Alcohol and alcoholism最新文献

Aims and methods: Hazardous alcohol use poses an increasing public health issue worldwide and it manifests as excessive consumption (acute or chronic), which may lead to addiction. The risk of alcohol-related pathologies correlates with the patterns of intake and increases with the amount of alcohol consumed. While the effects of alcohol consumption on ischemic stroke and ischemic heart disease are well documented, the impact on venous thromboembolism is less clear. Conflicting studies have reported that alcohol may be a risk factor for, or have a protective role against venous thromboembolism. Our narrative review aimed to assess the risk of unusual-site venous thrombosis in individuals with hazardous alcohol use, as it may stem from alcohol-related organ damage (e.g. liver cirrhosis, pancreatitis) as well as provide some suggestions for physicians.

Results: There appears to be a correlation between hazardous alcohol use and unusual-site thrombosis, though the underlying mechanisms are largely still unknown.

Conclusion: In subjects with hazardous alcohol use complicated by alcohol-related organ damage, physicians should be vigilant for potential thrombotic symptoms, and be prepared to diagnose and promptly initiate appropriate anticoagulation therapy.

Background: It seems that diet is one of the main triggers of migraine; one of the most studied is alcohol, and also, over the years, red wine has been shown to trigger headaches. Therefore, this systematic review and meta-analysis aims to examine the strength of the association between wine consumption and migraine.

Methods: In this systematic review and meta-analysis, a search of MEDLINE (via PubMed), Scopus, Cochrane, and Web of Science databases was conducted to assess the association between wine consumption and migraine, covering baseline to December 2023. Pooled Odds Ratio (p-OR) were calculated using the DerSimonian and Laird methods. This study was previously registered in PROSPERO (CRD42024511115). The risk of bias was evaluated using The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results: Five studies were included in this systematic review, and only four of them were in the meta-analysis. Using the DerSimonian and Laird method, the p-OR for the effect of wine consumption on migraine was 0.63 (95% CI 0.36-1.09). The included studies after the risk of bias assessment showed a moderate risk of bias.

Conclusions: The findings of this systematic review and meta-analysis indicate that there is no conclusive evidence to support an increased or decreased risk of migraine associated with wine consumption.

Aims: This study aimed to evaluate national alcohol sales and their association with the number of maxillofacial fractures in Southern Finland.

Methods: Patient data of all facial fracture patients admitted to tertiary trauma centers (Helsinki University Hospital, Helsinki, Finland) from January 2014 to October 2020 were reviewed retrospectively. Information on alcohol sales in Finland was obtained from the Finnish Institute for Health and Welfare.

Results: The annual number of facial fractures increased, as did the number of facial fractures caused by interpersonal violence. Unexpectedly, we found a mostly inverse association between alcohol sales and facial fractures, although three months were associated positively: April, June, and November.

Conclusion: We conclude that although the significance of alcohol use in the etymology of facial fractures has been unmistakably proven neither population-level alcohol use nor interpersonal violence as an injury mechanism explains the increase in facial fractures. However, there are some associations between the seasonality of alcohol consumption and facial fractures, suggesting the same predisposing factors in both. Further, certain groups of users, exceeding a threshold of alcohol use, appear to be responsible for the traumatic presentations in emergency units. Elucidating the associations between alcohol use and facial fractures requires an assessment of patient-specific factors, rather than population-level alcohol use, for a detailed understanding and justification of alcohol policy.

Aims: We evaluated the safety, efficacy, and patient adherence to oral ANS-6637, a selective, reversible inhibitor of aldehyde dehydrogenase 2 (ALDH2), for treating alcohol use disorder (AUD).

Methods: A 3-arm, double-blind, randomized, proof-of-concept human laboratory study embedded in a 5-week multisite clinical trial tested 200 mg and 600 mg daily doses of ANS-6637 compared to placebo in treatment-seeking adults with AUD. After 1 week of medication, participants completed an alcohol cue reactivity session. Drinking and safety assessments were measured during treatment; other exploratory outcomes were measured 1 week after treatment ended.

Results: The study was terminated following enrollment of 43 of 81 planned participants due to clinically significant, reversible increases in liver enzymes in three women. Adverse events consistent with ALDH2 inhibition in the presence of alcohol (heart rate/palpitations, flushing, nausea) were dose dependent. Group differences in cue-elicited craving were not significant; effect sizes (Cohen's d) comparing the 200 mg and 600 mg doses to placebo were .71 and .06, respectively. Secondary endpoints did not differ significantly between groups; Cohen's d ranged from .31 to .57 for the 600 mg dose compared to placebo for continuous drinking outcomes.

Conclusions: Findings of liver toxicity with ANS-6637 led to early termination and reduced power to test hypotheses. Effect size estimates are consistent with the hypothesis that selective ALDH2 inhibition may reduce craving and drinking, however these estimates may be unreliable due to the small sample size. Additional research with non-hepatotoxic selective and reversible ALDH2 inhibitors is needed to evaluate this approach to AUD pharmacotherapy.

Background and aims: Alcohol-associated hepatitis (AH) frequently triggers acute decompensation (AD) in cirrhosis, with severe AH linked to high short-term mortality, especially in acute-on-chronic liver failure. Current corticosteroid treatments have limited efficacy, highlighting the need for new therapies. We hypothesized that severe AH outcomes are influenced by early specialized care; thus, we examined the impact of time-to-tertiary care (TTTc).

Methods: Adults with cirrhosis or advanced chronic liver disease were enrolled (RH7, NCT04767945). AH was diagnosed using National Institute on Alcohol Abuse and Alcoholism criteria. Primary admission site, TTTc, and adverse outcomes (death or liver transplantation) were analyzed. Patients admitted directly to tertiary care were assigned a TTTc of zero.

Results: Of 221 AD-AH patients, 107 were transferred from secondary care to tertiary care (TTTc >0) and 114 were admitted directly (TTTc = 0). TTTc >0 patients were younger (48.3 vs. 52 years, P = .008) and had more severe disease, as shown by model for end-stage liver disease scores (25.5 vs. 20.8, P < .001) and Maddrey's discriminant function (59.3 vs. 40.6, P < .001). Propensity-score matching yielded 49 case pairs. The Cox model showed that transfer from secondary care was not associated with increased risk, but delayed transfer (days, hazard ratio = 1.03, 95% confidence interval 1.01-1.05) independently predicted adverse outcomes.

Conclusions: Delayed initiation of specialized care adversely impacts outcomes in AD-AH. If validated, timely care bundles could improve AH survival, similar to sepsis or vascular syndromes.

Highlights: AD-AH is a common syndrome associated with high short-term mortality. There is an unmet need for new prognosis-modifying therapies for AH. Currently, in real-life hepatology, refining the existing bundle of care is the only practical option to improve the prognosis of AD-AH. Past experience with acute coronary syndromes, stroke, and sepsis, emphasizing symptoms-to-intervention duration, combined with the recent COVID-19 lockdown finding of increased mortality due to skewed access to specialized liver care indicates that focusing on timely specialized care might be key to improved outcome in certain liver conditions. In this line, we set out to track the number of days elapsing between admission to SC and referral to TC, coining this interval as "time-to-tertiary care" (TTTc). We examined TTTc as a potential compound surrogate that might influence the prognosis in AD-AH. After correcting for important baseline differences, we conclude that the delay of transfer to the tertiary care hospital was independently associated with a worse prognosis with each additional day in TTTc increasing adverse outcomes by nearly 3%.

The study aimed to summarise the evidence of the association between preoperative alcohol consumption and postoperative complications in gastrointestinal surgeries. Comprehensive searches of MEDLINE, EMBASE, and Cochrane databases were undertaken to identify original studies investigating the association between preoperative alcohol consumption and postoperative complications occurring within 30 days of surgery. The primary outcome was 30-day mortality risk and secondary outcomes included postoperative complications such as surgical site infections and risk of anastomotic leak. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random effects model. In total, 3601 reports were identified and reviewed for eligibility, then data was extracted from 26 studies that met inclusion criteria. 13 studies were included in the meta-analysis. The total number of patients in the meta-analysis was 686 181 including 20 163 with a high alcohol intake. Clearly defined high preoperative alcohol consumption was associated with an increased risk of postoperative complications including 30-day mortality (OR = 1.56; 95% CI: 1.07-2.28). The risk of anastomotic leak was significantly increased in those undergoing colorectal surgery with a high alcohol intake, OR 2.17 (95% CI: 1.74-2.72). An increase in risk was also found for surgical site infections in those undergoing gastrointestinal surgery with high alcohol intake. (OR = 1.32; 95% CI: 1.15-1.53). Preoperative alcohol consumption was associated with an increased risk of 30-day mortality, anastomotic leak and surgical site infections. Preoperative modulation of alcohol intake may influence post-operative complications after gastrointestinal surgery.

Alcohol use disorder has adverse implications for individuals' health, utilisation of healthcare services, and societal costs. There are a group of individuals who frequently attend hospital for alcohol-related issues, have complex co-morbid needs, and experience barriers to engaging with specialised alcohol treatment services. To support these individuals and reduce healthcare system costs, Alcohol Assertive Outreach Treatment (AAOT) has been recommended. However, AAOT is not routinely used in the UK. Understanding the determinants of the implementation of AAOT can increase its utilisation and effectiveness. This study therefore employed the Consolidated Framework for Implementation Research (CFIR) framework to highlight barriers and facilitators to the successful and sustainable implementation of AAOT. Semi-structured interviews were conducted with twenty AAOT team staff members (team managers and outreach workers) from two North West England AAOT teams. Twenty-eight stakeholders (clinicians, commissioners, policy makers and academics across England) were also interviewed, who were considered to be key contributors to AAOT implementation, both within and external to North West England. Framework analysis based on the CFIR was conducted, whilst allowing for inductive coding where appropriate. Overall, participants recognised AAOT as acceptable and beneficial. Three main themes were identified: organisational and individual level factors, including team culture and staff characteristics; systemic partnerships and interagency communication; and an adaptable model driven by research and evaluation. Each theme relates to various CFIR domains and constructs which were perceived to influence the implementation of AAOT. Readers are encouraged to consider the findings in the development and implementation of AAOT teams, new or existing.

Aims: Structured clinical interviewing is considered the gold standard in psychiatric diagnosis. The Diagnostic Assessment Research Tool (DART) is a novel modularized, non-copywritten, semi-structured interview; however, no studies have examined the psychometric properties of its alcohol use disorder (AUD) module. The primary aims of this study were to: (i) validate the factor structure of the DART AUD module and (ii) examine measurement invariance across several key demographic and subgroup factors.

Methods: Participants were community members in Hamilton, Canada and Boston, USA who self-identified as making a significant AUD recovery attempt (N = 499). Internal reliability was examined via the Kuder-Richardson 20 statistic, and correlations between symptom count and drinking quantity/frequency were examined. Then, symptom-level data were included in a confirmatory factor analysis to examine model fit of a single hypothesized factor structure. Finally, measurement invariance analyses were conducted for sex, age, ethnicity (White vs. racialized), and study site.

Results: This study found evidence for adequate internal reliability (rKR20 = 0.75), and symptom scores correlated with drinking quantity and frequency (r = 0.16-0.43). Confirmatory factor analysis results suggested excellent fit for the unidimensional one-factor AUD model (χ2 = 0.09, confirmatory factor index = 0.99, Tucker Lewis index = 0.99, standardized root mean square residual = 0.06, root mean square error of approximation = 0.02). Measurement invariance analyses revealed that the factor structure was equivalent between sex, age, ethnicity, and study site.

Conclusions: Findings provide strong evidence for the psychometric validity of the DART AUD module and support its use in research and clinical practice. The DART represents a credible alternative to other diagnostic interviewing tools for AUD.

Aims: The COVID-19 pandemic increased alcohol consumption in the USA as a result of widespread individual changes in drinking patterns. Few studies have utilized longitudinal data allowing the prediction of increased or decreased drinking from COVID-19 economic, social, and health impacts.

Methods: Data are from 1819 respondents in the 2019-20 National Alcohol Survey and a one-year follow-up in early 2021. Changes in past-year alcohol volume, drinking days, days with 5+ drinks, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alcohol use disorder (AUD) severity were measured as outcomes. Measures of COVID-19 economic, health, and social impacts were assessed for the individual and household. Economic impacts were combined into Self and Household scores. Analyses utilized multinomial logistic regression models to estimate meaningful increases or decreases in outcomes, while generalized estimating equation models estimated overall effects.

Results: Increases in alcohol use and AUD severity were larger and more prevalent than decreases, and differences between sociodemographic groups in the prevalence of meaningful increases and decreases were found. Models of meaningful changes found that higher self-economic impact scores predicted increases in 5+ days and AUD severity. Generalized estimating equation models also found that the self-economic impact score predicted increased AUD severity and additionally that being an essential worker was associated with reductions in alcohol volume and 5+ days.

Conclusions: Substantial changes in drinking and AUD severity were observed, with increases in these outcomes being more prevalent and larger than decreases. Results highlight the importance of the pandemic's economic impacts in predicting changes in drinking and AUD severity.

Aims: Research indicates that shared and specific underlying factors influence different addictions, sometimes resulting in co-occurring problems. The evidence concerning risk and protective factors for gambling and alcohol addiction, along with their co-occurrence, remains ambiguous. To address this gap, this study will conduct longitudinal research to examine the factors associated with at-risk behaviours over time.

Methods: We utilize a sample of 18- to 75-year-old participants (N = 1530) from Finland. Participants were surveyed every six months between 2021 and 2023, covering six rounds of data collection (in total 6650 observations). Measures included the Alcohol Use Disorders Identification Test and the Problem Gambling Severity Index. The analysis used multilevel regression models to investigate risk and protective factors over time.

Results: Based on population-average models, younger age and being a man were associated with all examined dependent variables. Psychological distress, a sense of belonging to family and friends, and belonging to an online community were associated with at-risk gambling. At-risk drinking was associated with education and income, marital status, and the sense of belonging to family and friends. Being in debt enforcement, education, and psychological distress were associated with the co-occurrence of the two addictive behaviours. The fixed effects highlighted the importance of psychological distress in the development of co-occurring gambling and drinking problems.

Conclusion: The findings indicate that partly different sociodemographic and psychosocial factors are important underlying contributors to alcohol and gambling problems. Psychological distress is a particularly crucial factor predicting co-occurring at-risk gambling and drinking, indicating that co-occurrence is accompanied by psychological burden.