Care, co-survival, and decency: expanding the understanding of outdoor life and smaller alcohol and drug scenes in Denmark and Norway.

Introduction: Public spaces where alcohol and other drugs are openly used and marginal citizens gather, exist in many Nordic cities. The biggest open drug scenes in the Nordic countries are in cities like Oslo and Copenhagen; however, there are smaller scenes in other cities and suburbs, centered around shed-like structures, offering some form of shelter and a designated space for marginalized people involved in heavy drug and alcohol use who hang out in public space. In this paper, we investigate, in a comparative perspective, the characteristics and functions of smaller open alcohol and drug scenes, and how their existence is negotiated in the local community and among the citizens using them. Methods and material: This article is a comparative case-study based on data from fieldwork (participating observation and interviews) carried out in two specific, yet somewhat similar, locations in Denmark and Norway between 2017 - 2022. A cross-case analysis was performed to identify commonalities and differences. Results: Smaller open alcohol and drug scenes are non-regulated spaces of ambivalence and ongoing negotiation in local communities. Based on the data across locations, they represent possibilities for informal care and community for citizens in marginalized situations. The scenes are further, across location, characterized by a mutual agreement of performing decency, e.g., not allowing minor drug sale/use. Discussion: To enable public spaces as smaller alcohol and drug scenes can play a role in reducing harm for marginalized citizens. Communication and dialogue between citizens using an open drug scene and the wider community may help reduce stigma.

Alcohol consumption among pregnant women in James Town Community, Accra, Ghana.

BACKGROUND: Alcohol consumption among pregnant women is a public health concern, considering its adverse outcomes for both mother and the developing foetus. This study examined factors that facilitate prenatal alcohol consumption, knowledge of adverse outcomes of prenatal alcohol exposure and alcohol expenditure among pregnant women in an urban community in Ghana. METHODS: In June 2014, a survey was conducted among 250 pregnant women sampled from James Town, an urban community in the Greater Accra Region of Ghana. Data were collected through face-to-face interviews and descriptive statistics conducted. The prevalence of alcohol consumption among women was determined. Pearson chi-square was used to determine associations between variables where necessary. RESULTS: Fifty-four percent of the pregnant women were aged 20 - 29 years. Seventy-three percent reported that they have ever consumed an alcoholic beverage before pregnancy. Of these, 77% take alcohol "once a while" and 48% reported taking alcohol during pregnancy. Most of the pregnant women (53%) who currently consume alcoholic beverages had it from friends, and their main reason for prenatal alcohol consumption was socialization (39%). Majority of both current alcohol drinkers (78%) and non-current alcohol drinkers (74%) were aware that prenatal alcohol consumption can lead to spontaneous abortion. Additionally, current alcohol drinkers spend averagely GHS 4.54 (SD 4.63) on their favourite alcoholic drink and overall, also spend averagely GHS 4.63 (SD 4.82) on their entire alcoholic beverage weekly. Over two-thirds (63%) of women reported monthly average income of less than GHS200. CONCLUSION: This study shows high prenatal alcohol consumption in James Town, Accra, despite pregnant women's knowledge of its adverse effects on the developing foetus. Alcohol is usually sourced from friends with socialization noted as a major reason for prenatal alcohol consumption. These results could be used to inform future health advocacies and policies on prenatal alcohol exposure and maternal and child health interventions in the country.

The Information-Motivation-Behavioral Skills Model Revisited: A Network-Perspective Structural Equation Model Within a Public Sexually Transmitted Infection Clinic Sample of Hazardous Alcohol Users.

The information-motivation-behavioral skills (IMB) model is useful for understanding sexual risk behavior, but has not been tested with hazardously-drinking sexually transmitted infection (STI) clinic patients, a subpopulation at greater HIV risk, or with a network-perspective sexual risk behavior outcome. Participants (N = 569) were STI clinic patients who screened positive for hazardous drinking and risky sexual behavior. Sexual risk behavior (SRB) was operationalized as a latent variable with three indicators: (1) number of sexual partners, (2) number of unprotected sex occasions with primary partner, and (3) number of unprotected sex occasions with non-primary partner(s). Preliminary analyses suggested SRB was best operationalized as a latent variable with two indicators, while unprotected sex with primary partners should be considered separately. In structural models with good fit, the IMB model was generally supported. The IMB model functioned differently for non-primary and multiple partners compared to primary partners in STI clinic patients with hazardous alcohol use.

Intervenção com familiares, usuários de álcool e álcool mais outras drogas: um estudo clínico / Intervention with relatives, alcohol and alcohol users plus other drugs: a clinical trial

A Atenção Primária à Saúde (APS) pode ser uma possibilidade de acesso a usuários de álcool em uso de risco ou dependência, sendo a Intervenção Breve (IB) uma possiblidade de intervenção. Este estudo clínico randomizado por cluster objetiva verificar a efetividade da IB quando comparado ao grupo controle. Os participantes do estudo (Grupo Intervenção - GI - e Grupo Controle - GC) foram contatados por visita domiciliar após indicação dos serviços de Estratégia de Saúde da Família (ESF) da região Oeste de Saúde de Ribeirão Preto - SP. Os usuários inclusos foram usuários maiores de 18 anos e com escore de consumo >= 7, segundo AUDIT. Os instrumentos utilizados foram AUDIT (Alcohol Use Disorders Identification Test), ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), perfil sociodemográfico e Diário de consumo de álcool. Após as intervenções foram realizados follow-up de um mês e seis meses após término da última intervenção. As medidas quantitativas de desfecho foram a pontuação no instrumento AUDIT, na qual se utilizou as alterações na pontuação do instrumento como balizador para verificar a efetividade das intervenções. No grupo intervenção realizou-se ainda uma entrevista semiestruturada. A análise estatística foi feita com uso Regressão Linear Multinível para a amostra do estudo (23 participantes) e o mesmo com a amostra simulada de 30, 50 e 100 participantes hipotéticos. Os 23 participantes (12 do GI e 11 do GC) tinham média de idade em 48.2 anos, sendo 16 participantes homens (nove no GI e sete no GC). Sobre os anos de estudo, a média foi de 7.8 anos (GI a média foi de 9.5 e no GC 6.3 anos). No total, foram realizadas 323 visitas domiciliares. Referente consumo, a bebida mais escolhida foi cerveja e 15 dos 23 participantes não sabiam expressar como se sentiam antes da ingestão de bebida alcoólica. No que diz respeito ao uso de outras drogas na vida, dez participantes da amostra usavam apenas álcool (quatro do GI e seis do GC). Sete participantes usavam álcool e tabaco (quatro GI e três GC). Cinco participantes eram usuários de múltiplas drogas (3 GI e 2 GC). Entre as múltiplas drogas, as mais comuns foram a maconha e a cocaína. Sobre o comportamento de consumo abusivo de álcool episódico o consumo mais abusivo variou de 2,85 a 16, 2 doses. A média dos AUDIT durante o follow up não diferiu muito. A média de AUDIT do GI foi de 15.5 (T0), 16.25 (T1) e 11.6 (T2). Para o GC a média foi de 15.36 (T0), 8.1 (T1), 16.36 (T2). Sobre os resultados da efeito multinivel misto, na amostra real deste estudo não houve diferença significativa (p= 0.80) entre os grupo intervenção e controle, embora tenha sido observado efeito da intervenção. Sobre os dados prevenientes da simulação com tamanho amostral de 30, 50 e 100 participantes hipotéticos, não teve significância estatística, embora o efeito seja mantido. No que se refere aos resultados qualitativos, processados em três classes pelo software Alceste, foram analisados 74% do conteúdo textual, com riqueza de palavras de 94.05%, cujo conteúdo resultou em três classes: classe 1, com 33% da análise e correspondeu ao contexto geral do beber: pessoas e ocasiões que promovem ou desestimulam o beber, e os estímulos foram encontros com os amigos, os sentimentos negativos e às relações sociais; classe 2, 28% da análise e fez alusão ao indivíduo estar dependente de drogas em geral, situou o consumo de todas as substâncias (incluído o álcool) num contexto prejudicial; classe 3, que predominou com 39%, referiu-se ao indivíduo nos aspectos frequência, quantidade e abandono do consumo. Dados referentes ao perfil da amostra, bebida de escolha e influência cultural foram corroborados em outros estudos. Apareceu ainda que, o consumo de álcool não está vinculado apenas às preferências pessoais. O estudo revelou ser possível realizar a IB, todavia, há necessidade de encontrar as estratégias mais efetivas para contactar os usuários e envolver suas famílias e a equipe local dos serviços de saúde. O conhecimento de aspectos qualitativos mostrou que o consumo ligado ao hábito cotidiano pareceu se relacionar a padrão de consumo mensal alto, por isso, mais danoso. Inferiu-se ainda que nesta amostra esse padrão de consumo pode ser devido à carência de orientações e aconselhamento dos profissionais de saúde sobre o hábito de beber. As vivências sociais foram relacionadas ao consumo, prover espaços e momentos de lazer na comunidade sem o incentivo ao uso de álcool e/ou substâncias psicoativas, poderia auxiliar na diminuição do consumo ou abstinência das mesmas

Primary Health Care (PHC) may be a possibility for access to alcohol users who use risk or dependence and Brief Intervention (IB) is a possible intervention. Thus, this clinical trial randomized by cluster aimed to verify the effectiveness of IB when compared to the control group. The participants of the study (Intervention Group - IG - and Control Group - CG) were contacted by a home visit after indicating the Family Health Strategy (ESF) services of the West Region of Health of Ribeirão Preto/São Paulo state. The included users were users older than 18 years and with consumption score >= 7, according to AUDIT score. The instruments used were AUDIT (Alcohol Use Disorders Identification Test), ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), sociodemographic profile and Alcohol consumption diary. After the interventions, follow-up was performed one month and six months after the last intervention. The quantitative measures of outcome were the score in the AUDIT instrument, in which the changes in the instrument score were used as a benchmark to verify the effectiveness of the interventions. In the IG, a semi-structured interview was also carried out. The statistical analysis was done using Multi Level Linear Regression for the study sample (23 participants) and the same with the simulated sample of 30, 50 and 100 hypothetical participants. The 23 participants (12 from IG and 11 from CG) had a mean age of 48.2 years, of which 16 were men (nine in IG and seven in CG). Over the years of study, the mean was 7.8 years (mean IG was 9.5 and in CG 6.3 years). In total, 323 home visits were carried out. Regarding consumption, the most chosen beverage was beer and 15 of the 23 participants could not express how felt before drinking alcohol. Concerning the use of other drugs in life, ten participants in the sample used only alcohol (four from IG and six from CG). Seven participants used alcohol and tobacco (four IG and three CG). Five participants were users of multiple drugs (3 IG and 2 CG). Among the multiple drugs, the most common were marijuana and cocaine. On the behavior of abusive consumption episodic, the most abusive consumption ranged from 2.85 to 16.2 doses. The average AUDIT during the follow up did not differ much. The mean AUDI of the IG was 15.5 (T0), 16.25 (T1) and 11.6 (T2). For CG, the mean was 15.36 (T0), 8.1 (T1), 16.36 (T2). Concerning the results of the mixed multilevel effect, in the actual sample of this study there was no significant difference (p = 0.80) between the intervention and control groups, although the intervention effect was observed. Regarding the data of the simulation with sample size of 30, 50 and 100 hypothetical participants, it was not statistically significant also, although the effect was maintained. Regarding the qualitative results, processed in three classes by the software Alceste, 74% of the textual content was analyzed, with a wealth of words of 94.05%. Regarding Class 1, 33% of the analysis corresponds to the general context of drinking, people and occasions that promote or discourage drinking, where the incentive can be encounters with friends, negative feelings and social relations. Class 2 accounted for 28% of the analysis and refers to the individual being dependent of drugs in general, not just alcohol, placing the consumption of all substances in the same context. As for Class 3, higher class with 39%, refers to the individual regarding the frequency, quantity and abandonment of consumption. The knowledge of qualitative aspects showed us that the consumption linked to the daily habits seems to be related to patterns of high consumption monthly doses and, therefore, more harmful, even if in this sample it was observed that the consumption is high also possibly due to lack of guidance and conversations with professional about the habit of drinking. As the social experiences were related to the consumption high doses of alcohol, perhaps provide spaces and moments of leisure free alcohol could help in the diminution or abstinence to the alcohol

Socioeconomic impact of alcohol in patients with alcoholic liver disease in eastern India.

AIM: The aim of this study is to estimate the socioeconomic impact of alcohol use on patients with alcoholic liver disease (ALD) and their families. METHODS: The demographic and socioeconomic data were collected from hospitalized ALD patients and attendants using a self designed non validated questionnaire and analyzed. RESULTS: Study subjects included 100 consecutive ALD patients (all males). Sixty percent were between 30 and 50 years. Most were married (96 %), literate (63 %), either businessmen (37 %) or employed (30 %) and belonged to middle socioeconomic class. Ninety percent started alcohol use before age 30 years and half during teenage. Mean alcohol intake was 190 mL/day (mean duration 23 years); 60 % consumed alcohol daily. Concomitant tobacco abuse was noted in 79 %. Average expenditure on alcohol was Rs 3800/month. Average hospitalizations for ALD related problems was 2.6 times/year with average expenditure of INR 30,000 (~440 US$) during each hospitalization. For treatment expenses, 86 % of patients borrowed money from friends/relatives, 36 % used saving deposits, and 4 % sold personal belongings. Eleven percent lost their job, and 7 % sold immovable property. In 43 % of cases, children were deprived of education. Besides, 52 % had disturbed social and family life, 34 % abused their spouse, 20 % suffered accidents, and 37 % indulged in physical violence. CONCLUSION: Majority of ALD patients and their families had disturbed social and family life and incurred severe financial loss arising of alcohol use.

Glycemic Allostasis during Mental Activities on Fasting in Non-alcohol Users and Alcohol Users with Different Durations of Abstinence.

Glycemic allostasis is the process by which blood glucose stabilization is achieved through the balancing of glucose consumption rate and release into the blood stream under a variety of stressors. This paper reviews findings on the dynamics of glycemic levels during mental activities on fasting in non-alcohol users and alcohol users with different periods of abstinence. Referred articles for this review were searched in the databases of PubMed, Scopus, DOAJ and AJOL. The search was conducted in 2013 between January 20 and July 31. The following keywords were used in the search: alcohol action on glycemia OR brain glucose OR cognitive functions; dynamics of glycemia, dynamics of glycemia during mental activities; dynamics of glycemia on fasting; dynamics of glycemia in non-alcohol users OR alcohol users; glycemic regulation during sobriety. Analysis of the selected articles showed that glycemic allostasis during mental activities on fasting is poorly regulated in alcohol users even after a long duration of sobriety (1-4 weeks after alcohol consumption), compared to non-alcohol users. The major contributor to the maintenance of euglycemia during mental activities after the night's rest (during continuing fast) is gluconeogenesis.