Design of a randomized controlled trial of zinc supplementation to improve markers of mortality and HIV disease progression in HIV-positive drinkers in St. Petersburg, Russia.

Background Russia continues to have an uncontrolled HIV epidemic and its per capita alcohol consumption is among the highest in the world. Alcohol use among HIV-positive individuals is common and is associated with worse clinical outcomes. Alcohol use and HIV each lead to microbial translocation, which in turn results in inflammation. Zinc supplementation holds potential for lowering levels of biomarkers of inflammation, possibly as a consequence of its impact on intestinal permeability. This paper describes the protocol of a double-blinded randomized placebo-controlled trial of zinc supplementation in St. Petersburg, Russia. Methods Participants (n = 254) were recruited between October 2013 and June 2015 from HIV and addiction clinical care sites, and non-clinical sites in St. Petersburg, Russia. Participants were randomly assigned, to receive either zinc (15 mg for men; 12 mg for women) or placebo, daily for 18 months. The following outcomes were assessed at 6, 12, and 18 months: (1) mortality risk (primary outcome at 18 months); (2) HIV disease progression; (3) cardiovascular risk; and (4) microbial translocation and inflammation. Adherence was assessed using direct (riboflavin) and indirect (pill count, self-report) measures. Conclusion Given the limited effectiveness of current interventions to reduce alcohol use, zinc supplementation merits testing as a simple, low-cost intervention to mitigate the consequences of alcohol use in HIV-positive persons despite ongoing drinking.

Prognostic value of serum selenium levels in alcoholics.

In alcoholics, exposure of Kupffer cells to intestinal-borne Gram-negative bacteria increases free radical release, which may, in turn, enhance cytokine secretion, creating a positive feedback loop, which contributes to liver inflammation. Impaired antioxidant mechanisms further aggravates this scenario. Some trace elements, such as selenium, are main cofactors of antioxidant enzymes. Some authors have found low Se levels in alcoholics in relation either with undernutrition, liver dysfunction, or intensity of alcoholism, but in general, Se supplementation has no effect on survival. In this study we measured serum Se in 16 controls and 76 alcoholics, 34 of them cirrhotics, 68 of whom were followed up for a median period of 38 months; 17 died during this period. Se levels were lower in patients than in controls and were related to prothrombin activity and nutritional status, more closely to this last parameter (stepwise logistic regression analysis). Patients who died showed lower Se values than those who survived. Se values over the median were associated with better survival, assessed by Kaplan-Meier curves and log-rank test. However, in multivariate analysis (Cox regression model), prothrombin activity displaced serum Se as a prognostic factor. We conclude that serum Se levels are low in alcoholics; these low values depend more heavily on impaired nutrition but also on liver dysfunction; although low Se levels were associated with a higher mortality, prothrombin activity displaced serum Se when survival was assessed using Cox's regression model.

Relationship between diabetes and mortality among persons with co-occurring psychotic and substance use disorders.

OBJECTIVE: Individuals with diabetes and individuals with serious mental illness are more likely than the general population to die prematurely. The study examined the impact of diabetes on mortality among 197 individuals with co-occurring psychotic and substance use disorders who participated in a randomized controlled study of integrated mental health and substance abuse treatment. METHODS: The authors examined Medicaid claims for evidence of diabetes and applied survival analyses to examine whether time from study entry until death was different for individuals with and without evidence of diabetes. RESULTS: Of individuals with co-occurring psychotic and substance use disorders, 21% had evidence of diabetes. In a 12-year period, 41% of those with evidence of diabetes died compared with 10% of those without evidence of diabetes. CONCLUSIONS: Interventions targeted for diabetes prevention and diabetes management are critical for persons with serious mental illness, particularly among those who also abuse substances.

[Cultural history of wine, the theoretical background of wine therapy]. / A bor kultúrtörténete, a borterápia elméleti háttere.

The knowledge of wine and grapes as old as the cultural history of human population. The small consumption of wine could be advantageous. Also it has been well established for several thousands of years, that it could cause acute and chronic injuries after higher consumption. Its antiinfectious effect in dermatological drugs had been known in the archeological ages. The unguents containing wine polyphenols are advantageous in some dermatological injuries and also in the treatment of muscular and articular alterations. Moderate consumption of wine may decrease the mortality rate of cardiovascular diseases. In healthy individuals consumption of one-two dl of wine can decrease the mortality rate of cardiovascular diseases. This quantity, however, may be injurious in pregnancy, in children, and in various organic diseases, especially in liver disease, as well as if combined with common drugs.

The Indian Health Service approach to alcoholism among American Indians and Alaska Natives.

The transfer to the Indian Health Service (IHS) of 158 alcohol treatment programs that had been administered by the National Institute on Alcohol Abuse and Alcoholism began in 1978. Today, approximately 300 alcohol and substance abuse treatment programs offer services to American Indians, among them primary residential treatment, halfway houses, outreach, and aftercare. This system provides a national network upon which additional activities may be established. Along with increasing its attention to health promotion and disease prevention, the IHS has moved toward the prevention of alcoholism. A variety of preventive programs are in place that emphasize improved self-image, value and attitude clarification, decision-making, and physical and emotional effects of alcohol and substance abuse. Many begin as Head Start programs and continue through adulthood. In 1986, after consulting with both academic and tribal experts, the IHS devised a strategic plan for alcoholism control that stresses comprehensive care and prevention activities; it serves as a guide for further program development. The Secretary of Health and Human Services created a Task Force on Indian Alcoholism in 1986 to serve as a coordinating body for activities carried out by the IHS and other agencies and units of the Department. Passage of the Anti-Drug Abuse Act in 1986 added resources for the development of adolescent treatment centers and, more importantly, for community-based pre- and post-residential care for youths and their families. Concomitant with these initiatives have been several instances of increased attention by various tribes to the problem of alcoholism. The IHS strategic plan, together with the Secretary's initiative, the Anti-Drug Act, and tribal actions, has added substantial momentum to efforts directed at controlling alcoholism among American Indians. Although the mortality rate from alcoholism is about four times greater for the American Indian population than for the entire U.S. population, it decreased from 54.5 per 100,000 population to 26.1 between 1978 and 1985-a reduction of 52 percent.The philosophy of the IHS in emphasizing prevention of disease and promotion of wellness provides an opportunity for continuing the considerable progress already made. The critical and decisive role played by the Indian communities themselves will determine whether ultimate success can be achieved.

Abuso de alcohol y drogas en Puerto Rico: progreso hacia los objetivos nacionales de salud para 1990 (X) / Alcohol and drug abuse in Puerto Rico: progress running to the national objetives for health by 1990 (X)

En 1980 el Servicio de Salud Pública de los Estados Unidos promulgó unos objetivos para el mejoramiento de la salud de los habitantes del país en los próximos diez años. De los diecinueve objetivos nacionales de salud para 1990 referentes al abuso de alcohol y drogas, sólo uno está aparentemente alcanzado en Puerto Rico (el consumo per cápita de alcohol no excede los niveles de 1980). Ocho objetivos están bajo estudio o siendo perseguidos (la tasa anaual de miertes por colisiones de vehículo de motor CVM asociadas a conductores legalmente ebrios debe reducirse a menos de 9.5 por cien mil habitantes; la tasa de mortalidad por cirrosis debe reducirse a 12 por cien mil; la mortalidad por otras causas relacionadas al uso de drogas debe reducirse a 2 por cien mil; la proporción de adolescentes de 12 a 17 años que se abstiene de usar alcohol u otras drogas no debe caer bajo los niveles de 1977; la proporción de adolescentes de 14 a 17 años que informe problemas agudos relacionados a la bebida debe reducirse a menos de 17%; la proporción de bebedores problema entre todos los adultos de 18 años o más debe reducirse a 8%; la proporción de trabajadores en firmas grandes cuyos patronos proveen un programa de ayuda a empleados por abuso de sustancias intoxicantes debe ser mayor de 70%; y las normas médicas y farmacéuticas incluirán la elaboración de perfiles de medicamentos en la gran mayoría de los pacientes). No hay información para evaluar la situación en Puerto Rico respecto a los diez objetivos restantes: la tasa anual de mortalidad por otros accidentes aparte de las CVM, indirectamente atribuíbles al uso de alcohol, debe reducrise a 5 por cien mil; la incidencia del Síndrome Fetal de Alccohol deberá reducirse por 25%; las hospitalizaciones por reacciones adversas al uso de medicamentos deben reducirse por 25%; la proporción de jóvenes de 18 a 25 años que informe el uso frecuente de drogas, a parte del alcohol, no debe exceder los niveles de 1977; la proporción de adolescentes de 12 a 17 años que informe el uso frecuente de drogas, aparte del alcohol, no debe exceder los niveles de 1977; la proporción de mujeres de edad fértil consciente de los riesgos asociados con el embarazo y la bebida debe ser mayor de 90%;...

Alcoholism treatment and evaluation: in search of methods. II. Collation of two-year follow-up studies.

This study collated 23 articles reporting outcome of alcoholism treatment efforts over a 2-year follow-up period. Broad conclusions reached by Costello (1975) in a similar collation of studies reporting on a 1-year follow-up interval found general support. Similar consistencies were noted across studies within groups described as having good outcome profiles as was noted by the previous collation. Good outcome results from matching relatively better prognostic cases wtih programs with broad treatment resources. Multiple baselines were offered as guidelines for program evaluation. Baselines were generated in the process of collation by hierachal grouping of outcome profiles. Different baseline to measure effectiveness of performance should prove appropriate for different measuring tasks. No one baseline is appropriate for all measuring tasks.