Alcohol最新文献

We sought to quantify and describe the volume of emergency department visits related to alcohol intoxication at the Veterans Health Administration (VHA), the largest healthcare system in the United States. This is a retrospective cohort study of patients with VHA emergency department visits for alcohol intoxication from 2010 to 2019 as identified via ICD-9/10 code and/or serum ethanol concentration >50 mg/dL. Encounters were identified and demographic and clinical data were acquired by automated query of the VHA Corporate Data Warehouse. Descriptive statistics and univariate analysis were performed. We identified 95,123 patients with a total of 251,310 emergency department visits. The annual number of visits increased over the study period, reaching 32,333 in 2019. Men aged 40–60 were the most common demographic group in the cohort (48% of all patients), and men made up a higher proportion of patients in the database (94%) than the VHA population overall (90%). A disproportionate number of visits (32%) came from the top 4.4% of most frequent visitors. Most of the emergency department visits in the database (68%) were associated with medical or psychiatric admission, or interfacility transfer for admission elsewhere. Patients in the cohort accounted for 1.3% of all VHA emergency department visits during the study period, a proportion that is somewhat smaller than what has been reported at non-VHA facilities, despite the high prevalence of addiction disorders in the VHA patient population. We submit that this lower-than-expected proportion of alcohol-related emergency department visits may be due to the access to primary and mental care which is afforded by VHA patient benefits.

Background

Alcohol consumption is a significant risk factor for several types of injuries and trauma recidivism and remains an important public health concern worldwide. We aimed to describe the implementation of mandatory alcohol screening and the AUDIT tool among trauma patients admitted to a level 1 trauma center in a country with a partial ban on alcohol consumption.

Methods

This was a retrospective analysis of trauma patients (>12 years old) who required hospital admission and underwent blood alcohol concentration (BAC) screening between 2014 and 2019. This was achieved via an enzymatic method using alcohol dehydrogenase for ethanol detection in the plasma and serum samples. Trauma patients with a BAC <2.2 mmol/L were referred to as “negative”, and BAC >2.2 mmol/L was referred to as “BAC positive”. A comparative analysis was performed between the two BAC groups. Alcohol Screening, Brief Intervention, Referral for Treatment [ASBIRT] program, and AUDIT were applied.

Results

A total of 7326 BAC screening tests were performed on 7284 patients during the study period. With slight variation over the years, the compliance rate was 77% (70.4%–85.3%), and the test positivity rate was 10% (8.6%–12.5%). There were 42 repeated admissions, of which seven patients were BAC positive at every admission. Young age and non-Arab patients were more likely to test positive, and the main mechanism of injury (MOI) was road traffic-related trauma (p < 0.05). Assault and self-inflicted injuries were significantly higher in BAC-positive patients than in BAC-negative patients (18% vs. 4% and 2.7% vs. 1.3%, respectively; p = 0.001). The injury severity score (ISS) and mortality rate were comparable between the study groups. Patients with a positive BAC were significantly more likely to undergo pan-CT scan in the emergency department, intubation, and exploratory laparotomy than those with a negative BAC. In patients who sustained injuries due to assault, all-terrain vehicles, or motorcycle crashes, there was a significant association between the positivity of BAC tests and the patient's ISS.

Conclusion

Despite improvements in BAC screening in trauma admissions over the years, almost 20% of cases were missed. Although the mortality rates were comparable, alcohol consumption burdens resources in terms of excess imaging, intubation, open abdominal surgery, and possible disability. Further studies are needed to understand the key obstacles and challenges to achieving optimum compliance for screening in trauma settings.

Purpose

There is no intervention that quickly reduces a person's blood alcohol content (BAC). “Sober up before you drive” may prevent road traffic injury (RTI) caused by alcohol consumption. The aim of this study was to analyze the risk of RTI on an hourly basis (1–6 h) after the last drink and the determinants of this risk.

Methods

This was a case-crossover study of alcohol consumption among 430 patients who suffered an RTI and arrived at an emergency department in a large hospital in Mexico City from January to April 2022.

Results

Of the 430 patients studied, 46 reported drinking within 1 h before the RTI, for a risk ratio (RR) of 7.7 (95% CI [5.6, 10.4]). This RR decreased to 2.2 (95% CI [1.3, 3.7]) for the 12 patients drinking in the second hour before the RTI and was null for those drinking earlier (p ≤ 0.001 for the trend). The induction time was 3 h among those with higher BAC and intoxication levels. The RR for an RTI decreases 71% from the first to second hour from the last drink and 32% from the second to third hour. This decrease was similar among those intoxicated and those with increased BACs. In multiple regression models, higher levels of intoxication and higher BACs remained associated with higher RRs.

Discussion

People should avoid driving after drinking. Waiting to drive, walking, or riding after drinking reduces the risk of an RTI, especially for people with higher BAC and intoxication levels.

Objectives

Alcohol and nicotine are the two most important risk factors of chronic pancreatitis, and they often occur together. It is still unclear how much they influence the severity of the disease and which of the two addictions should be treated with priority.

Methods

We performed a single-center, retrospective, cross-sectional study in a mixed medicosurgical cohort of 870 patients diagnosed with chronic pancreatitis (CP). We analyzed the impact of the drinking pattern and abstinence for alcohol and nicotine on the course of the disease. Patients with alcoholic CP were subdivided into 1) patients with “life-time drinking history” (LTDH), 2) “current drinkers” with current alcohol abuse without signs of LTDH, and 3) “former drinkers” who stopped or reduced alcohol intake dramatically.

Results

Compared to patients with LTDH, “former drinkers” had a lower rate of exocrine insufficiency (29% vs. 59%) and pseudocysts (33% vs. 49%), were more often relapse-free (37% vs. 5%), and had less abdominal pain. There was no correlation detected between the quantity of alcohol consumption and the severity or progression of the disease. Regarding nicotine, 29 pack-years are the threshold for developing the early stage of CP. Under nicotine abstinence, only slightly more patients were relapse-free (37% vs. 22%). In contrast, the cumulative amount of nicotine consumed correlated with overall disease severity and the development of pseudocysts. The need for surgery was increased, with odds ratios of 1.8, for both alcohol and nicotine abuse.

Conclusions

Alcohol cessation in chronic pancreatitis reduces exocrine insufficiency, abdominal pain, and local complications. The effect of nicotine cessation is less pronounced in our cohort. However, nicotine abuse represents an important factor for the development of the disease.

Impulsivity and substance-related outcomes share a complex relationship, as various facets of impulsivity exhibit distinct associations with different drug-related outcomes. This study examines the associations between frequency and quantity of alcohol and marijuana use with impulsivity traits, psychological distress, and the utilization of emotion regulation strategies. A survey asked Argentinian citizens (n = 1507, 356 men) about frequency and quantity of alcohol or marijuana use on each day of a typical week, as well as anxiety, stress, and depression symptoms (DASS-21), impulsivity-like traits (UPPS-P), and emotion regulation strategies (ERQ). The 2-month prevalence of alcohol or marijuana use was 80.1%, and 27.2%, respectively. Premeditation was significantly (p < 0.05) and negatively associated with both frequency and quantity of alcohol consumed, whereas negative and positive urgency were positively and significantly (p < 0.05) associated with quantity of alcohol or marijuana use, respectively. Greater depression symptoms predicted greater quantity of alcohol use, whereas lower emotional suppression or lower cognitive reappraisal were significantly (p < 0.05) associated with a greater frequency of alcohol or marijuana use. Sensation seeking was significantly (p < 0.05) and positively associated with frequency of marijuana use. Individuals with higher levels of impulsivity-like traits, higher levels of depression, or lower use of emotional regulation abilities appeared to be at a higher risk of alcohol or marijuana use. In this sample, the use of alcohol (though not marijuana) seems to fit a negative reinforcement pathway. The study suggests that individuals with risk factors for drug misuse could benefit from interventions aimed at enhancing emotion regulation.