Mention Of Alcohol Research Articles

Development of an Algorithm to Identify Cases of Nonalcoholic Steatohepatitis Cirrhosis in the Electronic Health Record.

Current genetic research of nonalcoholic steatohepatitis (NASH) cirrhosis is limited by our ability to accurately identify cases on a large scale. Our objective was to develop and validate an electronic health record (EHR) algorithm to accurately identify cases of NASH cirrhosis in the EHR. We used Clinical Query 2, a search tool at Beth Israel Deaconess Medical Center, to create a pool of potential NASH cirrhosis cases (n = 5415). We created a training set of 300 randomly selected patients for chart review to confirm cases of NASH cirrhosis. Test characteristics of different algorithms, consisting of diagnosis codes, laboratory values, anthropomorphic measurements, and medication records, were calculated. The algorithms with the highest positive predictive value (PPV) and the highest F score with a PPV ≥ 80% were selected for internal validation using a separate random set of 100 patients from the potential NASH cirrhosis pool. These were then externally validated in another random set of 100 individuals using the research patient data registry tool at Massachusetts General Hospital. The algorithm with the highest PPV of 100% on internal validation and 92% on external validation consisted of ≥ 3 counts of "cirrhosis, no mention of alcohol" (571.5, K74.6) and ≥ 3 counts of "nonalcoholic fatty liver" (571.8-571.9, K75.81, K76.0) codes in the absence of any diagnosis codes for other common causes of chronic liver disease. We developed and validated an EHR algorithm using diagnosis codes that accurately identifies patients with NASH cirrhosis.

Texting to Reduce Alcohol Misuse (TRAM): main findings from a randomized controlled trial of a text message intervention to reduce binge drinking among disadvantaged men.

To test the effectiveness of a theoretically based text-message intervention to reduce binge drinking among socially disadvantaged men. A multi-centre parallel group, pragmatic, individually randomized controlled trial. Community-based study conducted in four regions of Scotland. A total of 825 men aged 25-44years recruited from socially disadvantaged areas who had two or more episodes of binge drinking (>8 UK units on a single occasion) in the preceding 28days: 411 men were randomized to the intervention and 414 to the control. A series of 112 interactive text messages was delivered by mobile phone during a 12-week period. The intervention was structured around the Health Action Process Approach, a comprehensive model which allows integration of a range of evidence-based behaviour change techniques. The control group received 89 texts on general health, with no mention of alcohol or use of behaviour change techniques. The primary outcome measure was the proportion of men consuming >8units on three or more occasions (in the previous 28days) at 12months post-intervention. The proportion of men consuming >8units on three or more occasions (in the previous 28days) was 41.5% in the intervention group and 47.8% in the control group. Formal analysis showed that there was no evidence that the intervention was effective [odds ratio (OR)=0.79, 95% confidence interval (CI)=0.57-1.08; absolute reduction 5.7%, 95% CI=-13.3 to 1.9]. The Bayes factor for this outcome was 1.3, confirming that the results were inconclusive. The retention was high and similar in intervention (84.9%) and control (86.5%) groups. Most men in the intervention group engaged with the text messages: almost all (92%) replied to text messages and 67% replied more than 10 times. A theoretically based text-messaging intervention aimed at reducing binge drinking in disadvantaged men was not found to reduce prevalence of binge drinking at 12-month follow-up.

Health behaviour information provided to clients during midwife-led prenatal booking visits: Findings from video analyses

Objectiveto quantify to what extent evidence-based health behaviour topics relevant for pregnancy are discussed with clients during midwife-led prenatal booking visits and to assess the association of client characteristics with the extent of information provided. Designquantitative video analyses. Setting and participants173 video recordings of prenatal booking visits with primary care midwives and clients in the Netherlands taking place between August 2010 and April 2011. Measurementsthirteen topics regarding toxic substances, nutrition, maternal weight, supplements, and health promoting activities were categorized as either ‘never mentioned’, ‘briefly mentioned’, ‘basically explained’ or ‘extensively explained’. Rates on the extent of information provided were calculated for each topic and relationships between client characteristics and dichotomous outcomes of the extent of information provided were assessed using Generalized Linear Mixed Modelling. Findingsour findings showed that women who did not take folic acid supplementation, who smoked, or had a partner who smoked, were usually provided basic and occasionally extensive explanations about these topics. The majority of clients were provided with no information on recommended weight gain (91.9%), fish promotion (90.8%), caffeine limitation (89.6%), vitamin D supplementation (87.3%), physical activity promotion (81.5%) and antenatal class attendance (75.7%) and only brief mention of alcohol (91.3%), smoking (81.5%), folic acid (58.4) and weight at the start of pregnancy (52.0%). The importance of a nutritious diet was generally either never mentioned (38.2%) or briefly mentioned (45.1%). Nulliparous women were typically given more information on most topics than multiparous women. Key conclusions and implications for practice:although additional information was generally provided about folic acid and smoking, when relevant for their clients, the majority of women were provided with little or no information about the other health behaviours examined in this study. Midwives may be able to improve prenatal health promotion by providing more extensive health behaviour information to their clients during booking visits.

Utility of urinary ethyl glucuronide analysis in post-mortem toxicology when investigating alcohol-related deaths

Use and abuse of alcohol are common findings when unnatural deaths are investigated as evidenced by high blood- and urine- alcohol concentrations (BAC and UAC) at autopsy. Because ethanol is metabolized in the liver until the time of death, the autopsy BAC or UAC might be negative even though the deceased had consumed alcohol in the immediate ante-mortem period. Analysis of the non-oxidative metabolite of ethanol [ethyl glucuronide (EtG)] offers a more sensitive test of recent drinking. In this paper, we determined the concentrations of ethanol and EtG in urine samples from 972 consecutive forensic autopsies. In 425 cases (44%) both EtG and ethanol were positive, which supports ante-mortem drinking. In 342 cases (35%), both EtG and ethanol was negative, which speaks against any consumption of alcohol just before death. In 181cases, ethanol was negative in urine (<0.2g/kg), whereas EtG was positive (>0.5mg/L), which points towards ingestion of alcohol some time before death. In these cases, mean and median concentrations of EtG were 53.2mg/L and 23.7mg/L, respectively, although there was no mention of alcohol on 131 of the death certificates. Alcohol was mentioned on death certificates as an underlying or immediate cause of death or a contributing factor in 435 (45%) cases, which rose to 566 (58%) cases when positive EtG results were included. This article demonstrates the usefulness of EtG analysis in routine post-mortem toxicology when ante-mortem drinking and alcohol-related deaths are investigated.

Grand Challenge of psychopathology in the years to come

Grand Challenge of psychopathology in the years to come

Evaluation of Certifier Practices Regarding Alcohol-Related Deaths

Alcohol can contribute to various manners of death by acute intoxication that places a person at risk for fatal injury, acute fatal alcohol poisoning, or the various fatal complications of chronic abuse with or without superimposed acute intoxication. The reporting of alcohol use on the death certificate may vary with office policy or procedure, certifier judgment, and the timing of information received during investigation. To determine the number of deaths including mention of alcohol use in the investigative case file, the number of death certificates on which alcohol use is reported, the number of discrepancies between the 2, and the possible reasons for observed discrepancies. Retrospective case review of all deaths where alcohol use was mentioned in the investigative case file and/or on the death certificate for deaths investigated by the Fulton County Medical Examiner in Atlanta, Georgia, during a 1-year period between January 1, 2004, and December 31, 2004. Percentage of deaths with alcohol use reported on the death certificate, tabulation of where and how alcohol use is reported on the death certificate, and tabulation of the differences between the investigative case file and death certificate regarding alcohol's possible role in causing death. Among the 1324 deaths certified by the office, 105 (8%) had alcohol use reported on the death certificate. The majority (67%) of these cases were natural deaths. Sixty-nine (5%) deaths had mention of alcohol use in the investigative case notes but did not include it on the death certificate. Twenty-five (2%) deaths had mention of alcohol on the death certificate but did not have mention of it in the investigative case file based on our search criteria. However, subsequent review of additional case follow-up information disclosed a history of alcohol use or acute intoxication in each case. The data show that more natural deaths are considered to be directly caused by alcohol than other manners of death. For the unnatural manners of death (excluding acute alcohol poisoning), alcohol use is often viewed by medical examiners as an incidental, associated finding or risk factor surrounding the circumstances of death rather than being an actual cause of death. In such cases, alcohol use is often omitted from the death certificate. For deaths directly caused by alcohol, the proportion of cases involving possible underreporting or overreporting of alcohol involvement was relatively small and usually involved the omission of chronic alcohol use from the death certificate. Researchers need to be aware of potential limitations of death certificate data for studying alcohol-related deaths.

Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol--the case of Canada.

To analyse post-war variations in per capita alcohol consumption in relation to gender-specific liver cirrhosis mortality in Canadian provinces and to assess the extent to which alcohol bears a different relation to cirrhosis deaths with mention of alcohol (alcoholic cirrhosis) compared to cirrhosis deaths without mention of alcohol (non-alcoholic cirrhosis). Annual liver cirrhosis mortality rates by 5-year age groups were converted into gender-specific and age-adjusted mortality rates. Outcome measures included total cirrhosis-the conventional measure of liver cirrhosis--alcoholic cirrhosis and non-alcoholic cirrhosis. Per capita alcohol consumption was measured by alcohol sales and weighted with a 10-year distributed lag model. A graphical analysis was used to examine the regional relationship and the Box-Jenkins technique for time-series analysis was used to estimate the temporal relationship. Geographical variations in alcohol consumption corresponded to variations in total liver cirrhosis and particularly alcoholic cirrhosis, whereas non-alcoholic cirrhosis rates were not associated geographically with alcohol consumption. In general, for all provinces, time-series analyses revealed positive and statistically significant effects of changes in alcohol consumption on cirrhosis mortality. In Canada at large, a 1-litre increase in per capita consumption was associated with a 17% increase in male total cirrhosis rates and a 13% increase in female total cirrhosis rates. Alcohol consumption had a stronger impact on alcoholic cirrhosis, which increased by fully 30% per litre increase in alcohol per capita for men and women. Although the effect on the non-alcoholic cirrhosis rate was weaker (12% for men and 7% for women) it was nevertheless statistically significant and suggests that a large proportion of these deaths may actually be alcohol-related. Some well-established findings in alcohol research were confirmed by the Canadian experience: per capita alcohol consumption is related closely to death rates from liver cirrhosis and alcohol-related deaths tend to be under-reported in mortality statistics.

Patterns of alcohol consumption and social consequences. Results from an 8-year follow-up study in Switzerland.

(1) To estimate the impact of drinking patterns on negative social (behaviour) consequences. (2) To test for the additional impact of overall volume of alcohol consumed on these social consequences. (3) To explore whether the impact on social consequences of drinking patterns is comparable for measures that do and do not explicitly mention alcohol consumption. An 8-year follow-up to a 1987 study of the Swiss general population carried out through face-to-face interviews; the follow-up data presented in this article was collected in 1995 through a mailed questionnaire. Nine hundred and fifty-three respondents from the 1987 survey who also completed the mailed questionnaire in 1995. Variables used were as follows: volume of drinking, eight drinking patterns differentiated by volume and frequency, four social consequences without mention of alcohol and six with mention of alcohol. All multivariate analyses control for sex, age and linguistic region. High volumes of drinking per occasion predicted negative social consequences independently of overall drinking volume. This finding was independent of explicit mention of alcohol in item formulation. For unemployment and accidents, if assessed independently of alcohol consumption, no significant relationship with either overall volume of drinking or drinking pattern was observed. Patterns of alcohol consumption are an important determinant of social problems. Future research with better design is necessary to establish their exact risk relations with different social consequences.

Nicotine Don't Get No Respect

To the Editor. —One focus of health care reform has been the allocation of resources to prevent and treat drug dependence. In this debate we believe that most clinicians, policymakers, and scientists are overlooking the most prevalent, most costly, and most deadly of the drug dependencies, ie, nicotine dependence. To test this belief empirically, we recently surveyed the most recent issues of six peer-reviewed scientific journals on drug abuse (Table). The journals chosen were those with large circulations or scientific impact in the field according to Science Citation Index . For each journal we searched for the 15 most recent articles the titles of which referred to a study on drug abuse, dependence, or use without specifying a certain drug or class of drugs. Within these generic drug abuse articles, we then searched for any mention of alcohol, cocaine, marijuana, nicotine, or opioids. Nicotine was consistently the least likely of these

Liver cirrhosis with and without mention of alcohol as cause of death

Changes in the estimated proportion of liver cirrhosis deaths attributable to alcoholism in the United States from 1940 to 1980 are reviewed. The value of this proportion from 1940 in the original Jellinek Alcoholism Estimation Formula, through Formula modifications, to 1980 use are presented; the rationale for various changes in its value are discussed. Essex County, New Jersey, USA decedents in 1984, aged 25-years or older, whose underlying cause of death was specified alcoholic cirrhosis and those who died of cirrhosis without mention of alcohol are analyzed for differences in background and post-mortem characteristics. Some appreciable proportion of cirrhosis deaths without mention of alcohol is considered to be attributable to alcoholism. Background and post-mortem differences between persons whose underlying cause of death is certified as cirrhosis with and without mention of alcohol suggest some bases for the under-reporting of specified alcoholic cirrhosis mortality.

Accuracy of death certificates in the diagnosis of alcoholic liver cirrhosis.

In 108 patients with alcoholic liver disease who died during a 10-year follow-up, the diagnoses from the liver biopsies were compared with that from the Death Certificates. Data show that the currently used ICD-9 category of cirrhosis with or without mention of alcohol has a 47.2% chance of missing the diagnosis of cirrhosis. On the other hand when the mention of liver disease in the Death Certificate is used for the diagnosis of cirrhosis, the percentage of undiagnosed cirrhosis decreases to 19.4% (p less than 0.0001).

Alcohol and Other Drug Abuse and Sleep Behavior Disorder

To the Editor.— The article by Schenck et al 1 made no mention of alcohol or other drug abuse in their sample of patients with sleep behavior disorder. Response to clonazepam in these patients is consistent with possible alcohol-sedative abuse. This symptom, often reported by alcohol and other drug abusers and by their families, usually resolves with abstinence and recovery from substance abuse in such patients. Future investigators of this phenomenon should consider data collection for substance abuse disorders (eg, via γ-glutamyltransferase assays, urine drug screens, the Michigan Alcoholism Screening Test, and collateral sources). For patients with sleep behavior disorder who engage in substance abuse, it is important that treatment be primary whenever possible (ie, recovery from substance abuse), especially when symptomatic therapy (eg, benzodiazepines) may exacerbate the primary condition.