Alcohol and alcoholism最新文献

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%.

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.

Aims: Excessive alcohol use is associated with an increased risk of cognitive impairment. Since increased amyloid plaque burden exacerbates cognitive decline, we sought to assess the potential impact of alcohol use disorder (AUD) on cognition, memory, and amyloid burden corresponding with age.

Methods: We conducted the retrospective analysis with 6036 subjects, including 269 AUD+ subjects. A four-item CAGE (C-Cutting Down, A-Annoyance by Criticism, G-Guilty Feeling, E-Eye-openers) alcohol questionnaire was given during the recruitment to determine AUD in each participant. We assessed cognitive function, focusing on memory using neuropsychological testing. For 1038 participants, including 57 AUD+ subjects, we measured amyloid burden using the 11C Pittsburgh Compound B tracer-based positron emission tomography imaging.

Results: AUD+ was significantly associated with lower scores of cognition and memory function relative to AUD- individuals. No significant association was found with AUD and elevated brain amyloid under the age of 65. However, further analysis showed that those aged ≥65 showed greater odds for abnormal amyloid in AUD+ compared to AUD- participants.

Conclusions: Our results underscore AUD as a risk factor for cognitive decline and diminished memory, particularly in aging populations. The role of AUD in brain amyloid accumulation requires further study.

In an analytical sample of 462 UK-based trans and non-binary respondents to a co-produced survey, 23.2% reported drinking with a higher risk of dependence (AUDIT scores ≥16), and 26.2% reported that they mostly drank at home alone. Pre-drinking and drinking mostly at home alone were associated with high-risk drinking and may be appropriate behaviours to address in harm reduction interventions.

Aims: People often drink alcohol and use other substances concurrently, increasing the risk of adverse health outcomes. Our aims were to: (i) assess temporal trends in tobacco and/or cannabis use by varying alcohol consumption levels and (ii) identify associated factors of polysubstance use in high-risk alcohol users.

Methods: We conducted a repeated cross-sectional study combining 2010-19 U.S. National Survey of Drug Use and Health (NSDUH). Alcohol consumption was categorized as no use, low-risk use, and high-risk use. Outcomes include past-month tobacco and/or cannabis use, nicotine dependence, and/or frequent cannabis use. We employed linear time trends and multivariable logistic regressions.

Results: We included 395 256 participants aged ≥18 years. From 2010 to 2019, the prevalence of tobacco use and nicotine dependence decreased while that of any and frequent cannabis use increased (P < .05). Tobacco use decreased faster in people with low-/high-risk alcohol use than no use (24% and 22% vs. 16%), whereas any cannabis use increased more rapidly in the no use group (155% vs. 77% in low- and 31% increase in high-risk groups). Among those with high-risk alcohol use, Hispanic individuals were less likely to use tobacco, cannabis, and both tobacco and cannabis, while non-Hispanic Black (NH Black) were more likely to use cannabis and both tobacco and cannabis than NH White counterparts (P < .05).

Conclusion: Past-month tobacco use decreased, while cannabis use increased significantly across all alcohol consumption levels. Sociodemographic subgroups, such as NH Black individuals and those with psychiatric comorbidities, showed increased odds of polysubstance use, underscoring the need for targeted public health interventions.

Aims: Prior research has established a correlation between increases of High-Density Lipoprotein Cholesterol (HDL-C) levels and alcohol consumption. This study aimed to explore the association between phosphatidylethanol (PEth) levels and the amount of consumed ethanol, utilizing HDL-C as a surrogate marker on a population level. This endeavor offers an adjunct to other studies.

Methods: PEth and HDL-C levels in 50 751 samples from 29 899 patients in Norway were measured simultaneously in whole blood and serum, respectively. Linear mixed model analyses were employed to assess HDL-C levels within different PEth intervals. Drawing on previous research indicating an increase of .0035 mmol/L in HDL-C per gram of pure ethanol consumed per day, and assuming no alcohol intake in the zero PEth group, we estimated mean daily ethanol intake at the group level for males in each PEth interval.

Results: Results revealed a significant correlation between PEth and HDL-C levels (Spearman's rho = .385 for women, .420 for men, P < .001). Estimated mean HDL-C levels indicated higher alcohol consumption with increasing PEth. Specifically, men with PEth values in the .031-0.100 μmol/L (22-70 ng/ml) interval were estimated to consume approximately mean 20 grams of ethanol daily, while those in the .301-0.500 μmol/L (212-351 ng/ml) PEth interval had an estimated mean daily ethanol intake of 51 grams.

Conclusions: The results from this study suggest an approximate estimation of mean daily amounts of consumed ethanol at group levels in different PEth intervals, based on previously shown correlation of ethanol consumption and HDL-C increase.

Aim: This study assessed the association between exposure to alcohol adverts on social media and alcohol use among university students in Uganda since alcohol consumption has severe effects, especially in countries with weak regulations for alcohol marketing.

Methods: In total, 996 undergraduate students at Makerere University responded to a questionnaire assessing exposure to alcohol advertising on social media (independent variable) and alcohol use (dependent variable). Adjusted multinomial logistic regression was used to analyse data.

Results: One in ten students reported hazardous drinking, while three in ten students were low-risk drinkers. Most students (70.1%) reported low exposure to alcohol adverts on social media, followed by high exposure (12.1%), and 17.8% reported no exposure. A key finding was that exposure to alcohol adverts on social media was significantly associated with alcohol use, especially the high exposure and hazardous drinking (odds ratio = 12.62, 95% confidence interval: 4.43-35.96). Students reporting high exposure to alcohol adverts on social media also had higher odds of low-risk drinking (odds ratio = 3.70, 95% confidence interval: 1.88-7.27) than those with low exposure (odds ratio = 1.77, 95% confidence interval: 1.09-2.87), in reference to no exposure.

Conclusion: Among Ugandan university students, exposure to alcohol adverts on social media is common and associated with alcohol use, in a dose-response manner. These findings suggest a need for a design and implementation of alcohol interventions for students using social media.