Harmful Alcohol Use Research Articles

69Effect of smoking on treatment outcomes among newly diagnosed Tuberculosis patients in Shimla city India

Abstract Background World health organization in 2015 had adopted “End TB Strategy” aimed at ending the global TB epidemic by 2035. Tobacco smoking has been reported to be associated with many aspects of TB disease, including increased vulnerability to being infected, recurrence with TB and related mortality. Methods A prospective cohort study was carried out among newly diagnosed tuberculosis patients of Shimla city which is the capital of Himachal Pradesh, a northern state of India. Data related to smoking status was collected using the standard questionnaire which was used for collection of data regarding tobacco use in Global Adult Tobacco Survey (GATS). Details of the participant’s final treatment outcomes after end of standardized treatment of 6 months was collected from the treatment records of the patients. Results 72 TB patients were included as study subjects. The prevalence of smoking came out to be 37.5%. In our analyses, the risk of unfavorable treatment outcomes was higher among smokers (p value 0.049), Smokeless tobacco users (p value 0.031) and those with history of harmful alcohol use (p value 0.002). Conclusions There is high prevalence of smoking among TB patients and risk factors associated with unfavorable treatment outcome are smoking, Smokeless tobacco and history of harmful alcohol use. Key messages Smoking and smokeless tobacco cessation programmes need to be targeted at Tuberculosis patients. Tuberculosis patients with alcohol related problems should be identified at the time of diagnosis and should be attached with de-addiction centre

Тhe impact of alcohol abuse on the development of non-communicable diseases (analytical review)

The harmful use of alcohol is a risk factor for the development of non-communicable diseases (NCDs), such as cancer, cardiovascular disease, gastrointestinal diseases, diabetes and others. In addition to morbidity, alcohol abuse increases mortality, especially at young ages. An important characteristic is the frequency and amount of alcohol consumed by a person. The more often and more a person abuses alcohol, the higher the risk of developing NCDs and the mortality rate. Purpose of the study: analysis of publications of the World Health Organization and scientific publications of foreign researchers on the influence of alcohol on the development of non-communicable diseases.Materials and research methods. Content analysis of documents of the World Health Organization and foreign studies on the assessment of the impact of alcohol In total, 48 documents of international organizations were analyzed, including the World Health Organization (WHO), the United Nations (UN), the International Agency for Research on Cancer (IARC-IARC) and the World Bank, as well as 211 scientific publications. Of these, 19 documents were selected, which included materials from WHO, UN, IARC and the World Bank on the impact of alcohol abuse on health, and 63 scientific publications on this topic. Selection criterion: the content in the documents of materials that adequately describe the impact of alcohol abuse on health as a risk factor for the development of various diseases.Results. An analysis of the documents and publications presented revealed a large massif of evidence that the harmful use of alcohol is a causal factor in the development of a number of noncommunicable diseases, an increase in mortality and disability at earlier stages of life, and the development of a link between harmful use of alcohol and a number of mental and behavioral disorders.

Suicidal ideation among women who engage in sex work and have a history of drug use in Kazakhstan

Suicide rates in Kazakhstan rank fourth worldwide. Suicidal ideation is a strong predictor of death by suicide. Yet there is limited information about factors associated with suicidal ideation among women who engage in sex work (WESW) with a history of drug use. Guided by the Diathesis-Stress Theory of Suicide, this study examined the risk and protective factors associated with suicidal ideation among WESW in Kazakhstan. Data drew from the baseline assessments from a sample of four hundred women who participated in a cluster randomized control trial comparing a treatment arm which received a combination of HIV Risk Reduction (HIVRR) and microfinance intervention, and a control arm which received HIVRR alone. Multiple logistic regression models controlling for sociodemographic characteristics examined the effects of risk and protective factors on suicidal ideation. More than half of the participants (52.5%) reported suicidal ideation in the past seven days. Women with vulnerabilities such as child sexual abuse and harmful alcohol use and stressors such as stigma were more likely to think about suicide compared with those who did not. Keeping income from sex work was associated with a lower risk of suicidal ideation. HIV interventions targeting WESW and use drugs must include a mental health component to decrease the risk of suicidal ideation among this group. Women's ability to keep income from sex work suggests the potential to strengthen women's financial stability as a source of empowerment, which may in turn lessen the detrimental effects of childhood adversities and life stressors experienced by WESW.

Identifying the Assumptions and Bias That Affect Screening and Brief Interventions for Harmful Alcohol Use.

Screening for harmful alcohol use (HAU) is standard in clinical settings; however, self-reports of the quantity/frequency of use are often inconsistent with population survey data and objective assessment. Inaccuracies of self-reported alcohol use prompt exploration of patients' reluctance to share this information with their health care providers. The purpose of this article is to identify the assumptions and biases that affect screening and brief interventions for HAU. A total of 22 research articles were selected for a systematic review of the literature. The studies included prospective and retrospective studies, randomized controlled trials, case studies, and quantitative and qualitative research from 2015 to 2021. This systematic review identified alcohol health literacy, the inherent bias of surveys and screening tools, stigma, avoidance bias, and the normalization/villainization of alcohol use as contributors to the assumptions and biases that affect screening and brief interventions for HAU. Exploring these assumptions and biases presents opportunities to develop strategies that promote positive change.

Prevalence of non-communicable diseases risk factors and their determinants: Results from STEPS survey 2019, Nepal.

The World Health Organization (WHO) recommends ongoing surveillance of non-communicable diseases (NCDs) and their risk factors, using the WHO STEPwise approach to surveillance (STEPS). The aim of this study was to assess the distribution and determinants of NCD risk factors in Nepal, a low-income country, in which two-thirds (66%) of annual deaths are attributable to NCDs. A nationally representative NCD risk factors STEPS survey (instrument version 3.2), was conducted between February and May 2019, among 6,475 eligible participants of age 15-69 years sampled from all 7 provinces through multistage sampling process. Data collection involved assessment of behavioral and biochemical risk factors. Complex survey analysis was completed in STATA 15, along with Poisson regression modelling to examine associations between covariates and risk factor prevalence. The most prevalent risk factor was consumption of less than five servings of fruit and vegetables a day (97%; 95% CI: 94.3-98.0). Out of total participants, 17% (95% CI: 15.1-19.1) were current smoker, 6.8% (95% CI: 5.3-8.2) were consuming ≥60g/month alcohol per month and 7.4% (95% CI:5.7-10.1) were having low level of physical activity. Approximately, 24.3% (95% CI: 21.6-27.2) were overweight or obese (BMI≥25kg/m2) while 24.5% (95% CI: 22.4-26.7) and 5.8% (95% CI: 4.3-7.3) had raised blood pressure (BP) and raised blood glucose respectively. Similarly, the prevalence of raised total cholesterol was 11% (95% CI: 9.6-12.6). Sex and education level of participants were statistically associated with smoking, harmful alcohol use and raised BP. Participants of age 30-44 years and 45-69 years were found to have increased risk of overweight, raised BP, raised blood sugar and raised blood cholesterol. Similarly, participants in richest wealth quintile had higher odds of insufficient physical inactivity, overweight and raised blood cholesterol. On average, each participant had 2 NCD related risk factors (2.04, 95% CI: 2.02-2.08). A large portion of the Nepalese population are living with a variety of NCD risk factors. These surveillance data should be used to support and monitor province specific NCD prevention and control interventions throughout Nepal, supported by a multi-sectoral national coordination mechanism.

Gender differences in any alcohol screening and discussions with providers among older adults in the United States, 2015 to 2019.

Unhealthy alcohol use is increasing among older adults, particularly women. We estimated gender differences in the prevalence of alcohol screening/discussions with healthcare providers among older adults who use alcohol. Using the 2015 to 2019 National Survey on Drug Use and Health, we included 9663 adults age 65 and older in the United States who used alcohol and had a past-year healthcare encounter. We estimated the weighted prevalence of alcohol screening/discussions (no screening; screening only; discussions with providers) by gender. We used weighted multinomial logistic regression models to examine correlates of alcohol use screening/discussions. Among older adults who used alcohol and encountered the healthcare system in the past year, 24.68% of men and 27.04% of women reported no alcohol screening/discussions. Men were more likely than women to be asked about drinking frequency, amount, or problems related to drinking. Compared to no alcohol screening/discussions, women were 22% more likely (95% CI: 1.05, 1.42) to report alcohol screening only but were 18% less likely to discuss alcohol with providers (95% CI: 0.73, 0.91) than men. Women had 0.67 times (95% CI: 0.60, 0.74) the adjusted odds of reporting alcohol discussions with providers versus any alcohol screening only compared with men. Over a quarter of older adults who used alcohol were not asked about their drinking, and older women were less likely than men to discuss alcohol use with providers. Given the increased risk for harms of alcohol use with aging, older adults should be screened and counseled regarding their alcohol use.

Efficacy of brief intervention for harmful and hazardous alcohol use: a systematic review and meta-analysis of studies from low middle-income countries.

Low and middle-income countries (LMIC) have a disproportionately higher alcohol-attributable disease burden, in conjunction with a minimal focus on primary prevention. Screening and brief interventions can be a promising approach to address this problem. This systematic review aimed to perform a qualitative and quantitative synthesis of studies of brief interventions for harmful and hazardous alcohol use in LMIC. Systematic review of randomized controlled trials of brief interventions for harmful and hazardous alcohol identified from four electronic databases, conducted in any country identified as LMIC as per the World Bank. We measured differences in intervention and control groups on risk-scores using standard screening instruments, the frequency of heavy drinking, the drinking risk-level, or quality of life and other mental health-related outcomes. A total of 14 studies were included, seven of them from South Africa. On standardized screening instruments, the brief intervention (BI) group had significantly lower scores than controls at 3months (Hedges' g=- 0.34, P=0.04), but the effects did not persist at 6- and 12-month follow-up (g=- 0.06, P=0.68 and g=0.15, P=0.41, respectively). There was little evidence to suggest that BIs led to changes in the frequency of heavy drinking or change in the risk level of alcohol use. Surprisingly, a single session (g=-0.55, P<0.001) fared better than multiple sessions (g=-0.03, P=0.85). A nurse delivered brief intervention (g=-0.44, P=0.02) showed better results than BIs delivered by others (g=-0.14, P=0.66), whereas the outcomes were similar for young adults and middle-age people. Brief interventions for alcohol use show some promise in low- and middle-income countries. Specifically, a single session, nurse-delivered brief intervention for harmful and hazardous alcohol use appears to show a small but significant positive effect in low- and middle-income countries.

Alcohol-associated liver disease in the United States is associated with severe forms of disease among young, females and Hispanics.

Alcohol use and alcohol-associated liver disease (ALD) burden are increasing in young individuals. To assess host factors associated with this burden. National Health and Nutrition Examination Survey (NHANES), National Inpatient Sample (NIS), and United Network for Organ Sharing (UNOS) databases (2006-2016) were used to identify individuals with harmful alcohol use, ALD-related admissions, and ALD-related LT listings respectively. Of 15981 subjects in NHANES database, weighted prevalence of harmful alcohol use was 17.7%, 29.3% in <35years (G1) versus 16.9% in 35-64years (G2) versus 5.1% in ≥65years (G3). Alcohol use was about 11 and 4.7 folds higher in G1 and G2 versus G3, respectively. Male gender and Hispanic race associated with harmful alcohol use. Of 593600 ALD admissions (5%, 77%, and 18% in G1-G3 respectively), acute on chronic liver failure (ACLF) occurred in 7.2%, (7.2 in G2 vs 6.7% in G1 and G3, P<0.001). After controlling for other variables, ACLF development among ALD hospitalizations was higher by 14% and 10% in G1 and G2 versus G3, respectively. Female gender and Hispanic race were associated with increased ACLF risk by 8% and 17% respectively. Of 20,245 ALD LT listings (3.4%, 84.4%, and 12.2% in G1-G3 respectively), ACLF occurred in 28% candidates. Risk of severe (grade 2 or 3) ACLF was higher by about 1.7 fold in G1, 1.5 fold in females and 20% in Hispanics. Young age, female gender, and Hispanic race are independently associated with ALD-related burden and ACLF in the United States. If these findings are validated in prospective studies, strategies will be needed to reduce alcohol use in high risk individuals to reduce burden from ALD.

Predicting binge drinking among university students: Application of integrated behavioral model.

BackgroundBinge drinking is a pattern of harmful use of alcohol and it is defined as four drinks for women and five drinks for men in about 2 hours. This behavior causes public health problems like damaging different body organs.ObjectiveTo assess binge drinking and associated factors among Bahir Dar University students in Northwest Ethiopia.MethodA cross sectional study was conducted in November 2017. Systematic sampling technique was used to select 422 participants. Structured questionnaire was used to collect data. Linear and Logistic regression models were used to predict the role of explanatory variables on behavioral intention and binge drinking, respectively. Independent variables with a p-value of <0.05 at 95% confidence interval were considered as statistically significant in the final model.ResultA total of 413 students participated in this study and 33.4%(95% CI: 28.3–38.9) were engaged in binge drinking. Experiential attitude, instrumental attitude, and self-efficacy were found to be significant predictors of intention to binge drinking (p<0.05). Experiential attitude, environmental constraint, injunctive norm, and knowledge predictors were significantly associated with binge drinking (p<0.05).ConclusionOur study indicated that one-third of the students practiced binge drinking. This behavior was associated with experiential attitude, injunctive norm, environmental constraints, and knowledge factors. Additionally, experiential attitude, instrumental attitude, and self-efficacy constructs had explained behavioral intention. This implies focusing on the abovementioned determinant factors is imperative while designing intervention strategy.

Addressing harmful alcohol use in primary care in Colombia: Understanding the sociocultural context

Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reduce the burden of alcohol-use problems. In preparation for introducing screening and treatment for at-risk drinking in primary care clinics in Colombia, we conducted interviews with clinicians, clinic administrators, patients, and participants in Alcoholics Anonymous. Interviews were conducted within the framework of the Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (DIADA, [Detection and Integrated Care for Depression and Alcohol Use in Primary Care] www.project-diada.org) research project, and its qualitative phase that consisted of the collection of data from 15 focus groups, 6 interviews and field observations in 5 regional settings. All participants provided informed consent to participate in this research. Findings revealed the association of harmful alcohol use with a culture of consumption, within which it is learned and socially accepted practice. Recognition of harmful alcohol consumption includes a social context that influences its screening, diagnosis and prevention. The discussion highlights how, despite the existence of institutional strategies in healthcare settings and the awareness of the importance of at-risk drinking among health personnel, the recognition of the harmful use of alcohol as a pathology should be embedded in an understanding of historical, social and cultural dimensions that may affect different identification and care scenarios.

Primary care implementation study to scale up early identification and brief intervention and reduce alcohol-related negative outcomes at the community level (PINO): study protocol for a quasi-experimental 3-arm study

BackgroundPrimary healthcare-based Early Identification and Brief Intervention (EIBI) for hazardous and harmful alcohol use is both a clinically relevant and cost-effective strategy to reduce heavy drinking. Unfortunately, it remains poorly implemented in daily practice. Multiple studies have shown that training and support (T&S) programs can increase the use of EIBI. Nonetheless, gains have only been modest and short-term at best. Suggestions have been made to rely more on multicomponent programs that simultaneously address several barriers to the implementation of EIBI. The PINO-project aims to evaluate the added value of such a multicomponent program to improve EIBI delivery in daily practice.Methods/designA quasi-experimental three-arm implementation study in Flanders (Belgium) will assess the effects of tailored T&S to General Practitioners (GPs) with or without community mobilisation on EIBI delivery in general practice. The study lasts 18 months and will take place in three comparable municipalities. In municipality 1 and 2, GPs receive a tailored T&S program. The T&S is theoretically founded and tailored to the GPs’ views, needs and practice characteristics. Furthermore, community actions will be embedded within municipality 1 providing additional, contextual, support. In municipality 3, GPs are offered a minimal intervention to facilitate data collection.The primary outcome is the proportion of adult patients screened for hazardous and harmful alcohol use at the end of an 18-month implementation period. The secondary outcome is the scaling up activity at municipal level in screening rates, as assessed every 3 months, and the proportion of patients who received an additional brief intervention when necessary. Furthermore, the correlation between the opinions and needs of the GP’s, their practice organisation and their EIBI performance will be explored.DiscussionThe PINO-project addresses the gap between what is theoretically possible and the current practice. This is an innovative study combining T&S at GP level with community actions. At the same time, it implements and evaluates practice T&S based on the theoretical domains framework.Trial registrationThis trial was approved by the Ethics Committee for Research of UZ/KU Leuven (reference number s63342 and G-2020-2177-R2(MAR)) and is registered on clinicaltrials.gov (NCT04398576) in May 2020.

A Descriptive Study to assess the knowledge and Attitude of Coronary Artery Disease risk factors among adults in Christian Mission Hospital at Madurai, Tamilnadu

Cardiovascular diseases are the world’s largest killers, claiming 17.1 million lives a year. Tobacco use, an unhealthy diet, physical inactivity and harmful use of alcohol increase the risk of cardiovascular diseases. CAD which encompasses Acute Myocardial infarction, Angina pectoris, and Atherosclerotic cardiovascular disease is the leading cause of death in the industrialized world. Objectives: 1. To assess the knowledge on CAD risk factors among adults. 2. To assess the attitude on CAD risk factors among adult. 3. To find out the correlation between the knowledge and attitude on CAD risk factors among adults. 4. To find out association between knowledge and attitude on CAD risk factors with selected demographic variable among adults. Hypothesis: H1- there is a significant relationship between the knowledge and attitude regarding CAD risk factors among adults.H2-there is a significant association between the knowledge and attitude on CAD risk factors with selected demographic variables among adults. Methodology: The research design of the study was descriptive in nature. The sample size for this study is 30 adult patients between the ages of 20 – 60 years. Samples for this study were selected through convenience sampling technique. Data was analyzed by using descriptive and inferential statistics such as mean, standard deviation, and chi square. Results: Results show that majority of adult patient’s adequate knowledge (73.3%) and favorable attitude (100%) on CAD. The obtained “r” value for correlation between knowledge and attitude was 0.802, which was highly positive.

Relationship between the sociodemographic characteristics of participants in the DIADA project and the rate of compliance with follow-up assessments in the initial stage of the intervention

ObjectiveAnalyse the relationship between the sociodemographic profile of the DIADA study participants and the rate of compliance with the follow-up assessments in the early stage of this project’s intervention for depression and unhealthy alcohol use offered within primary care. MethodsA non-experimental quantitative analysis was conducted. The sociodemographic data of DIADA [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)] study participants had been previously collected. At the time of the evaluation (September 12, 2019), only the participants who had been in the project for a minimum of 3 months were included. By using univariate (Chi-squared) analyses, we studied the association between participants’ sociodemographic profile and their rate of compliance with the first follow-up assessment at 3 months after study initiation. ResultsAt the date of the evaluation, 584 adult participants were identified, of which 389 had been involved in the project for more than 3 months. From the participants included, 320 performed the first follow-up, while 69 did not. The compliance rate to the first follow-up was 82.3% (95 % [CI] 78.1%–86%) and was not affected by: site location, age, sex, civil status, level of education, use of smartphone, PHQ9 score (measuring depression symptomatology) or AUDIT score (measuring harmful alcohol use). Participants who do not use a smartphone, from rural areas and with a lower socioeconomic status, tended to show higher compliance rates. Statistically significant associations were found; participants with lower job stability and a lack of access to the Internet showed higher compliance rates to the early initial follow-up assessment. ConclusionsThe compliance rate was high and generally constant in spite of the variability of the sociodemographic profiles of the participants, although several sub-groups of participants showed particularly high rates of compliance. These findings may suggest that integrating mental health into primary care allows the structural and financial barriers that hinder access to health in Colombia to be broken down by raising awareness about mental illnesses, their high prevalence and the importance of timely and accessible medical management.

Suicide and Suicide risk factors: A Literature Review

Suicide can be defined as intentional self-inflicted death. It is a serious cause of mortality worldwide. Suicide is considered as a psychiatric emergency and the awareness of the seriousness of suicide in our society should not be overlooked. It is estimated that approximately 1.5% of all deaths worldwide are by suicide in the year 2020. The suicide mortality rate in 2015 was 12% in 100,000, which means about one death every 20 s. Rates of completed suicides are generally higher among men than among women, ranging from 1.5 times as much in the developing world to 3.5 times in the developed world. Suicide is generally most common among those over the age of 70; however, in certain countries, those aged between 15 and 30 are at the highest risk. Suicidal behavior is the second leading cause of death in adolescents in the world. Suicide behavior in adolescents can be prevented by recognizing risk factors and protective factors originating from themselves and the surrounding environment. This study aimed to identify risk factors and protective factors for adolescents who demonstrate suicidal behavior. Prevention programs that target young people, females, and low socioeconomic groups, and aimed to reduce harmful alcohol use can help prevent suicidal behaviours.

A Framing Analysis of Consultation Submissions on the WHO Global Strategy to Reduce the Harmful Use of Alcohol: Values and Interests.

In response to the magnitude of harms caused by alcohol, the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol (GAS) was endorsed in 2010. We analysed submissions to the 2019 WHO consultation on the implementation of the GAS to identify how different stakeholders frame alcohol use and control; and to assess how stakeholders engage with the consultation process, with possibly harmful consequences for public health policy. All submissions from WHO Member States, international organisations, non-governmental organisations (NGOs), academic institutions and private sector entities were identified and used as data for an inductive framing analysis. This involved close reading and data familiarisation, thematic coding and identifying emergent framings. Through the analysis of texts, framing analysis can give insights into the values and interests of stakeholders. Because framing influences how issues are conceptualised and addressed, framing analysis is a useful tool to study policy-making processes. We identified 161 unique submissions and seven attachments. Emerging frames were grouped according to their function: defining the problem, assigning causation, proposing solutions, or justifying and persuading. Submissions varied in terms of the framing they deployed and how this was presented, eg, how the problem was defined. Proposed policy solutions also varied. Targeted solutions emphasising individual responsibility tended to be supported by industry and some Member States. Calls for universal regulation and global mobilisation often came from NGOs and academia. Stakeholders drew on evidence and specific value systems to support the adoption of certain problem and solution ideas and to oppose competing framing. Alcohol control is a contested policy field in which different stakeholders use framing to set the agenda and influence what policy solutions are considered legitimate. WHO should consider which interests are served by these different framings and how to weigh different stakeholders in the consultation process.

Prevalence of Coronary Heart Disease (CHD) and Selected Risk Factors of CHD, Among People Aged 30-64 Years in the District of Gampaha, Sri Lanka

Background- Coronary heart disease (CHD) is the leading cause of hospital deaths in Sri Lanka. The underlying risk factors include; tobacco smoking, unhealthy diet, harmful alcohol use, physical inactivity, and medical conditions; hypertension, diabetes mellitus, obesity, dyslipidaemia. Objective of this study was to determine prevalence of CHD and risk factors among people aged 30-64 in Gampaha District, Sri Lanka. Methods- A community based cross-sectional study was conducted among 1192 people aged 30-64 years in district of Gampaha, recruited by probability proportionate to the population size, cluster sampling. Data were collected using a pre-tested interviewer-administered questionnaire on prevalence of CHD, hypertension, diabetes mellitus, dyslipidaemia, obesity, harmful alcohol use, unhealthy diet, physical inactivity and tobacco smoking and anthropometric measurements by trained data collectors. Twelve-lead ECG, blood pressure, fasting plasma glucose and lipid levels were done for previously undiagnosed. Data were analyzed using SPSS-21. Results- The estimated prevalence of CHD based on already diagnosed cases and Rose positive angina 6.9% (95% CI 5.4% – 8.4%), CHD based on already diagnosed cases and ECG 6.4 (95% CI 4.9% – 7.8%), hypertension 37.5% (95% CI 34.7% to 40.3%), diabetes mellitus 17.4% (95% CI 15.2% to 19.6%), dyslipidaemia 66.5% (95% CI 63.8% – 69.2%). The estimated prevalence of other modifiable risk factors of generalized obesity (BMI≥25.0) (44.0%, 95%CI41.1-46.9), sub-optimal quality diet (71.9%, 95%CI 69.3-74.5), low level of physical activity (21.7%, 95%CI 19.3-24.1), heavy or high-risk drinking 11.4% (95%CI 9.56-13.2), smoking 14.2% (95%CI 12.2-16.2). Conclusions- Estimated prevalence of CHD and selected risk factors were high in Gampaha District with a large proportion of previously undiagnosed disease. Immediate public health action is needed including training programs for healthcare workers on detection of risk factors and awareness among the public for screening for risk factors.

Antiretroviral treatment adherence and mental disorders: observational case-control study in people living with HIV in Spain

ABSTRACT Mental disorders hamper immunological control of HIV infection by exerting a negative influence on antiretroviral therapy (ART) adherence. We sought to address the possible relationship between non-adherence to antiretroviral treatment (ART), mental disorders and substance use in people living with HIV/AIDS (PLWHA) in Spain, which presents a high prevalence of intravenously transmitted HIV infection. We assessed 125 PLWHA attending regular outpatient follow-up. The main adherence measure was pill collection from the Hospital Pharmacy. We included sociodemographic variables, mental disorders diagnosis, and substance use in the 12 months prior to the assessment. Harmful alcohol consumption (OR: 6.834; 95% CI: 2.008-23.257; p = 0.002), suffering from depression (OR: 5.851; 95% CI: 1.470-23.283; p = 0.012) and being at risk of suicide (OR: 3.495; 95% CI: 1.136-10.757; p = 0.029) increased the likelihood of non-adherence. 29.6% of the sample had been infected via blood contact. HCV co-infection was present in 46.4% of the study sample, increasing the likelihood of non-adherence (OR: 3.223; 95% CI: 1.119-9.286; p = 0.030). Harmful alcohol use and some serious mental disorders (especially depression and suicide risk) are consistently associated with non-adherence to ART. HCV co-infection could be an important risk marker of non-adherence among PLWHA with a high prevalence of intravenous drug use.

An Investigation of Hypertension Risk Factors among Adults in Oshikoto Region in Namibia

INTRODUCTION: Hypertension complications are responsible for 9.4 million deaths worldwide and among these deaths, 51 % are due to stroke and 45% are due to heart disease like heart failure. This study aims to investigate the hypertension risk factors among adult in Oshikoto region, Namibia. &#x0D; &#x0D; METHODS: A community population-based, cross- sectional survey was conducted using WHO STEPwise approach among 375 adults in Oshikoto region. Bivariate and multivariate analysis was done to determine the association between risk factors and Hypertension, based on p-value &amp;lt;0.05. &#x0D; &#x0D; RESULTS: Overall prevalence for risk factors was: physical inactivity (25.3%), unhealthy diet (75.7%), tobacco use (9.1%), harmful use of alcohol (40.8%). 20.5% overweight with majority (85.7%) of them were females. Obesity was 9.1% in which 91.2% were females. Hypertension prevalence was 24.3%. Four percent of individuals were having two multiple risk factors for hypertension, 2.4% with four risk factors and 1.1% with more than four risk factors. Age group (OR=2.48, 95%CI=1.44-4.26, P=0.001), Obesity (OR=3.48, 95%CI=1.55-7.79, P=0.003), and overweight (OR=2.34, 95%CI=1.31-4.19, P =0.004) were significant risk factors for hypertension.&#x0D; &#x0D; CONCLUSIONS: This study revealed a high prevalence and burden of hypertension risk factors such as obesity and overweight among adults in Oshikoto region, thus, these results highlight the need for interventions to reduce and prevent those risk factors of hypertension in Oshikoto region, Namibia.

“Take Care of You” – Efficacy of integrated, minimal-guidance, internet-based self-help for reducing co-occurring alcohol misuse and depression symptoms in adults: Results of a three-arm randomized controlled trial

BackgroundDepression and harmful alcohol use are two of the top five leading causes of years of life lost to disability in high-income countries. Integrated treatment targeting both at the same time is often considered more complicated and difficult and, therefore, more expensive. Consequently, integrated internet-based interventions could be a valuable addition to traditional care. MethodsA three-arm randomized controlled trial was conducted comparing the effectiveness of (1) an integrated, minimal-guidance, adherence-focused self-help intervention designed to reduce both alcohol use and depression symptoms (AFGE-AD); (2) a similar intervention designed to reduce alcohol use only (AFGE-AO), and (3) internet access as usual (IAU) as a control condition, in at least moderately depressed alcohol misusers from February 2016—March 2020. We recruited 689 alcohol misusers (51.6 % males, mean age = 42.8 years) with at least moderate depression symptoms not otherwise in treatment from the general population. Six months after baseline, 288 subjects (41.8 %) were reachable for the final assessment. ResultsAll interventions yielded reduced alcohol-use after six months (AFGE-AD: -16.6; AFGE-AO: -19.8; IAU: -13.2). Those who undertook active-interventions reported significantly fewer standard drinks than controls (AFGE-AD: p = .048, d=0.10; AFGE-AO: p = .004, d=0.20). The two active-intervention groups also reported significantly less severe depression symptoms than controls (AFGE-AD: p = .006, d=0.41; AFGE-AO: p = .008, d=0.43). Testing revealed noninferiority between the two interventions. ConclusionsThis study documented sustained effectiveness of the first integrated, fully internet-based self-help intervention developed for the reduction of both alcohol use and depression symptoms in at least moderately depressed adult alcohol misusers recruited from the general population.

Perspectives of Women Living With HIV on Addressing Violence and Use of Alcohol During HIV Services: Qualitative Findings From Fishing Communities in Uganda.

The syndemic relationship between harmful alcohol use, intimate partner violence (IPV), and HIV is well established across international settings. Less is known about how these health issues are perceived by women living with HIV (WLWH), who are disproportionately affected by these intertwined epidemics. A qualitative study was undertaken with 20 WLWH in Rakai, Uganda, to assess their perceptions of how these issues have affected their lives and their communities and to assess the acceptability of integrating a screening and brief intervention for alcohol use and IPV into HIV posttest counseling. Recommendations for intervention programming arising from the results are discussed.