Analysis of drowning fatalities in the Vistula River in years 2011-2020 in the Lesser Poland Voivodeship. / Analiza przypadków smiertelnych utoniec w Wisle w latach 2011-2020 na terenie województwa malopolskiego.

Aim: The aim of the present study is to analyze drowning fatalities in the Vistula River from 2011 to 2020 in the Lesser Poland Voivodeship. Material and methods: The material for the study consisted of autopsy protocols provided by the Department of Forensic Medicine in Cracow. Demographic data, results of post-mortem examinations and results of basic toxicological tests - levels of ethyl alcohol in the blood and urine of decedents were analyzed. The extracted data were subjected to statistical analysis using TIBCO Statistica® 13.3.0 software. χ2 and one-way ANOVA tests of independence (p < 0.05) were performed. Results: 79 cases were analyzed. The mean age was 44.2 years (SD = 16.81). The majority of the study group was male (73.1%). 57.9% of men were under the influence of alcohol (>0.5 per mille) at the time of drowning, compared to 23.8% of women (p = 0.008). Most bodies were found between the Kosciuszko and Dabie barrages (57.0%). Spring and summer were the most common seasons for drownings (59.5%). 35.4% of victims suffered from psychiatric illnesses. Emphysema aquosum was more frequent in bodies that were not in an advanced state of putrefaction (p = 0.000). 23.1% of victims had head injuries, 14.1% - upper limb injuries, while 11.5% had lower limb injuries. Conclusions: Inebriated men are more likely to be victims of drowning, which may be due to a greater tendency toward reckless behavior and irresponsible consumption of alcoholic beverages. Most drownings occur in the city center, which points to suicide as the cause of incident. The occurrence of external injuries is the result of jumping from a great height or the effect of carrying the corpse downstream.

Environmental and occupational exposures associated with male infertility.

The upsurge in male infertility over the last two decades, possibly due to environmental exposure, has raised significant interest, particularly boosted by reports from fertility clinics, which showed that chronic diseases and hereditary or other medical conditions might only partially explain current incidence of male infertility. Both environmental and occupational settings may have a significant role in exposure to complex mixtures of endocrine disruptors (ED), which play a major role in fertility disorders. The aim of this review is to give an insight into the current knowledge on exposure settings which may be associated with male infertility. Our study relied on a systematic search of PubMed, Scopus, and Web of Science for articles published between January 2000 and September 2020. It showed that some well documented factors associated with male infertility include smoking, and physiological disturbances or chronic diseases such as obesity and diabetes, which in turn, may also reflect lifestyle choices and environmental exposures, especially to EDs such as phthalates, bisphenols, pesticides, and flame retardants. However, the number of studies on the aetiology of male infertility is still too low in comparison with the size of affected population. Occupational health follow-ups and medical surveillance do not collect any data on male infertility, even though ED chemicals are part of many technological processes.

[CME/Answers: Harmful Alcohol Consumption in the Elderly]. / CME/Antworten: Riskanter Alkoholkonsum im Alter.

CME/Answers: Harmful Alcohol Consumption in the Elderly Abstract. Harmful alcohol consumption is an increasing clinical problem in many patients. Often excessive alcohol consumption is not addressed in clinical practice and there is still a high level of stigmatization around this topic. The early recognition and early therapeutic intervention are crucial for success. The general practitioner plays a key role in the (early) diagnosis, initiation and follow-up of alcohol-related problems. In this article the ideal procedures for the recognition of high-risk consumption are summarized. In daily practice, an ideal tool is the 'brief intervention' approach. The major steps and procedures for brief intervention for alcohol misuse are summarized and discussed.

[CME: Harmful Alcohol Consumption in the Elderly]. / CME: Riskanter Alkoholkonsum im Alter.

CME: Harmful Alcohol Consumption in the Elderly Abstract. Harmful alcohol consumption is an increasing clinical problem in many patients. Often excessive alcohol consumption is not addressed in clinical practice and there is still a high level of stigmatization around this topic. The early recognition and early therapeutic intervention are crucial for success. The general practitioner plays a key role in the (early) diagnosis, initiation and follow-up of alcohol-related problems. In this article the ideal procedures for the recognition of high-risk consumption are summarized. In daily practice, an ideal tool is the 'brief intervention' approach. The major steps and procedures for brief intervention for alcohol misuse are summarized and discussed.

[Recommendations for the Prevention, Diagnostics and Therapy of Addiction Disorders in the Elderly]. / Empfehlungen für die Prävention, Diagnostik und Therapie der Abhängigkeitserkrankungen im Alter.

Recommendations for the Prevention, Diagnostics and Therapy of Addiction Disorders in the Elderly Abstract. Although the chronic consumption of alcohol and sedatives, and increasingly opioids, represents a major problem in old age with consequential damage for those affected, little attention has been paid to the substance abuse disorders in old age. The aim of the present recommendations, a collaboration work of the Swiss Society for Geriatric Psychiatry and Psychotherapy (SGAP), Swiss Nurses Association (SBK) and Swiss Society of Addiction Medicine (SSAM), is to summarize the current state of knowledge in prevention, diagnostics and therapy of substance abuse disorders in old age for an interprofessional clinical team. They are intended to help strengthen prevention and early diagnosis, and consciously emphasize psychotherapy and nursing intervention options.

Regression II. Development through regression.

As shown in our previous paper ('Regression I. Experimental approaches to regression', JAP, 65, 2, 345-65), the common mechanism of regression can be described as reversible dedifferentiation, which is understood as a relative increase of the proportion of low-differentiated (older) systems in actualized experience. Experimental data show that regression following disease (chronic tension headache) is followed by adaptation and an increase in system differentiation in that experience domain which contains systems responsible for that adaptation. The results of mathematical modelling support the idea that reversible dedifferentiation can be one of the mechanisms for increasing the effectiveness of adaptation through learning. Reversible dedifferentiation, which is phenomenologically described as regression, is a general mechanism for restructuring the organism-environment interactions in situations where behaviours that were effective in the past become ineffective. Reversible dedifferentiation has evolved as a component of adaptation when new behaviours are formed and large-scale modifications in the existing behaviours are required in the face of changes in the external and/or internal environment. Thus, the authors believe that this article provides evidence for Jung's view that regression is not only a 'return' to past forms of thinking, affects and behaviour, but that regressive processes provide a significant impetus for psychological growth and development.

Comme nous l'avons montré dans notre article précédent (« Régression I. Les approches expérimentales de la régression ¼), le mécanisme propre à la régression peut être décrit en tant que dé-différentiation réversible, ce que l'on peut comprendre comme une hausse relative de la proportion de systèmes peu différentiés (plus vieux) dans l'expérience actualisée. Les données expérimentales montrent que la régression suite à une maladie (mal de tête de tension chronique) est suivie par une adaptation et un accroissement dans la différentiation des systèmes dans le domaine d'expérience qui contient les systèmes responsables de cette adaptation. Les résultats de la modélisation mathématique soutiennent l'idée que la dé-différentiation réversible peut être l'un des mécanismes pour accroitre l'efficacité de l'adaptation par l'apprentissage. La dé-différentiation réversible, qui est décrite phénoménologiquement comme régression, est un mécanisme général pour restructurer les interactions organisme-environnement dans des situations où les comportements qui fonctionnaient par le passé sont devenus inefficaces. La dé-différentiation réversible a évolué comme un élément de l'adaptation quand de nouveaux comportements se développent et que des changements dans l'environnement extérieur ou intérieur requièrent des modifications à grande échelle dans les comportements existants. Ainsi, les auteurs pensent que cet article apporte un soutien à la perspective de Jung selon laquelle la régression n'est pas seulement un « retour ¼ à des formes anciennes de fonctionnement, d'affects et de comportement, mais que les processus régressifs fournissent un élan significatif pour la croissance et le développement psychologiques.

Como hemos mostrado en nuestros trabajos previos ('Regresión I. Abordajes experimentales hacia la regresión'), el mecanismo común de la regresión puede ser descripto como desdiferenciación reversible, el cual es comprendido como un relativo incremento en la proporción de sistemas de baja-diferenciación en la experiencia actual. Data experimental muestra que la regresión luego de una enfermedad (tensión de cabeza crónica) es seguida por la adaptación y por un incremento en la diferenciación de sistemas en aquel dominio de la experiencia, que contiene sistemas responsables para tal adaptación. Los resultados del modelo matemático sostienen la idea de que la desdiferenciación reversible puede ser uno de los mecanismos para incrementar la efectividad de la adaptación a través del aprendizaje. La desdiferenciación reversible, la cual fenomenológicamente se describe como regresión, es un mecanismo general para restructurar las interacciones entre el organismo y el medio ambiente, en situaciones en las que las conductas que eran efectivas en el pasado se vuelven ineficaces. La desdiferenciación reversible ha evolucionado como un componente de la adaptación cuando se forman nuevas conductas y se requieren modificaciones a gran escala en las conductas existentes frente a los cambios en el medio ambiente externo y/o interno. Así, los autores consideran que el artículo proporciona evidencia a la perspectiva de Jung sobre la regresión, no solamente como un 'retorno' a formas de pensar, sentir y actuar del pasado sino que los procesos regresivos proveen un estímulo significativo para el desarrollo y el crecimiento psicológico.

Regression I. Experimental approaches to regression.

The concept of regression is considered with an emphasis on the differences between the positions of Freud and Jung regarding its significance. The paper discusses the results of experimental analyses of individual experience dynamics (from gene expression changes and impulse neuronal activity in animals to prosocial behaviour in healthy humans at different ages, and humans in chronic pain) in those situations where regression occurs: stress, disease, learning, highly emotional states and alcohol intoxication. Common mechanisms of regression in all these situations are proposed. The mechanisms of regression can be described as reversible dedifferentiation, which is understood as a relative increase of the representation of low-differentiated (older) systems in the actualized experience. In all of the cases of dedifferentiation mentioned above, the complexity of the systemic organization of behaviour significantly decreases.

Le concept de régression est étudié en mettant l'accent sur les différences entre les positions de Freud et celles de Jung concernant sa portée. L'article discute les résultats des analyses expérimentales de dynamiques de l'expérience individuelle (de changements dans l'expression des gènes et de l'activité des réflexes neuronaux chez les animaux aux comportements pro-sociaux chez des humains en bonne santé et à des âges de vie divers, et chez des humains en situation de souffrance chronique) dans ces situations où se produit la régression: le stress, la maladie, l'apprentissage, les états hautement émotionnels et l'intoxication par l'alcool. Les mécanismes communs de régression dans toutes ces situations sont présentés. Les mécanismes de régression peuvent être décrits en tant que dé-différentiation réversible, ce qui est interprété comme un accroissement relatif de la représentation de systèmes peu-différenciés (plus vieux) dans l'expérience actualisée. Dans tous les cas de dé-différentiation mentionnés plus haut, la complexité de l'organisation systémique du comportement décroit de manière significative.

Se considera el concepto de regresión, con énfasis en las diferencias entre Freud y Jung en lo que concierne a su significado. El trabajo desarrolla los resultados de análisis experimentales sobre dinámicas experienciales individuales (desde cambios en la expresión genética y actividad neuronal en animales a conductas prosociales en humanos saludables en diferentes edades, y humanos en dolor crónico) en aquellas situaciones donde la regresión ocurre: estrés, enfermedad, aprendizaje, estados altamente emocionales e intoxicación alcohólica. Se proponen mecanismos comunes de regresión en todas estas situaciones. Los mecanismos de regresión pueden describirse como de-diferenciación reversible, la cual es comprendida como un incremento relativo de la representación de sistemas de baja-diferenciación (antiguos) en la experiencia actualizada. En todos los casos de de-diferenciación mencionados anteriormente, la complejidad de la organización sistemática de conducta decrece significativamente.

[Alcohol and the Bariatric Patient: When One Drink Becomes Two Drinks]. / «Ich bin plötzlich so besäuselt!¼ Alkoholstoffwechsel und Bariatrie: wenn ein Drink zu zwei Drinks wird CME-Fragen.

Alcohol and the Bariatric Patient: When One Drink Becomes Two Drinks Abstract. Moderate consumption of alcohol is a risk factor for weight gain and obesity. Alcohol affects all components of the energy balance. Alcohol consumption is - as in the general population - also a widespread phenomenon in obese and bariatric patients. As a function of the bariatric surgery technique, alcohol metabolism is altered: gastric bypass surgery and sleeve gastrectomy lead to a faster absorption of alcohol, higher peak alcohol concentration and a longer alcohol persistence in the circulation. Further reward mechanisms for alcohol are changed, so that alcohol consumption is enhanced and promoted, with an increased risk to develop alcohol dependency. It is time to address these issues in the daily practice and to fill the existing research gaps.

[The first step towards a unified approach: validation of the Hungarian version of the Clinical Institute Withdrawal Assessment of Alcohol, Revised in Hungarian general hospital settings]. / Elso lépés egy egységes szemlélet felé: az Alkohol Megvonási Skála bevezetése a hazai betegellátási gyakorlatba.

Introduction and aim: The available literature and protocols have unequivocally suggested that the Clinical Institute Withdrawal Assessment of Alcohol, Revised is a psychometric scale for identifying and following the signs of alcohol withdrawal. However, there has not been any validated tool for the identification of withdrawal symptoms in Hungarian general hospital settings. The aim of the present study was to evaluate the validity and the reliability of the Hungarian version of this scale among patients hospitalized with alcohol withdrawal syndrome. Method: The translation of the scale into Hungarian was done by 'back translation' method, followed by testing the face validity. The empirical phase was performed in the Department of Psychiatry, University of Szeged. Patients admitted with alcohol withdrawal syndrome (n = 30) were recruited from the inpatient units of the clinic. Clinical Institute Withdrawal Assessment of Alcohol, Revised and Clinical Global Impression - Severity Scale were recorded every two days. Statistical comparisons of data were performed with repeated-measures ANOVA. Cronbach's alpha, item-total correlation, convergent and discriminant validity were determined. Results: Significant decrease of the total scores of Clinical Institute Withdrawal Assessment of Alcohol, Revised and Clinical Global Impression - Severity Scale was observed between the six measurements (F = 202.46, p<0.001; F = 503.04, p<0.001). Cronbach alpha values were above 0.7 during the first 3 measurement days. The withdrawal and severity scores recorded the same day showed positively significant correlations (>0.45). Conclusion: Our findings demonstrate that the Clinical Institute Withdrawal Assessment of Alcohol, Revised is a reliable and valid psychometric tool for the detailed analysis of withdrawal symptoms in Hungarian general hospital settings. Orv Hetil. 2019; 160(30): 1184-1192.

[Alcoholic liver disease: the roles of genetic-epigenetic factors and the effect of abstinence]. / Alkoholos májbetegség: a genetikai-epigenetikai tényezok szerepe és az absztinencia hatása.

The pathogenesis of alcoholic liver disease depends not only on the toxic effects of alcohol, but also on the complex interaction of host's and environmental factors. Thus, the genetic pre-disposition, co-morbidities and behavioral factors all play a role in the individual variations in the disease outcomes. On the other hand, the essential part of the therapeutic strategy is the complete withdrawal of the harmful etiological agent. The present paper is devoted to overview the genetics, the environmental factors and the effects of abstinence in alcoholic liver disease. Genetic variants in two enzymes involved in the metabolism of ethanol, alcohol-dehydrogenase ADH1B *2 and aldehyde-dehydrogenase ALDH2 *2 through increasing the blood level of acetaldehyde, may play a "protective" role against alcoholism. The P450 CYP2E1 *5 c2, an inducible microsomal oxidase, upregulated by ethanol and by formation of acetaldehyde and reactive oxygen species, increases liver toxicity. Three novel gene polymorphisms - such as the patatin-like phospholipase domain-containing 3 (PNPLA3 I148M C>G), the transmembrane 6 superfamily member 2 (TM6SF2 E167K), and the membrane-bound O-acyltransferase domain-containing 7 (MB0AT7 rs641738 C>T) - have been proven as risk factors of steatosis, fibrosis and even hepatocellular carcinoma in both alcoholic and non-alcoholic fatty liver disease patients. Alcohol-induced epigenetic effects, reversible but inheritable gene expression alterations - as histon modulations, DNA methylation and micro-RNA-s - are of importance in the pathogenesis as well, and in the future, they may serve as diagnostic markers and therapeutic targets. Women are at greater risk of developing alcoholic cirrhosis, furthermore, malnutrition, obesity, diabetes, smoking, and hepatitis virus infections are also risk factors. Alcoholic liver disease should be regarded as a preventable disease. Several clinical studies revealed that abstinence may result in the regression of steatohepatitis and fibrosis, compensation of cirrhosis, improving disease outcome and increasing survival even in patients with advanced stages. Early diagnosis and multidisciplinary interventions are highly required to achieve long-term abstinence and to prevent alcoholic cirrhosis. Orv Hetil. 2019; 160(14): 524-532.

[Prediction of binge drinking in young adults: a cohort study over nine years]. / Vorhersage des Rauschtrinkens im jungen Erwachsenenalter: Eine Kohortenstudie über 9 Jahre.

Prediction of binge drinking in young adults: a cohort study over nine years Abstract. OBJECTIVE: Which person characteristics and environmental factors predict binge drinking at age 21? METHOD: A longitudinal observational study with a nine-year follow-up. A total of 5,176 adolescents from the German states Schleswig-Holstein and Saxony-Anhalt were surveyed in 2006 with paper-pencil questionnaires (mean age 12.6 years, SD = 0.6). A follow-up assessment was conducted in the year 2015. Baseline predictors were age, gender, school type, school performance, parenting style, early experience with alcohol, alcohol use of parents, alcohol use of friends, and sensation seeking. Primary outcome in 2015 was binge drinking at least once a month (six or more alcoholic drinks during one drinking occasion). RESULTS: A subsample of 1,087 (20.9 %) of the former students could be surveyed nine years after baseline (mean age 21.6 years, SD = 0.8). One out of four (25.4 %) reported binge drinking at least once in a month. A multiple regression model revealed three significant predictors of binge drinking: male gender, early experience with alcohol and frequency of parental alcohol use at baseline. CONCLUSIONS: Perceived frequency of parental alcohol use might be an important risk factor for children's alcohol use in early adulthood. Parents need to reflect their role as alcohol-specific socialization agents.

[Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use]. / Einfluss von Berater/innen- und Interventionsvariablen auf die Veränderungsmotivation nach einer motivierenden Kurzintervention zur Reduktion riskanten Alkoholkonsums.

Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use Brief interventions are recommended for prevention and early intervention of risky alcohol use. However, evidence of their effectiveness, in particular for children and adolescents, is heterogeneous. Analysis of counsellor and intervention variables may provide insights into mechanisms of action in brief interventions and thereby contribute to an enhanced effectiveness. We analyzed data of N = 141 children and adolescents who were treated for acute alcohol intoxication in the emergency department. Study participants received a brief motivational intervention to reduce risky alcohol use during hospitalization. We applied multiple regression analysis to examine counsellor variables (empathy, affirmation, competence, congruence) and intervention variables (readiness and confidence ruler, decisional balance, goal agreement) as predictors of motivation to change. Higher scores on the basic therapeutic skill "positive affirmation" (R2 = 7.1 %; p < .01), finishing the intervention with a written goal agreement (R2 = 2.9 %; p < .05) and younger age were associated with greater readiness to change (R2 = 10.2 %; p < .01). Therefore, a special focus should be put on the counsellor skill "positive affirmation" when training new counsellors. Results also indicate that younger patients respond stronger to a brief intervention in this context.

[General practitioners' commitment to treating excessive alcohol consumption: A question of role security in treating affected patients?]. / Hausärztliche Bereitschaft zur Intervention bei zu hohem Alkoholkonsum: Eine Frage der Sicherheit im Umgang mit betroffenen Patienten?

Only a few general practitioners (GPs) are committed to screen their patients for alcohol consumption and, in case of excessive alcohol consumption conduct by a brief intervention according to WHO recommendations. Apart from inadequate compensation and work load, another barrier identified by the GPs was their uncertainty about how to deal with affected patients. Most German universities presently spend no more than 90minutes lecture time on addiction medicine teaching. Our research aims to investigate the question whether medical studies and advanced medical education increases the role security of medical students and physicians and their commitment to implementing alcohol screening and brief intervention. Moreover, we will explore whether lack of therapeutic commitment can be related to lack of role security. Questionnaires were administered to pre-clinical and clinical medical students as well as senior house officers. Role security and therapeutic commitment of students and senior house officers were assessed using the Alcohol and Alcohol Problems Questionnaire (SAAPPQ) subscales "Role Security" and "Therapeutic Commitment". Analysis was based on 367 questionnaires. As expected, senior house officers reported more Role Security than clinical medical students who showed a higher level of Role Security than pre-clinical medical students. No differences could be found for Therapeutic Commitment. An association between Role Security and Therapeutic Commitment was only revealed for clinical medical students. Medical studies and advanced medical education can increase students' and senior house officers' Role Security to treat patients with excessive alcohol consumption, but not Therapeutic Commitment. Moreover, no association between Role Security and Therapeutic Commitment could be found for senior house officers. Hence, it may be assumed that educational activities aiming to increase Role Security do not promote the development of motivational aspects such as Therapeutic Commitment to the management of patients with excessive alcohol intake.

[A novel surgical mesh suitable for laparoscopy, studied on animal model]. / Új, laparoszkópos beültetésre alkalmas sérvháló állatkísérletes vizsgálata.

INTRODUCTION: Reconstruction of the abdominal wall with mesh is a widely used surgical procedure. The non-absorbable meshes tend to cause numerous side-effects. AIM: The aim of the author was to produce an absorbable, polymer-based mesh that possesses appropriate chemical, mechanical and biological properties. METHOD: A three-dimensional, biocompatible mesh was produced from poly-vinyl-alcohol using reactive electrospinning. Toxicity and cell-mesh interactions were tested using human lung carcinoma epithelial cells (A-549), and in vivo tests were conducted in 42 male Wistar rats at the 1-5, 7 and 14 postoperative days (3 rats/groups). RESULTS: In the in vitro tests poly-vinyl-alcohol was biocompatible. In the in vivo tests no major complication was associated with the mesh made of poly-vinyl-alcohol. CONCLUSIONS: The author concludes that this polymer mesh is biocompatible, it does not damage the surrounding tissues and integrates well with them.

[Associations between concurrent use of tobacco and alcohol and symptoms of attention-deficit hyperactivity disorder among ninth grader students]. / A dohányzás és az alkoholfogyasztás együttes elofordulásának összefüggései a figyelemhiányos hiperaktivitás-zavar tüneteivel kilencedik osztályos tanulók körében.

INTRODUCTION: Attention-deficit hyperactivity disorder is a risk factor of smoking and alcohol drinking in adolescence. Since attention-deficit hyperactivity disorder and smoking and alcohol drinking in adolescence are predictors for the development of substance use disorders in adulthood, it is important to understand the nature of these associations. AIM: The aim of the authors was to investigate associations between attention-deficit hyperactivity disorder symptoms and the joint use of alcohol and nicotine among 9th graders. METHOD: A representative sample of 944 pupils attending state-run secondary schools in Budapest were recruited. Generalized Linear Mixed Model and logistic regression analyses have been conducted. RESULTS: The prevalence was 29.6% and 41.4% for current smoking and current alcohol drinking, respectively. The prevalence of their concurrent-use was 21.7%. Alcohol drinking and smoking showed a significant positive association with the total scores of Attention-Deficit Hyperactivity Disorder Scale and with the Attention Deficit and Hyperactivity/Impulsivity subscales. CONCLUSIONS: The findings highlight the potential importance of attention-deficit hyperactivity disorder in the development of the joint use of these substances.

[Fill it up...! Combined consumption of alcohol with energy drinks and its correlation with risk taking behaviour among young adults]. / Tölts rá...! Az alkohol és energiaital együttes fogyasztásának és a kockázatvállaló magatartási formák kapcsolatának felmérése fiatal felnottek körében.

INTRODUCTION: In Hungary and all around the world the incidence of consumption of energy drinks together with alcohol has increased among adolescents and young adults. AIM: The foremost aim of this survey was to find out whether alcohol mixed with energy drinks can enhance the appearance of other forms of risky behaviour among young adults. METHOD: In spring 2013 the authors carried out a quantitative sociological survey at three faculties of two major universities in Budapest, Hungary. RESULTS: The survey showed that 1) consumers, who mixed alcohol with energy drinks, were likely to drink more alcohol both at parties and on ordinary days, and they took part in binge drinking more frequently than those consuming only alcohol; 2) students drank significantly less alcohol when they mixed it with energy drink. CONCLUSIONS: The conflicts of the results showed that even at the starting point there was a clear distinction between the two groups, moreover, it is not yet clear what interactions the combined effect of caffeine and alcohol can trigger in the behaviour of the individual.

Age and gender as independent predictors of violence under the influence of alcohol in Zurich, Switzerland.

Violent behaviour associated with alcohol consumption is frequently reported by different media. Clinical data analysing the correlation between alcohol intoxication, age, gender and violence are scarce. The aim of this study was to evaluate the influence of age, gender and blood alcohol content on violent behaviour under the influence of alcohol under central European conditions. Three hundred patients admitted to the emergency department were included into this study in the time period from January 01. to December 31. 2009. The inclusion criteria were a blood alcohol content (BAC) of ≥10 mmol/l, any traumatic injury and an age ≥16 years. Violence was defined as an evitable act committed by others leading to patient's hospitalisation. The data were compared with Wilcoxon and χ2-test for proportions. The data were considered as significant if p<0,05. Predictive quality was evaluated by using receiver operating characteristic (ROC) curve. Independent predictors were analyzed by logistic regression analysis. The average age was 36,9±16,9 years (range: 16-84 years), 259 (86%) males and 41 (24%) females. There was a significant difference in gender (odds ratio for gender male 2,88; CI 95%: 1,24-6,67; p<0,001) and age dependent (odds ratio for each year of age 0,94; CI 95%: 0,93-0,96; p<0,0001) violence with no correlation to blood alcohol content found. Logistic regression analysis revealed male gender and young age as an independent predictor for violence. These results clarify the relationship between alcohol, age, gender and violence and have important implications for municipal-level alcohol policies.

Les comportements violents associés à l'alcoolisme sont fréquemment rapportés dans différentes médias. Les données cliniques analysant la corrélation entre l'intoxication alcoolique, l'âge, le genre et la violence sont rares. Le but de la présente étude était d'évaluer l'influence de l'âge, du genre et de la concentration sanguine d'alcool sur le comportement violent sous l'influence de l'alcool, ceci dans des conditions rencontrées en Europe centrale. 300 malades hospitalisés dans le Département d'urgences de l'Hôpital universitaire de Zürich ont été inclus pendant une période allant du 1.1.2009 au 31.1.2009. Les critères d'inclusion consistaient en une alcoolémie ≥10 mmol/l, une atteinte traumatique de n'importe quelle nature et un âge ≥16 ans. La violence était définie comme un acte évitable commis par d'autres et ayant conduit à l'hospitalisation du malade. Les résultats ont été comparés par un test de Wilcoxon et de chi-carré. Une différence a été considérée comme significative à partir d'un p<0,05. La valeur prédictive a été évaluée sur la base d'une courbe ROC. Les facteurs prédictifs indépendants ont été recherchés à l'aide d'une analyse de régression logistique. L'âge moyen était de 36,9±16,9 (intervalle: 16­84 ans). Il y avait 259 (86%) hommes et 41 femmes (24%). Il y a vait une différence significative entre les genres (odds ratio pour les hommes=2,88; intervalle de confiance 95%: 0,93­0,96; p<0,0001) en ce qui concerne la violence, mais pas de différence du point de vue de l'alcoolémie. L'analyse de régression logistique a mis en évidence le genre masculin et le jeune âge comme des facteurs prédictifs indépendants. Ces résultats clarifient la relation entre l'alcool, l'âge, le genre et la violence. Ils ont ainsi d'importantes implications au niveau municipal pour l'attitude à avoir face à l'alcool.

[Substance abuse in older adults]. / Sucht im Alter.

In respect of demographic change, the number of older patients with substance abuse and addiction is on the raise. In this review we present important clinical and therapeutic aspects of substance abuse and addiction in the elderly and focus on alcohol, benzodiazepines and opioids. Daily and risky alcohol consumption is common among older people. They also have an increased risk getting alcohol-related complications. For early detection, laboratory parameters and questionnaires such as the AUDIT-C are suitable. Therapeutically brief interventions have been proved successful. Also, abuse of benzodiazepines, especially low-dose addiction, is widespread among older persons, although often overlooked, and patients often do not recognize their addiction. The physician has to know the correct indication, adequate dosage and pharmacological interactions. A slow-dose reduction is recommended in case of addiction. Thanks to opioid substitution therapy, patients with an opioidaddiction can reach a higher age. Age influences the effects of the substitute, which may require an adjustment of the dosage. Treatment of elderly patients should be based on their needs and resources and is usually very effective.

Sur le plan démographique le nombre de personnes âgées abusant ou dépendant de substances est en augmentation. Dans cette revue seront présentés des aspects cliniques et thérapeutiques de l'abus et de la dépendance de substances dans cette classe de la population, en particulier en ce qui concerne l'alcool, les benzodiazépines et les opioïdes. La consommation d'alcool quotidienne est fréquente chez les personnes âgées et augmente chez elles le risque de complications. Pour la détection précoce d'un abus d'alcool des paramètres de laboratoire et des questionnaires comme le AUDIT-C sont appropriés. Des interventions thérapeutiques brèves se sont avérées efficaces. L'abus de benzodiazépines, en particulier la dépendance à ces substances à petites doses, est aussi très répandu et souvent négligé chez les personnes âgées, de telle sorte que ces dernières n'en ont pas conscience. Le médecin doit connaître l'indication correcte, le dosage adéquat et les interactions des benzodiazépines. Une réduction lente des doses est recommandée en cas de dépendance. Les patients présentant une dépendance aux opioïdes ont leur vie prolongée grâce à un traitement substitutif. L'âge influence les effets des substances substitutives, ce qui peut nécessiter des adaptations de dosage. Le traitement des personnes âgées devrait être basé sur leurs besoins et leurs ressources. Il est généralement très efficace.