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1.
Forensic Sci Int ; 306: 110071, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31785510

RESUMO

The presence of Ethyl glucuronide (EtG) in hair provides a strong indication of ethanol consumption and its investigation is of interest in both clinical and forensic contexts because of the wide window of detection. However, due to the possibility of false negative results in cases of small ethanol intake or excessive hair washing, the combined measurement of ethyl palmitate (EtP) with EtG could be useful. In this study, a sensitive UHPLC-MS/MS procedure for the measurement of EtG in hair was developed and validated, using optimized sample preparation and chromatographic separation. Milled hair was extracted with water for 24 h at room temperature, followed by clean-up of the extract by ion-exchange solid phase extraction (SPE). Extraction was highly efficient, with yield of 96.93-101.06%. Chromatographic separation was performed with a Fluoro-Phenyl stationary phase. The assay was linear from 4 to 500pgmg-1, with accuracy in the range of 100.30-106.16%. Matrix effects (-0.87 to 5.89%) were adequately compensated by the use of deuterated EtG as internal standard. EtG was measured in hair samples of 46 volunteers, and results were compared with hair concentrations of ethyl palmitate (EtP) and the score in the AUDITC questionnaire. EtG hair concentrations were significantly correlated to the AUDIT-C classification (rs=0.365, p<0.05), but not to EtP hair levels. The diagnostic performance of EtG hair concentrations to identify excessive or moderate ethanol use was similar to the capability of AUDIT-C to identify severe and high health risk (Kappa, p=0.013). The developed assay is suitable for clinical use, providing a useful tool to evaluate chronic ethanol consumption.


Assuntos
Consumo de Bebidas Alcoólicas , Alcoolismo/diagnóstico , Glucuronatos/análise , Cabelo/química , Detecção do Abuso de Substâncias/métodos , Adulto , Biomarcadores/análise , Cromatografia Líquida , Feminino , Toxicologia Forense/métodos , Humanos , Masculino , Ácidos Palmíticos/análise , Extração em Fase Sólida , Espectrometria de Massas em Tandem
2.
J Forensic Sci ; 65(1): 189-192, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31310667

RESUMO

Through the measurement of ethyl glucuronide in hair (hETG), it is possible to assess chronic alcohol abuse over time. In this paper, we present a study on hETG in Italian prison inmates. Analyses were performed by LC-MS according to a previously published method. Results were evaluated using the cut-offs established by the Society of Hair Testing. Positives samples (ETG > 30 pg/mg) accounted for 6% of all subjects, with concentrations ranging from 42 pg/mg up to 270 pg/mg, abstinent subjects (ETG < 7 pg/mg) accounted for 88%, and moderate alcohol consumption (7 < ETG < 30 pg/mg) for 6% of the subjects. No females displayed ETG values above 30 pg/mg. Among positive samples, only two subjects did not declare heavy alcohol consumption and were found strongly positive at 210 and 270 pg/mg. To the best of our knowledge, this represents the first study on ETG hair concentration on prison inmates.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/diagnóstico , Glucuronatos/análise , Cabelo/química , Prisioneiros/estatística & dados numéricos , Adulto , Biomarcadores/análise , Cromatografia Líquida , Feminino , Humanos , Itália/epidemiologia , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Detecção do Abuso de Substâncias/métodos , Adulto Jovem
3.
J Stroke Cerebrovasc Dis ; 28(11): 104395, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31540781

RESUMO

BACKGROUND AND PURPOSE: We investigated the associations between alcohol-related emergency department visits and hospitalizations and vascular events including acute ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage. METHODS: The New York State Inpatient and Emergency Department Databases were examined (2006-2013). Validated International Classification of Diseases 9th edition definitions identified index vascular hospitalizations and alcohol abuse encounters. We used case cross-over analysis with conditional logistic regression to estimate odds ratios (OR) for the association between alcohol-related encounters during 6 case periods (7, 14, 30, 60, 90, and 120 days before index event) compared to control periods (1 year before). Multivariate logistic regression was used to examine the association between an alcohol-related encounter within 6 months before index admission and 30-day readmission after discharge. RESULTS: An alcohol encounter before index admission was associated with acute ischemic stroke (OR = 1.765 within 60 days, 1.418 within 90 days, and 1.287 within 120 days) and subarachnoid hemorrhage (OR = 2.375 within 90 days), but not ICH. Alcohol-related encounters within 6 months before index vascular events increased the likelihood of 30-day readmission after index admission. CONCLUSION: We found that a recent alcohol-related counter was associated with occurrence of vascular events, but not ICH, as well as worse outcomes after index admission.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/epidemiologia , Serviço Hospitalar de Emergência , Hemorragias Intracranianas/epidemiologia , Trombose Intracraniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Tromboembolia Venosa/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/diagnóstico , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/terapia , Trombose Intracraniana/diagnóstico , Trombose Intracraniana/terapia , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Prognóstico , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Fatores de Tempo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia
4.
Lancet ; 394(10200): 781-792, 2019 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-31478502

RESUMO

Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.


Assuntos
Alcoolismo/epidemiologia , Alcoolismo/terapia , Alcoolismo/diagnóstico , Alcoolismo/genética , Efeitos Psicossociais da Doença , Feminino , Saúde Global , Humanos , Masculino , Programas de Rastreamento , Atenção Primária à Saúde/métodos
6.
Transplant Proc ; 51(6): 1934-1938, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399178

RESUMO

Excessive alcohol consumption has a negative impact on graft survival after liver transplantation (LT). However, it is difficult to predict alcohol relapse before LT. This study surveyed the alcohol consumption of LT recipients to identify the risk factors for harmful drinking. We surveyed the alcohol consumption of LT recipients by using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). AUDIT-C scores ≥ 5 points in men and ≥ 4 points in women indicated a high risk for harmful and hazardous drinking. Excessive alcohol consumption was considered to be > 20 g per day. Ninety-nine LT recipients completely filled out the questionnaire. Alcohol consumption after LT was detected in 26 recipients (26.5%); 4 of them had alcoholic liver disease before transplantation and 22 did not have alcoholic liver disease. The amount of alcohol consumption per day significantly decreased after LT (alcohol consumption per day: 49.6 g before LT vs 8.1 g after LT, P < .05). Fourteen recipients (14.1%) consumed alcohol excessively after LT. The AUDIT-C score before LT and smoking were risk factors for excessive alcohol consumption in the multivariate analysis. To properly manage post-transplant recipients, assessing the risk of excessive alcohol consumption by using the AUDIT-C is necessary.


Assuntos
Alcoolismo/diagnóstico , Hepatopatias Alcoólicas/cirurgia , Transplante de Fígado/efeitos adversos , Medição de Risco/métodos , Adulto , Alcoolismo/complicações , Feminino , Sobrevivência de Enxerto , Humanos , Hepatopatias Alcoólicas/etiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Período Pós-Operatório , Recidiva , Fatores de Risco , Inquéritos e Questionários
7.
Nord J Psychiatry ; 73(7): 397-400, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31347426

RESUMO

Aims: The Alcohol Use Disorders Identification Test (AUDIT) is a well-established and widely used screening instrument. It has been shown that AUDIT has good criterion validity in relation to alcohol abuse and dependence according to DSM-IV, but it has not yet been validated following the introduction of the DSM-5 diagnostic system. The aim of this study was to evaluate concurrent validity for the AUDIT in relation to self-reported DSM-5 severity levels for Alcohol Use Disorder (AUD) in a Swedish general population sample. Methods: A postal questionnaire, containing the AUDIT and the 13-item brief DSM-5 AUD diagnostic assessment screener, was sent to a random sample of 1,500 persons drawn from the Swedish population, aged between 17 and 80 years and having a public residence address in Sweden. To evaluate the concurrent validity of AUDIT in relation to DSM-5 severity criteria for AUD, a Receiver Operating Characteristics (ROC) curve analysis was conducted. Results: Area under the curve (AUROC) showed excellent differentiation between AUD or not, mild (.93), moderate (.92) and severe (.99). Higher individual AUDIT scores were associated with more severe levels of AUD according to the DSM-5 screener. The optimal cutoff scores approximate earlier research on the DSM-IV and were identified as 5, 7 and 13 points, respectively, for mild, moderate and severe AUD. Conclusions: Our findings indicate that AUDIT is a valid screener for detecting concurrent AUD at three severity levels in the Swedish general population.


Assuntos
Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Programas de Rastreamento/normas , Índice de Gravidade de Doença , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Distribuição Aleatória , Reprodutibilidade dos Testes , Autorrelato/normas , Suécia/epidemiologia , Adulto Jovem
8.
J Abnorm Psychol ; 128(5): 473-486, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31192638

RESUMO

Increasingly, the structure of mental disorders has been studied in the form of a network, characterizing how symptoms or criteria interact with and influence each other. Many studies of psychiatric symptoms and diagnostic criteria employ community or population-based surveys using co-occurrence of the symptoms/criteria to form the networks. However, given the overall low prevalence rates of mental disorders and their symptoms in the general population, most of those surveyed may not exhibit or endorse any symptoms and yet are often included in network analyses. Consequently, because network models are built on associations between symptoms/criteria, much of the observed variability is driven by individuals who are asymptomatic. Using data from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) Wave 2 and NESARC-III, we explore the effect of these "asymptomatic" observations on the estimated relations among diagnostic criteria of alcohol use disorder to determine the effects of such observations on estimated networks. We do so using the eLasso tool, as well as with traditional measures of correlation between binary variables (the Φ coefficient and odds ratio). We find that when the proportion of asymptomatic individuals are systematically culled from the sample, the estimated pairwise relations are often significantly affected, even changing signs in some cases. Our findings indicate that researchers should carefully consider the population(s) included in their sample and the implications it has on their interpretations of pairwise similarity estimates and resulting generalizability and reproducibility of estimates of network structures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Alcoolismo , Manual Diagnóstico e Estatístico de Transtornos Mentais , Projetos de Pesquisa , Adulto , Idoso , Alcoolismo/classificação , Alcoolismo/diagnóstico , Alcoolismo/fisiopatologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Reprodutibilidade dos Testes
9.
Psychopharmacology (Berl) ; 236(11): 3245-3255, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31161452

RESUMO

RATIONALE: Human telomeres consist of tandem repeats at chromosome ends which protect chromosomal DNA from degradation. Telomere shortening occurs as part of natural aging; however, life stressors, smoking, drug use, BMI, and psychiatric disorders could disrupt cell aging and affect telomere length (TL). In this context, studies have evaluated the effects of alcohol consumption on TL; however, results have been inconsistent, which may reflect diverse drinking cut-offs and categorizations. OBJECTIVES: To help clarify this, the present study addresses the association of TL with alcohol use disorder (AUD), drinking behaviors, lifetime stress, and chronological age. METHODS: TL was quantified as the telomere to albumin ratio (T/S ratio) obtained from peripheral blood DNA using the quantitative PCR assay, from 260 participants with AUD and 449 non-dependent healthy controls (HC) from an existing National Institute on Alcohol Abuse and Alcoholism (NIAAA) database. RESULTS: AUD participants showed shorter TL compared to HC with both, age, and AUD, as independent predictors as well as a significant AUD with age interaction effect on TL. TL was also associated with impulsiveness in AUD participants. We did not observe an association between TL and chronicity of alcohol use, alcohol doses ingested, or childhood trauma exposures in either AUD or HC, although very few HC reported a history of childhood trauma. CONCLUSION: Our results support previous findings of telomere shortening with chronic alcohol exposures and show both an effect of AUD on TL that is independent of age as well as a significant AUD by age interaction on TL. These findings are consistent with accelerated cellular aging in AUD.


Assuntos
Envelhecimento/genética , Alcoolismo/genética , Senescência Celular/genética , Encurtamento do Telômero/genética , Adulto , Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Envelhecimento/patologia , Envelhecimento/psicologia , Alcoolismo/diagnóstico , Alcoolismo/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Telômero/genética , Telômero/patologia
10.
Alcohol Alcohol ; 54(4): 386-395, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31206165

RESUMO

AIMS: The aims of this study were to: examine differences in alcoholic cardiomyopathy (ACM) prevalence, temporal trends and the distribution of socio-demographic factors and comorbidities by sex; and investigate differences in selected inpatient outcomes between women and men with ACM. METHODS: We used the 2002-2014 Nationwide Inpatient Sample databases. Overall and sex-specific rates of ACM were estimated across sociodemographic, clinical, and hospital characteristics. Joinpoint regression was used to estimate temporal trends (annual percent change [APC]) of ACM-related hospitalization by sex and race/ethnicity. Adjusted odds ratios (AOR) representing associations between sex and selected ACM outcomes were calculated using survey logistic regression. RESULTS: The rate of ACM among all inpatient men and women was 128 per 100,000 and 17 per 100,000 hospitalizations, respectively. Among women, the rate of ACM remained unchanged during the study period, while for men, there was 1.2% annual reduction from 2002-2010 (APC -1.3, 95% CI: -1.7, -0.8). Women with ACM were more likely than men with ACM to experience depression (AOR=2.24, 95% CI: 2.06-2.43) and anxiety (AOR=1.94, 95% CI: 1.75-2.15), while men with ACM were 21% and 24% more likely than women with ACM to experience 'any heart failure (HF)' and HF with reduced ejection fraction respectively. One in 1,471 hospitalizations were related to ACM with a male-to-female ratio of 8:1. CONCLUSION: Individuals with ACM are at increased likelihood of adverse outcomes. Women with ACM are at increased risk of depression and anxiety, while men are at increased risk of HF.


Assuntos
Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Cardiomiopatia Alcoólica/diagnóstico , Cardiomiopatia Alcoólica/epidemiologia , Caracteres Sexuais , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/terapia , Cardiomiopatia Alcoólica/terapia , Estudos Transversais , Feminino , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
Dig Dis Sci ; 64(7): 1878-1892, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31076986

RESUMO

BACKGROUND: Alcohol-related liver disease is one of the most prevalent chronic liver diseases worldwide. Mechanisms involved in the pathogenesis of alcohol-related liver disease are not well understood. Oxylipins play a crucial role in numerous biological processes and pathological conditions. Nevertheless, oxylipins are not well studied in alcohol-related liver disease. AIMS: (1) To characterize the patterns of bioactive ω-3 and ω-6 polyunsaturated fatty acid metabolites in alcohol use disorder and alcoholic hepatitis patients and (2) to identify associations of serum oxylipins with clinical parameters in patients with alcohol-related liver disease. METHODS: We performed a comprehensive liquid chromatography with tandem mass spectrometry (LC-MS/MS) analysis of serum and fecal oxylipins derived from ω-6 arachidonic acid, ω-3 eicosapentaenoic acid, and docosahexaenoic acid in a patient cohort with alcohol-related liver disease. RESULTS: Our results show profound alterations in the serum oxylipin profile of patients with alcohol use disorder and alcoholic hepatitis compared to nonalcoholic controls. Spearman correlation of the oxylipins with clinical parameters shows a link between different serum oxylipins and intestinal permeability, aspartate aminotransferase, bilirubin, albumin, international normalized ratio, platelet count, steatosis, fibrosis and model for end-stage liver disease score. Especially, higher level of serum 20-HETE was significantly associated with decreased albumin, increased hepatic steatosis, polymorphonuclear infiltration, and 90-day mortality. CONCLUSIONS: Patients with alcohol-related liver disease have different oxylipin profiles. Future studies are required to confirm oxylipins as disease biomarker or to connect oxylipins to disease pathogenesis.


Assuntos
Alcoolismo/sangue , Ácidos Graxos Ômega-3/sangue , Ácidos Graxos Ômega-6/sangue , Fezes/química , Hepatite Alcoólica/sangue , Oxilipinas/sangue , Adulto , Idoso , Alcoolismo/diagnóstico , Biomarcadores/sangue , Cromatografia Líquida de Alta Pressão , Cromatografia de Fase Reversa , Feminino , Hepatite Alcoólica/diagnóstico , Humanos , Masculino , Metabolômica/métodos , Pessoa de Meia-Idade , Espectrometria de Massas por Ionização por Electrospray , Espectrometria de Massas em Tandem
12.
Recenti Prog Med ; 110(5): 230-235, 2019 05.
Artigo em Italiano | MEDLINE | ID: mdl-31140455

RESUMO

Psychiatry and addiction disorders are closely linked, but the current epidemiological and clinical evidence impose us to effectively define the "dependence medicine" (DM) discipline, and to review its management. The need for change is also suggested indirectly by the new DSM-5 which proposes a partial overcoming of the term 'addiction' by introducing the definitions Substances Use Disorders (SUDs), Alcohol Use Disorders (AUDs), and disorders related to behavioral alterations (behavioral disorders): eating disorders, gambling, etc. These disorders can generate organic diseases, psychic, family and social problems. The onset of psycho-pathological diseases, in young poly-dependents, occurs in a high percentage of cases of SUDs and/or AUDs (40-70%); the constant increase of young poly-dependents requires us to avoid psychiatrization as a first approach. For these reasons we suggest a change of management in this field, underlining how the DM combines elements of public health, prevention, internal medicine, clinical pharmacology, neurology 'and even psychiatry'.


Assuntos
Alcoolismo/diagnóstico , Transtornos Mentais/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Alcoolismo/fisiopatologia , Alcoolismo/terapia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Transtornos Mentais/fisiopatologia , Transtornos Mentais/terapia , Saúde Pública , Transtornos Relacionados ao Uso de Substâncias/fisiopatologia , Transtornos Relacionados ao Uso de Substâncias/terapia
13.
Eur Addict Res ; 25(4): 198-206, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31117072

RESUMO

BACKGROUND: In police officers, posttraumatic stress disorder (PTSD) is associated with alcohol use disorder (AUD), but we lack data on the association between PTSD and other substance-related and addictive disorders. OBJECTIVES: We assessed whether PTSD could be a risk factor for different substance-related and addictive disorders in police officers, including alcohol, tobacco, cannabis, and gambling. METHOD: This cross-sectional study included all police officers admitted consecutively for alcohol to an inpatient ward dedicated to police officers (Le Courbat rehabilitation center, France; n= 133). Each patient completed self-administered questionnaires that assessed lifetime exposure to potentially traumatic events (Life Event Checklist for DSM-5), PTSD severity and diagnosis (PTSD Checklist for DSM-5), AUD severity (Alcohol Use Disorder Identification Test [AUDIT]), tobacco dependence (Fagerström test for Nicotine Dependence), cannabis dependence (Cannabis Abuse Screening test), and gambling disorder (Canadian Problem Gambling Index). RESULTS: Mean AUDIT score was 23.7 ± 8.0; 66.2% had an AUDIT score ≥20. Our sample comprised a high prevalence for PTSD (38.3%) and for substance-related and addictive disorders: tobacco dependence (68.4%), cannabis dependence (3.8%), and pathological gambling (3%). Patients with PTSD experienced higher lifetime exposure to traumatic experiences: physical assault, severe human suffering, sudden accidental death of another person, and other types of stressful events/experiences. In multiple linear regressions adjusted for age, sex, and marital status, PTSD was a significant predictor of the severity of AUD and tobacco use disorder, but not of the severity of cannabis use disorder nor gambling disorder. CONCLUSIONS: PTSD is common in police officers hospitalized for alcohol and associated with a higher severity of some addictive disorders (alcohol/tobacco). PTSD and its comorbid addictive disorders should be systematically screened and treated in this population.


Assuntos
Alcoolismo/diagnóstico , Comportamento Aditivo/psicologia , Polícia/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Tabagismo/diagnóstico , Alcoolismo/epidemiologia , Alcoolismo/reabilitação , Canadá/epidemiologia , Estudos Transversais , Feminino , Hospitalização , Humanos , Masculino , Abuso de Maconha/diagnóstico , Abuso de Maconha/epidemiologia , Pessoa de Meia-Idade , Polícia/psicologia , Prevalência , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Inquéritos e Questionários , Tabagismo/epidemiologia
14.
Forensic Sci Int ; 300: 106-119, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31096163

RESUMO

Ethyl glucuronide (EtG) is a minor, non-oxidative ethanol metabolite that can be detected in several matrices (e.g. blood, urine, hair, meconium) for variable periods of time. Quantification of EtG in hair (hEtG) has established itself, over recent years, as one of the most reliable biomarkers of long-term alcohol consumption habits, with the Society of Hair Testing (SoHT) offering cut-off values for assessment of both abstinence and heavy drinking (>60 g/day). Despite its high diagnostic performance, however, issues concerning inter- and intra-laboratory variability as well as data interpretation are still being investigated and represent the ultimate barrier to widespread acceptance of hEtG in the forensic context. The aim of this review is to summarize currently available analytical methods of hEtG testing, provide a framework to understand current hEtG cut-offs and their possible upcoming changes (in particular, a lower abstinence cut-off has been proposed for the 2019 revision of the SoHT consensus), and offer a schematic but exhaustive overview of the pitfalls in result reproducibility and interpretation that may limit applications of hEtG testing in the forensic context. Ultimately, the purpose of the authors is not to undermine the reliability of hEtG as an alcohol use marker, but rather to enhance it by promoting familiarization with all aspects related to it, from ethanol pharmacokinetics and EtG incorporation into hair, to sample preparation and analytical methods, to specific cases warranting close attention and additional tests for correct interpretation of hEtG results.


Assuntos
Glucuronatos/análise , Cabelo/química , Fatores Etários , Alcoolismo/diagnóstico , Biomarcadores/análise , Índice de Massa Corporal , Cromatografia Líquida , Toxicologia Forense , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Fatores Raciais , Reprodutibilidade dos Testes , Fatores Sexuais , Manejo de Espécimes , Detecção do Abuso de Substâncias/métodos
15.
Drug Alcohol Depend ; 199: 35-41, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30981047

RESUMO

BACKGROUND: Despite evidence that insomnia symptoms exacerbate alcohol use disorder symptoms, there is a dearth of prospective research testing bidirectional associations between these variables. Furthermore, no studies have prospectively examined these associations among military personnel, a vulnerable population for sleep- and alcohol-related problems. Thus, the current study examined whether insomnia symptoms prospectively predicted increased alcohol use disorder symptoms among a sample of military service members and veterans over a 6-month follow-up period, as well as whether alcohol use disorder symptoms led to increases in insomnia. METHOD: Hypotheses were tested among a sample of 274 current and past military service members who participated in a baseline and 6-month assessment using self-report measures. RESULTS: Path analyses revealed that insomnia symptoms significantly prospectively predicted increased month-6 heavy drinking and alcohol-related problems, but not days drinking or being bothered by drinking. None of the alcohol variables significantly predicted insomnia. CONCLUSION: Results support a model in which insomnia symptoms exacerbate alcohol use disorder symptoms, specifically heavy drinking and alcohol-related problems. Future research should seek to examine these findings in diverse populations and test potential mechanisms and clinical implications of these results.


Assuntos
Alcoolismo/epidemiologia , Alcoolismo/psicologia , Militares/psicologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Veteranos/psicologia , Adulto , Alcoolismo/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Adulto Jovem
16.
Nervenarzt ; 90(11): 1156-1161, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-30976828

RESUMO

BACKGROUND: Routine screening using self report questionnaires for attention deficit/hyperactivity disorder (ADHD) in patients with alcohol use disorder is recommended due to its high prevalence and the time-consuming and demanding diagnostic assessment. The psychometric properties of such self-report instruments have hardly been investigated in this patient group. METHODS: The performance of the ADHD self-report scale (ADHD-SR) and the German short form of the Wender Utah Rating Scale (WURS-k) was determined in 402 patients with alcohol dependence during long-term residential weaning treatment. The diagnosis of adult ADHD had been confirmed in 85 of these patients using an extensive, standardized diagnostic procedure. RESULTS: The ADHD-SR at a cut-off ≥15 showed the best psychometric properties (sensitivity 75.3%, specificity 94.0%, positive predictive value, PPV 77.1%, negative predictive value, NPV 93.4%). The results of the WURS-k were unsatisfactory at the established cut-off ≥30 and also at lower cut-offs with more false positive screening results compared to the ADHD-SR. The combination of both instruments (ADHD-SR ≥ 15 and/or WURS-k ≥ 30) increased sensitivity (86.9%) albeit at the expense of a higher rate of false positive screening results (specificity 87.7%, PPV 65.2%). CONCLUSION: The ADHD-SR is a suitable instrument for routine screening of ADHD in alcohol dependent patients. To improve sensitivity, a lower cut-off (≥15) should be applied. The WURS-k as a single screening instrument cannot be recommended in alcohol dependent patients. If a higher sensitivity is desired, a combination of ADHD-SR and WURS-k is feasible.


Assuntos
Alcoolismo , Transtorno do Deficit de Atenção com Hiperatividade , Adulto , Alcoolismo/complicações , Alcoolismo/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Psicometria , Autorrelato , Utah
17.
Value Health ; 22(4): 446-452, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30975396

RESUMO

BACKGROUND: Paired-gamble methods have been proposed to avoid the "certainty effect" associated with standard gamble methods. OBJECTIVE: This study examines the role of starting-point effects in paired-gamble methods. In particular, it examines how the utilities so derived vary as a function of the probabilities of the stimulus lottery. METHODS: A sample of 455 members of the Spanish general population valued 9 health states via face-to-face interviews. Subjects were randomly placed into 3 subgroups, which differed in terms of the stimulus gamble's probability. Nonparametric tests and an interval regression model were used to test if utilities change when the probability distribution is modified. RESULTS: Nonparametric tests showed that the probability of a health state being considered worse than death did not differ among subgroups. Nevertheless, changes in the stimulus gamble did produce significant differences in the distribution of utilities: the higher the probability of full health in the stimulus, the higher the utility elicited. Regression estimates support the existence of starting-point effects when the utilities are obtained under expected utility. According to the prospect theory, the conclusions depend on the reference point considered. When the reference points used are death or the health state evaluated, we observe differences among these groups. Nevertheless, when full health is used, these differences disappear. CONCLUSION: This research suggests that paired-gamble methods may also be susceptible to starting-point effects. Yet the differences are small, and they disappear when the data are analyzed using prospect theory with full health as the reference point.


Assuntos
Alcoolismo/diagnóstico , Indicadores Básicos de Saúde , Nível de Saúde , Teoria da Probabilidade , Qualidade de Vida , Alcoolismo/mortalidade , Alcoolismo/psicologia , Alcoolismo/terapia , Efeitos Psicossociais da Doença , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Preferência do Paciente , Probabilidade , Anos de Vida Ajustados por Qualidade de Vida , Fatores Socioeconômicos , Espanha/epidemiologia
18.
BMC Psychiatry ; 19(1): 91, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30876474

RESUMO

BACKGROUND: Hazardous alcohol use has often been found to be more prevalent amongst psychiatric outpatients than the general population. Additionally, it has also been associated with poorer outcomes. The study aimed to investigate (1) the prevalence and (2) socio-demographic and clinical correlates of hazardous alcohol use, as well as (3) the relationship between hazardous alcohol use and quality of life in an outpatient sample with First Episode Psychosis (FEP) in Singapore. METHODS: Baseline data (N = 280) was extracted from a longitudinal study investigating smoking and alcohol use amongst outpatients with FEP in a psychiatric hospital. Information on socio-demographics, hazardous alcohol use, and quality of life was collected through a self-report survey. Hazardous alcohol use was ascertained by total scores of 8 or higher on the Alcohol Use Disorders Identification Test (AUDIT). Data was analysed using logistic regression and linear regression analyses. RESULTS: The prevalence of hazardous alcohol use over the past 12-month period was 12.9%. Those who had never smoked in their lifetime (vs current smokers) and those with a diagnosis of brief psychotic disorder (vs schizophrenia spectrum disorders) were found to have significantly lower odds of hazardous alcohol use. Hazardous alcohol use was also associated with lower negative symptom scores. Lastly, hazardous alcohol use was found to significantly predict lower scores on the physical health, social relationship and environment domains of quality of life. CONCLUSIONS: The association between hazardous alcohol use and lower negative symptom scores is a surprising finding that needs to be further explored. The significant impact of hazardous alcohol use in reductions in quality of life suggests that early screening and interventions could benefit patients with hazardous alcohol use and comorbid psychosis.


Assuntos
Alcoolismo/epidemiologia , Alcoolismo/psicologia , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/diagnóstico , Comorbidade , Feminino , Hospitais Psiquiátricos , Humanos , Estudos Longitudinais , Masculino , Transtornos Psicóticos/diagnóstico , Qualidade de Vida/psicologia , Singapura/epidemiologia , Adulto Jovem
20.
Alcohol Alcohol ; 54(3): 235-242, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30882135

RESUMO

AIM: To assess the feasibility and acceptability of screening for alcohol misuse and delivering brief advice to eligible patients attending NHS dental practices in London. METHODS: A two-arm cluster randomized controlled feasibility trial was conducted. Twelve dental practices were recruited and randomized to intervention and control arms. Participants attending for a dental check were recruited into the study and were eligible if they consumed alcohol above recommended levels assessed by the AUDIT-C screening tool. All eligible participants were asked to complete a baseline socio-demographic questionnaire. Six months after the completion of baseline measures, participants were contacted via telephone by a researcher masked to their allocation status. The full AUDIT tool was then administered. Alcohol consumption in the last 90 days was also assessed using the Form 90. A process evaluation assessed the acceptability of the intervention. RESULTS: Over a 7-month period, 229 participants were recruited (95.4% recruitment rate) and at the 6 months follow-up, 176 participants were assessed (76.9% retention rate). At the follow-up, participants in the intervention arm were significantly more likely to report a longer abstinence period (3.2 vs. 2.3 weeks respectively, P = 0.04) and non-significant differences in AUDIT (44.9% vs. 59.8% AUDIT positive respectively, P = 0.053) and AUDIT C difference between baseline and follow-up (-0.67 units vs. -0.29 units respectively, P = 0.058). Results from the process evaluation indicated that the intervention and study procedures were acceptable to dentists and patients. CONCLUSIONS: This study has demonstrated the feasibility and acceptability of dentists screening for alcohol misuse and providing brief advice.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Alcoolismo/diagnóstico , Odontologia/métodos , Adulto , Alcoolismo/psicologia , Atitude do Pessoal de Saúde , Aconselhamento , Estudos de Viabilidade , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde
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