High Alcohol Levels Research Articles

Effects of Minimum Unit Pricing for Alcohol in South Africa Across Different Drinker Groups and Wealth Quintiles: A Modelling Study

Background: Previous research in high income countries has found Minimum Unit Pricing (MUP) for alcohol to be an effective policy for reducing alcohol-related harm. However, these results may not translate well to South Africa, notable for high levels of abstinence, binge drinking, unrecorded alcohol and alcohol-related injury and infectious disease. Methods: We built an epidemiological policy appraisal model using secondary data to estimate the effects of MUP across sex, drinker groups and wealth quintiles. Stakeholder interviews and workshops informed model development and ensured policy relevance. Model outcomes include individual consumption, individual spend, tax revenue, retail revenue and group health harms (HIV, intentional injury, road injury, liver cirrhosis and breast cancer). Findings: We estimate that a MUP of R10 per standard drink (15ml of pure alcohol) would lead to an immediate reduction in consumption of 5.5%. The absolute reduction in standard drinks per drinker per year is greatest for heavy drinkers, followed by moderate drinkers and then binge drinkers (-97.76, -25.48, -17.16).A R10 MUP generates 23,149 lives saved and 1,009,477 cases averted across the five health harms over 20 years. Poorer drinkers would see greater impacts from the policy (consumption: -7.9% in poorest, -3.7% in richest quintile). The bottom three wealth quintiles accrue 76% of the deaths averted and 74% of the cases averted. Interpretation: Our model estimates minimum pricing would reduce alcohol consumption in South Africa, improving health outcomes whilst raising retail and tax revenue. Consumption and harm reductions would be greater in poorer compared to richer groups. Funding Statement: This work was supported by the Wellcome Trust Doctoral Training Centre in Public Health Economics and Decision Science [108903/Z/19/Z] and the University of Sheffield. Also the South African Medical Research Council. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Ethical approval for engaging with stakeholders was granted by the South African Medical Research Council (Protocol ID: EC005-4/2019) and the School of Health and Related Research at the University of Sheffield, UK (Reference Number: 023357). All data for the model came from secondary sources and was managed according to an approved information governance plan.

DIAGNOSTIC AND MANAGEMENT APPROACH ON ACUTE INTOXICATION PATIENTS IN EMERGENCY SETTING: A CASE REPORT

Background: Acute intoxication is one common cause of loss of consciousness in emergency setting. However, its diagnosis and management usually neglected. In addition, multiple toxin might make etiological diagnosis and management more difficult. Aim: This report describes the approach to diagnose and manage acutely intoxicated patients with suspected multiple substance in emergency unit of Dr. Sardjito Hospital Case description: A 30-year-old male was admitted to emergency unit with loss of consciousness and return of spontaneous circulation after resuscitation prior to admission. He was comatose, with miosis and decreased physiological reflex. Further laboratory examination discovered decreased renal function and high level of serum alcohol. The patient regained his consciousness after he was given naloxone, dexamethasone, mecobalamin, and pantoprazole. Conclusion: In the future, there is a need to integrate substance intoxication management to the algorithm of loss of consciousness management to improve the quality of acute intoxication management.

Short-term risk of suicide attempt associated with patterns of patient-reported alcohol use determined by routine AUDIT-C among adults receiving mental healthcare

ObjectiveTo evaluate the association between alcohol use routinely reported during outpatient mental healthcare visits and short-term risk of subsequent suicide attempt. MethodsUsing a longitudinal retrospective-cohort design, electronic health records identified adult outpatient visits to a mental health provider (1/1/2010–6/30/2015) at Kaiser Permanente Washington with a documented Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]. Suicide attempts within 90 days of AUDIT-C documentation were defined using death certificate cause-of-death and diagnosis codes (non-lethal). Visit-level analyses used generalized estimating equations to account for correlation between multiple AUDIT-Cs for individuals. Separate models evaluated the association between (1) level of consumption and (2) frequency of heavy drinking episodes and suicide attempts, adjusted for visit year, demographics, depressive symptom, and suicidal ideation. ResultsOf 59,382 patient visits, 0.62% (N = 371) were followed by a suicide attempt within 90 days. Patients reporting high-level alcohol use were 1.77 times (95% CI, 1.22–2.57) more likely to attempt suicide than those reporting low-level use. Patients reporting daily or almost daily heavy drinking episodes were 2.33 times (95% CI, 1.38–3.93) more likely to attempt suicide than those reporting none. Conclusions and relevanceThe AUDIT-C is a valuable tool for assessing patterns of patient-reported alcohol use associated with subsequent suicide attempt.

Pre-fermentative supplementation of unsaturated fatty acids alters the effect of overexpressing ATF1 and EEB1 on esters biosynthesis in red wine

The production of esters is largely influenced by functional gene expressions and the nutrition status of grape must. In this study, the effects of unsaturated fatty acids (UFAs) mixture (including linoleic acid, oleic acid and linolenic acid) on volatile esters of wine fermented with T73::ATF1 (overexpressing ATF1-encoded alcohol acetyltransferases) and T73::EEB (overexpressing EEB1-encoded acyl-CoA: ethanol O-acyltransferases) were investigated in alcoholic fermentation, respectively. The inoculation of T73::ATF1 into UFAs added juice significantly increased acetate esters production (ethyl acetate, isoamyl acetate and phenylethyl acetate) compared to in the control juice. The promotion on ethyl esters biosynthesis was also found in T73::EEB1 when supplemented with low level of UFAs, but the function became inhibition with the further increment of UFAs concentration. The levels of higher alcohols, medium fatty acids and the major genes expression (ADH1, BAT1, PDC1, ACC1, FAS1 and IAH1) were changed and varied among the both strains. These results indicated that UFAs can modulate the effect of overexpressing ATF1 and EEB1 on esters biosynthesis by influencing the substrates availability. The combination of increasing ATF1 and EEB1 expressions and modulating UFAs content is a potential means to increase the esters production and improve the aromatic quality of wines.

The tetramerization domain of the tree shrew p53 protein displays unique thermostability despite sharing high sequence identity with the human p53 protein

The p53 protein plays a number of roles in protecting organisms from different genotoxic stresses and this includes DNA damage induced by acetaldehyde, a metabolite of alcohol. Since the common tree shrew ingests high levels of alcohol as part of its normal diet, this suggests that its p53 protein may possess unique properties. Using a combination of biophysical and modeling studies, we demonstrate that the tetramerization domain of the tree shrew p53 protein is considerably more stable than the corresponding domain from humans despite sharing almost 90% sequence identity. Based on modeling and mutagenesis studies, we determine that a glutamine to methionine substitution at position 354 plays a key role in this difference. Given the link between stability of the p53 tetramerization domain and its transcriptional activity, the results suggest that this enhanced stability could lead to important consequences at p53-regulated genes in the tree shrew.

Investigating the effect of Crocus sativus L. petal hydroalcoholic extract on inflammatory and enzymatic indices resulting from alcohol use in kidney and liver of male rats.

BackgroundStudies have shown that consumption of high levels of alcohol causes many negative effects on the liver and kidneys where antioxidant ingredients can be a proper solution to reducing the resulting damages. So, the present study investigated the effect of hydroalcoholic extract of Crocus sativus L. (saffron) petal with antioxidant properties on the changes in inflammatory and enzymatic indices resulting from alcohol use in the male rats’ kidney and liver.Materials and methodsAfter preparing the extract, LD50 was determined and high-performance liquid chromatography (HPLC) was employed to specify the type and the rate of the active ingredients of the extract. Then, 36 male Wistar rats were randomly assigned into six groups (n=6). The first group was only administered with normal saline and the second group only received ethyl alcohol 6 mL/kg/day·BW. The third and the fourth groups received ethyl alcohol 6 mL/kg/day·BW plus 167.5 and 335 mg/kg/day·BW saffron petal extract for 8 weeks. The fifth and the sixth groups received ethyl alcohol 6 mL/kg/day·BW for the first 8 weeks and were subsequently gavage fed on saffron extract for 167.5 and 335 mg/kg/day·BW, respectively, during the next 8 weeks. In the beginning and after the termination of the treatment, blood samples were collected from all rats.ResultsThe LD50 of the extract was about 670 mg/kg. The HPLC results indicated that the extract contains important antioxidant ingredients. At the end of the study, the serum concentration of the inflammatory indices, renal enzymes, and hepatic enzymes experienced a significant reduction in all of the intervened groups compared to the negative control group (minimum significant difference: P<0.05) except for the treatment group 1.ConclusionBased on the current results, the extract has a protective effect in a dosage-dependent way and greater protective roles were documented for higher dosages.

Effect of sodium chloride reduction or partial substitution with potassium chloride on the microbiological, biochemical and sensory characteristics of semi-hard and soft cheeses.

Sodium reduction in the human diet is currently one of the main concerns for public health agencies and, consequently, has become a challenge for the food industries. In this study, the impact of reduced sodium chloride content (20%) or its partial substitution with potassium chloride in soft ("Camembert"-type) and semi-hard ("Reblochon"-type) cheeses was evaluated. Analyses included physicochemical and biochemical composition, microbial counts, 16S rRNA gene metabarcoding and metatranscriptomic analysis, volatile aroma compounds and sensory analysis. Regarding soft cheeses, the salt content of cheeses affected proteolysis at 21 days of ripening. RNA sequencing revealed that the relative activity of G. candidum increased, whereas that of P. camemberti decreased in reduced salt cheeses in comparison to the controls. Higher global intensity of odor and taste was observed in cheeses with reduced salt content, consistent with higher levels of alcohol and ester components. Regarding semi-hard cheeses, modifications of salt content did not significantly affect either their biochemical parameters and sensory characteristics or their technological microbial composition at day 21 of ripening. Finally, no impact of salt content was observed on the growth of the spoiler Yarrowia lipolytica in soft cheeses. In contrast, reducing salt content increased spoiler growth in semi-hard cheeses, as highlighted by a greater development of Pseudomonas that led to an increase in cheese proteolysis and lipolysis. In conclusion, the effect of reducing salt content is highly dependent on the cheese type. This factor should thus be taken into account by the dairy industry when the reduction of salt content is being considered. Moreover, the quality of raw products, in particular, the level of spoiler microorganisms, must be controlled before use during dairy processes.

Alcohol consumption, life satisfaction and mental health among Norwegian college and university students

ObjectiveHigh-level alcohol consumption is common in, and central to, the student community. Among adults, high-level alcohol consumption, and sometimes also low, has been associated with poorer social integration and mental health. We aimed to investigate how alcohol consumption relates to life satisfaction and mental health among students in higher education. MethodsData from the Norwegian study of students' health and well-being (SHoT, 2014, n = 9632) were used. Associations between alcohol consumption (AUDIT; abstainers, low risk, risky and hazardous consumption) and life satisfaction and mental health complaints, as well as number of close friends, and social and emotional loneliness were investigated using linear regression models. Crude models and models adjusted for age, gender and relationship status were conducted. ResultsStudents reporting hazardous consumption reported lower life satisfaction, more mental health complaints, and more emotional and social loneliness than students with low risk consumption. Students reporting risky consumption reported slightly reduced life satisfaction and more mental health complaints, but more close friends and less social loneliness. Abstainers did not report reduced life satisfaction or more mental health complaints, despite reporting fewer close friends and more social loneliness. ConclusionHigh-level alcohol consumption among students might indicate increased risk of several problems in the future – but also currently. Our findings further imply that the quality of friendships might be more important for life satisfaction and mental health than the number of friends, but also that social integration in student communities might be more difficult for students who do not drink.

PARP inhibition in vivo blocks alcohol-induced brain neurodegeneration and neuroinflammatory cytosolic phospholipase A2 elevations

Chronic alcoholism promotes brain damage that impairs memory and cognition. High binge alcohol levels in adult rats also cause substantial neurodamage to memory-linked regions, notably, the hippocampus (HC) and entorhinal cortex (ECX). Concurrent with neurodegeneration, alcohol elevates poly (ADP-ribose) polymerase-1 (PARP-1) and cytosolic phospholipase A2 (cPLA2) levels. PARP-1 triggers necrosis when excessively activated, while cPLA2 liberates neuroinflammatory ω-6 arachidonic acid. Inhibitors of PARP exert in vitro neuroprotection while suppressing cPLA2 elevations in alcohol-treated HC-ECX slice cultures. Here, we examined in vivo neuroprotection and cPLA2 suppression by the PARP inhibitor, veliparib, in a recognized adult rat model of alcohol-binging. Adult male rats received Vanilla Ensure containing alcohol (ethanol, 7.1 ± 0.3 g/kg/day), or control (dextrose) ± veliparib (25 mg/kg/day), by gavage 3x daily for 4 days. Rats were sacrificed on the morning after the final binge. HC and ECX neurodegeneration was assessed in fixed sections by Fluoro-Jade B (FJB) staining. Dorsal HC, ventral HC, and ECX cPLA2 levels were quantified by immunoblotting. Like other studies using this model, alcohol binges elevated FJB staining in the HC (dentate gyrus) and ECX, indicating neurodegeneration. Veliparib co-treatment significantly reduced dentate gyrus and ECX neurodegeneration by 79% and 66%, respectively. Alcohol binges increased cPLA2 in the ventral HC by 34% and ECX by 72%, which veliparib co-treatment largely prevented. Dorsal HC cPLA2 levels remained unaffected by alcohol binges, consistent with negligible FJB staining in this brain region. These in vivo results support an emerging key role for PARP in binge alcohol-induced neurodegeneration and cPLA2-related neuroinflammation.

Sequential Changes in Brain Glutamate and Adenosine A1 Receptors May Explain Severity of Adolescent Alcohol Withdrawal after Consumption of High Levels of Alcohol.

There is an excellent correlation between the age when alcohol consumption begins and the likelihood of lifelong problems with alcohol abuse. Alcohol use often begins in adolescence, a time marked by brain development and maturation of numerous brain systems. Rats are an important model, wherein the emergence of alcohol withdrawal symptoms serves as a gauge of dependency following chronic alcohol consumption. Previous work has shown that adolescent Long-Evans rats consume high levels of alcohol and develop a severe alcohol withdrawal syndrome when fed alcohol as part of a liquid diet. Acutely, alcohol inhibits two important excitatory receptors for glutamate (NMDA and AMPA) and may further decrease glutamate activity through modulatory adenosine receptors. The present study focuses on potential adaptive changes in expression of these receptors that may create a receptor imbalance during chronic alcohol consumption and lead to severe overexcitation of the adolescent brain during alcohol withdrawal. Levels of brain expression of NMDA, AMPA, and adenosine A1 and A2a receptors were determined by Western blotting after adolescent rats consumed an alcohol-containing liquid diet for 4, 11, or 18 days. Severity of alcohol withdrawal was also assessed at these time points. Levels increased for both AMPA and NMDA receptors, significant and approaching maximal by day 11. In contrast, A1 receptor density showed a slow decline reaching significance at 18 days. There were no changes in expression of adenosine A2a receptor. The most severe withdrawal symptoms appear to coincide with the later downregulation of adenosine A1 receptors coming on top of maximal upregulation of excitatory AMPA and NMDA glutamate receptors. Thus, loss of adenosine “brakes” on glutamate excitation may punctuate receptor imbalance in alcohol-consuming adolescents by allowing the upregulation of the excitatory receptors to have full impact during early alcohol withdrawal.

Characterization of a New Saccharomyces cerevisiae Isolated From Hibiscus Flower and Its Mutant With L-Leucine Accumulation for Awamori Brewing.

Since flavors of alcoholic beverages produced in fermentation process are affected mainly by yeast metabolism, the isolation and breeding of yeasts have contributed to the alcoholic beverage industry. To produce awamori, a traditional spirit (distilled alcoholic beverage) with unique flavors made from steamed rice in Okinawa, Japan, it is necessary to optimize yeast strains for a diversity of tastes and flavors with established qualities. Two categories of flavors are characteristic of awamori; initial scented fruity flavors and sweet flavors that arise with aging. Here we isolated a novel strain of Saccharomyces cerevisiae from hibiscus flowers in Okinawa, HC02-5-2, that produces high levels of alcohol. The whole-genome information revealed that strain HC02-5-2 is contiguous to wine yeast strains in a phylogenic tree. This strain also exhibited a high productivity of 4-vinyl guaiacol (4-VG), which is a precursor of vanillin known as a key flavor of aged awamori. Although conventional awamori yeast strain 101-18, which possesses the FDC1 pseudogene does not produce 4-VG, strain HC02-5-2, which has the intact PAD1 and FDC1 genes, has an advantage for use in a novel kind of awamori. To increase the contents of initial scented fruity flavors, such as isoamyl alcohol and isoamyl acetate, we attempted to breed strain HC02-5-2 targeting the L-leucine synthetic pathway by conventional mutagenesis. In mutant strain T25 with L-leucine accumulation, we found a hetero allelic mutation in the LEU4 gene encoding the Gly516Ser variant α-isopropylmalate synthase (IPMS). IPMS activity of the Gly516Ser variant was less sensitive to feedback inhibition by L-leucine, leading to intracellular L-leucine accumulation. In a laboratory-scale test, awamori brewed with strain T25 showed higher concentrations of isoamyl alcohol and isoamyl acetate than that brewed with strain HC02-5-2. Such a combinatorial approach to yeast isolation, with whole-genome analysis and metabolism-focused breeding, has the potentials to vary the quality of alcoholic beverages.

Psychiatric Diagnoses Differ Considerably in Their Associations With Alcohol/Drug-Related Problems Among Adolescents. A Norwegian Population-Based Survey Linked With National Patient Registry Data.

The aim of this study was to examine alcohol/drug use and problems across psychiatric diagnoses and to what extent associations between each psychiatric diagnosis and alcohol/drug use and problems were independent from the potential confounding effects of psychiatric comorbidity, socioeconomic status, sex and age. We used a dataset comprising a linkage between a large population-based and cross-sectional study among Norwegian adolescents (the youth@hordaland conducted in 2012) and national registry-based data on specialist mental health care use during the 4 years prior to the survey (2008 to 2011). The study sample included 16 to 19 year olds who participated in the youth@hordaland survey and consented to the linkage with patient registry data (n = 9,408). Among these, 853 (9%) had received specialist mental health care and comprised the clinical group, while the rest (n = 8,555) comprised the comparison group. The main outcome variables were several self-reported indicators for alcohol/drug use, including any alcohol use, frequent alcohol intoxication, high-level alcohol consumption, and lifetime illicit drug use, as well as one indicator for potential alcohol/drug-related problems: a positive CRAFFT-score. Adolescents receiving specialist mental health care (n = 853) reported more frequently alcohol/drug use and problems compared to adolescents not receiving these services (Cohens d’s ranging from 0.09 to 0.29, all p ≤ 0.01). Anxiety, depression, conduct disorders, eating disorders, ADHD, and trauma-related disorders were all associated with single measures of alcohol/drug use and problems, with odds ratios (ORs) ranging from 1.58 to 4.63, all p < 0.05) in unadjusted models. Trauma-related disorders, depression and conduct disorders were also positively associated with higher scores on a combined indicator of alcohol/drug use and problems (ORs ranging from 1.89 to 3.15, all p < 0.01), even after the full adjustment from psychiatric comorbidity and sociodemographic variables (adjusted odds ratios ranging from 1.61 to 2.79, p < 0.05). These results suggest that alcohol/drug use and problems were slightly more common among adolescents who received specialist mental health care during the past 4 years compared with the general adolescent population, and adolescents with trauma-related disorders, depression and conduct disorders were high-risk groups for alcohol/drug use and problems.

The effect of pitching rate on the production of higher alcohols by top-fermenting yeast in wheat beer fermentation

The level of higher alcohols on top-fermentation determines the flavor profile and is one of the most important elements dictating the favorable top-fermented wheat beer (Ale beer) development. The optimization of the pitching rate has been shown to be crucial for industrial beer brewing. This study focused on understanding the effect of the variable inoculum size on the synthesis of higher alcohols. We utilized sequencing to investigate the transcript changes under different inoculum sizes and link the results to fermentation performance. Variable cell inoculum density levels were linked with differences in higher alcohol production. Specifically, we observed significantly less higher alcohols produced at lower cell inoculum density during the stationary phase. Importantly, the accumulation of higher alcohols during the exponential growth phase was overall similar between different pitching rates. Moreover, free amino nitrogen (FAN) consumption and yeast cell viability were significantly decreased during stationary phase at the lowest inoculum density. Transcriptomic analysis revealed that amino acid metabolism genes ALD4, ALD6, ARO9, ARO10, and PUT1 were differentially expressed once the cells entered the declining growth phase at the lowest inoculum size. The results suggest that the variable accumulation of higher alcohols in the top-fermenting yeast at different inoculum sizes is mostly accounted for in the stationary phase. We discovered that lower pitching rate was associated with a negative effect on amino acid metabolism and synthesis of higher alcohols during the stationary phase, leading to the decrease in higher alcohol concentration at low inoculum densities. Overall, our study provides valuable insights that could benefit wheat beer production.

Preliminary results on forcing vine regrowth to delay ripening to a cooler period

The most important climate-change-related effect on wine grapes is the advance in the harvest period. The increase of temperature during the whole growing season, and consequently, the warmer conditions over ripening, lead to the production of unbalanced wines with high alcohol levels, low acidities, a modified varietal aroma and a lack of color. One of the strategies to mitigate these unpleasant effects consists on delaying the berry ripening to cooler conditions. With the aim of delaying the grape ripeness more than two months, the study of a technique consisting on forcing vine regrowth has been studied. This technique consists on cutting the green shoots off, between the second and the third node of each shoot and at different phenological stages (from state G to state K, according to the Baillod and Baggiolini system, 1993); leaves and lateral shoots of the first and second nodes are removed as well. Depending on the phenological stage of vines during the forcing treatment, the fruit ripening was shifted from one month to more than two months, i.e. this practice was effective to shift harvest time from the warm August to the cooler October and November. Forced vines produced smaller berries with lower pH and higher acidity and anthocyanins concentration, compared to non-forced vines. This treatment is an effective technique to restore the anthocyanin-to-sugar ratio decoupled by climate warming.

Impact of Artificially Induced Respiratory Deficient Yeast on Beer Flavor and Fermentation

Respiratory deficient cells or “petites” are the most common type of mutation found in brewing yeast. High levels of petites are known to contribute to unwanted flavors in beer along with yeast flocculation problems during fermentation. However, a minimal amount is known regarding the impact of petites when present at naturally occurring frequencies. Accordingly, this study investigated if petites, which are present at low frequencies, affect beer flavor and fermentation profiles. Laboratory [20 mL] fermentations were undertaken with yeast that contained a range of petite populations 3.7, 5.1, 8.7, and 10.8%. During fermentation, the yeast in suspension, wort density, and alcohol were monitored. At the end of the fermentation, the beer was analyzed for volatile flavor compounds. Correlations between petite levels and levels of vicinal diketones, acetate esters, and medium chain fatty acid (MCFA) ethyl esters existed. Higher alcohol levels were unchanged (propan-1-ol, 3-methyl butanol, 2-methyl butanol, and isobutanol) with increasing levels of petite concentrations. Similarly, the yeast in suspension behavior and the change in wort density attenuation between the control and petite enriched fermentations were not significantly different (P > 0.05). This study suggests that low concentrations of petites in the pitched yeast would not be detectable in the final product characteristics.

Consumer preferences for different red wine styles and repeated exposure effects

As the complexity of wine flavor is strongly linked with grape quality, depending on grape-growing practices and winemaking procedures, winemakers are concerned to anticipate some stabilization of consumer preferences for specific, intrinsic, wine characteristics.The objective of our experiment was to compare the impact of tasting wine over time at home, with first impressions in a single tasting session under laboratory conditions on the preference for certain types of premium red Bordeaux wines available on the market.To assess the consistency of evaluation at home, half of the participants tasted two contrasting wines (fresh/jammy fruit, low/high alcohol) on several occasions. In both cases, traditional sensory analysis and experimental economic techniques were applied to evaluate the preferences of French consumers (N = 184) and their willingness to pay.This observation of the effect of repeated exposure to wines with high alcohol levels (15% vol.), marked by jammy fruit flavors, on the stability of appreciation of these wines clearly revealed the fragility of short-term preferences and the importance of giving consumers time to evaluate wines in a familiar atmosphere.

Indigenous land management as primary health care: qualitative analysis from the Interplay research project in remote Australia

BackgroundFor Indigenous Australians, health transcends the absence of disease, and includes the health and wellbeing of their community and Country: their whole physical, cultural and spiritual environment. Stronger relationships with Country and greater involvement in cultural practices enhance the wellbeing of Indigenous Australians, and those in more remote regions have greater access to their Country and higher levels of wellbeing. However this does not translate into improvements in clinical indicators, and Indigenous Australians in more remote regions suffer higher levels of morbidity and mortality than Indigenous people in non-remote areas, and other Australians.The Interplay research project aimed to explore how Indigenous Australians in remote regions experience high levels of wellbeing despite poor health statistics, and how services could more effectively enhance both health and wellbeing.MethodsIndigenous Australians in remote regions, together with researchers and government representatives developed a wellbeing framework, comprising government and community priorities: education, employment and health, and community, culture and empowerment respectively. To explore these priorities Indigenous community researchers recruited participants from diverse Indigenous organizations, including Indigenous land management, art, business development, education, employment, health and municipal services. Fourteen focus groups and seven interviews, involving 75 Indigenous and ten non-Indigenous service providers and users were conducted. These were recorded, transcribed and analyzed, using thematic analysis, based on the wellbeing framework.ResultsResearch participants highlighted Indigenous land management as a source of wellbeing, through strengthened identity and empowerment, access to traditional food sources, enjoyable physical activity, and escape from communities where high levels of alcohol are consumed. Participants described how collaboration and partnerships between services, and recognition of Indigenous languages could enhance wellbeing, while competition between services undermines wellbeing. Indigenous land management programs work across different sectors and promote collaboration between services, serving as a source of comprehensive primary health care.ConclusionsDeveloping primary health care to reflect distinctive health needs of Indigenous Australians will enhance their health and wellbeing, which includes their communities and Country. Indigenous land management consolidates aspects of comprehensive primary health care, providing both clinical benefits and wellbeing, and can provide a focus for service collaboration.

Enterococcus Bacteremia

Enterococcus Bacteremia

Gender and alcohol use: influences on HIV care continuum in a national cohort of patients with HIV.

To investigate whether gender is associated with three recommended stages of the HIV care continuum and whether gender modifies known associations between level of alcohol use and HIV care among US veterans. Retrospective cohort. Veterans Aging Cohort Study data were used to identify Veterans Health Administration (VA) patients with HIV and AUDIT-C alcohol screening from 1 February 2008 to 30 September 2014. Modified Poisson regression models estimated the relative risk and predicted prevalences of engagement in HIV care (documented CD4 cells/μl or viral load copies/ml lab values), ART treatment (at least one prescription), and viral suppression (HIV RNA <500 copies/ml) in the year following AUDIT-C (1) for women compared to men, and (2) for each level of alcohol use compared to nondrinking among women and among men. A multiplicative interaction between gender and alcohol use was tested. Among 33 224 patients, women (n = 971) were less likely than men (n = 32 253) to receive HIV care (P values <0.001). Respective predicted prevalences for women and men were 71.9% (95% CI 69.1-74.7%) and 77.9% (77.5-78.4%) for engagement, 60.0% (57.0-73.14%) and 73.8% (73.4-74.3%) for ART treatment, and 46.4% (43.3-49.6%) and 55.8% (55.3-56.3%) for viral suppression. Although the interaction between gender and alcohol use was not statistically significant, stratified analyses suggested worse outcomes for women than men at higher levels of alcohol use. In this large national cohort, women were less likely than men to be engaged in HIV medical care, prescribed ART, and virally suppressed. Interventions to improve HIV care for women are needed at all levels of alcohol use.

Co-administration of amphetamine with alcohol results in decreased alcohol withdrawal severity in adolescent rats.

Simultaneous use of stimulants and alcohol is a growing problem, particularly among older adolescents already prone to binge alcohol consumption. Adolescent rats consume high levels of alcohol when administered in a liquid diet and develop a strong alcohol withdrawal syndrome. We exploited this system to administer amphetamine in combination with alcohol and to test the effect of co-administration of amphetamine on alcohol withdrawal-induced hypoactivity and overall withdrawal severity. The presence of dietary amphetamine (≤40 mg/l) had no effect on consumption of control or alcohol-containing diets. Measured in an activity chamber, alcohol withdrawal hypoactivity was reduced significantly by co-administration of amphetamine with alcohol. Overall withdrawal severity was also reduced significantly when rats consumed amphetamine with alcohol. The results suggest that amphetamine co-use may mask physical signs of alcohol dependency and add to the importance of educational strategies pointing out the potential problems associated with co-use of stimulants and alcohol.