Alcohol and alcoholism最新文献

Aims: Alcohol related cognitive impairment (ARCI) impacts an individual's ability to engage in treatment thus may result in poorer outcomes. We aimed to describe outcomes in a legacy cohort of patients with ARCI, identified in an acute hospital setting.

Method: We conducted a retrospective review of a cohort of patients who underwent screening for ARCI between 1 April 2017 and 31 March 2018. Those identified with alternative causes of cognitive impairment were excluded. The Montreal Cognitive Assessment Tool (MoCA©) was utilized to determine presence, and severity, of cognitive impairment. These patients were referred to a multi-disciplinary meeting (MDT) and an out-patient clinic. Mortality was recorded at 3 years. Cox-regression analysis was undertaken and, Kaplan Meier (KM) plots were prepared to visualize the data.

Results: A total of 210 patients met criteria for ARCI screening. Multi-variate analysis found an association between ARCI and mortality at 3 years, Hazard Ratio (HR) 1.732 (p = .019). Co-existent Chronic Liver disease (CLD) increased this association, HR 1.722 (p = .020) but CLD in isolation did not increase mortality risk, HR 1.223 (p = .401). Severe ARCI had the strongest mortality association (p = <.001). Subsequent engagement with the ARCI care pathway improved outcomes, HR .324; (p = .008).

Conclusion: ARCI, identified by a simple, bed-side test is significantly associated with early mortality. This relationship is more marked in the presence of liver disease. The more severe the ARCI, the stronger relationship with death by 3 years. The cohort mean age was 52, a decade younger than the expected age at diagnosis of cognitive impairment in the general population.

Objective: Many genetic studies of psychiatric disorders rely on participants to mail in DNA samples. Differences in who returns a sample may affect the generalizability of these studies, but little attention has focused on possible differences between participants who do and do not provide samples. The present study compared participants with severe lifetime alcohol use disorder (AUD) who did and did not return saliva DNA samples.

Methods: N = 3927 individuals were recruited through Facebook for a genome-wide association study of severe AUD. Participants completed an online survey and agreed to provide a saliva DNA sample by mail. Survey measures included: demographics, quantity and frequency of recent alcohol and tobacco use, impulsivity, and personality. Participants who returned the saliva kit (n = 2412) were compared to those who did not provide DNA samples (n = 1515) were compared using univariate Chi-square and t-tests.

Results: The sample was predominantly White (88.3%) and female (64.0%). DNA providers were more likely than non-providers to report graduate-level education. DNA providers were also less likely to report recent cigarette smoking and scored higher on measures of conscientiousness, perseverance, and premeditation. Using multivariate regression, the most parsimonious model found that being male, a non-smoker, and endorsing perseverance was associated with providing DNA.

Conclusions: In an online sample of individuals with severe AUD, participants who did not provide DNA samples showed multiple demographic and psychosocial differences from those who did provide samples. These findings may have implications for generalizability and suggest that further research is needed.

Introduction: Empirical evidence of the buffering effect of social capital and its underlying psychosocial mechanisms on socio-economic inequalities in alcohol use disorder (AUD) symptoms is limited. As socio-economic disadvantages often go together with deficits in resources and considering social capital's beneficial effects on health, we hypothesized a stronger buffering (at high scores) and a cumulative disadvantaged effect (at low scores) of social capital on AUD symptoms among people reporting higher socio-economic disadvantage compared with their more advantaged counterparts. Additionally, we investigated whether this moderation effect was associated with drinking motives.

Method: Three-hundred and sixty-five young adults participated in a cross-sectional online questionnaire measuring all model variables. First, we tested a moderation model, including AUD symptoms (DV), perceived socio-economic disadvantage (IV), and social capital (moderator). Secondly, we tested a moderated mediation model, additionally including drinking motives as mediators of the moderation effect tested in the first model.

Results: In the case of high social capital, young adults reporting higher socio-economic disadvantage reported fewer AUD symptoms than their advantaged counterparts, which was associated with their lower endorsement of coping, enhancement, and social motives. When social capital was low, those reporting higher socio-economic disadvantages showed higher AUD symptoms than their advantaged counterparts, which was associated with their higher endorsement of coping motives only.

Conclusion: Social capital can buffer (at high levels) or aggravate (at low levels) socio-economic inequalities in AUD symptoms, and drinking for coping, enhancement, and social motives may explain why this happens.

Cytochrome P450 (CYPs) superfamily of enzymes metabolize thousands of endogenous and exogenous substrates including ethanol. Results: Cytochrome P4502E1 (CYP2E1) is involved in ethanol metabolism as part of the so-called microsomal ethanol metabolizing system, in the metabolism of fatty acids and some drugs such as acetaminophen and isoniazid, and in the activation of a variety of procarcinogens (PCs). Chronic ethanol consumption induces CYP2E1 which may result in an enhanced metabolism of these drugs to their toxic intermediates, and in the generation of carcinogens. In addition, ethanol oxidation increases and is associated with the generation of reactive oxygen species (ROS). This oxidative stress is an important driver for the development of alcohol-associated liver disease (AALD) and alcohol-mediated cancer (AMC). ROS may bind directly to proteins and to DNA. ROS may also lead to lipid peroxidation (LPO) with the generation of LPO products. These LPO products may bind to DNA forming etheno-DNA adducts. Cell culture studies as well as animal experiments have shown that CYP2E1 knock-out animals or the inhibition of CYP2E1 by chemicals results in a significant improvement of liver histology. CYP2E1 is also involved in pathogenesis of hepatic steatosis and fibrosis. More recent studies in patients with AALD have demonstrated an improvement of serum transaminase activities when CYP2E1 was inhibited by clomethiazole. In addition to its role in the generation of ROS, CYP2E1 also enhances the activation of PCs and decreases the level of retinol and retinoic acid in the liver. Conclusion: Inhibition of CYP2E1 may improve AALD and may inhibit AMC.

Aims: The COVID-19 pandemic had a demonstrated impact on parenting but little is known about how parental drinking, stress, and use of aggressive discipline (a parenting behavior associated with abusive parenting and negative outcomes for children) have changed over time. We examine rates of alcohol use, stress, and aggressive discipline at three time points during the COVID-19 pandemic and investigate what maternal, child, and time-varying factors predict weekly use of aggressive parenting.

Methods: We use longitudinal data from the Central Ohio Family Study (COFLS), including women (n = 234) with a child between the ages of 0-12 and recruited via Facebook, Craigslist.org, and word of mouth. Participants completed an on-line survey for 3 consecutive years beginning in April-May 2020 and 1 and 2 years later. Multilevel logistic regression models were used to examine use of aggressive discipline at the three time points, controlling for time-varying, and maternal and child characteristics.

Results: Past week use of aggressive discipline peaked in Wave 1 (35.9%) and decreased at Wave 2 (3.8%) and Wave 3 (28.2%; OR = .463; 95% CI: .369, .580). Parental stress (OR = 1.052; 95% CI: 1.010, 1.096), social isolation (OR = 1.412; 95% CI: 1.197, 1.668), social companionship (OR = 1.113; 95% CI: 1.007, 1.229), and frequency of drinking (OR = 1.049; 95% CI: 1.014, 1.085) were significantly related to higher odds of using aggressive discipline over the three waves.

Conclusions: Although rates of aggressive discipline declined, frequency of drinking and stress demonstrated a consistent pattern in relation to aggressive discipline during the COVID-19 pandemic.

Aims: To examine predictors of 30-day readmissions to acute hospitals in England for patients treated for alcohol withdrawal (AW).

Methods: Retrospective cross-sectional analysis of routine hospital administrative data (i.e. Hospital Episode Statistics-Admitted Patient Care records) for adults admitted to non-specialist hospitals in England 2017-18.

Results: AW admissions were associated with digestive, circulatory, respiratory, and endocrine disorders and were of short duration (median 3 days). Of the 19 588 completed AW admissions examined in 2017-18, 3957 (20.2%) resulted in readmission within 30 days. The strongest predictors of 30-day readmission were being no fixed abode (Adjusted Odds Ratio (AOR) 1.81, 95%CI 1.44-2.26), prior discharge against medical advice (AOR 1.57, 95%CI 1.40-1.77), and greater Charlson comorbidity index total score (AOR 1.02, 95%CI 1.02-1.03).

Discussion: AW 30-day admissions are common and associated to complex case presentations that require high levels of community support on discharge. Hospital-based alcohol teams should prioritize strategies, which maximize medically managed AW, effective transitions to specialist community care including outreach teams and strong collaborations with physical and mental health outpatient services. Together with specialist initiatives within community mental health teams, assertive outreach, and homeless services 30-day readmissions may be minimized.

Aims: We sought to explore how acute alcohol exposure alters decision-making in rats performing an approach-avoid decision-making task. Increasing concentrations of alcohol were mixed with decreasing concentrations of sucrose to mimic mixed/sweetened alcoholic beverages.

Methods: Rats were trained on an apparatus in which different concentrations of sucrose were available in four different corners of the arena. During daily sessions, a tone signaled each trial start, followed by illumination (15 lux, blue LEDs) of a single corner port, indicating the potential availability of sucrose at that location. The rat (one rat per arena, both females and males) then chose to approach the lit corner to have the solution dispensed or avoid it, with no solution being dispensed. We examined how the decisions to pursue sucrose rewards shifted with the addition and subsequent removal of ethanol from the sucrose ports.

Results: Males were greatly affected by the introduction of alcohol into the task environment, shifting their approach preference to solutions containing higher alcohol concentrations rather than maintaining the prior preference for high-sucrose-concentration solutions. In contrast, females' choice patterns and task performance remained largely unchanged. We also explore a method for identifying changes in decision-making tendencies during and after alcohol consumption within individual subjects.

Conclusions: This research explores the introduction of alcohol in varying concentrations with sucrose solutions during an approach-avoid task, with male decision-making and behavioral patterns significantly impacted. We also explore a novel approach for identifying individual adaptations of decision-making behavior when alcohol becomes available, which could be expanded upon in future research.

Aims: Alcohol misuse may adversely impact health-promoting behaviors. Our objective was to evaluate health-related behaviors in people with HIV with alcohol misuse during the early phase of the COVID-19 pandemic, aiming to understand how alcohol misuse influences these behaviors during health-related emergencies.

Methods: Eighty people with HIV (64% male, 51 ± 11 years of age), enrolled in the ALIVE-Ex Study (NCT03299205), consented to a cross-sectional phone survey during the Louisiana stay-at-home order. Alcohol use, dietary intake, physical activity (PA), and emotional well-being over the previous week were assessed. Based on their pre-pandemic Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) score, participants were categorized into having alcohol misuse (AUDIT-C ≥ 3 female (F)/4 male (M)) or having no/low use (AUDIT-C < 3F/4M). Descriptive statistics, Spearman correlations, and crude and adjusted logistic regression models were estimated.

Results: Participants with alcohol misuse reported more alcohol use, more frequent meat and salty snack intake, and higher frequency of feeling tense and panicked over the previous week than people with HIV having no/low use (P < .05). Higher alcohol use was associated with more meat and salty snack intake, more frequent vigorous PA, higher PA level, and more emotional distress (P < .05).

Conclusions: Overall, participants having alcohol misuse and those reporting higher alcohol use during the stay-at-home order reported less healthy dietary patterns and more emotional distress, while engaging in more PA, compared to participants with lower alcohol use. These data suggest that during health-related emergencies, consideration of patients' prior and current alcohol use is necessary when encouraging healthy behavioral patterns.

Aims: Problem drinking in healthcare workers (HCWs) is highly relevant to study as it could result in personal suffering, as well as inefficiencies in health service delivery. This study aims to investigate the prevalence of nondrinking, drinking, and problem drinking and to investigate the comorbidity between drinking alcohol and mental illness (burnout and depression) among HCWs in Sweden.

Methods: This cross-sectional study draws on the 2022 Longitudinal Occupational Health survey in Healthcare Sweden of physicians, nurses, and nurse assistants in Sweden (N = 5966). Measures include levels of alcohol use assessed by the Cut, Annoyed, Guilty, and Eye Opener questionnaire, the 12-item Burnout Assessment Tool, and the Symptom CheckList-Core Depression. Multinomial Logistic regressions were used to investigate the likelihood of reporting nondrinking and problem drinking compared to drinking.

Results: The prevalence of problem drinking among Swedish HCWs was 3.7%. Only sex differences were observed for those with a problem drinking, with male nurses and nurse assistants being more likely to report problem drinking. Comorbidity was found between problem drinking and depression but not between problem drinking and burnout.

Conclusions: This study demonstrated that ~3.7% of Swedish HCWs had problem drinking and that those also had a higher likelihood of reporting depression but not burnout. Results contribute to new knowledge about the use of alcohol and comorbidities with depression and burnout among HCWs in Sweden. Findings could benefit employers in implementing preventive and tailored strategies to preserve the psychosocial well-being of HCWs.

Aims: Magnetic resonance imaging (MRI) studies have identified brain structural predictors of treatment response in individuals with alcohol use disorder (AUD) but with varying findings and primarily in male veterans. The present study investigated cortical surface area and thickness (CT) as predictors of brief intervention response in community-based adults with AUD.

Methods: Sixty-five non-treatment-seeking adults with AUD (44.6% male, aged 33.2 ± 1.3 years) underwent an MRI and received a brief intervention comprising personalized feedback and motivational interviewing, with follow-up ~6-8 weeks later to quantify changes in drinks/week (DPW), the primary outcome. Eighteen bilateral a priori regions of interest (ROIs) were used to predict DPW at follow-up, adjusting for baseline drinking. Significant predictors were examined with secondary outcomes, percent drinking and heavy drinking days, and in relation to out-of-scanner measures of impulsivity and comorbidities.

Results: Participants exhibited significant decreases in alcohol consumption in response to the brief intervention. Eight bilateral CT ROIs in the frontal, temporal, and occipital lobes, most notably medial orbitofrontal, middle temporal, and lateral occipital gyri, predicted DPW; however, only three predicted the secondary outcomes. Significant associations were observed between CT in frontal and occipital regions and impulsivity (delay discounting, lack of premeditation), executive functioning, anxiety, and stress.

Conclusions: Thinner frontal, temporal, and occipital ROIs predicted poorer brief intervention response, with notable overlap with brain regions previously implicated in AUD. Clarifying whether these regions reflect premorbid or acquired differences and, if the latter, the potential for recovery of cortical gray matter following drinking reductions are future priorities.