Alcohol Purchases: ARIMA Analyses of Spanish Household Data.

In its action plan (2022–2030) to reduce the harmful use of alcohol, the WHO calls on economic operators to “substitute, whenever possible, higher-alcohol products with no-alcohol and lower-alcohol products in their overall product portfolios, with the goal of decreasing the overall levels of alcohol consumption in populations and consumer groups”. This paper investigates substitution at the level of the consumer, based on Spanish household purchase data. ARIMA modelling of market research data of 1.29 million alcohol purchases from 18,954 Spanish households is used to study the potential impact of lower-strength alcohol products and the impact of beer prices in reducing household purchases of grams of alcohol between the 2nd quarter of 2017 and 1st quarter of 2022. Reducing the alcohol strength of existing higher-strength beers and wines had a much greater associated impact on reducing the purchases of all grams of alcohol than the relatively small increases in purchases of no-alcohol beers (ABV ≤ 1.0%) and zero-alcohol wines (ABV = 0.0%). For beers, the relative price per gram of alcohol decreased with the increasing ABV of the beer. Increasing the price per gram of alcohol in beers with an ABV > 3.5%, adjusted for the ABV of the beer, was associated with much greater increases in purchases of no-alcohol beers (ABV ≤ 1.0%) and much greater decreases in purchases of all grams of alcohol than decreases in the price of no-alcohol beers or increases in the price of beers with an ABV > 3.5% unadjusted for ABV. Thus, a key to reducing purchases of grams of alcohol, which also results in increased purchases of no-alcohol beers, is to increase the price of higher strength beers (ABV > 3.5%) with the price per gram of alcohol increasing as the ABV of the product increases.

Risk factors modification as a preventive strategy in mortality reduction caused by digestive organs malignant neoplasms

Purpose of this study is to research contribution of chronic non-communicable diseases (CNCDs) risk factors (RF) to the prevalence rate of digestive organs diseases and risks of digestive system malignant neoplasms development in the context of Omsk region municipal districts. Material and methods: the analysis includes following risk factors (RF): unhealthy diets, overweight, harmful use of alcohol, physical inactivity with proved causal relationship with of digestive organs diseases such as stomach and duodenal ulcer, gastritis and duodenitis, liver fibrosis and liver cirrhosis, and with digestive organs malignant neoplasms (MNP): esophageal cancer, stomach cancer, colon cancer, rectal cancer, liver cancer and intrahepatic bile ducts cancer. This research used Russian Federation Federal State Statistics Service statistic material. Statistic material processing was conducted using traditional correlation analysis and the estimation of reliability of data differences method. Correlation analysis was carried out using online-calculator of statistics on the www.medstatistic.ru website. Results: the group of region municipal districts with the most unfavorable population mortality rates for malignant neoplasms has “unhealthy diets” RF associated with high risk of stomach cancer development, “overweight” RF associated with high risk of colorectal cancer and liver cancer development, “harmful use of alcohol” RF associated with high risk of stomach cancer and pancreatic cancer development, “physical inactivity” RF associated with high risk of stomach cancer development. Conclusion: the analysis made it possible to determine priorities in primary prevention of oncological diseases strategy in Omsk region municipal districts and to form key MNP development risk groups among region population to be targeted by preventive measures.

Trend Analysis of Global Web Searches (2004–2022) on Oral Cancer and Its Major Risk Factors

Abstract Background Oral cancer is the 15th leading cause of mortality globally. The Internet is an online source of information pertaining to oral cancer and its major risk factors. This study aims to analyze the trend of global online interest on oral cancer and its major risk factors through an analysis of web searches of oral cancer. Materials and Methods This study analyzed the web searches conducted, from 2004 to January 2022, on oral cancer and its major risk factors (tobacco use, harmful alcohol use, and human papillomavirus [HPV] infection) using data obtained from Google Trends. Results Within the time frame under study, oral cancer had multiple peak search periods, with the highest relative search volume index (SVI) for a period being 1; the peak search period for alcohol was March 2020 (SVI = 100); the peak search periods for tobacco were March to April 2004 (SVI = 17); and the peak search period of HPV was April 2004 (SVI = 1). Globally, alcohol was the most common searched term among these four terms (oral cancer, alcohol, tobacco, and HPV) except in Turkey where tobacco was the most common (55%) searched term. The top 25 search queries for oral cancer, HPV, tobacco, and alcohol had SVI ranges of 22 to 100, 12 to 100, 28 to 100, and 18 to 100, respectively. From these search queries, it was observed that people have interest in oral cancer symptomatology, and the adverse effects of tobacco, alcohol, and HPV. Conclusion This study revealed an overall decline in the online interest on oral cancer and its major risk factors on a global scale.

Alcohol Use during COVID-19 Pandemic: A Cross-Sectional Survey among Healthcare and Office Workers in Italy.

Background: The aim of our study of a sample of Italian healthcare (HCWs) and office workers (OWs) carried out during the pandemic period was to understand alcohol consumption patterns during the COVID-19 pandemic. Methods: A web-based cross-sectional survey based on Google Forms was developed. Harmful alcohol use was assessed through a validated questionnaire (AUDIT-C). Three multivariate logistic regression models were implemented for the overall sample of HCWs and OWs. The presence of harmful alcohol consumption (AUDIT-C score) was considered as a dependent variable. Results: A total of 1745 workers answered the survey. A lower risk of harmful drinking behavior among men overall and in both working groups was found (aOR 0.42, CI 95% 0.33–0.53), but also for both HCWs (aOR 0.62, CI 95% 0.46–0.84) and OWs (aOR 0.17, CI 95% 0.11–0.27). Comparing OWs and HCWs, we found a higher risk of harmful drinking in the first group (aOR 1.62, CI 95% 1.20–2.18). Conclusions: The results of the survey indicate that unhealthy behaviors were elevated during the pandemic. It is urgent to implement company policies managed by an occupational doctor to raise workers’ awareness of alcohol-related dangers and provide educational tools that have the task of preventing the damage caused by alcohol.

AI-Based Personalized Virtual Therapist for Alcohol Relapse

Binge drinking is one type of harmful alcohol use that has a variety of negative health impacts in both the drinker and others, either globally or in Malaysia. According to previous research, one in two current drinkers in Malaysia who are 13 years and older reported having engaged in binge drinking. Therefore, increased attention should be given to understand the drinking pattern of an individual and propose a solution that can help with addiction relapse. Thus, this study identified interventions that could assist alcohol relapse recovery and proposed a new generation of relapse prevention solution based on artificial intelligence (AI). By using a deep learning approach and machine learning based recommendation technique, it predicts the relapse rate of users, providing recovery consultation based on the user’s data and clinical data through a chatbot. This study involved helpful data collection, advanced data modeling, prediction analysis to support the alcohol relapse recovery journey. Hence, the proposed AI solution acted as a personalized virtual therapist to help the addicts stay sober. The objective is to present the design and realization of the AI based solution for sober journey. The proposed solution was tested with pilot study and significant benefits of virtual therapists for alcohol addiction relapse is reported in this paper.

Harmful Use of Alcohol as Predictor of Presex Drinking in Mexican Young College Women.

The aim of this study was to identify whether the harmful use of alcohol is associated with an increased probability of presex drinking in Mexican young women. This was a study with a predictive design. Multiple logistic regressions were performed in a random sample of 304 young college women (between the ages of 18 and 24 years) from Guanajuato and Tamaulipas, Mexico. Participants completed a sociodemographic data survey and the Alcohol Use Disorders Identification Test questionnaire. Women with a pattern of harmful use of alcohol were more likely to report drinking before sex (adjusted odds ratio = 4.679, 95% confidence interval [1.619, 13.520], McFadden's pseudo R2 = 25.5%). Further analyses revealed that presex drinking by partners was an even stronger predictor of alcohol use before sexual intercourse in women (adjusted odds ratio = 12.749, 95% confidence interval [4.714, 34.483], McFadden's pseudo R2 = 34.7%). The findings demand additional nursing studies to corroborate-and to better understand-the relationship between harmful use of alcohol in Mexican women, their partners' drinking behavior, and unhealthy behaviors like drinking before sexual intercourse.

Development of alcohol control law, Sao Tome and Principe.

The World Health Organization (WHO) African Region is struggling with increasing harm associated with alcohol consumption. Legislators of Sao Tome and Principe, concerned about this harm and the high prevalence of alcohol use disorders, designed a comprehensive alcohol control bill to tackle this situation. Input into the design of the bill was obtained through interviews involving many stakeholders. The process had five phases: (i) scoping the problem to understand the social burden of the harm caused by alcohol consumption; (ii) updating the evidence on alcohol policies and identifying areas for legislative interventions; (iii) drafting the bill; (iv) aligning the legislative framework of the bill; and (v) initiating the parliamentary procedure. The new bill scored 92/100 using a standardized alcohol control policy scale. The bill covers all domains of WHO’s 2010 global strategy to reduce the harmful use of alcohol, and includes the three most cost-effective interventions for reducing alcohol consumption: increased excise taxes on alcohol; bans or comprehensive restrictions on exposure to alcohol advertising; and restrictions on the availability of retailed alcohol through reduced hours of sale. The National Assembly plenary session upheld the bill, which is now under evaluation of the specialized First Commission on Political, Legal, Constitutional and Ethical Affairs. Approval of the bill requires the final voting once it is back with the National Assembly and its promulgation by the President. Drafting an alcohol control bill which is country-led, inclusive, evidence-based and free of interference by the alcohol industry helps prioritize public health objectives over other interests.

Prevalence of Burnout and Psychiatric Illness among Postgraduate Trainee Doctors of a Tertiary Care Hospital

Objective: Burnout is a state of physical and emotional depletion, and it is a result of prolonged exposure to the stressful working environment. Burnout has three primary symptoms: (a) emotional exhaustion (EE) occurs due to a depletion of emotional resources, feeling no longer to give any more to their job; (b) depersonalization (DP) occurs in response to EE, making employees detached from their job and developing uncaring attitudes to their work; and (c) reduced personal accomplishment (PA) with perceiving less enjoyment from their work. Psychological distress is also higher among medical students and doctors than that in the general population. In this study, we intended to study the prevalence of burnout and various psychological problems among postgraduate trainee (PGT) doctors of a tertiary care hospital. Methods: In this cross-sectional study of one year, we recruited postgraduate training doctors whoever gave valid and informed consent. Results: We included 170 PGTs from various clinical departments at the time of our study, but 126 PGTs were included as the sample population. They were assessed for sociodemographic determinants first. Then received assessment using sociodemographic pro forma and Abbreviated Maslach Burnout Inventory and International Classification of Diseases 10 for screening psychiatric morbidity among them. Results: In this study, 31.7% of PGTs had high EE, 34.9% of them higher DP, and 30.2% of them a high burnout rate. Of them, 31.7% of PGTs had a reduced PA with a score ≤ 25 percentile. In this study, 83.3% had no psychiatric illness and 16.7% had a psychiatric disorder. Among psychiatric disorders, 4% had harmful use of tobacco, 4% had mild depression, 1.6% had panic disorder, 4.8% had mixed anxiety depression, 1.6% had obsessive-compulsive disorder, 0.8% had harmful use of alcohol. Highest EE was noted among PGTs from the Department of Anesthesiology, followed by those from the Departments of Pulmonary Medicine and then Radiotherapy. Conclusion: One-third of PGTs suffered from burnout. Psychiatric diseases were also increased with a higher burnout rate.

Patient and health-care provider experience of a person-centred, multidisciplinary, psychosocial support and harm reduction programme for patients with harmful use of alcohol and drug-resistant tuberculosis in Minsk, Belarus

BackgroundTuberculosis (TB) often concentrates in groups of people with complex health and social issues, including alcohol use disorders (AUD). Risk of TB, and poor TB treatment outcomes, are substantially elevated in people who have AUD. Médecins sans Frontières and the Belarus Ministry of Health have worked to improve treatment adherence in patients with multi-drug or rifampicin resistant (MDR/RR)-TB and harmful use of alcohol. In 2016, a person-centred, multidisciplinary, psychosocial support and harm reduction programme delivered by TB doctors, counsellors, psychiatrists, health-educators, and social workers was initiated. In 2020, we described patient and provider experiences within the programme as part of a wider evaluation.MethodsWe recruited 12 patients and 20 health-care workers, using purposive sampling, for in-depth individual interviews and focus group discussions. We used a participant-led, flexible, exploratory approach, enabling participants and the interviewer to shape topics of conversation. Qualitative data were coded manually and analysed thematically. As part of the analysis process, identified themes were shared with health-care worker participants to enable their reflections to be incorporated into the findings.ResultsKey themes related to the patients’ and practitioners experience of having and treating MDRTB with associated complex health and social issues were: fragility and despair and guidance, trust and health. Prejudice and marginalisation were global to both themes. Counsellors and other health workers built a trusting relationship with patients, enabling guidance through a multi-disciplinary approach, which supported patients to achieve their vision of health. This guidance was achieved by a team of social workers, counsellors, doctors and health-educators who provided professional and individualised help for patients’ illnesses, personal or interpersonal problems, administrative tasks, and job searches.ConclusionsPatients with MDR/RR-TB and harmful use of alcohol faced complex issues during treatment. Our findings describe how person-centred, multi-disciplinary, psychosocial support helped patients in this setting to cope with these challenges and complete the treatment programme. We recommend that these findings are used to: i) inform programmatic changes to further boost the person-centred care nature of this program; and ii) advocate for this type of person-centred care approach to be rolled out across Belarus, and in contexts that face similar challenges.

Targeting the Maladaptive Effects of Binge Drinking on Circadian Gene Expression.

Previous studies (1) support a role of circadian genes in regulating alcohol intake, and (2) reveal that harmful alcohol use alters circadian rhythms. However, there is minimal knowledge of the effects of chronic alcohol processes on rhythmic circadian gene expression across brain regions important for circadian biology and alcohol intake. Therefore, the present study sought to test the effects of chronic binge-like drinking on diurnal circadian gene expression patterns in the master circadian pacemaker (SCN), the ventral tegmental area (VTA), and the nucleus accumbens (NAc) in High Drinking in the Dark-1 (HDID-1) mice, a unique genetic risk model for drinking to intoxication. Consistent with earlier findings, we found that 8 weeks of binge-like drinking reduced the amplitude of several core circadian clock genes in the NAc and SCN, but not the VTA. To better inform the use of circadian-relevant pharmacotherapies in reducing harmful drinking and ameliorating alcohol’s effects on circadian gene expression, we tested whether the casein kinase-1 inhibitor, PF-67046, or the phosphodiesterase type-4 (an upstream regulator of circadian signalling) inhibitor, apremilast, would reduce binge-like intake and mitigate circadian gene suppression. PF-67046 did not reduce intake but did have circadian gene effects. In contrast, apremilast reduced drinking, but had no effect on circadian expression patterns.