Changes in alcohol consumption during the COVID-19 among First-Year University Students in Spain, considering the risk of problematic use - UniHcos Project.

The aim of this study was to evaluate the possible impact of the COVID-19 pandemic on prevalence rates and self-reported changes in patterns of alcohol use among first-year university students in Spain, considering the risk of problematic alcohol use. A serial cross-sectional study based on the uniHcos project was carried out. Data from 10,518 first-year university students (73.3% female, mean age 19 (SD=1.6)) collected between 2012 and 2022 were analysed. The evolution of the pooled prevalence rates during the time series was analysed and the risk of problematic alcohol consumption was assessed using the AUDIT. Also, self-reported changes in alcohol use patterns during the pandemic were assessed. According to the results, during the COVID-19 pandemic, the prevalence of alcohol use in the past 30-days was reduced (76.3% in 2019 vs. 63.7% in COVID-19) and increased again in the New Normal period. Thus, a similar pattern in the practice of binge drinking was observed. Regarding the AUDIT score, 21.7% (95%CI 20.9, 22.6) of the students had harmful alcohol consumption, with a higher proportion among males. In the multivariable logistic models, a higher AUDIT score was significantly associated (p-value<0.001) with being male and living with roommates. According to self-reported changes in consumption patterns during the COVID-19 pandemic, a higher proportion of participants with harmful use reported an increase in alcohol consumption compared to those at low-risk (43% vs 19%). Finally, despite the overall reduction in drinking prevalence during COVID-19, changes were not equal for all students and depended on their previous level of problematic drinking, highlighting that this should be considered in the development of strategies against alcohol use in this population.

The Impact of Tobacco Smoking and Alcohol Consumption on the Development of Gastric Cancers.

Chronic infection of Helicobacter pylori is considered the principal cause of gastric cancers, but evidence has accumulated regarding the impact of tobacco smoking and alcohol consumption on the development of gastric cancers. Several possible mechanisms, including the activation of nicotinic acetylcholine receptors, have been proposed for smoking-induced gastric carcinogenesis. On the other hand, local acetaldehyde exposure and ethanol-induced mucosal inflammation have been proposed as the mechanisms involved in the development of gastric cancers in heavy alcohol drinkers. In addition, genetic polymorphisms are also considered to play a pivotal role in smoking-related and alcohol-related gastric carcinogenesis. In this review, we will discuss the molecular mechanisms involved in the development of gastric cancers in relation to tobacco smoking and alcohol consumption.

Association of lifestyle modification with the development of cardiovascular disease in gastric cancer patients who underwent gastrectomy: A nationwide population-based study.

BACKGROUND: While cancer patients are at an increased risk of cardiovascular disease (CVD), the role of modifiable risk factors remains poorly understood. This study investigated whether lifestyle modifications affect CVD development in gastric cancer patients who undergo surgery. METHODS: Using data from the Korean National Health Insurance Service (NHIS), gastric cancer patients who underwent surgery from 2010 to 2017 were identified. Lifestyle behaviours, surveyed within 2 years before and after surgery were analysed. Incident CVD, defined as a composite of myocardial infarction and stroke, was compared among subgroups of lifestyle behaviour changes. RESULTS: Among 22,211 gastrectomy patients, 628 (2.8%) developed CVD (5.68/1000 person-years). Persistent smokers (HR: 1.72, 95% CI: 1.33-2.22) and new smokers (HR: 1.85, 95% CI: 1.04-3.30) faced higher CVD risks than non-smokers, with an especially pronounced risk in persistent-smoking females (HR: 3.89, 95% CI: 1.20-12.62). Smoking cessation showed no significant risk difference compared to non-smokers (HR: 1.16, 95% CI: 0.93-1.43). Female new drinkers had a higher CVD risk than non-drinking females (HR: 2.89, 95% CI: 1.06-7.88), while men did not show such association. Changes in physical activity, when compared to physical inactivity, were not associated with CVD risk. CONCLUSION: Gastric cancer patients who smoked after surgery were more likely to develop CVD irrespective of their prior smoking status, with a notable vulnerability in persistent female smokers. Smoking cessation could potentially mitigate CVD risk to levels observed in non-smokers. Alcohol intake should be avoided following surgery, especially for female gastric cancer patients.

Sex Differences in Mouse Models of Voluntary Alcohol Drinking and Abstinence-Induced Negative Emotion.

Alcohol Use Disorder (AUD) is a growing problem worldwide, causing an incredible burden on health and the economy. Though AUD impacts people of all backgrounds and demographics, increasing evidence has suggested robust sex differences in alcohol drinking patterns and AUD-induced negative emotionality or hyperkatifeia. Rates of problematic drinking have significantly risen among women, and women face more severe negative emotional consequences in abstinence such as increased risk of comorbidity with an anxiety or mood disorder and more severe symptoms of depression. As such, a bevy of preclinical literature using contingent methods of alcohol (ethanol) consumption has amassed in recent years to better understand sex as a biological variable in alcohol drinking and abstinence-induced negative emotionality. Mice are widely used to model alcohol drinking, as they are conducive to genetic manipulation strategies, and many strains will voluntarily consume alcohol. Sex-specific results from these mouse studies, however, have been inconsistent. Therefore, this review aims to summarize the current knowledge on sex differences in AUD-related contingent ethanol drinking and abstinence-induced negative emotionality in mice. Various contingent mouse drinking models and negative emotional-based behavioral paradigms are introduced and subsequently discussed in the context of sex differences to show increasing indications of sex specificity in mouse preclinical studies of AUD. With this review, we hope to inform future research on potential sex differences in preclinical mouse models of AUD and provide mounting evidence supporting the need for more widespread inclusion of preclinical female subjects in future studies.

Smoking and alcohol habits in head and neck cancers: how many patients stop after diagnosis?

BACKGROUND: Smoking and alcohol are the main risk factors for head and neck cancer. Despite the significant psychological impact, many patients continue to smoke and drink alcohol after diagnosis of cancer. This study aims to analyze the patients' behavior post diagnosis and treatment of head and neck cancer. METHODS: An observational retrospective study was conducted on patients suffering from head and neck cancer. Their smoking and alcohol habits before and after diagnosis of cancer were studied. RESULTS: A total of 85 patients were recruited: 80% males, mean age 61.77±9.30 years. Among smokers, 35.80% continued smoking post-diagnosis. A statistically significant correlation was found between smoking habit after diagnosis of cancer and type of treatment and tracheostomy. Among drinkers, 65.52% continued to consume alcohol after diagnosis of cancer. A statistically significant correlation was found between alcohol consumption post-diagnosis and sex. CONCLUSIONS: Patients undergoing more invasive treatments are more likely to quit smoking and/or drinking alcohol, suggesting the strong psychological impact of cancer and its therapy. Many patients continue smoking and consuming alcohol due to unawareness, depression, or addiction. However, most patients reduced cigarette smoking and alcohol consumption. Comprehensive care, including psychological support, is essential for these patients.

[Health effects of alcohol: untangling the truth from the false!] / Effets de l'alcool sur la santé : démêler le vrai du faux !

HEALTH EFFECTS OF ALCOHOL: UNTANGLING THE TRUTH FROM THE FALSE! Daily alcohol consumption is associated with an increased risk of death, even at low doses. However, it remains high in France, where a large proportion of the population consumes alcohol in excess of reasonable limits. The most recent data invalidate the idea that a low dose could reduce cardiovascular risk. Santé publique France recommended in 2017 not to exceed the dose of 100 g of pure alcohol per week and not to drink alcohol every day. Harmonizing taxes on different types of alcoholic beverages upwards and indicating on each container: "Do not exceed 10 glasses per week" would be two good public health measures.

"EFFETS DE L'ALCOOL SUR LA SANTÉ : DÉMÊLER LE VRAI DU FAUX ! La consommation quotidienne d'alcool est associée à un risque augmenté de décès, et ce même si la dose d'alcool est faible. Elle reste toutefois élevée en France où une bonne partie de la population a une consommation dépassant les limites d'une consommation raisonnable. Les données les plus récentes infirment l'idée qu'une faible dose pourrait réduire le risque cardiovasculaire. Santé publique France a recommandé en 2017 de ne pas dépasser la dose de 100 g d'alcool pur par semaine et de ne pas boire d'alcool tous les jours. Harmoniser par le haut les taxes sur les différents types de boissons alcoolisées et indiquer sur chaque contenant : « Ne pas dépasser 10 verres par semaine ¼ seraient deux bonnes mesures de santé publique."

Alcohol intake and endogenous sex hormones in women: Meta-analysis of cohort studies and Mendelian randomization.

BACKGROUND: The mechanisms underlying alcohol-induced breast carcinogenesis are not fully understood but may involve hormonal changes. METHODS: Cross-sectional associations were investigated between self-reported alcohol intake and serum or plasma concentrations of estradiol, estrone, progesterone (in premenopausal women only), testosterone, androstenedione, dehydroepiandrosterone sulfate, and sex hormone binding globulin (SHBG) in 45 431 premenopausal and 173 476 postmenopausal women. Multivariable linear regression was performed separately for UK Biobank, European Prospective Investigation into Cancer and Nutrition, and Endogenous Hormones and Breast Cancer Collaborative Group, and meta-analyzed the results. For testosterone and SHBG, we also conducted Mendelian randomization and colocalization using the ADH1B (alcohol dehydrogenase 1B) variant (rs1229984). RESULTS: Alcohol intake was positively, though weakly, associated with all hormones (except progesterone in premenopausal women), with increments in concentrations per 10 g/day increment in alcohol intake ranging from 1.7% for luteal estradiol to 6.6% for postmenopausal dehydroepiandrosterone sulfate. There was an inverse association of alcohol with SHBG in postmenopausal women but a small positive association in premenopausal women. Two-sample randomization identified positive associations of alcohol intake with total testosterone (difference per 10 g/day increment: 4.1%; 95% CI, 0.6-7.6) and free testosterone (7.8%; 4.1-11.5), and an inverse association with SHBG (-8.1%; -11.3% to -4.9%). Colocalization suggested a shared causal locus at ADH1B between alcohol intake and higher free testosterone and lower SHBG (posterior probability for H4, 0.81 and 0.97, respectively). CONCLUSIONS: Alcohol intake was associated with small increases in sex hormone concentrations, including bioavailable fractions, which may contribute to its effect on breast cancer risk.

Is alcohol outlet availability associated with binge drinking in Canadian young adults? Findings from British Columbia and Quebec.

OBJECTIVES: Alcohol availability is associated with alcohol consumption and related harms, but there is less evidence on associations with heavy episodic drinking (HED), a drinking pattern prevalent among young adults. This study aimed to assess the associations between alcohol availability and HED among young Canadians. METHODS: We used a population-based sample of Canadian urban-dwelling young adult drinkers (18‒29 years) from the cross-sectional Canadian Community Health Survey (CCHS; cycles 2015‒2019). We linked data from CCHS respondents in British Columbia and Quebec with two measures of alcohol availability for both offsite and onsite outlets: density (AOD) and accessibility (SAI) within dissemination areas (N = 1,067,747). We used logistic regression to estimate the associations between alcohol availability and monthly HED, adjusting for covariates. RESULTS: The associations between availability and HED differed by province, and availability measure. In British Columbia, offsite and onsite accessibility using SAI was inversely associated with HED. For example, living in neighbourhoods with medium alcohol accessibility (as compared to low) was significantly associated with reduced odds of HED (offsite OR = 0.33, 95% CI 0.17‒0.64; onsite OR = 0.49, 95% CI 0.27‒0.89). In Quebec, offsite availability was positively associated with HED using SAI (although not statistically significant) while no clear trend was seen for onsite availability. CONCLUSION: Results were consistent with previous evidence. Restricting spatial availability of alcohol remains an important public health strategy for decreasing the ease/convenience of access. Understanding why patterns of availability and drinking differ across regions could inform regionally tailored policies.

RéSUMé: OBJECTIFS: La disponibilité des points de vente d'alcool (PVA) dans les quartiers est associée à la consommation d'alcool et aux méfaits qui y sont reliés, mais il y a encore peu de données probantes sur les associations avec la forte consommation épisodique, un mode de consommation d'alcool répandu chez les jeunes adultes. Cette étude visait à évaluer les associations entre la disponibilité des PVA et la forte consommation épisodique d'alcool chez les jeunes adultes canadiens. MéTHODES: Nous avons analysé les données de jeunes adultes (18 à 29 ans) ayant participé à l'Enquête sur la santé dans les collectivités canadiennes (ESCC; cycles 2015‒2019) et vivant en milieu urbain en Colombie-Britannique et au Québec. Nous avons couplé ces données à deux mesures de disponibilité des PVA : la densité et l'accessibilité calculées à l'échelle des aires de diffusion (N = 1 067 747). Nous avons estimé les associations entre la disponibilité des PVA, en distinguant les PVA à consommer sur place (p. ex., bars) et pour emporter (p. ex., dépanneurs), et la forte consommation épisodique d'alcool à l'aide de modèles de régression logistique ajustés pour les variables de confusion potentielle. RéSULTATS: Les associations entre la disponibilité des PVA et la forte consommation épisodique différaient selon la province et la mesure de disponibilité choisie. En Colombie-Britannique, l'accessibilité aux PVA à consommer sur place et à emporter était inversement associée à une forte consommation épisodique d'alcool. Par exemple, le fait de vivre dans des quartiers où l'accessibilité à l'alcool était moyenne (comparativement à faible) était significativement associé à une plus faible probabilité de forte consommation épisodique (RC PVA à consommer sur place = 0,49, IC à 95% : 0,27‒0,89; RC PVA pour emporter = 0,33, IC à 95% : 0,17‒0,64). Au Québec, l'accessibilité aux PVA pour emporter était associée positivement à la forte consommation épisodique (bien que l'association n'était pas statistiquement significative), tandis qu'aucune tendance claire n'a été observée pour la disponibilité des PVA à consommer sur place. CONCLUSION: Nos résultats concordent avec les données probantes antérieures. Restreindre la disponibilité des points de vente d'alcool dans les quartiers demeure une stratégie de santé publique intéressante pour réduire la facilité d'accès à l'alcool. Une exploration plus en profondeur des raisons pour lesquelles les associations entre disponibilité et consommation d'alcool diffèrent entre provinces servirait à énoncer des politiques publiques adaptées aux régions.

Predictive Models for the Transition from Mild Neurocognitive Disorder to Major Neurocognitive Disorder: Insights from Clinical, Demographic, and Neuropsychological Data.

Neurocognitive disorders (NCDs) are progressive conditions that severely impact cognitive function and daily living. Understanding the transition from mild to major NCD is crucial for personalized early intervention and effective management. Predictive models incorporating demographic variables, clinical data, and scores on neuropsychological and emotional tests can significantly enhance early detection and intervention strategies in primary healthcare settings. We aimed to develop and validate predictive models for the progression from mild NCD to major NCD using demographic, clinical, and neuropsychological data from 132 participants over a two-year period. Generalized Estimating Equations were employed for data analysis. Our final model achieved an accuracy of 83.7%. A higher body mass index and alcohol drinking increased the risk of progression from mild NCD to major NCD, while female sex, higher praxis abilities, and a higher score on the Geriatric Depression Scale reduced the risk. Here, we show that integrating multiple factors-ones that can be easily examined in clinical settings-into predictive models can improve early diagnosis of major NCD. This approach could facilitate timely interventions, potentially mitigating the progression of cognitive decline and improving patient outcomes in primary healthcare settings. Further research should focus on validating these models across diverse populations and exploring their implementation in various clinical contexts.

Identification of Alcohol Use Prior to Major Cancer Surgery: Timeline Follow Back Interview Compared to Four Other Markers.

BACKGROUND: The postoperative complication rate is 30-64% among patients undergoing muscle-invasive and recurrent high-risk non-muscle-invasive bladder cancer surgery. Preoperative risky alcohol use increases the risk. The aim was to evaluate the accuracy of markers for identifying preoperative risky alcohol. METHODS: Diagnostic test sub-study of a randomized controlled trial (STOP-OP trial), based on a cohort of 94 patients scheduled for major bladder cancer surgery. Identification of risky alcohol use using Timeline Follow Back interviews (TLFB) were compared to the AUDIT-C questionnaire and three biomarkers: carbohydrate-deficient transferrin in plasma (P-CDT), phosphatidyl-ethanol in blood (B-PEth), and ethyl glucuronide in urine (U-EtG). RESULTS: The correlation between TLFB and AUDIT-C was strong (ρ = 0.75), while it was moderate between TLFB and the biomarkers (ρ = 0.55-0.65). Overall, sensitivity ranged from 56 to 82% and specificity from 38 to 100%. B-PEth showed the lowest sensitivity at 56%, but the highest specificity of 100%. All tests had high positive predictive values (79-100%), but low negative predictive values (42-55%). CONCLUSIONS: Despite high positive predictive values, negative predictive values were weak compared to TLFB. For now, TLFB interviews seem preferable for preoperative identification of risky alcohol use.

Alcohol Consumption Patterns for Excessive Drinkers in a Multi-Ethnic Society Short Running Title: Drinking Patterns and Health Education.

Objective: Culture and eating habits, which vary greatly across different ethnic groups, have a substantial impact on drinking behavior. This study aimed to examine whether the drinking patterns and reasons differ by ethnic groups, and provide useful insights for multi-ethnic areas that seek to cut down alcohol intake. Methods: We recruited excessive drinkers and collected the drinking patterns and motivations by questionnaire in a multi-ethnic society. Multiple linear regressions were used to evaluate the variations in drinking characteristics among different ethnic groups. Results: We recruited 1287 participants through convenience sampling (a non-probability sampling technique used in research where the researcher selects participants or units for a study based on their accessibility and proximity), among whom 439 excessive drinkers were eligible. The mean age was 38 years for the 439 participants, 92.9% were men, 36.0% were Han, and 64.0% were minorities mainly composed of the Yi. The majority of the participants were married (75.9%) and did physical work (58.1%). Ethnic minorities consumed more alcohol on a single occasion than Han people did (47.3 vs 41.8g/session) while drinking less frequently. For the minority and Han participants, 67% and 42% were not used to drinking with food, respectively. Peer pressure and fostering a good atmosphere were the most common drinking reasons for the minority and Han, respectively. Conclusion: We found substantial differences in drinking patterns and reasons between ethnic minorities and Han ethnicity, attributable to their culture and customs. Findings highlight the importance of drinking habits and motivations in exploring alcohol control education strategies in the context of ethnic integration and population immigration.

Alcohol Misuse and Sexually Transmitted Infections: Using the CAGE Questionnaire as a Screening Tool.

Background: While the connection between alcohol and risky behavior is well known, a clear correlation between alcohol misuse and contracting sexually transmitted infections (STIs) has not been determined. The 4-question CAGE questionnaire-the acronym stands for attitudes and activities related to alcohol use-is often administered at primary care annual visits to screen patients for alcohol abuse. This study assessed the relationship between CAGE scores and STI results to determine if the CAGE questionnaire could help determine the need for STI screening at annual visits. Methods: All patients who received a CAGE screening from 2015 to 2022 at a Gulf South health system were included in the analysis. The primary outcome of the study was the relationship between a positive CAGE score (a score ≥2) and a positive STI result. STIs included in the primary analysis were human immunodeficiency virus (HIV), hepatitis B, syphilis, chlamydia, gonorrhea, and trichomoniasis. The correlation between a positive CAGE score and hepatitis C was examined as a secondary outcome. Results: A total of 40,022 patients received a CAGE screening during the study period, and 757 (1.9%) scored ≥2 on the CAGE questionnaire. Significant associations were found between a positive CAGE score and hepatitis B (odds ratio [OR]=2.69, 95% CI 1.91, 3.80; P<0.001), gonorrhea (OR=5.43, 95% CI 1.80, 16.39; P=0.003), and hepatitis C (OR=2.10, 95% CI 1.57, 2.80; P<0.001). No associations were found between a positive CAGE score and HIV, chlamydia, or trichomoniasis. No patients with a CAGE score ≥2 had a syphilis diagnosis; therefore, no syphilis analysis was possible. Conclusion: Based on the results of this study, patients with a CAGE score ≥2 may benefit from screening for hepatitis B, hepatitis C, and gonorrhea at their primary care annual visit. Early STI detection could lead to prompt treatment and prevent further transmission and complications.

Addressing causal relationship between drinking behavior and metabolic syndrome: one-sample Mendelian randomization analysis.

AIMS: Alcohol drinking is associated with central obesity, hypertension, and hyperlipidemia, which further causes metabolic syndrome (MetS). However, prior epidemiological studies on such associations lack experimental evidence for a causal relationship. This study aims to explore the causal relationship between drinking behavior and MetS in Taiwan population by using Mendelian randomization (MR) analysis. METHODS: A cross-sectional study was conducted using the Taiwan Biobank database, which comprised 50 640 Han Chinese who were 30-70 years old without cancer from 2008 to 2020. In MR analysis, we constructed weighted and unweighted genetic risk scores by calculating SNP alleles significantly associated with alcohol drinking. We calculated odds ratios and 95% confidence interval (CI) by using a two-stage regression model. RESULTS: A total of 50 640 participants were included with a mean age of 49.5 years (SD: 1.67 years), 36.6% were men. The adjusted odds ratio (aOR) of MetS per 5% increase in the likelihood of genetic predisposition to drink based on weighted genetic risk score with adjustment was 1.11 (95% CI: 1.10, 1.12, P < .001). Analysis was also conducted by grouping the likelihood of genetic predisposition to drink based on quartiles with multivariate adjustment. Using Q1 as the reference group, the aORs of MetS for Q2, Q3, and Q4 were 1.19 (1.12, 1.27, p < .001), 1.31 (1.23, 1.40, p < .001), and 1.87 (1.75, 2.00, p < .001), respectively, for the weighted genetic risk score. CONCLUSIONS: This study shows a modest relationship between drinking behavior and MetS by using MR analysis.

Short-chain fatty acid valerate reduces voluntary alcohol intake in male mice.

BACKGROUND: Despite serious health and social consequences, effective intervention strategies for habitual alcohol binge drinking are lacking. The development of novel therapeutic and preventative approaches is highly desirable. Accumulating evidence in the past several years has established associations between the gut microbiome and microbial metabolites with drinking behavior, but druggable targets and their underlying mechanism of action are understudied. RESULTS: Here, using a drink-in-the-dark mouse model, we identified a microbiome metabolite-based novel treatment (sodium valerate) that can reduce excessive alcohol drinking. Sodium valerate is a sodium salt of valeric acid short-chain fatty acid with a similar structure as γ-aminobutyric acid (GABA). Ten days of oral sodium valerate supplementation attenuates excessive alcohol drinking by 40%, reduces blood ethanol concentration by 53%, and improves anxiety-like or approach-avoidance behavior in male mice, without affecting overall food and water intake. Mechanistically, sodium valerate supplementation increases GABA levels across stool, blood, and amygdala. It also significantly increases H4 acetylation in the amygdala of mice. Transcriptomics analysis of the amygdala revealed that sodium valerate supplementation led to changes in gene expression associated with functional pathways including potassium voltage-gated channels, inflammation, glutamate degradation, L-DOPA degradation, and psychological behaviors. 16S microbiome profiling showed that sodium valerate supplementation shifts the gut microbiome composition and decreases microbiome-derived neuroactive compounds through GABA degradation in the gut microbiome. CONCLUSION: Our findings suggest that sodium valerate holds promise as an innovative therapeutic avenue for the reduction of habitual binge drinking, potentially through multifaceted mechanisms. Video Abstract.

Do later school start times improve adolescents' sleep and substance use? A quasi-experimental study.

OBJECTIVE: A later school start time policy has been recommended as a solution to adolescents' sleep deprivation. We estimated the impacts of later school start times on adolescents' sleep and substance use by leveraging a quasi-experiment in which school start time was delayed in some regions in South Korea. METHODS: A later school start time policy was implemented in 2014 and 2015, which delayed school start times by approximately 30-90 minutes. We applied difference-in-differences and event-study designs to longitudinal data on a nationally representative cohort of adolescents from 2010 to 2015, which annually tracked sleep and substance use of 1133 adolescents from grade 7 through grade 12. RESULTS: The adoption of a later school start time policy was initially associated with a 19-minute increase in sleep duration (95% CI, 5.52 to 32.04), driven by a delayed wake time and consistent bedtime. The policy was also associated with statistically significant reductions in monthly smoking and drinking frequencies. However, approximately a year after implementation, the observed increase in sleep duration shrank to 7  minutes (95% CI, -12.60 to 25.86) and became statistically nonsignificant. Similarly, the observed reduction in smoking and drinking was attenuated a year after. CONCLUSIONS: Our findings suggest that policies that increase sleep in adolescents may have positive effects on health behaviors, but additional efforts may be required to sustain positive impacts over time. Physicians and education and health policymakers should consider the long-term effects of later school start times on adolescent health and well-being.

Tobacco exposure and alcohol drinking prevalence and associations with hypertension in rural southwest China: A cross-sectional study.

INTRODUCTION: This study examined the prevalence of tobacco exposure and drinking and ascertained the relationships between tobacco exposure, alcohol drinking, concurrent smoking and drinking, and hypertension in rural southwestern China. METHODS: Data were collected from a cross-sectional health interview and examination survey, which included 7572 adults aged ≥35 years, in rural China. Participant demographic characteristics, smoking habits, exposure to secondhand smoke (SHS), and alcohol drinking habits were obtained using a standard questionnaire. Blood pressure (BP), height, weight, and waist circumference were measured for each participant. RESULTS: The overall prevalence of smoking, SHS exposure, drinking, concurrent smoking and drinking, concurrent exposure to SHS and drinking, and hypertension was 37.7%, 27.4%, 16.2%, 12.6%, 1.6%, and 41.3%, respectively. Males had a significantly higher prevalence of smoking (74.1% vs 2.2%, p<0.01), drinking (31.1% vs 1.7%, p<0.01), and concurrent smoking and drinking than females (25.3% vs 0.3%, p<0.01). However, females had a higher prevalence of SHS exposure than males (30.2% vs 20.6%, p<0.01). Ethnic minorities had a higher prevalence of SHS exposure, drinking, and concurrent smoking and drinking, than Han participants (p<0.01). Participants with a higher education level had a higher prevalence of smoking, drinking, and concurrent smoking and drinking than their counterparts (p<0.01). In contrast, participants with a lower education level had a higher prevalence of SHS exposure than their counterparts (p<0.01). Multivariate logistic regression analysis found that smokers (AOR=1.31; 95% CI: 1.13-1.51), individuals exposed to SHS (AOR=1.24; 95% CI: 1.11-1.43), drinkers (AOR=1.31; 95%: CI: 1.15-1.50), and concurrent smokers and drinkers (AOR=1.45; 95% CI: 1.25-1.67) all had a higher probability of having hypertension (p<0.01). Additionally, concurrent smoking and drinking had the strongest association with the prevalence of hypertension (AOR=1.45; 95% CI: 1.25-1.67; p<0.01). CONCLUSIONS: Socioeconomic factors play an important role in influencing the prevalence of smoking, exposure to SHS, and drinking in rural southwest China. Interventions to prevent and reduce hypertension should, in particular, focus on smokers, individuals exposed to SHS, drinkers, and, in particular, concurrent smokers and drinkers.

The Combined Effects of Alcohol Consumption and Smoking on Cancer Risk by Exposure Level: A Systematic Review and Meta-Analysis.

BACKGROUND: Alcohol consumption is a major risk factor for cancer, and when combined with smoking, the risk increases. Nevertheless, few studies have comprehensively evaluated the combined effects of alcohol consumption and smoking on the risk of various cancer types. Therefore, to assess these effects, we conducted a systematic review and meta-analysis. METHODS: We performed a systematic search of five literature databases, focusing on cohort and case-control studies. Considering exposure levels, we quantified the combined effects of alcohol consumption and smoking on cancer risk and assessed multiplicative interaction effects. RESULTS: Of 4,452 studies identified, 24 (4 cohort studies and 20 case-control studies) were included in the meta-analysis. We detected interaction effect of light alcohol and moderate smoking on head and neck cancer risk (relative risk [RR], 4.26; 95% confidence interval [CI], 2.50-7.26; I² = 65%). A synergistic interaction was observed in heavy alcohol and heavy smoking group (RR, 35.24; 95% CI, 23.17-53.58; I² = 69%). In more detailed cancer types, the interaction effect of heavy alcohol and heavy smoking was noticeable on oral (RR, 36.42; 95% CI, 24.62-53.87; I² = 46%) and laryngeal (RR, 38.75; 95% CI, 19.25-78.01; I² = 69%) cancer risk. CONCLUSION: Our study provided a comprehensive summary of the combined effects of alcohol consumption and smoking on cancers. As their consumption increased, the synergy effect became more pronounced, and the synergy effect was evident especially for head and neck cancer. These findings provide additional evidence for the combined effect of alcohol and smoking in alcohol guidelines for cancer prevention.

Alcohol drinking modified the effect of plasma YKL-40 levels on stroke-specific mortality of acute ischemic stroke.

OBJECTIVES: Our study aimed to evaluate the association between plasma human cartilage glycoprotein-39 (YKL-40) and stroke-specific mortality at two years in acute ischemic stroke patients according to the drinking status and amount of alcohol consumption. We further investigated the effect of the interaction between these conditions and YKL-40 levels on the outcome. METHODS: We measured plasma YKL-40 levels in 3267 participants from the China Antihypertensive Trial in Acute Ischemic Stroke. Outcome data on stroke-specific mortality were collected at two years after stroke onset. RESULTS: During the two years of follow-up, 208 (6.4 %) patients, including 44 drinkers and 164 nondrinkers, died of stroke-specific causes. The patients in the highest quartile of YKL-40 had a 3.52-fold (95 % CI: 1.15-10.76, P for trend = 0.006) risk of stroke-specific mortality compared with those in the lowest quartile among drinkers. However, no significant association between YKL-40 and the outcome was observed among nondrinkers (HR: 1.18, 95 % CI: 0.75-1.86, P for trend = 0.08). Alcohol drinking modified the effect of YKL-40 on the outcome (P for interaction = 0.04). Subgroup analyses revealed that each 1-unit increase in log-transformed YKL-40 was associated with a 72 % greater risk of stroke-specific mortality for light drinkers. This association was amplified with a 226 % increased risk of the outcome among heavy drinkers. CONCLUSIONS: Elevated YKL-40 levels were associated with an increased risk of stroke-specific mortality at two years among drinkers with ischemic stroke. Drinking status substantially modified the effect of plasma YKL-40 levels on the outcome. This effect was amplified with the increased amount of alcohol consumption. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT01840072.

A Rare Cause of Vitamin B12 Deficiency in the Pediatric Age.

Vitamin B12 plays an important role in DNA synthesis, hematopoiesis, and neuronal mechanisms, and its deficiency can be associated with insufficient intake or poor absorption and autoimmune and genetic diseases. Although rare, excessive, and chronic alcohol consumption may also justify a deficiency in this vitamin. We present a case of a 17-year-old Iraqi adolescent refugee in Portugal with a deficiency of vitamin B12 due to excessive and chronic alcohol consumption. Although intramuscular (IM) supplementation with cyanocobalamin is the most used, it was decided to initiate oral supplementation. After four months, vitamin B12 levels were replenished. With this clinical case, we aim to raise awareness of the cause of cyanocobalamin deficiency, which although rare in pediatric age should be considered in adolescents, given the possibility of risky behaviors in this age group. Additionally, given the therapeutic options, we have found that oral administration of vitamin B12 has been effective, as reported in the literature.

Situational factors affecting abstinence from drugs: Panel data analysis of patients with drug use disorders in residential drug use treatment.

Aim: To identify situational factors that can predict drug abstention in patients with drug use disorders undergoing residential drug use treatment. Methods: Patients with drug use disorders admitted to drug addiction rehabilitation centers (DARCs) in 2016 were involved in this study. Longitudinal panel data were used, with eight follow-up surveys over 6 years, approximately every 6 months. Of the 2752 samples from the eight follow-up surveys, 2293 were analyzed as the complete panel data set. The primary outcome was drug abstention for approximately 6 months. The influences of situational factors during this period on the primary outcome were also assessed using a generalized linear mixed model in which inter-individual differences were controlled as variable effects. Results: The use of residential DARCs positively influenced the primary outcome (adjusted odds ratio [AOR] 3.33, 95% confidence interval [CI] 1.79-6.21) when compared to no DARC usage. The cessation of drinking also positively affected the primary outcome (AOR 3.10, 95% CI 1.79-4.62), while employment status (AOR 2.22, 95% CI 1.12-4.41) and the cessation of drinking (AOR 4.92, 95% CI 2.77-8.72) positively impacted the primary outcomes of patients not using DARCs. Conclusion: The use of residential DARCs and the cessation of drinking positively affected drug abstention rates. Employment and the cessation of drinking for patients who were not using the DARCs also had a positive effect. This information will aid in the development of social recovery strategies for people with drug use disorders.