Alcohol Abuse Research Articles

ERAS Implementation in Thoracic Surgery

This manuscript provides an overview of the principles and requirements for implementing the ERAS program in thoracic surgery.The ERAS program optimises perioperative management of elective lung resection procedures and is based on the ERAS Guidelines for Thoracic Surgery of the ERAS Society. The clinical measures are described as in the current literature, with a focus on postoperative outcome. There are currently 45 enhanced recovery items covering four perioperative phases: from the prehospital admission phase (patient education, screening and treatment of potential risk factors such as anaemia, malnutrition, cessation of nicotine or alcohol abuse, prehabilitation, carbohydrate loading) to the immediate preoperative phase (shortened fasting period, non-sedating premedication, prophylaxis of PONV and thromboembolic complications), the intraoperative measures (antibiotic prophylaxis, standardised anaesthesia, normothermia, targeted fluid therapy, minimally invasive surgery, avoidance of catheters and probes) through to the postoperative measures (early mobilisation, early nutrition, removal of a urinary catheter, hyperglycaemia control). Most of these measures are based on scientific studies, with a high level of evidence and aim to reduce general postoperative complications.The ERAS program is an optimised perioperative treatment approach aiming to improve the postoperative recovery in patients after elective lung resection by reducing the overall complication rates and overall morbidity.

THE LEGAL DILEMMA OF MANAGING AND REGULATING PRIVATE CONSUMPTION OF CANNABIS IN RELATION TO THE WORKPLACE

In South Africa, consumption of cannabis was a criminal offence in past decades. However, in September 2018, the Constitutional Court judgment in the Prince case decriminalised the private consumption of cannabis. Although the judgment was welcomed by many South Africans, including employees, its interpretation and implementation has been marred by legal ambiguity. The Constitutional Court did not prescribe how employers should manage and regulate the private consumption of cannabis in relation to the workplace. In order to maintain workplace safety, a majority of employers have adopted and enforced a zero-tolerance policy on alcohol, drugs and substance abuse. A majority of employers have relied on urinalysis testing to detect cannabis in the workplace. Some employees, after testing positive for cannabis, have been dismissed for contravening their employer’s zero-tolerance policy, without conclusive evidence of impairment. This thorny issue is explored in this article. First, it seeks to examine whether merely testing positive for cannabis is sufficient to prove intoxication that may result in an employee’s impairment. Secondly, the question is whether urinalysis testing precisely determines whether an employee cannot function and perform their duties normally.

‘Born Free’ Dreams: South African Township Youth Discuss Their Hopes for a Better Life in Future

AbstractThe advent of democracy in 1994 promised South Africans a ‘better life for all’ and the so-called ‘born free’ generation hoped for better education and job opportunities than those of their parents and grandparents, who had lived under apartheid. In focus group discussions, township youth living in a small university town in the country’s poorest Eastern Cape Province had the opportunity to express what hopes they had for their future in the post-Covid-19 era and confirmed the important role of hope in their lives as a useful tool that motivated them to aspire to fulfil their dreams. In response to select items from the Snyder hope scales, youth discussed their life goals, optimism, agency, and pathway thinking to realise their dreams. Youth recognised hope could be both harmful as well as useful. The discussions provided an opportunity for youth to share and compare with others their experiences of disappointment and failure, of times when they had felt hopeless, with the worst cases of hopelessness resulting in alcohol and substance abuse, which was reportedly widespread among township youth. Family, neighbours and significant others provided support and advice that assisted youth to recover from hopelessness, and to find new direction in life. Results from this qualitative study point to the importance of providing township youth with a platform to share their experiences of hopelessness. Policy and practical interventions are needed to support and guide hopeless youth to regain their mental health, well-being, and hope for the future.

Hovenia dulcis Fruit Peduncle Polysaccharides Reduce Intestinal Dysbiosis and Hepatic Fatty Acid Metabolism Disorders in Alcohol-Exposed Mice.

Alcohol abuse can lead to alcoholic liver disease, becoming a major global burden. Hovenia dulcis fruit peduncle polysaccharides (HDPs) have the potential to alleviate alcoholic liver injury and play essential roles in treating alcohol-exposed liver disease; however, the hepatoprotective effects and mechanisms remain elusive. In this study, we investigated the hepatoprotective effects of HDPs and their potential mechanisms in alcohol-exposed mice through liver metabolomics and gut microbiome. The results found that HDPs reduced medium-dose alcohol-caused dyslipidemia (significantly elevated T-CHO, TG, LDL-C), elevated liver glycogen levels, and inhibited intestinal-hepatic inflammation (significantly decreased IL-4, IFN-γ and TNF-α), consequently reversing hepatic pathological changes. When applying gut microbiome analysis, HDPs showed significant decreases in Proteobacteria, significant increases in Firmicutes at the phylum level, increased Lactobacillus abundance, and decreased Enterobacteria abundance, maintaining the composition of gut microbiota. Further hepatic metabolomics analysis revealed that HDPs had a regulatory effect on hepatic fatty acid metabolism, by increasing the major metabolic pathways including arachidonic acid and glycerophospholipid metabolism, and identified two important metabolites-C00157 (phosphatidylcholine, a glycerophospholipid plays a central role in energy production) and C04230 (1-Acyl-sn-glycero-3-phosphocholine, a lysophospholipid involved in the breakdown of phospholipids)-involved in the above metabolism. Overall, HDPs reduced intestinal dysbiosis and hepatic fatty acid metabolism disorders in alcohol-exposed mice, suggesting that HDPs have a beneficial effect on alleviating alcohol-induced hepatic metabolic disorders.

Risk Factors Portending a Total Hip Arthroplasty for Patients Who Have Osteonecrosis of the Femoral Head.

Osteonecrosis of the femoral head (ONFH) poses a substantial burden to orthopaedic surgeons. However, the exact risk attributed by each specific patient factor for those who end up receiving a total hip arthroplasty (THA) are not well known. We assessed: (1) patient demographics (age and sex); (2) blood cell dyscrasias (sickle-cell disease and hypercoagulable states); and (3) substance use (oral corticosteroid use, tobacco use, and alcohol abuse). A retrospective search examined all patients who had a primary THA (n=715,100) between January 1, 2010 and April 30, 2020 using a national, all-payer database. Risk factors studied included age, sex, sickle-cell, hypercoagulable state, oral corticosteroid use, tobacco use, and alcohol abuse. Several risk factors were found to be significantly predictive for ONFH requiring THA: age <55 years (odds ratio [OR] 1.02, 95% confidence interval [CI] of 1.01 to 1.02, p<0.001), men (OR 1.07, 95% CI of 1.04 to 1.10, p<0.001), oral corticosteroid use (OR 1.21, 95% CI of 1.17 to 1.25, p<0.001), tobacco use (OR 1.15, 95% CI of 1.11 to 1.18, p<0.001), and alcohol abuse (OR 1.05, 95% CI of 1.01 to 1.08, p=0.009). Based on the results of this study, young age, men, oral corticosteroid use, tobacco use, and alcohol abuse are risk factors for patients who have ONFH and had a THA. The degree of risk from greatest to least were: oral corticosteroid use, tobacco use, men, alcohol abuse, and age <55 years old.

Self-Reported Disability Type and Risk of Alcohol-Induced Death – A Longitudinal Study Using Nationally Representative Data

Background Disability is associated with alcohol misuse and drug overdose death, however, its association with alcohol-induced death remains understudied. Objective To quantify the risk of alcohol-induced death among adults with different types of disabilities in a nationally representative longitudinal sample of US adults. Methods Persons with disabilities were identified among participants ages 18 or older in the Mortality Disparities in American Communities (MDAC) study (n = 3,324,000). Baseline data were collected in 2008 and mortality outcomes were ascertained through 2019 using the National Death Index. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated for the association between disability type and alcohol-induced death, controlling for demographic and socioeconomic covariates. Results During a maximum of 12 years of follow-up, 4000 alcohol-induced deaths occurred in the study population. In descending order, the following disability types displayed the greatest risk of alcohol-induced death (compared to adults without disability): complex activity limitation (aHR = 1.7; 95% CI = 1.3–2.3), vision limitation (aHR = 1.6; 95% CI = 1.2–2.0), mobility limitation (aHR = 1.4; 95% CI = 1.3–1.7), ≥2 limitations (aHR = 1.4; 95% CI = 1.3–1.6), cognitive limitation (aHR = 1.2; 95% CI = 1.0–1.4), and hearing limitation (aHR = 1.0; 95% CI = 0.9–1.3). Conclusions The risk of alcohol-induced death varies considerably by disability type. Efforts to prevent alcohol-induced deaths should be tailored to meet the needs of the highest-risk groups, including adults with complex activity (i.e., activities of daily living – “ALDs”), vision, mobility, and ≥2 limitations. Early diagnosis and treatment of alcohol use disorder within these populations, and improved access to educational and occupational opportunities, should be considered as prevention strategies for alcohol-induced deaths.

Screening for harmful substance use in emergency departments: a systematic review

BackgroundSubstance use-related emergency department (ED) visits have increased substantially in North America. Screening for substance use in EDs is recommended; best approaches are unclear. This systematic review synthesizes evidence on diagnostic accuracy of ED screening tools to detect harmful substance use.MethodsWe included derivation or validation studies, with or without comparator, that included adult (≥ 18 years) ED patients and evaluated screening tools to identify general or specific substance use disorders or harmful use. Our search strategy combined concepts Emergency Department AND Screening AND Substance Use. Trained reviewers assessed title/abstracts and full-text articles for inclusion, extracted data, and assessed risk of bias (QUADAS-2) independently and in duplicate. Reviewers resolved disagreements by discussion. Primary investigators adjudicated if necessary. Heterogeneity precluded meta-analysis. We descriptively summarized results.ResultsOur search strategy yielded 2696 studies; we included 33. Twenty-one (64%) evaluated a North American population. Fourteen (42%) applied screening among general ED patients. Screening tools were administered by research staff (n = 21), self-administered by patients (n = 10), or non-research healthcare providers (n = 1). Most studies evaluated alcohol use screens (n = 26), most commonly the Alcohol Use Disorders Identification Test (AUDIT; n = 14), Cut down/Annoyed/Guilty/Eye-opener (CAGE; n = 13), and Rapid Alcohol Problems Screen (RAPS/RAPS4/RAPS4-QF; n = 12). Four studies assessing six tools and screening thresholds for alcohol abuse/dependence in North American patients (AUDIT ≥ 8; CAGE ≥ 2; Diagnostic and Statistical Manual of Mental Disorders, 4th Edition [DSM-IV-2] ≥ 1; RAPS ≥ 1; National Institute on Alcohol Abuse and Alcoholism [NIAAA]; Tolerance/Worry/Eye-opener/Amnesia/K-Cut down [TWEAK] ≥ 3) reported both sensitivities and specificities ≥ 83%. Two studies evaluating a single alcohol screening question (SASQ) (When was the last time you had more than X drinks in 1 day?, X = 4 for women; X = 5 for men) reported sensitivities 82–85% and specificities 70–77%. Five evaluated screening tools for general substance abuse/dependence (Relax/Alone/Friends/Family/Trouble [RAFFT] ≥ 3, Drug Abuse Screening Test [DAST] ≥ 4, single drug screening question, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST] ≥ 42/18), reporting sensitivities 64%-90% and specificities 61%-100%. Studies’ risk of bias were mostly high or uncertain.ConclusionsSix screening tools demonstrated both sensitivities and specificities ≥ 83% for detecting alcohol abuse/dependence in EDs. Tools with the highest sensitivities (AUDIT ≥ 8; RAPS ≥ 1) and that prioritize simplicity and efficiency (SASQ) should be prioritized.

Social Discipline and the Refusal of Poor Relief under the English Old Poor Law, c. 1650–1730

Abstract There has been debate about the extent to which the English old poor law could operate as a system of social discipline. This article looks closely at an almost completely neglected set of sources, petitions by local communities asking to stop (or cut) a pauper’s relief, to assess how far poor relief was used as a disciplinary tool. Taking 182 appeals by Lancashire townships from the Civil War to the appearance of workhouses in the county, it suggests that poor relief operated robustly as a system of labour discipline, but only weakly as a wider tool of behavioural control. There is some evidence that townships wanted to end doles to those engaged in ‘bad’ behaviour, such as excessive drinking, gambling, or insubordination, but such cases were infrequent. Far more important were attempts to stop relief where paupers could work or could support themselves through their own productive assets. In turn, townships’ focus on the ability to work suggests that ‘deserving’ poverty was understood in terms of bodily impotence, whilst the need to restrict poor relief to those who were ‘necessitous’ required officers to engage in close surveillance of the poor and their bodies.

Horse owner experiences and observations with the use of SGLT2i for the management of equine metabolic syndrome and hyperinsulinaemia‐associated laminitis

SummaryBackgroundSodium‐glucose cotransporter 2 inhibitors (SGLT2i) are being used increasingly in equine practice. While there is emerging clinical evidence of the safety and efficacy of these drugs, there are currently no reports to document owner experiences with treatment.ObjectiveThe objective of the study was to report owner experiences and observations following treatment with SGLT2i in horses.Study designA cross‐sectional online survey.MethodsHorse owners were recruited via social media, online forums and their veterinarians to participate in an anonymous online survey to document their experiences and observations when treating their horses with SGLT2i.ResultsThree hundred forty‐two responses met the inclusion criteria. Ertugliflozin was the most commonly prescribed SGLT2i (79.8%), and the most common reasons for treatment were high insulin concentrations (84.2%) and active laminitis (59.7%). 85.3% of owners reported their horses had an improved quality of life after commencing treatment, while 9.4% reported no change and 5.3% reported a worsening of clinical signs. Of owners who had considered euthanasia prior to treatment (n = 77), 80.5% reported their horse's level of pain to be either mild or absent after 30 days of treatment and 94.8% reported their horse's quality of life to be improved. Most owners (n = 220, 64.7%) reported they were either extremely satisfied or somewhat satisfied (n = 72, 21.2%) with treatment. Treatment concerns included safety/side effects, medication cost, availability and long‐term efficacy. 114 owners (33.3%) reported one or more initial adverse effects upon induction onto the medication, particularly excessive urination (n = 70, 20.5%), excessive drinking (n = 38, 11.1%), excessive weight loss (n = 34, 9.9%) and dullness (n = 26, 7.6%).Main limitationSampling bias through social media and veterinary practices and reliance on subjective owner reports.ConclusionThe use of SGLT2i in horses was associated with excellent rates of owner satisfaction and owner‐reported improved quality of life for the horse; however, some adverse effects were observed.

The effect of substance use Certificate‐of‐Need laws on access to substance use disorder treatment facilities

AbstractWe investigate how substance use Certificate‐of‐Need (CON) laws influence access to substance use disorder treatment facilities in the United States. We use the National Directory of Drug and Alcohol Abuse Treatment Facilities data set, which lists all federal, state, and local government facilities and private facilities that provide substance use treatment services in 2020. Based on the locations of these facilities, we develop a novel access index to substance use disorder treatment facilities that accounts for driving distance and duration to measure the ease of reaching these facilities for individuals living at the population‐weighted county centroids. We find that counties in states with CON laws that border counties without such laws have nearly 10% less spatial accessibility to substance use disorder treatment facilities at a 5% level of significance.

Shorter communications: Exploring the impact of a brief smartphone-based alcohol intervention app (DrinksRation) on the quality of life of UK military veterans

Alcohol misuse – defined as consuming more than 14 units of alcohol per week - is a well-established problem among veterans. This study investigated the change in quality of life among help-seeking UK veterans who completed a 28-day brief alcohol intervention delivered via a digital smartphone application (called DrinksRation) and have previously sought clinical help for a mental health disorder. This study was a secondary outcome analysis of data collected during a randomised control trial. In total, 123 UK veterans participated in the study and were randomly allocated to either the intervention or control arm. Participants completed self-report questionnaires regarding their alcohol use and quality of life (WHOQOL-BREF) at baseline, day 28 (end of intervention), day 84, and day 168. At the primary endpoint (day 84), we found significantly greater improvements in the intervention arm compared to the control arm for psychological quality of life (Cohen's d = 0.47), and environmental quality of life (d = 0.34). However, we observed no statistically significant differences between the intervention and control arm for social relationships and physical quality of life. Further, for day 168 we found no significant differences. Findings suggest that DrinksRation can increase quality of life among help-seeking veterans who have previously sought help for a mental health disorder, but the increases were modest and restricted to certain domains. Additional treatment may be needed for long-term and sustained improvements in quality of life.

Neighborhood socioeconomic disadvantages associated with increased rates of revisions, readmissions, and complications after total joint arthroplasty.

Low socioeconomic status based on neighborhood of residence has been suggested to be associated with poor outcomes after total joint arthroplasty (TJA). The area deprivation index (ADI) is a scale that ranks (zero to 100) neighborhoods by increasing socioeconomic disadvantage and accounts for median income, housing type, and family structure. We sought to examine the potential differences between high (national median ADI = 47) and low ADI among TJA recipients at a single institution. Specifically, we assessed: (1) 30-day emergency department visits/readmissions; (2) 90-day and 1-year revisions; as well as (3) medical and surgical complications. A consecutive series of primary TJAs from September 21, 2015, through December 29, 2021, at a tertiary healthcare system were reviewed. A total of 3,024 patients who had complete ADI data were included. Patients were divided into groups below the national median ADI of 47 (n = 1,896) and above (n = 1,128). Multivariable regressions to determine independent risk factors accounting for ADI, race, age, sex, American Society of Anesthesiologists Classification grade, body mass index, diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease, hypertension, chronic kidney disease, alcohol abuse, substance abuse, and tobacco use. The primary outcomes of interest include evaluation of the independent association of ADI with total postoperative complications (at 30days, 90days, and 1year) after adjusting for multiple relevant cofactors. After adjusting for multiple relevant cofactors, at 90days, ADI > 47 (OR, 1.36, 95% CI 1.00-1.83, P = 0.04), men versus women (OR, 0.73, 95% CI 0.54-0.99, P = 0.039), and CHF (OR, 1.90, 95% CI 1.18-3.06, P = 0.009) were independently associated with increased total complications. The ADI was not associated with increased total complications at 30days or 1-year (All P > 0.05). Our findings of higher complications of the ADI > 47 cohort at 90days, reaffirm the complex relationship between ADI, patient demographics, and additional socioeconomic parameters that may influence postoperative outcomes and complications after TJA. This study utilizing ADI demonstrates potential areas of intervention and further investigation for assessing arthroplasty outcomes.

High-risk smoking in the United States: Nicotine staining predicts increased colonic adenomas and advanced adenomas on colonoscopy

BackgroundSmoking is linked with numerous adverse health effects. Nicotine staining on fingers or teeth is thought to suggest active or heavy smoking. The significance of nicotine staining within gastroenterology remains unclear. AimWe set out to establish the predictive value of nicotine staining for adenomas and advanced adenomas. MethodsThis was a cross-section study of patients who underwent colonoscopy at the Oklahoma City Veterans Affairs Medical Center from November 2019 to November 2020. Pre-procedure patient survey ascertained current smoking status. Endoscopist performed a nicotine staining survey upon completion of the respective colonoscopy. Chart review allowed determination of patient demographics, comorbidities, and colonoscopy findings. Patients without smoking history were assigned to a control cohort. We applied one-way analysis of variance when comparing the mean of continuous variables and the Chi-square test when comparing categorical variables. Lastly, we used stepwise logistic regression to estimate adjusted odds ratio. A p-value <0.05 was considered statistically significant. ResultsCompared to those without smoking history or evidence of nicotine staining, patients with positive nicotine staining were older (P = 0.03), leaner (P < 0.0001), and more likely to have chronic obstructive pulmonary disease (P < 0.0001) or history of alcohol abuse (P < 0.0001). Furthermore, presence of nicotine staining independently predicted increased likelihood of multiple adenomas (OR 1.5, 95% CI [1.2–1.9]) and advanced adenomas (OR 1.6, 95% CI [1.2–2.2]). ConclusionThis marks the first investigation of nicotine staining within gastroenterology. We have demonstrated that the presence of nicotine staining independently predicts numerous adenomas and advanced adenomas.

Childhood trauma and alcohol misuse in college students: The moderating role of minimization

BackgroundHistory of childhood trauma as a risk factor for alcohol misuse in early adulthood is very well documented. Given the associations between childhood trauma and alcohol misuse, more work is needed to understand the factors that influence this relationship. ObjectiveThe purpose of this study was to examine the relationship between childhood trauma, minimization of such events and alcohol misuse in a French college student sample. Participants and settingA convenience sampling method was used to recruit students from several colleges located in Western France. The data set included 1180 records with complete responses. MethodsThis study employed a cross-sectional online survey. Data collection instruments included the Childhood Trauma Questionnaire Short-Form (CTQ-SF) and the Alcohol Use Disorders Identification Test (AUDIT). ResultsThe strength of the association between CTQ score and AUDIT total score was increased by minimization score (β = 0.122, p = .07). This result suggests that under-reporting childhood trauma experiences tends to increase the impact of such events on alcohol misuse. ConclusionThese findings suggest that a tendency to minimize threatening childhood events may specifically be related to increased risk of greater alcohol misuse among college students. Therefore, it may be important for clinician to assess minimization of early events in students with a history of childhood trauma.

Numerical treatment of stochastic and deterministic alcohol drinker dynamics with Euler–Maruyama method

Alcohol abuse is a substantial cause of various health and societal issues, as well as a significant factor in global disease. Once alcohol is consumed in the gastrointestinal tract, it undergoes metabolism in the liver and lungs. In this investigation, the nonlinear deterministic and stochastic differential frameworks are analyzed numerically to predict the dynamic evolution of the virus in the drinker alcohol model. The framework for apprehending drinking patterns is categorized into three distinct groups: the susceptible population, risk drinkers, and moderate drinkers. The approximate solution for each population group is determined by exhaustively creating scenarios that vary the probability ratio of infection in susceptible individuals who do not consume alcohol, the increasing rate of alcohol consumption, the rate at which individuals transition from acute to chronic drinking categories, the rate at which new non-drinking consumers are attracted, the death rate of the population, the ratio affecting the rate of sociability in heavy drinkers, and the overall population rate. The Euler–Maruyama approach for the stochastic framework and the Adams method for the deterministic framework are utilized, respectively, to determine the solutions of the alcohol drinker model. This study compares deterministic and stochastic frameworks to underscore their distinct characteristics and efficiency, achieved through comprehensive simulations and in-depth analysis of the numerical outcomes.

Combined Motivational Interviewing and Ecological Momentary Intervention to Reduce Hazardous Alcohol Use Among Sexual Minority Cisgender Men and Transgender Individuals: Protocol for a Randomized Controlled Trial.

Sexual minority cisgender men and transgender (SMMT) individuals, particularly emerging adults (aged 18-34 years), often report hazardous drinking. Given that alcohol use increases the likelihood of HIV risk behaviors, and HIV disproportionately affects SMMT individuals, there is a need to test interventions that reduce hazardous alcohol use and subsequent HIV risk behaviors among this population. Ecological momentary interventions (EMIs), which use mobile phones to deliver risk reduction messages based on current location and behaviors, can help to address triggers that lead to drinking in real time. This study will test an EMI that uses motivational interviewing (MI), smartphone surveys, mobile breathalyzers, and location tracking to provide real-time messaging that addresses triggers for drinking when SMMT individuals visit locations associated with hazardous alcohol use. In addition, the intervention will deliver harm reduction messaging if individuals report engaging in alcohol use. We will conduct a 3-arm randomized controlled trial (N=405 HIV-negative SMMT individuals; n=135, 33% per arm) comparing the following conditions: (1) Tracking and Reducing Alcohol Consumption (a smartphone-delivered 4-session MI intervention), (2) Tracking and Reducing Alcohol Consumption and Environmental Risk (an EMI combining MI with real-time messaging based on geographic locations that are triggers to drinking), and (3) a smartphone-based alcohol monitoring-only control group. Breathalyzer results and daily self-reports will be used to assess the primary and secondary outcomes of drinking days, drinks per drinking day, binge drinking episodes, and HIV risk behaviors. Additional assessments at baseline, 3 months, 6 months, and 9 months will evaluate exploratory long-term outcomes. The study is part of a 5-year research project funded in August 2022 by the National Institute on Alcohol Abuse and Alcoholism. The first 1.5 years of the study will be dedicated to planning and development activities, including formative research, app design and testing, and message design and testing. The subsequent 3.5 years will see the study complete participant recruitment, data collection, analyses, report writing, and dissemination. We expect to complete all study data collection in or before January 2027. This study will provide novel evidence about the relative efficacy of using a smartphone-delivered MI intervention and real-time messaging to address triggers for hazardous alcohol use and sexual risk behaviors. The EMI approach, which incorporates location-based preventive messaging and behavior surveys, may help to better understand the complexity of daily stressors among SMMT individuals and their impact on hazardous alcohol use and HIV risk behaviors. The tailoring of this intervention toward SMMT individuals helps to address their underrepresentation in existing alcohol use research and will be promising for informing where structural alcohol use prevention and treatment interventions are needed to support SMMT individuals. ClinicalTrials.gov NCT05576350; https://www.clinicaltrials.gov/study/NCT05576350. PRR1-10.2196/55166.

Genetic, lifestyle and metabolic factors contributing to cardiovascular disease in the Italian population: a literature review.

Cardiovascular diseases (CVD) represent a major health problem worldwide. In Italy, despite the decline in CVD mortality and disability-adjusted life years recently observed, CVD remains the leading cause of death. The development of CVD has a complex and multifactorial etiology that involves environmental, lifestyle/behavioral (e.g., unhealthy diet, physical inactivity, smoking, and alcohol abuse), metabolic, and genetic factors. Although a large number of CVD susceptibility genetic variants have been identified, some seem to confer risk according to the genetic background or ethnicity of the population. Some CVD-associated polymorphisms with appreciable frequency in the Italian population may be important contributors to the development and progression of the most prevalent CVD in the population. This literature review aims to provide an overview of the epidemiology of CVD in Italy, as well as to highlight the main genetic, lifestyle/behavioral, and metabolic factors contributing to CVD risk in this population.

Interpretation of refusal to use contraceptive methods in university students through systematic literature review

The interpretation of the refusal to use contraceptive methods in university students is important because it helps to understand the beliefs, attitudes and behaviors regarding sexual and reproductive health in this demographic group, and also allows the identification of possible cultural, educational or access barriers that may be affecting decision making related to the use of contraceptives. The objective of this systematic review was to analyze the causes of refusal to use contraceptive methods in university students based on a systematic literature review. For the development of the research, a search of electronic documents was carried out in databases such as PubMed, Scopus, Medline and Embase. Fourteen scientific articles were selected by applying the PRISMA 2020 guidelines, using descriptors such as: ("level of knowledge about contraceptive methods" OR "refusal to use contraceptive methods") AND ("University students") and an evaluation of the quality of the articles based on the use of the STROBE guidelines. The results reflected that most studies agree that students are knowledgeable about contraceptive methods, but do not use contraceptives for the most part. The main causes of refusal are related to inappropriate sexual behaviors, alcohol and drug abuse, early age of sexual debut, gender stereotypes, religion, lack of family counseling, and misuse of contraceptives. Currently, the education and training of students is a key factor in the prevention of unwanted pregnancies and sexually transmitted diseases

Treating drunk driving: Burmese refugees’ alcohol misuse and its implications for social work practice and education

ABSTRACT An alarming number of DUI/DWI arrests of Burmese refugees stirred public concerns in a Midwestern city. Unfortunately, the community’s responses to the crisis came to an end after years of effort to make a change. The study seeks to explain why this occurred and uses this case to reflect on refugee research and social work practice. This article analyzes how the ineffectiveness in three social institutions – the criminal justice system, the mental health care system, and Burmese churches – led to the failure to correct alcohol misuse behavior among the Burmese. Burmese offenders’ language barriers and unfamiliarity with the criminal justice system led to their quick conviction. Once entering court-ordered therapy, their cultural differences in perceiving mental illness and their lack of language proficiency minimized the intended benefit of alcohol addiction treatment. Furthermore, Burmese pastors normalized drinking as part of Burmese culture, which underestimates the indication of excessive drinking for potential mental health issues. Drawing from the findings, the article discusses the impact of excessive drinking on refugees’ social integration and the implications for social work practice and education.

A qualitative study of military service members undergoing medical separation.

Little research explores military perspectives on medical disability-related transition. A qualitative study sought to understand transition experiences of United States military Service members found unfit for duty following medical and physical evaluation boards (MEBs and PEBs). Confidential telephone interviews were conducted with 25 current and prior Service members. Participants were asked to share their experiences before, during, and after the MEB and PEB processes. Interview questions explored (1) health conditions that prompted the medical disability evaluation, (2) reactions to being recommended for separation, (3) transition-related stress and challenges, and (4) coping strategies. Salient themes were identified across chronological narratives. Participants expressed that debilitating physical (e.g., injury) and/or mental (e.g., post-traumatic stress disorder) illnesses prompted their medical evaluation. In response to the unfit for duty notice, some participants reported emotional distress (e.g., anxiety, anger) connected to uncertainty about the future. Other participants reported relief connected to a sense of progression toward their medical disability claim status. Transition stress included the length of the MEB/PEB process, impact of the COVID-19 pandemic on the process, financial stress, impact on family life, and compounded effect of these stressors on emotional distress, including depression and suicidal thoughts. Participants reported using adaptive (e.g., psychotherapy) and maladaptive (e.g., excessive drinking) strategies to cope with stress. Preliminary reports of emotional distress and transition stress following unfit for duty notices highlight the need for increased support and interventions to facilitate adaptive coping strategies during this vulnerable period.