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1.
Nutr Metab Cardiovasc Dis ; 31(4): 1113-1120, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33549459

RESUMO

BACKGROUND AND AIMS: Most studies assess the relationship between alcohol and stroke at some point. Little is known about the effect on stroke of drinking status changes over time. This study aimed to examine the association of median 2.4-year drinking status changes with risk of stroke. METHODS AND RESULTS: We examined 22,691 adults from rural China. Drinking status was assessed at 2004-2006 and in 2008. Participants were divided into four change patterns: consistent non-drinkers, abstainers, starters, and consistent drinkers. A Cox proportional hazards model were performed. We observed 1215 cases of stroke during a median follow-up period of 11.8 years. A faint J-shaped association between alcohol consumption and risk of stroke was found in this population. Based on the amount of alcohol consumption, only current drinkers with ≥721 g/week at baseline in both males and females had a higher risk of stroke [hazard ratio (HR): 1.342; 95% confidence interval (CI): 1.070-1.683 and HR: 2.130; CI: 1.041-4.357, respectively]. Based on change patterns, Compared with consistent non-drinkers, the HR (95% CI) for consistent drinkers, abstainers and starters was 1.298 (1.070-1.576), 1.093 (0.877-1.362) and 1.263 (1.034-1.543), respectively. The same trend was observed in male. The HR (95% CI) for consistent drinkers, abstainers and starters was 1.360 (1.098-1.685), 1.139 (0.883-1.470) and 1.364 (1.092-1.703), respectively. No difference was observed in females. CONCLUSION: High alcohol consumption was associated with increased risk of stroke in both males and females. However, based on change patterns, consistent drinkers and starters were at higher risk of stroke only in males.


Assuntos
Abstinência de Álcool , Consumo de Bebidas Alcoólicas/efeitos adversos , Saúde da População Rural , Acidente Vascular Cerebral/patologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo
2.
JAMA ; 325(4): 382-390, 2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33496779

RESUMO

Importance: In the United States, acute pancreatitis is one of the leading causes of hospital admission from gastrointestinal diseases, with approximately 300 000 emergency department visits each year. Outcomes from acute pancreatitis are influenced by risk stratification, fluid and nutritional management, and follow-up care and risk-reduction strategies, which are the subject of this review. Observations: MEDLINE was searched via PubMed as was the Cochrane databases for English-language studies published between January 2009 and August 2020 for current recommendations for predictive scoring tools, fluid management and nutrition, and follow-up and risk-reduction strategies for acute pancreatitis. Several scoring systems, such as the Bedside Index of Severity in Acute Pancreatitis (BISAP) and the Acute Physiology and Chronic Health Evaluation (APACHE) II tools, have good predictive capabilities for disease severity (mild, moderately severe, and severe per the revised Atlanta classification) and mortality, but no one tool works well for all forms of acute pancreatitis. Early and aggressive fluid resuscitation and early enteral nutrition are associated with lower rates of mortality and infectious complications, yet the optimal type and rate of fluid resuscitation have yet to be determined. The underlying etiology of acute pancreatitis should be sought in all patients, and risk-reduction strategies, such as cholecystectomy and alcohol cessation counseling, should be used during and after hospitalization for acute pancreatitis. Conclusions and Relevance: Acute pancreatitis is a complex disease that varies in severity and course. Prompt diagnosis and stratification of severity influence proper management. Scoring systems are useful adjuncts but should not supersede clinical judgment. Fluid management and nutrition are very important aspects of care for acute pancreatitis.


Assuntos
Nutrição Enteral , Hidratação , Pancreatite/terapia , APACHE , Abstinência de Álcool , Humanos , Pancreatite/diagnóstico , Pancreatite/etiologia , Comportamento de Redução do Risco , Índice de Gravidade de Doença
3.
Medicine (Baltimore) ; 99(52): e23899, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350787

RESUMO

BACKGROUND: Alcohol dependence is one of the biggest problems facing public health worldwide. Currently, it is an under-diagnosed and under-treated disease. Even when given treatments for addiction withdrawal, over 2/3 of patients who have undergone abstinence-oriented treatment will relapse in the first year. Therefore, it is necessary to find an efficacious way to prevent and treat alcohol dependence. ASF (a Compound of Traditional Chinese Medicine) has proven to inhibit the formation and expression of ethanol-induced behavioral sensitization and the development of conditioned place preference in mice. As an empirical prescription for abstinence from alcohol, ASF has long been used in clinical patients. However, the effect of ASF in humans has not yet been investigated. The purpose of this study is to evaluate the efficacy of ASF for patients with alcohol dependence. METHODS: The effect of ASF will be studied in a randomized, double-blinded, placebo-controlled clinical trial. 82 outpatients and inpatients will be recruited and randomly assigned to treatment with either ASF or placebo for 6 weeks as a complement to cognitive behavioural therapy. The primary endpoints are the changes in the average daily alcohol consumption of the 2 groups before and after treatment and comparison of the scores of the psychological craving self-rating scale during the courses of treatment of 2 groups. The secondary endpoints include abstinence rates of the 2 groups during the follow-up period, days without consumption, and changes of Short Form Health Survey (SF-36) scores in 2 groups before and after therapy. DISCUSSION: This study is the first randomized controlled trial to investigate ASF in the treatment of alcohol dependence. ASF is likely to be a new and effective drug for the treatment of alcohol dependence developed from natural products with a low incidence of side effects or toxicity. TRIAL REGISTRATION: Registry number: ChiCTR2000039397.


Assuntos
Abstinência de Álcool , Alcoolismo , Fissura/efeitos dos fármacos , Epimedium , Medicina Tradicional Chinesa/métodos , Ziziphus , Adulto , Abstinência de Álcool/psicologia , Abstinência de Álcool/estatística & dados numéricos , Alcoolismo/psicologia , Alcoolismo/terapia , Autoavaliação Diagnóstica , Método Duplo-Cego , Medicamentos de Ervas Chinesas/administração & dosagem , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
PLoS One ; 15(9): e0239330, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32997688

RESUMO

BACKGROUND: Hazardous alcohol use is prevalent among people living with HIV (PWH), leading to sub-optimal HIV treatment outcomes. In Vietnam, alcohol use is highly normative making it socially challenging for PWH to reduce or abstain. We used mixed methods to develop a quantitative scale to assess alcohol abstinence stigma and examined the association between alcohol abstinence stigma with alcohol use among PWH in Vietnam. METHODS: We conducted qualitative interviews with 30 PWH with hazardous alcohol use from an antiretroviral therapy (ART) clinic in the Thai Nguyen to inform item development. Alcohol use was assessed using the Alcohol Use Disorders Identification Test. We tested items in a survey of 1,559 ART clinic patients to assess internal consistency and structural validity. We used log binomial modeling to estimate associations between any reported alcohol abstinence stigma and alcohol use. RESULTS: Using the results from the qualitative interview data, we developed the alcohol abstinence stigma scale with seven final items with scores ranging from 0 (no stigma) to 28 (high stigma). The scale had good internal consistency (α = 0.75). Exploratory factor analysis suggested the presence of three factors: internalized, experienced, and anticipated stigma that explained 56.9% of the total variance. The mean score was 2.74, (SD = 4.28) and 46% reported any alcohol abstinence stigma. We observed a dose-response relationship between alcohol abstinence stigma and alcohol use. PWH who reported any alcohol abstinence stigma had greater hazardous alcohol use (aPR = 1.32, 95% CI: 1.12, 1.56), harmful alcohol use (aPR = 2.26, 95% CI: 1.37, 3.72), and dependence symptoms (aPR = 3.81, 95% CI: 2.19, 6.64). CONCLUSION: Alcohol abstinence stigma is associated with increased alcohol levels of alcohol use among PWH in Vietnam, signaling challenges for alcohol reduction. Consideration of alcohol abstinence stigma will be essential for the design of effective alcohol reduction interventions and policy efforts to prevent adverse health consequences of alcohol use among PWH.


Assuntos
Abstinência de Álcool/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Infecções por HIV/psicologia , Estigma Social , Adulto , Feminino , Humanos , Masculino , Vietnã
8.
PLoS One ; 15(8): e0236641, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776986

RESUMO

Alcohol Use Disorder (AUD) has been associated with abnormalities in hippocampal volumes, but these relationships have not been fully explored with respect to sub-regional volumes, nor in association with individual characteristics such as age, gender differences, drinking history, and memory. The present study examined the impact of those variables in relation to hippocampal subfield volumes in abstinent men and women with a history of AUD. Using Magnetic Resonance Imaging at 3 Tesla, we obtained brain images from 67 participants with AUD (31 women) and 64 nonalcoholic control (NC) participants (31 women). The average duration of the most recent period of sobriety for AUD participants was 7.1 years. We used Freesurfer 6.0 to segment the hippocampus into 12 regions. These were imputed into statistical models to examine the relationships of brain volume with AUD group, age, gender, memory, and drinking history. Interactions with gender and age were of particular interest. Compared to the NC group, the AUD group had approximately 5% smaller subiculum, CA1, molecular layer, and hippocampal tail regions. Age was negatively associated with volumes for the AUD group in the subiculum and the hippocampal tail, but no significant interactions with gender were identified. The relationships for delayed and immediate memory with hippocampal tail volume differed for AUD and NC groups: Higher scores on tests of immediate and delayed memory were associated with smaller volumes in the AUD group, but larger volumes in the NC group. Length of sobriety was associated with decreasing CA1 volume in women (0.19% per year) and increasing volume size in men (0.38% per year). The course of abstinence on CA1 volume differed for men and women, and the differential relationships of subfield volumes to age and memory could indicate a distinction in the impact of AUD on functions of the hippocampal tail. These findings confirm and extend evidence that AUD, age, gender, memory, and abstinence differentially impact volumes of component parts of the hippocampus.


Assuntos
Abstinência de Álcool , Alcoolismo/patologia , Hipocampo/patologia , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Memória , Pessoa de Meia-Idade , Tamanho do Órgão
9.
Int J Law Psychiatry ; 71: 101579, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768113

RESUMO

In response to the COVID-19 pandemic, as with other countries across the world, the Central and State Governments of India initiated several measures to slow down the spread of the virus and to 'flatten the curve'. One such measure was a 'total lockdown' for several weeks across the country. A complex and unexpected outcome of the lockdown which has medical, ethical, economic, and social dimensions is related to alcohol consumption. The lockdown and consequent acute non-availability of alcohol resulted in people with alcohol dependence going into withdrawals, black marketing of alcohol, and in extreme cases suicide resulting from the alleged frustration of not having access to alcohol. The health dilemmas around this situation are biological (e.g. pushing people into risky situations-potentially fatal alcohol withdrawal, consumption of illicit or other non-consumable alcohol) and psychosocial (e.g. isolation increasing the risk of relapses, loss of control over the decision to abstain which can be detrimental to recovery, restriction of access to services for alcohol problems). The legal and rights-related dilemmas are centred around whether States have the right to impinge on individual autonomy on the grounds of public health, the capacity of the health systems to provide appropriate services to cope with those who will struggle with the unavailability of alcohol, the constitutionality of the Central government's impinging on jurisdiction of states under the guise of a health emergency caused by the pandemic, and the ability of the State to make unbiased decisions about this issue when it is highly dependent on the revenue from the sale of alcohol and associated industries. The way forward could be a pragmatic and utilitarian approach involving continued access to alcohol, while observing all physical distancing norms necessary during the pandemic, for those who want to continue drinking; and implementing innovative measures such as tele-counselling for those who wish not to return back to drinking.


Assuntos
Abstinência de Álcool/ética , Abstinência de Álcool/psicologia , Infecções por Coronavirus/epidemiologia , Direitos Humanos , Pneumonia Viral/epidemiologia , Saúde Pública , Betacoronavirus , Governo Federal , Redução do Dano , Humanos , Índia/epidemiologia , Pandemias , Quarentena , Governo Estadual , Síndrome de Abstinência a Substâncias/epidemiologia
10.
Ann Intern Med ; 172(10): JC53, 2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32422098

RESUMO

SOURCE CITATION: Voskoboinik A, Kalman JM, De Silva A, et al. Alcohol abstinence in drinkers with atrial fibrillation. N Engl J Med. 2020;382:20-8. 31893513.


Assuntos
Fibrilação Atrial , Adulto , Abstinência de Álcool , Consumo de Bebidas Alcoólicas , Humanos , Recidiva
11.
Lancet Gastroenterol Hepatol ; 5(5): 485-493, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32277901

RESUMO

Alcohol-related liver disease has become the leading indication for liver transplantation in the USA, partly due to an increase in the prevalence of high-risk drinking behaviour and alcohol use disorder, particularly among young women. Achieving sustained alcohol abstinence might not only prevent the development and progression of alcohol-related liver disease, but could also lead to clinically significant improvements, even in the advanced stages of disease. In this Series paper, we discuss the diagnosis and outpatient management of alcohol-related liver disease, with an emphasis on treatment options for alcohol use disorder and the assessment of nutritional status.


Assuntos
Assistência Ambulatorial/métodos , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/terapia , Abstinência de Álcool , Comorbidade , Diagnóstico Diferencial , Humanos , Hepatopatias Alcoólicas/complicações , Hepatopatias Alcoólicas/patologia , Desnutrição/etiologia , Desnutrição/terapia , Programas de Rastreamento , Avaliação Nutricional , Estado Nutricional , Apoio Nutricional
12.
Lancet Gastroenterol Hepatol ; 5(5): 507-514, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32277903

RESUMO

The survival of patients with alcohol-related liver disease who receive a liver transplant has steadily improved to reach 80-85% at 1 year post-transplantation. The standard requirement for liver transplant-abstinence from alcohol for 6 months before transplantation-has been applied widely, but few data support the use of this rule as the sole criterion for selecting candidates for liver transplantation. When determining the suitability of a patient for transplantation, many liver transplant programmes now try to balance the period of abstinence against the risk of death associated with the severity of liver damage. Data accumulated since 2011 suggest that early liver transplantation (ie, transplantation without a specific period of abstinence) in patients with severe alcoholic hepatitis who do not respond to medical therapy is an effective therapeutic strategy. Further studies are needed to help refine the selection of patients with alcohol-related liver disease who have been abstinent for less than 6 months as suitable liver transplant candidates, and to improve the treatment of alcohol use disorder in those patients who have received a liver transplant.


Assuntos
Hepatopatias Alcoólicas/cirurgia , Transplante de Fígado , Seleção de Pacientes , Abstinência de Álcool , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/complicações , Alcoolismo/terapia , Aloenxertos/patologia , Hepatite Alcoólica/cirurgia , Humanos , Hepatopatias Alcoólicas/etiologia , Hepatopatias Alcoólicas/psicologia , Período Pós-Operatório
13.
Lancet Gastroenterol Hepatol ; 5(5): 494-506, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32277902

RESUMO

Alcoholic hepatitis is an acute, inflammatory liver disease associated with high morbidity and mortality both in the short term and long term. Alcoholic hepatitis often arises in patients with a background of chronic liver disease and it is characterised by the rapid onset of jaundice and the development of myriad complications. Medical therapy for severe alcoholic hepatitis relies on corticosteroids, which have modest effectiveness. Abstinence from alcohol is critically important in patients with alcoholic hepatitis, but recidivism is high. Because of the absence of effective medical treatments for alcoholic hepatitis and alcohol dependency, there is a pressing need to develop new and effective therapeutics. Supported by promising preliminary and preclinical studies, many ongoing clinical trials of new therapies for alcoholic hepatitis are currently underway and are discussed further in this Series paper.


Assuntos
Corticosteroides/uso terapêutico , Alcoolismo/terapia , Anti-Inflamatórios/uso terapêutico , Hepatite Alcoólica/terapia , Abstinência de Álcool , Alcoolismo/complicações , Antibacterianos/uso terapêutico , Antioxidantes/uso terapêutico , Suplementos Nutricionais , Hepatite Alcoólica/diagnóstico , Hepatite Alcoólica/etiologia , Humanos , Ácidos Pentanoicos/uso terapêutico , Probióticos/uso terapêutico , Receptores de Interleucina-1/antagonistas & inibidores , Transdução de Sinais , Fator de Necrose Tumoral alfa/antagonistas & inibidores
19.
J Gerontol B Psychol Sci Soc Sci ; 75(3): 674-683, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-32059056

RESUMO

OBJECTIVES: While understanding of complex within-person clustering of health behaviors into meaningful profiles of risk is growing, we still know little about whether and how U.S. adults transition from one profile to another as they age. This study assesses patterns of stability and change in profiles of tobacco and alcohol use and body mass index (BMI). METHOD: A nationally representative cohort of U.S. adults 25 years and older was interviewed up to 5 times between 1986 and 2011. Latent transition analysis (LTA) models characterized the most common profiles, patterning of transitions across profiles over follow-up, and assessed whether some were associated with higher mortality risk. RESULTS: We identified 5 profiles: "health promoting" with normal BMI and moderate alcohol consumption; "overweight"; "current smokers"; "obese"; and "nondrinkers". Profile membership was largely stable, with the most common transitions to death or weight gain. "Obese" was the most stable profile, while "smokers" were most likely to transition to another profile. Mortality was most frequent in the "obese" and "nondrinker" profiles. DISCUSSION: Stability was more common than transition, suggesting that adults sort into health behavior profiles relatively early. Women and men were differently distributed across profiles at baseline, but showed broad similarity in transitions.


Assuntos
Comportamentos Relacionados com a Saúde , Adulto , Fatores Etários , Abstinência de Álcool/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/epidemiologia , Índice de Massa Corporal , Feminino , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Fatores Sexuais , Fumar/epidemiologia , Uso de Tabaco/epidemiologia , Estados Unidos/epidemiologia
20.
MMW Fortschr Med ; 162(2): 28, 2020 02.
Artigo em Alemão | MEDLINE | ID: mdl-32016723
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