Routine Alcohol Research Articles

The utility of alcohol saliva test strips compared to the breathalyzer in trauma patients in a resource-limited setting.

The correlation between alcohol consumption and injury is undeniable. However, past research relying on self-reporting alcohol use likely resulted in underreporting and emphasizing the need to increase alcohol testing, especially in resource-limited settings where the burden of injuries is highest. This is a prospective analysis of injured patients presenting to the trauma center at Kamuzu Central Hospital in Lilongwe, Malawi. We collected information including patient age, sex, admission date, mechanism of injury, breathalyzer test and Rapid ResponseTM Alcohol Saliva Test Strips (AST) result, and survival. A total of 805 trauma patients were included. The overall prevalence of alcohol consumption in this trauma cohort is 18.3%. There was a 95.5% agreement between the AST and breathalyzer test with a Kappa coefficient of 0.83. The sensitivity and specificity of the AST were determined to be 78.5% (CI 75.7-81.2) and 99.3% (CI 98.7-99.9), respectively. ROC analyses showed the AST to have excellent discrimination with an area under the curve of 0.88 (95% CI 0.85-0.92). The prevalence of alcohol-related injury is high in Malawi and the use of the Alcohol Saliva Test Strips is feasible and correlated with results derived from the breathalyzer. Routine alcohol testing for trauma patients presenting to a resource-limited setting is imperative and should be implemented.

Inequities in Alcohol Screening of Primary Care Patients with Chronic Conditions

Routine alcohol screening of people with chronic health conditions that are exacerbated by alcohol can help to prevent morbidity and mortality. The U.S. Affordable Care Act and other recent health reforms expanded insurance coverage and supported alcohol screening in primary care. This study assessed increases in alcohol screening following health reform and insurance-related and racial and ethnic disparities in screening. Data are from the 2013 to 2019 National Surveys on Drug Use and Health for adults with alcohol-related chronic conditions who received primary care in the past year (N=46,014). The outcome was receipt of alcohol screening (yes/no) in which a healthcare provider inquired whether, how often, or how much the respondent drank, or about having alcohol-related problems. Multivariable logistic regression models assessed temporal changes in screening overall and by insurance type and race/ethnicity, adjusting for demographics, health conditions, and primary care utilization. Statistical analysis was performed in 2023. Alcohol screening prevalence rose from 69% to 77% from 2013 through 2019, with a notable increase in 2014-2015 for both Medicaid-insured and privately-insured patients. Black and Asian American patients were generally less likely to be screened than White patients. Importantly, racial disparities in screening were found among privately-insured patients, patients with hypertension, patients with heart disease, and patients with diabetes who drink alcohol. Alcohol screening of primary care patients with chronic conditions increased following health reform, but persistent disparities among patients with private insurance and specific chronic conditions underscore the need to address drivers of unequal preventive care.

Effect of family intervention on relapse rate of Chinese patients with alcohol-dependent.

This study explored the impact of a family intervention on the relapse rate of Chinese patients with alcohol dependence. A total of 151 male patients with alcohol dependence who were discharged from the Substance Dependence Department of the Wenzhou Seventh People's Hospital from January to December 2020 were selected. They were divided into the control (n = 73) and experimental (n = 78) groups. Patients in both groups received routine alcohol cessation treatment. Moreover, patients in the experimental group were followed up by a professional psychiatrist to carry out individual family intervention. The Family Function Rating Scale (FAD), a Self-made general information questionnaire, and the Chinese version of the Family Intimacy and Adaptability Scale (FACESI-CV) were performed. Re-drinking rate and readmission rate were assessed. Family intervention could reduce relapse rate (31, 39.74%) and rehospitalization (27, 34.62%) compared with the control group. After family training, FAD factor scores were improved in the experiment group in comparison with the control group. Family training improved communication (18.2 ± 3.7), role (20.8 ± 2.5), emotional response (10.8 ± 1.8), emotional involvement (13.7 ± 1.2), behavioral control (19.8 ± 1.2), and overall functionality (23.5 ± 2.1) in the experiment group in comparison with the control group. After family training, intimacy (70.5 ± 8.7) and adaptability (64.1 ± 6.9) in the experiment group was higher than in the control group. After family intervention, Michigan Alcohol Dependence Scale (MAST) (9.21 ± 0.68) and Short-Form 36 (SF-36) (80.32 ± 4.47) in the experiment group were higher than the control group. Family intervention for families of patients with alcohol dependence can improve their family function, increase their family intimacy and adaptability, and reduce the rate of relapse.

Assisted Versus Unassisted Domiciliary Alcohol Detoxification: A Randomized Controlled Trial

Background: Detoxification stands as a crucial phase in the treatment of alcohol use disorders (AUD), yet only limited data is available on the outcomes of home-based detoxification. Assisted domiciliary detoxification involves monitoring an individual’s withdrawal progress, while offering psychosocial support and detoxification services in the comfort of their home. Aim: To study outcomes of assisted over routine domiciliary alcohol detoxification in randomized controlled trials. Methodology: 100 consenting male patients who were advised of domiciliary detoxification were randomized into intervention ( n = 49) and control ( n = 51) groups. A predesigned semi-structured questionnaire was used to assess the socio-demographic and drinking-related variables. Both groups received routine care for alcohol withdrawal from respective treating doctors. Additionally, the intervention group received two sessions of brief intervention for alcohol and daily phone call assistance. Records were kept for adverse events. Phone calls were discontinued once detoxification was completed. Outcomes were measured for successful completion of detoxification and abstention from alcohol at the end of one month. Results: The intervention group had significantly higher successful detoxification rates (85.7% vs. 62.7%, p = .008) and significantly higher abstinence days at the end of one month compared to the control group (22 vs. 10 days, p < .001) with an effect size of 1.2 (confidence interval (CI) 0.69–1.53). Conclusion: This study demonstrates that receiving assistance in the acute phase of domiciliary detoxification helps in a successful detoxification and achieving a significant level of abstinence at the end of one month compared to the control group.

The surge of bromazolam-related fatalities replacing other novel designer benzodiazepines-related fatalities in San Francisco.

Bromazolam, a novel designer benzodiazepine (NBD), exhibits potent sedative, hypnotic and anxiolytic effects, raising concerns regarding its potential for misuse and fatal outcomes, particularly when combined with opioids such as fentanyl. Despite limited documented fatalities globally, its use poses a significant threat, exacerbated by under-reporting and a lack of routine testing. This study analysed NBD-related deaths in a major US city over a 4-year period. Analysis of accidental overdose deaths involving NBDs in San Francisco, CA, USA from 2020 to 2023, was performed utilizing medico-legal death investigations including comprehensive forensic toxicology, pathology and demographic information. San Francisco conducts thorough investigations into all non-natural and sudden unexpected deaths, including routine alcohol and drug testing of decedents under its jurisdiction, including etizolam, flualprazolam, flubromazolam and bromazolam analysis. There was a sudden surge in bromazolam-related deaths, with 44 fatalities documented in 2023, contrasting with relatively fewer deaths related to other NBDs. Bromazolam fatalities frequently involved co-ingestion with opioids, primarily fentanyl, and stimulants such as methamphetamine and cocaine. Demographic characteristics indicated a predominance of males, with a significant proportion lacking fixed addresses. Blood concentrations of bromazolam increased during the study period, suggesting heightened availability and/or purity in the community. There was a surge in bromazolam-related deaths during 2023 in San Francisco, CA, USA, contrasting with relatively stable numbers of deaths associated with other NBDs over the preceding years. The findings underscore the urgency for enhanced death investigation, testing and reporting to facilitate targeted harm reduction strategies for individuals at risk of bromazolam-related morbidity and mortality.

Prevalence of alcohol and other drug detections in non-transport injury events.

To measure the prevalence of alcohol and/or other drug (AOD) detections in suspected major trauma patients with non-transport injuries who presented to an adult major trauma centre. This registry-based cohort study examined the prevalence of AOD detections in patients aged ≥18 years who: (i) sustained non-transport injuries; and (ii) met predefined trauma call-out criteria and were therefore managed by an interdisciplinary trauma team between 1 July 2021 and 31 December 2022. Prevalence was measured using routine in-hospital blood alcohol and urine drug screens. A total of 1469 cases met the inclusion criteria. Of cases with a valid blood test (n = 1248, 85.0%), alcohol was detected in 313 (25.1%) patients. Of the 733 (49.9%) cases with urine drug screen results, cannabinoids were most commonly detected (n = 103, 14.1%), followed by benzodiazepines (n = 98, 13.4%), amphetamine-type substances (n = 80, 10.9%), opioids (n = 28, 3.8%) and cocaine (n = 17, 2.3%). Alcohol and/or at least one other drug was detected in 37.4% (n = 472) of cases with either a blood alcohol or urine drug test completed (n = 1263, 86.0%). Multiple substances were detected in 16.6% (n = 119) of cases with both blood alcohol and urine drug screens (n = 718, 48.9%). Detections were prevalent in cases of interpersonal violence (n = 123/179, 68.7%) and intentional self-harm (n = 50/106, 47.2%), and in those occurring on Friday and Saturday nights (n = 118/191, 61.8%). AOD detections were common in trauma patients with non-transport injury causes. Population-level surveillance is needed to inform prevention strategies that address AOD use as a significant risk factor for serious injury.

Biases in the collection of blood alcohol data for adult major trauma patients in Victoria, Australia

BackgroundIn-hospital alcohol testing provides an opportunity to implement prevention strategies for patients with high risk of experiencing repeated alcohol-related injuries. However, barriers to alcohol testing in emergency settings can prevent...

Effect of Jinlida granule on glycolipid metabolism, oxidative stress, and inflammatory factors in type 2 diabetes mellitus patients with non alcoholic fatty liver disease

Purpose: To investigate the effect of Jinlida granule on glycolipid metabolism, oxidative stress, and inflammatory factors in type 2 diabetes mellitus (T2DM) patients with non-alcoholic fatty liver disease (NAFLD). Methods: A total of 132 T2DM patients with NAFLD were equally and randomly divided into study and control groups. Patients in the control group were treated with non-drug therapy including routine diet control, exercise, alcohol avoidance, and drug therapy (using blood glucose and lipid lowering drugs). The study group was treated with Jinlida granule in addition to other measures used in the control group. Blood glucose, blood lipid, and liver function parameters were compared after treatment. Nesfatin-1, oxidative stress, inflammatory factors, liver fat content, and degree of fibrosis were assessed. The efficacy and potential mechanism of Jinlida granule in the patients were assessed. Results: Blood glucose, lipid, and liver function parameters in the study group were lower than in the control group following treatment. Nesfatin-1, GSH-Px, and adiponectin levels were higher, while MDA, TNF-α, liver fat, LSM and CAP levels were lower than in the control group (p < 0.05). The response rate of the study group was 96.97 %, which was higher than the 87.88 % in the control group (p < 0.05). The incidence of adverse drug reactions in the two groups during treatment was comparable (p > 0.05). Conclusion: Jinlida granule exerts positive effect on T2DM patients with NAFLD. Thus, Jinlida granule has potentials for application as an adjuvant in the treatment of T2DM with NAFLD.

The Efficacy of the Bees Honey as Alternative for Routine Ethyl Alcohol in Cytological Fixation: Cross_ Sectional Study

The Efficacy of the Bees Honey as Alternative for Routine Ethyl Alcohol in Cytological Fixation: Cross_ Sectional Study

Efficacy of machine learning to identify clinical factors influencing levothyroxine dosage after total thyroidectomy

BackgroundWe employed Machine Learning (ML) to evaluate potential additional clinical factors influencing replacement dosage requirements of levothyroxine. MethodThis was a retrospective study of patients who underwent total or completion thyroidectomy with benign pathology. Patients who achieved an euthyroid state were included in three different ML models. ResultsOf the 487 patients included, mean age was 54.1 ± 14.1 years, 86.0% were females, 39.0% were White, 53.0% Black, 2.7% Hispanic, 1.4% Asian, and 3.9% Other. The Extreme Gradient Boosting (XGBoost) model achieved the highest accuracy at 61.0% in predicting adequate dosage compared to 47.0% based on 1.6 mcg/kg/day (p < 0.05). The Poisson regression indicated non-Caucasian race (p < 0.05), routine alcohol use (estimate = 0.03, p = 0.02), and osteoarthritis (estimate = −0.10, p < 0.001) in addition to known factors such as age (estimate = −0.003, p < 0.001), sex (female, estimate = −0.06, p < 0.001), and weight (estimate = 0.01, p < 0.001) were associated with the dosing of levothyroxine. ConclusionsAlong with weight, sex, age, and BMI, ML algorithms indicated that race, ethnicity, lifestyle and comorbidity factors also may impact levothyroxine dosing in post-thyroidectomy patients with benign conditions.

The Effects of Citalopram and Thalamic Dopamine D2/3 Receptor Availability on Decision-Making and Loss Aversion in Alcohol Dependence.

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for patients who misuse alcohol, especially in the context of comorbid depressive symptoms. Deficits in impulse control and decision-making are linked to routine alcohol consumption and alcohol dependence. The goal of this study was to determine the effects of a single dose of citalopram on measures of impulsivity, decision-making, and/or brain dopamine receptor availability in alcohol-dependent individuals. A double-blind, placebo-controlled, within-subject, outpatient study was conducted with active alcohol-dependent (DSM-IV-TR criteria) participants (n = 12) and matched healthy controls (n = 13). Serial doses of both citalopram (40 mg) and saline were administered intravenously before laboratory tests of decision-making (Balloon Analogue Risk Task, delay discounting task, and Loss Aversion Gambling Task) and positron emission tomography with [18F]-fallypride to measure dopamine D2/3 receptor availability, separated by at least one week. Alcohol-dependent participants demonstrated greater loss aversion than healthy controls, but there were no group differences in risk taking on the Balloon Analogue Risk Task. Citalopram increased delay discounting across groups, with no group difference in the effect. There were no effects of citalopram on risk taking on the Balloon Analogue Risk Task. PET showed a negative correlation between thalamic dopamine D2/3 receptor availability and loss aversion across groups. The effect of citalopram to decrease the valuation of monetary reward as a function of delay raises the possibility that SSRIs can influence risky decision-making in clinical populations. In addition, these results suggest that altered thalamic dopamine signaling may play an important role in disproportionately valuing losses in patients with Alcohol Use Disorder. This trial is registered under ClinicalTrials.gov registration NCT01657760.

New perspectives for hypertension management: progress in methodological and technological developments.

Hypertension is the most common and preventable risk factor for cardiovascular disease (CVD), accounting for 20% of deaths worldwide. However, 2/3 of people with hypertension are undiagnosed, untreated, or under treated. A multi-pronged approach is needed to improve hypertension management. Elevated blood pressure (BP) in childhood is a predictor of hypertension and CVD in adulthood; therefore, screening and education programmes should start early and continue throughout the lifespan. Home BP monitoring can be used to engage patients and improve BP control rates. Progress in imaging technology allows for the detection of preclinical disease, which may help identify patients who are at greatest risk of CV events. There is a need to optimize the use of current BP control strategies including lifestyle modifications, antihypertensive agents, and devices. Reducing the complexity of pharmacological therapy using single-pill combinations can improve patient adherence and BP control and may reduce physician inertia. Other strategies that can improve patient adherence include education and reassurance to address misconceptions, engaging patients in management decisions, and using digital tools. Strategies to improve physician therapeutic inertia, such as reminders, education, physician-peer visits, and task-sharing may improve BP control rates. Digital health technologies, such as telemonitoring, wearables, and other mobile health platforms, are becoming frequently adopted tools in hypertension management, particularly those that have undergone regulatory approval. Finally, to fight the consequences of hypertension on a global scale, healthcare system approaches to cardiovascular risk factor management are needed. Government policies should promote routine BP screening, salt-, sugar-, and alcohol reduction programmes, encourage physical activity, and target obesity control.

Simple and simultaneous quantification of cyanide, ethanol, and 1-propanol in blood by headspace GC–MS/NPD with a Deans switch

This study aimed to develop a method to simultaneously quantify cyanide, ethanol, and 1-propanol in blood using headspace gas chromatography–mass spectrometry/nitrogen-phosphorus detection (HS–GC–MS/NPD) with a Deans switch. Cyanide is a powerful and rapidly acting poison. However, routine cyanide testing can be costly and time-consuming, given that cyanide poisoning rarely occurs in Japan. Therefore, we attempted to combine cyanide and routine alcohol (ethanol and 1-propanol) testing using HS–GC–MS/NPD with a Deans switch. 1-Propanol can be used as an indicator of putrefaction. NPD is advantageous over MS in terms of sensitivity for cyanide detection, and the Deans switch allows for switching between two detectors in a single run. Three analytical columns with different characteristics were investigated to achieve adequate separation. In addition, we verified whether 18 other volatile compounds could be simultaneously detected using this system. The following instruments were used: 7697A headspace sampler, 7890A GC, 5975 C MS, and NPD via a Deans switch (Agilent Technologies); Columns: PoraBOND Q (25 m × 0.25 mm × 3 μm), CP-Sil 5 CB (25 m × 0.25 mm × 1.2 μm), and HP-INNOWax (30 m × 0.25 mm × 0.5 μm). For sample preparation, whole blood (0.1 mL) was placed into a 10-mL headspace vial, and 50 μL of internal standard (IS) mixture (4 μg/mL propionitrile for cyanide, and 1 mg/mL ethanol-d6 for ethanol and 1-propanol) and 20 μL of 0.5-M ascorbic acid were added. After capping, 21.25% phosphoric acid (0.1 mL) was added to the vial using a syringe. The vial was incubated at 60 °C for 20 min, and 1 mL of the headspace was automatically injected into the GC–MS/NPD system. The target compounds were cyanide, ethanol, 1-propanol, sulfide, azide, 1,1-difluoroethane, methanol, acetaldehyde, acetone, butane, isobutane, pentane, hexane, heptane, octane, nonane, chloroform, benzene, toluene, ρ-xylene, and styrene. Among the three columns investigated, PoraBOND Q achieved the most effective separation, and its sensitivity was equal to or greater than that of the other columns for all compounds, except hydrogen azide; therefore, PoraBOND Q was selected. After selecting the analytical column, the switching times of the Deans switch were determined. All 23 compounds, including the IS, were successfully detected. The calibration curves for cyanide, ethanol, and 1-propanol were linear, and their R2 values were >0.999. The intra- and inter-day accuracy and precision were <15%. Forensic laboratories must conduct several blood examinations, including biochemical test, alcohol test, and drug screening. However, obtaining a sufficient amount of blood during an autopsy can be occasionally challenging. This method allows simultaneous quantification of cyanide, ethanol, and 1-propanol in a single run with a small amount of blood (0.1 mL). In this method, a chief feature is that only the part where hydrogen cyanide or propionitrile (IS) appeared was cut into NPD, improving sensitivity to cyanide. Although the Deans switch chooses one of two detectors, sufficient separation achieved using the PoraBOND Q column enabled the detection of all target compounds in this system. A simple and simultaneous quantification method for cyanide, ethanol, and 1-propanol in blood was developed using headspace GC–MS/NPD with a Deans Switch. This method could also detect 18 other volatile compounds. Therefore, this method could be valuable for the routine analysis of volatile compounds in forensic practice.

Predicting severe alcohol use disorders in primary care using number of heavy drinking days.

Although screening for unhealthy alcohol use is becoming more common, severe alcohol use disorders (AUDs) associated with the most severe medical and socio-economic sequelae still often go unidentified in primary care. To improve identification of severe AUDs and aid clinical decision-making, we aimed to identify a threshold of heavy drinking days (HDDs) associated with severe AUDs. This cohort study analyzed electronic health record data of 138 765 adults who reported ≥ 1 HDD (4+ drinks/occasion for women and men aged ≥ 65 years, 5+ for men aged 18-64 years) during a 3-month period at a routine alcohol screening in primary care in a large Northern California, USA health-care system from 2014 to 2017. Our sample was 66.5% male, 59.7% white, 11.0% Asian/Pacific Islander, 5.0% black, 17.4% Latino/Hispanic and 7.0% other/unknown race/ethnicity; the mean age was 40.6years (standard deviation = 15.2). We compared sensitivity and specificity of different thresholds of the reported number of HDDs during a 3-month period for predicting severe AUD diagnoses in the following year, in the full sample and by sex and age. The prevalence of severe AUD diagnoses in the year after the screening was 0.6%. The optimal threshold predicting future severe AUD diagnoses in the full sample was ≥ 5 HDDs during a 3-month period [sensitivity = 68.9%, 95% confidence interval (CI) = 65.9, 72.0; specificity = 63.2%, 95% CI = 62.9, 63.4], but varied by sex and age. Women had a lower threshold than men (4 versus 6 HDDs), which decreased as women aged (from 5 HDDs among 18-24 years to 4 HDDs ≥ 25 years), but increased as men aged (from 5 HDDs among 18-24 years to 6 HDDs among 25-64 years, to 7 HDDs ≥ 65 years). Five or more heavy drinking days in a 3-month period may indicate heightened risk of future severe alcohol use disorder in an adult primary care population. The optimal thresholds are lower for women than for men, and thresholds decrease as women age but increase as men age.

Estimating and Testing Causal Mediation Effects in Single-Case Experimental Designs Using State-Space Modeling.

In this article, we present single-case causal mediation analysis as the application of causal mediation analysis to data collected within a single-case experiment. This method combines the focus on the individual with the focus on mechanisms of change, rendering it a promising approach for both mediation and single-case researchers. For this purpose, we propose a new method based on time-discrete state-space modeling to estimate the direct and indirect treatment effects. We demonstrate how to estimate the model for a single-case experiment on stress and craving in a routine alcohol consumer before and after an imposed period of abstinence. Furthermore, we present a simulation study that examines the estimation and testing of the standardized indirect effect. All parameters used to generate the data were recovered with acceptable precision. We use maximum likelihood and permutation procedures to calculate p-values and standard errors of the parameters estimates. The new method is promising for testing mediated effects in single-case experimental designs. We further discuss limitations of the new method with respect to causal inference, as well as more technical concerns, such as the choice of the time lags between the measurements.

Liver Mass: Thinking Out of the Box

Question: A 52-year-old Hispanic man with obesity (body mass index 30 kg/m2) and hypertension on amlodipine presented with abdominal pain, hematemesis, and melena. Patient reported routine alcohol consumption of 2–3 beers per day for 30 years, but was never a smoker. He denied any personal or family history of chronic liver disease, cirrhosis, or malignancy. On examination, jaundice, scleral icterus, and abdominal distension without tenderness were present. Laboratory studies revealed increased aspartate transaminase of 151 U/L, alanine aminotransferases of 40 U/L, alkaline phosphatase of 729 U/L, total bilirubin of 4.5 mg/dL, and prothrombin international normalized ratio of 1.4.

Comparison of routine blood alcohol tests and ICD-10-AM coding of alcohol involvement for major trauma patients.

Alcohol use is a key preventable risk factor for serious injury. To effectively prevent alcohol-related injuries, we rely on the accurate surveillance of alcohol involvement in injury events. This often involves the use of administrative data, such as International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding. To evaluate the completeness and accuracy of using administrative coding for the surveillance of alcohol involvement in major trauma injury events by comparing patient blood alcohol concentration (BAC) with ICD-10-AM coding. This retrospective cohort study examined 2918 injury patients aged ≥18 years who presented to a major trauma centre in Victoria, Australia, over a 2-year period, of which 78% (n = 2286) had BAC data available. While 15% of patients had a non-zero BAC, only 4% had an ICD-10-AM code suggesting acute alcohol involvement. The agreement between blood alcohol test results and ICD-10-AM coding of acute alcohol involvement was fair (κ = 0.33, 95% confidence interval: 0.27-0.38). Of the 341 patients with a non-zero BAC, 82 (24.0%) had ICD-10-AM codes related to acute alcohol involvement. Supplementary factors Y90 Evidence of alcohol involvement determined by blood alcohol level codes, which specifically describe patient BAC, were assigned to just 29% of eligible patients with a non-zero BAC. ICD-10-AM coding underestimated the proportion of alcohol-related injuries compared to patient BAC. Given the current role of administrative data in the surveillance of alcohol-related injuries, these findings may have significant implications for the implementation of cost-effective strategies for preventing alcohol-related injuries.

Public perceptions of how alcohol consumption is dealt with in Swedish and Norwegian health care.

Aims:The aims of this study were to evaluate and compare popular beliefs and attitudes regarding alcohol conversations in healthcare in Sweden and Norway; and to explore which factors were associated with different levels of support for alcohol-prevention work in the two countries.Methods:Population-based cross-sectional surveys were conducted in Sweden (n = 3000) and Norway (n = 1208). Logistic regression was used to identify the characteristics of participants who were supportive of routine alcohol screening and brief intervention delivery.Results:A higher proportion of Swedish respondents agreed to a large extent that healthcare professionals should routinely ask about alcohol consumption. In addition, a higher proportion of Swedish respondents compared to respondents from Norway agreed that healthcare providers should only ask about patient’s alcohol consumption if this was related to specific symptoms. There were similar correlates of being supportive of routine alcohol screening and brief intervention delivery in both countries. Support was lower in both countries amongst moderate and risky drinkers, and among single adults or those on parental leave, but higher amongst older individuals. Having had an alcohol conversation in healthcare increased the level of support for alcohol prevention in routine healthcare among risky drinkers.Conclusions:There is a high level of support for preventative alcohol conversations in routine healthcare in Norway and Sweden, although there was a lower proportion of respondents who were positive to alcohol prevention in routine healthcare in Norway compared to Sweden. Experiencing alcohol conversation may positively affect risky drinkers’ attitudes towards and support for alcohol prevention. Thus, more frequent alcohol conversations in routine healthcare may also result in increased level of support for alcohol prevention among risky drinkers.

Does Advice Based on Biomarkers of Liver Injury or Non-Invasive Tests of Liver Fibrosis Impact High-Risk Drinking Behaviour: A Systematic Review With Meta-analysis.

Alcohol dependence affects over 240 million people worldwide and attributed to 3 million deaths annually. Early identification and intervention are key to prevent harm. We aim to systematically review literature on the effectiveness of adding advice based on biomarkers of liver injury or non-invasive tests of liver fibrosis (intervention-based advice) to prevent alcohol misuse. Electronic search was conducted on Ovid Medline, PubMed, EMBASE, Psychinfo and CINAHL for articles published up to end of February 2020. Additionally, we searched study citations, Scopus, Ethos and Clinical trials. The primary outcome measure was changed in self-reported alcohol consumption analysed by random-effects meta-analysis. Secondary outcomes included change to liver blood markers and alcohol-related health outcomes. Fourteen randomized controlled trials (RCTs) and two observational studies comprising n=3763 participants were included. Meta-analyses showed a greater reduction in alcohol consumption and liver biomarkers for the intervention compared to control group: mean difference for weekly alcohol intake was -74.4 g/week (95% confidence interval (CI) -126.1, -22.6, P=0.005) and mean difference for gamma-glutamyl transferase (GGT) -19.7IU/l (95% CI -33.1, -6.4, P=0.004). There was a higher incidence of alcohol-attributed mortality, number of days spent in the hospital, physician visits and sickness absence in the non-intervention group. The quality of the included studies was moderate for RCTs and high for observational studies. The review confirmed a significant association between the addition of intervention-based advice in routine care to the reduction of harmful alcohol consumption, GGT and alcohol-related mortality. The findings support the inclusion of this type of advice in routine alcohol care.

The Effects of Alcohol Consumption on Cardiometabolic Health Outcomes Following Weight Loss in Premenopausal Women with Obesity: A Pilot Randomized Controlled Trial.

Alcohol (i.e., ethanol) is consumed regularly by much of the adult population; yet, the health effects associated with its use are not well-characterized. Clinical interventions to investigate the effects of moderate alcohol consumption on metabolic outcomes, including adiposity and cardiovascular risk factors, are limited and have yielded conflicting data. In addition, no study has reported the effects of routine alcohol intake during weight loss in a controlled feeding trial. We present the first randomized controlled pilot trial to investigate the effects of moderate alcohol consumption on metabolic outcomes during weight loss in women with obesity. Both groups consumed 30% energy restricted diets and were randomized to either an ethanol-free control (CTL) group or a group (EtOH) that consumed 35 g ethanol daily for eight weeks. Our findings demonstrate that, despite similar weight loss, the decrease in mean arterial pressure was attenuated in the EtOH group, relative to the CTL group (p = 0.02). In addition, decreases in other outcomes, including visceral adipose tissue (p = 0.23), circulating lipids (triglycerides (p = 0.11) and cholesterol (p = 0.11)), and uric acid (p = 0.07) tended to be attenuated with alcohol consumption. These pilot data provide potential evidence that moderate alcohol consumption may mitigate the beneficial effects of weight loss and support the need for larger Randomized Controlled Trials (RCTs) to better investigate the metabolic effects of moderate alcohol intake in humans.