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1.
Neurology ; 93(21): e1944-e1954, 2019 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-31653706

RESUMO

OBJECTIVE: To determine the association between alcohol abuse (AA) and alcohol withdrawal (AW) with acute ischemic stroke (AIS) outcomes. METHODS: All adult AIS admissions in the United States from 2004 to 2014 were identified from the National Inpatient Sample (weighted n = 4,438,968). Multivariable-adjusted models were used to evaluate the association of AW with in-hospital medical complications, mortality, cost, and length of stay in patients with AIS. RESULTS: Of the AA admissions, 10.6% of patients, representing 0.4% of all AIS, developed AW. The prevalence of AA and AW in AIS increased by 45.2% and 40.0%, respectively, over time (p for trend <0.001). Patients with AA were predominantly men (80.2%), white (65.9%), and in the 40- to 59-year (44.6%) and 60- to 79-year (45.6%) age groups. After multivariable adjustment, AIS admissions with AW had >50% increased odds of urinary tract infection, pneumonia, sepsis, gastrointestinal bleeding, deep venous thrombosis, and acute renal failure compared to those without AW. Patients with AW were also 32% more likely to die during their AIS hospitalization compared to those without AW (odds ratio 1.32, 95% confidence interval 1.11-1.58). AW was associated with ≈15-day increase in length of stay and ≈$5,000 increase in hospitalization cost (p < 0.001). CONCLUSION: AW is associated with increased cost, longer hospitalizations, and higher odds of medical complications and in-hospital mortality after AIS. Proactive surveillance and management of AW may be important in improving outcomes in these patients.


Assuntos
Alcoolismo/epidemiologia , Isquemia Encefálica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Síndrome de Abstinência a Substâncias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/economia , Alcoolismo/fisiopatologia , Isquemia Encefálica/economia , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Depressores do Sistema Nervoso Central/efeitos adversos , Etanol/efeitos adversos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Prognóstico , Respiração Artificial/estatística & dados numéricos , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Síndrome de Abstinência a Substâncias/economia , Síndrome de Abstinência a Substâncias/fisiopatologia , Síndrome de Abstinência a Substâncias/terapia , Terapia Trombolítica , Estados Unidos/epidemiologia , Adulto Jovem
2.
Artigo em Inglês | MEDLINE | ID: mdl-31546662

RESUMO

The economic aspects of alcohol misuse are attracting increasing attention from policy makers and researchers but the evidence on the economic burden of this substance is hardly comparable internationally. This study aims to overcome this problem by estimating production losses (indirect costs) associated with alcohol-attributable mortality in 28 European Union (EU) countries in the year 2016. This study applies the prevalence-based top-down approach, societal perspective and human capital method to sex- and age-specific data on alcohol-related mortality at working age. The alcohol-attributable mortality data was taken from estimates based on the Global Burden of Disease Study 2016. Uniform data on labor and economic measures from the Eurostat database was used. The total production losses associated with alcohol-related deaths in the EU in 2016 were €32.1 billion. The per capita costs (share of costs in gross domestic product (GDP)) were €62.88 (0.215%) for the whole EU and ranged from €17.29 (0.062%) in Malta to €192.93 (0.875%) in Lithuania. On average, 81% of the losses were associated with male deaths and mortality among those aged 50-54 years generated the highest burden. Because alcohol is a major avoidable factor for mortality, public health community actions aimed at limiting this substance misuse might not only decrease the health burden but also contribute to the economic welfare of European societies.


Assuntos
Alcoolismo/economia , Alcoolismo/mortalidade , União Europeia/economia , Adulto , Efeitos Psicossociais da Doença , Bases de Dados Factuais , Feminino , Produto Interno Bruto , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Saúde Pública
3.
Aust N Z J Public Health ; 43(5): 484-495, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31390112

RESUMO

OBJECTIVE: The aim of this literature review was to establish the economic burden of preventable disease in Australia in terms of attributable health care costs, other costs to government and reduced productivity. METHODS: A systematic review was conducted to establish the economic cost of preventable disease in Australia and ascertain the methods used to derive these estimates. Nine databases and the grey literature were searched, limited to the past 10 years, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed to identify, screen and report on eligible studies. RESULTS: Eighteen studies were included. There were at least three studies examining the attributable costs and economic impact for each risk factor. The greatest costs were related to the productivity impacts of preventable risk factors. Estimates of the annual productivity loss that could be attributed to individual risk factors were between $840 million and $14.9 billion for obesity; up to $10.5 billion due to tobacco; between $1.1 billion and $6.8 billion for excess alcohol consumption; up to $15.6 billion due to physical inactivity and $561 million for individual dietary risk factors. Productivity impacts were included in 15 studies and the human capital approach was the method most often employed (14 studies) to calculate this. CONCLUSIONS: Substantial economic burden is caused by lifestyle-related risk factors. Implications for public health: The significant economic burden associated with preventable disease provides an economic rationale for action to reduce the prevalence of lifestyle-related risk factors. New analysis of the economic burden of multiple risk factors concurrently is needed.


Assuntos
Alcoolismo/economia , Doença Crônica/economia , Doença Crônica/prevenção & controle , Assistência à Saúde/economia , Custos de Cuidados de Saúde , Doenças não Transmissíveis/economia , Obesidade/economia , Obesidade/prevenção & controle , Comportamento Sedentário , Fumar/economia , Alcoolismo/terapia , Austrália/epidemiologia , Doença Crônica/epidemiologia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Humanos , Estilo de Vida , Doenças não Transmissíveis/terapia , Obesidade/epidemiologia , Fumar/efeitos adversos
4.
Alcohol Alcohol ; 54(5): 532-539, 2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31206150

RESUMO

AIMS: The study aims to examine how socio-economic status (SES) among youth is related to binge-drinking and alcohol-related problems using three SES indicators: (i) SES of origin (parental education level), (ii) SES of the school environment (average parental education level at student's school) and (iii) SES of destination (academic orientation). METHODS: Cross-sectional data on upper secondary students (n= 4448) in Sweden. Multilevel logistic and negative binomial regression were used to estimate the relationship between each SES indicator and binge-drinking and alcohol-related problems, respectively. RESULTS: Only SES of destination was significantly associated with binge-drinking, with higher odds for students in vocational programmes (OR= 1.42, 95% CI= 1.13-1.80). For the second outcome, SES of destination (rr=1.25; 95%CI=1.08-1.45) and SES of the school environment (rr=1.19, 95% CI=1.02-1.39) indicated more alcohol-related problems in vocational programmes and in schools with lower-educated parents. After adjustment for drinking patterns, the relationship remained for SES of the school environment, but became non-significant for SES of destination. CONCLUSION: Our results suggest that the SES gradient among youth is stronger for alcohol-related problems than for harmful drinking. By only focusing on SES differences in harmful alcohol use, researchers may underestimate the social inequalities in adverse alcohol-related outcomes among young people. Our findings also support the notion that the environment young people find themselves in matters for social inequalities in alcohol-related harm.


Assuntos
Comportamento do Adolescente , Alcoolismo/economia , Alcoolismo/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários , Adolescente , Comportamento do Adolescente/psicologia , Alcoolismo/psicologia , Bebedeira/economia , Bebedeira/epidemiologia , Bebedeira/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Suécia/epidemiologia
5.
Eur Addict Res ; 25(5): 224-228, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31216535

RESUMO

IMPORTANCE: According to recent studies, only a small proportion of alcoholics in the system for addiction treatment receive expedited treatment [Rehm et al.: Sucht 2014;60:93-105] and that those who are untreated are at risk of harmful and dependent alcohol consumption. This is associated with significantly negative effects on morbidity, mortality, and quality of life [Kraus et al.: Sucht 2010;56:337-347]. As a result, not only individuals and their environment suffer but there is also a health economic impact. OBJECTIVE: How often do patients with a primary or secondary diagnosis of alcohol dependence who have been discharged from inpatient treatment receive anticraving medication in the follow-up period of 6 months? DESIGN, SETTING, AND PARTICIPANTS: Based on data from a statutory health insurance in Germany, 12,958 patients were investigated regarding alcohol dependence, rates for readmission to hospital, and prescription of anticraving drugs. In addition, outpatient and inpatient treatment costs were calculated. Main Outcomes and Measures: There will be an examination of how often anticraving medications are prescribed and what the economic consequences are. RESULTS: Two hundred and eighty-eight (2.22%) patients received anticraving medication, 98 (0.76%) in the first 6 months after inpatient treatment. Fifty-nine of the 288 patients were monitored with a pre- and postcomparison over a 90-day period. Inpatient treatment fell from 0.83 times (±1.10) during the 3 months afterward to 0.79 (±1.01). On average, the duration of an inpatient stay before anticraving treatment (n = 29) was 17.34 days (±14.37), with an average cost of EUR 4,142.70 (±2,721.28). Among the anticraving treatment group, this fell to 14.03 days (±9.96) with an average cost of EUR 3,685.43 (±2,307.67). Overall, the average outpatient and inpatient treatment costs dropped from EUR 1,533.88 before treatment to EUR 1,462.76 after treatment. If this is extrapolated to the whole group, it leads to between EUR 921,500 and EUR 6.6 million saving for a health insurance company. CONCLUSION: Anticraving medications are hardly ever prescribed. Their routine use could reduce hospital readmission rates and save on health-care costs.


Assuntos
Dissuasores de Álcool/uso terapêutico , Alcoolismo , Redução de Custos/economia , Naltrexona/uso terapêutico , Padrões de Prática Médica , Alcoolismo/tratamento farmacológico , Alcoolismo/economia , Feminino , Alemanha , Hospitalização , Humanos , Pacientes Internados , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos
6.
Int J Equity Health ; 18(1): 78, 2019 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-31138225

RESUMO

BACKGROUND: Globally, alcohol consumption accounts for a substantial burden of disease, which translates into high social and economic costs. To address this burden, several policies (e.g. age and trading hour restrictions, increasing alcohol taxation) were implemented. Despite the existence of these policies evidence shows that alcohol misuse and alcohol-related harms have increased in South Africa over recent years. The objective of this paper is to assess progressivity and the changes in progressivity of alcohol expenditure at the household level in South Africa using datasets that span 15 years. METHODS: Data come from the 1995, 2000, 2005/06 and 2010/11 South Africa Income Expenditure Survey. Distribution of spending on alcoholic beverages were analyzed using standard methodologies. Changes in progressivity between 1995 and 2000, and between 2005/06 and 2010/11 were also assessed using the Kakwani index. RESULTS: Alcohol spending was regressive between 1995 and 2011 as the fraction of poorer households' expenditure spent on alcohol beverage exceeds that for the richest households. Also, the difference in Kakwani indexes of progressivity indicates that spending on alcoholic beverages has become less regressive between the same time periods. CONCLUSION: The results show no evidence that alcohol policy including taxation increased regressivity. Thus, there is an opportunity to further reduce the regressivity using coherent alcohol policies. This paper concludes that there is a need for further research to unpack why alcohol spending became less regressive over the years that goes beyond just looking at changes in the distribution of alcohol expenditure.


Assuntos
Consumo de Bebidas Alcoólicas , Bebidas Alcoólicas , Comportamento do Consumidor , Pobreza , Política Pública , Impostos , Adulto , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/tendências , Bebidas Alcoólicas/economia , Alcoolismo/economia , Comportamento do Consumidor/economia , Características da Família , Feminino , Gastos em Saúde , Humanos , Renda , Masculino , África do Sul , Inquéritos e Questionários
7.
Asian J Psychiatr ; 43: 132-136, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31136909

RESUMO

OBJECTIVES: To estimate the average cost of an integrated alcohol intervention program at community hospitals of Thailand and identify patient predictors and sources of variation of the program cost. METHODS: Activity-based costing was conducted under a societal perspective among 113 outpatient alcohol users (29 low-risk, 43 high-risk and 41 dependent drinkers), aged 15 years and older, at four community hospitals in southern Thailand. Multivariate regression models were performed to identify individual-level determinants of cost components. RESULTS: The average cost per low-risk, high-risk, and dependent drinkers were 516 (16 USD), 2,961 (94 USD), and 5,325 baht (168 USD), respectively, of which labor and patient costs were the major components. Regardless of drinking risk level, past-year functional disturbance lasting more than 20 days (ß = 0.215, p = 0.035) and increasing number of previous treatment episodes (ß = 0.035, p = 0.046) independently increased overall program cost. Variation in the program cost was mainly caused by length of hospital stay followed by staff time for screening and delivering interventions. CONCLUSION: The study underlines the important role of pretreatment alcohol-related problems and human resources in alcohol intervention programs. Efforts should be focused on adequacy of treatment for the very first episode of alcohol problems to reduce the high healthcare costs.


Assuntos
Alcoolismo/economia , Alcoolismo/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitais Comunitários/economia , Atenção Primária à Saúde/economia , Adolescente , Adulto , Humanos , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Tailândia , Adulto Jovem
8.
Drug Alcohol Depend ; 199: 129-135, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31048089

RESUMO

BACKGROUND: This study aimed to characterize the associations of racial and socioeconomic discrimination with timing of alcohol initiation and progression from initiation to problem drinking in Black youth. METHODS: Data were drawn from a high-risk family study of alcohol use disorder. Mothers and their offspring (N = 806; Mage = 17.87, SDage = 3.91; 50% female) were assessed via telephone interview. Cox proportional hazards regression analyses were used to examine associations between discrimination and timing of first drink and progression from first drink to problem drinking in two separate models. Predictor variables were considered in a step-wise fashion, starting with offspring racial and socioeconomic discrimination, then adding (2) maternal racial and/or socioeconomic discrimination experiences; (3) religious service attendance and social support as potential moderators; and (4) psychiatric and psychosocial risk factors and other substance use. RESULTS: Offspring racial discrimination (HR: 2.01, CI: 1.17-3.46 ≤ age 13) and maternal experiences of discrimination (HR: 0.79, CI: 0.67-0.93) were associated with timing of initiation in the unadjusted model only; offspring socioeconomic discrimination predicted timing of initiation among female offspring, even after adjusting for all covariates (HR: 1.49, CI: 1.14-1.93). Socioeconomic discrimination predicted a quicker transition from first use to problem drinking exclusively in the unadjusted model (HR: 1.70, CI: 1.12-2.58 ≤ age 18). No moderating effects of religious service attendance or social support were observed for either alcohol outcome. CONCLUSIONS: Findings suggest socioeconomic discrimination is a robust risk factor for initiating alcohol use in young Black female youth and should be considered in the development of targeted prevention programs.


Assuntos
Afro-Americanos , Consumo de Bebidas Alcoólicas/economia , Alcoolismo/economia , Racismo/economia , Fatores Socioeconômicos , Adolescente , Adulto , Afro-Americanos/etnologia , Afro-Americanos/psicologia , Consumo de Bebidas Alcoólicas/etnologia , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/etnologia , Alcoolismo/psicologia , Feminino , Humanos , Masculino , Racismo/etnologia , Racismo/psicologia , Fatores de Risco , Fatores Sexuais , Adulto Jovem
9.
PLoS One ; 14(3): e0211940, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30856184

RESUMO

INTRODUCTION: Non-communicable diseases (NCDs) like cancer, cardiovascular disease, and diabetes have spread at a remarkable pace in European countries over the past decades. Overweight/obesity and alcohol use are two leading risk factors contributing to both economic and epidemiological burden associated with NCDs. In OECD countries, the impact of indirect costs of obesity varies between 0.20% and 1.21% of GDP. Indirect costs of alcohol use range from 0.19% (Portugal) to 1.6% (Estonia) of GDP. AIM: To assess the longitudinal impact of alcohol use and high body-mass index (BMI) on labour market outcomes in the European region by modeling the direct effect of high BMI and alcohol use, and the effect via associated diseases. METHODS: The impact of BMI, alcohol use, and associated diseases on employment likelihood, intent to retire early, days of absenteeism, and hours of work per week, were modelled via lagged Poisson and Zero-inflated Poisson regressions, adjusting for missingness via inverse probability weighting, as appropriate, using European SHARE data. RESULTS: Controlling for other chronic conditions, being overweight increases employment likelihood among men, but not among women. Obesity decreased female, but not male, employment chances. All chronic conditions linked with high BMI negatively affected employment likelihood, and increased the intention to retire early significantly. Alcohol use positively affects employment likelihood in women at all drinking levels relative to lifetime abstainers, but only in moderate (not heavy) male drinkers. There is super-additionality of impact of NCDs on absenteeism and hours worked, presenting a key economic argument to tackle NCD prevention and compression of morbidity. IMPLICATIONS: NCD prevention is not just important for employment and hours worked, but also for employee morale, especially given increasing retirement age in Europe and globally.


Assuntos
Alcoolismo/economia , Obesidade/economia , Absenteísmo , Adulto , Consumo de Bebidas Alcoólicas , Alcoolismo/epidemiologia , Índice de Massa Corporal , Doenças Cardiovasculares , Doença Crônica , Diabetes Mellitus , Emprego , Etanol , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/economia , Doenças não Transmissíveis/epidemiologia , Obesidade/epidemiologia , Sobrepeso , Fatores de Risco
10.
J Addict Nurs ; 30(1): 24-31, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829997

RESUMO

Relapse is the unauthorized use of any mind-altering substance, prescribed or not, after an individual has entered treatment for substance use (Darbro, 2011). Among nurses with impaired practice, the 5-year relapse rate is estimated at about 40% (Zhong, Kenward, Sheets, Doherty, & Gross, 2009), and the risk of relapse is highest in the first year of recovery (Clark & Farnsworth, 2006). Many factors influence susceptibility to relapse among nurses including presence of psychiatric comorbidities (Schellekens, de Jong, Buitelaar, & Verkes, 2015), history of criminal background (Zhong et al., 2009), spirituality and religiosity (Allen & Lo, 2010), and receiving prelicensure education in the United States (Waneka, Spetz, & Keane, 2011). The purpose of this study was to examine the correlates and predictors of relapse among nurses and to establish at what point they are most susceptible to relapse. This study was a retrospective secondary data analysis of nurses in Texas with impaired practice. The total number of participants was 1,553. The time it takes participants to enroll in a peer assistance program is negatively associated with length in program (p < .001). Conversely, there is a strong, positive, significant relationship between the number of days abstinent and the length in program (p < .001). More men compared with women (p = .037) were likely to be employed while participating in the program. Finally, participants who were referred for substance use disorders alone had 55% less risk of relapse. Those who used alcohol as their primary drug of choice had 1.7 times higher risk of relapse.


Assuntos
Alcoolismo/epidemiologia , Transtornos Mentais/epidemiologia , Enfermeiras e Enfermeiros/psicologia , Adulto , Idoso , Alcoolismo/economia , Distribuição de Qui-Quadrado , Comorbidade , Emprego , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Risco , Fatores Sexuais , Estatísticas não Paramétricas , Texas/epidemiologia , Adulto Jovem
11.
Health Promot Chronic Dis Prev Can ; 39(1): 15-24, 2019 Jan.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-30652839

RESUMO

INTRODUCTION: Many Canadians continue to drink alcohol in excess of the recommended low-risk guidelines. In this study, we visualized the geographic variation of licensed premises alcohol expenditures in Toronto and examined the effects of area-level socioeconomic characteristics, alcohol availability and built environment influences on alcohol expenditures at the Dissemination Area (DA) level. METHODS: Dissemination Area average total household expenditures on alcohol from licensed premises, from the 2010 Survey of Household Spending, was the main outcome variable. Moran's I and Local Moran's I were used to quantify geographic variation and determine hot spots and cold spots of expenditure. We used DA-level socioeconomic characteristics from the 2006 Census of Canada, and the density of licensed premises and other built environment characteristics from the 2008 DMTI Spatial and 2010 CanMap datasets to predict alcohol expenditures in multivariate spatial regression models. RESULTS: The results indicated that the most significant area-level predictors of alcohol expenditure were the percentage of individuals in management or finance occupations and the percentage with postsecondary education (one-unit increases associated with 78.6% and 35.0% increases in expenditures respectively). Presence of subway lines in the immediate and neighbouring areas was also significant (one-unit increases resulted in 5% and 28% increases respectively). Alcohol outlet density was also positively associated with alcohol expenditures. CONCLUSION: The associations identified between licensed premises alcohol expenditures and small-area-level characteristics highlight the potential importance of small-area-level factors in understanding alcohol use. Understanding the small-area-level characteristics of expenditures and geographic variation of alcohol expenditures may provide avenues for alcohol use reduction initiatives and policies.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Ambiente Construído/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Pessoal Administrativo/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Alcoolismo/economia , Ambiente Construído/economia , Ambiente Construído/legislação & jurisprudência , Escolaridade , Meio Ambiente , Humanos , Ontário/epidemiologia , Fatores Socioeconômicos , Transportes/estatística & dados numéricos , População Urbana/estatística & dados numéricos
13.
Clin Liver Dis ; 23(1): 39-50, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30454831

RESUMO

Alcohol abuse is a major determinant of public health outcomes. Worldwide data from 2016 indicate that alcohol is the seventh leading risk factor in terms of disability-adjusted life years, an increase of more than 25% from 1990 to 2016. Understanding the epidemiology of alcoholic liver disease, including the regional variations in consumption and public policy, is an area of active research. In countries where the per capita consumption of alcohol decreases, there appears to be an associated decrease in disease burden. Given alcohol's health burden, an increased focus on alcohol control policies is needed.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Hepatopatias Alcoólicas/epidemiologia , Abstinência de Álcool , Consumo de Bebidas Alcoólicas/economia , Alcoolismo/economia , Alcoolismo/reabilitação , Custos e Análise de Custo , Humanos , Hepatopatias Alcoólicas/economia , Prevalência , Estados Unidos
14.
Ann Agric Environ Med ; 25(4): 659-664, 2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-30586972

RESUMO

INTRODUCTION: Risky alcohol consumption is one of the main threats to the health of both individuals and society as a whole. These threats affect, among others, health, safety and financial situation. Their scale and intensity cause the issue of alcohol consumption to become a significant challenge for public health. OBJECTIVE: The aim of the study was assessment of the occurrence of the problem of alcohol consumption among residents of rural areas in Western Pomerania and the Lubuskie Province of Western Poland. MATERIAL AND METHODS: The study was conducted on 350 residents of rural areas - 236 females (66.4%) and 114 males (32.6%), median age - 42 y. (range - 20-76 years). The tools used included MAST and AUDIT questionnaires, Health Behaviour Inventory (HBI), Social Activity Questionnaire (SA), and original questions. RESULTS: In the studied group the problem with proper alcohol consumption occurred. High convergence was observed between results obtained by individual respondents with both tools (r=0.868 with p<0.001). Median on the AUDIT scale indicated the possibility of alcoholism occurrence in the studied group, whereas the MAST test indicated the necessity to conduct an in-depth alcohol diagnosis. Factors that differentiated the points scored by respondents in AUDIT test included gender - more women drank alcohol in a risky way (Z=-2.54, p=0.011), education, health behaviours, professional passivity, and using various forms of support. In the AUDIT test, the alcoholism threat was over 7 times higher in people without permanent employment (vs. employed people), OR=7.41 (95% CI-4.56-12.04), and in MAST test it was over 4 times higher in these individuals: OR =4.45 (95% CI-2.64-7.49). CONCLUSIONS: Results indicate the need to intensify the work of regional facilities for solving alcohol problems, as well as educational campaigns in schools and health care facilities.


Assuntos
Alcoolismo/epidemiologia , Adulto , Idoso , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/economia , Alcoolismo/psicologia , Emprego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , População Rural/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
15.
Eur Addict Res ; 24(5): 245-254, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30384381

RESUMO

Alcohol use disorders (AUD) are a major contributor to the global burden of disease, and have huge societal impact. Some studies show that AUD patients carrying the G-allele of the OPRM1 variant c.118A>G respond better to naltrexone, resulting in reduced relapse rates compared to carriers of the AA genotype. Genotype-guided treatment allocation of these patients carrying a G-allele to naltrexone could potentially improve the treatment outcome. However, cost-effectiveness of this strategy should be investigated before considering clinical implementation. We, therefore, evaluated costs and Quality-Adjusted Life-Years (QALYs), using a modelling approach, from an European perspective, of genotype-guided treatment allocation (G-allele carriers receiving naltrexone; AA homozygotes acamprosate or naltrexone) compared to standard care (random treatment allocation to acamprosate or naltrexone), by using a Markov model. Genotype-guided treatment allocation resulted in incremental costs of EUR 66 (95% CI -28 to 149) and incremental effects of 0.005 QALYs (95% CI 0.000-0.011) per patient (incremental cost-effectiveness ratio of EUR 13,350 per QALY). Sensitivity analyses showed that the risk ratio to relapse after treatment allocation had the largest impact on the cost-effectiveness. Depending on the willingness to pay for a gain of one QALY, probabilities that the intervention is cost-effective varies between 6 and 79%. In conclusion, pharmacogenetic treatment allocation of AUD patients to naltrexone, based on OPRM1 genotype, can be a cost-effective strategy, and could have potential individual and societal benefits. However, more evidence on the impact of genotype-guided treatment allocation on relapse is needed to substantiate these conclusions, as there is contradictory evidence about the effectiveness of OPRM1 genotyping.


Assuntos
Acamprosato/economia , Alcoolismo/tratamento farmacológico , Alcoolismo/genética , Análise Custo-Benefício , Custos de Cuidados de Saúde/estatística & dados numéricos , Naltrexona/economia , Receptores Opioides mu/genética , Acamprosato/uso terapêutico , Alcoolismo/economia , Alelos , Simulação por Computador , Genótipo , Humanos , Cadeias de Markov , Modelos Estatísticos , Naltrexona/uso terapêutico , Farmacogenética/economia , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento
17.
Ann Behav Med ; 52(4): 273-286, 2018 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30084891

RESUMO

Background: Overweight and obesity are among the leading risk factors for death worldwide. Scientists believe that the increase in obesity is primarily due to environmental changes and thus favor obesity prevention measures targeting the environment. However, it is less clear what lay people perceive as causes of obesity, and which measures they deem acceptable and promising in fighting it. Purpose: This article compares lay beliefs about obesity with beliefs about other major health risks sharing certain similarities with obesity (alcohol and tobacco dependence, depression) in three countries with high obesity rates. Methods: Computer-assisted face-to-face interviews with representative samples in the UK (N = 1,216) and Germany (N = 973) and an online survey in the USA (N = 982) tapping beliefs about locus of responsibility, liability for treatment costs, and effectiveness of policy measures. Results: In each country, respondents attributed responsibility for obesity primarily to the individual; the same pattern emerged for alcohol and tobacco dependence, but not for depression (ps < .01). The higher the attribution of personal responsibility, the more strongly respondents endorsed individual liability for treatment costs (ps < .01). Respondents judged information and fiscal policies as most and least effective, respectively, in obesity prevention. Conclusions: Respondents' views about obesity are similar to those about addictions; however, they regard fiscal and regulatory policies as less effective for obesity than for addictions. Raising awareness about environmental drivers of obesity and framing policy measures by reference to the fight against tobacco and alcohol could increase public support of obesity-targeted policies.


Assuntos
Alcoolismo , Conhecimentos, Atitudes e Prática em Saúde , Obesidade , Tabagismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/economia , Alcoolismo/etiologia , Alcoolismo/prevenção & controle , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/economia , Obesidade/etiologia , Obesidade/prevenção & controle , Risco , Tabagismo/economia , Tabagismo/etiologia , Tabagismo/prevenção & controle , Reino Unido , Estados Unidos , Adulto Jovem
18.
BMJ Open ; 8(8): e020563, 2018 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-30158219

RESUMO

OBJECTIVES: Heavy alcohol use can cause somatic and mental diseases, affects patients' social life and is associated with social isolation, unemployment and reduced quality of life. Therefore, societal costs of alcohol dependence are expected to be high. The aim of this study was to estimate excess costs of patients with alcohol dependence diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria compared with individuals without alcohol dependence in Germany. DESIGN: In a secondary analysis, baseline data of patients with alcohol dependence enrolled in a randomised controlled trial (German Clinical Trials Register DRS00005035) were compared with data collected via a telephone survey from individuals without alcohol dependence and that had been matched by entropy balancing. Health service use was evaluated retrospectively for a 6-month period. SETTINGS: Four German psychiatric university clinics (patients with alcohol dependence) and the German general adult population (individuals without alcohol dependence). PARTICIPANTS: n=236 adult patients with alcohol dependence and n=4687 adult individuals without alcohol dependence. PRIMARY AND SECONDARY OUTCOME MEASURES: The excess costs of health service use, absenteeism and unemployment of patients with alcohol dependence were calculated and compared with individuals without alcohol dependence. In subgroup analyses, the associations between excess cost and gender, comorbidities and the duration of disease were investigated. RESULTS: Total 6-month excess costs of €11 839 (95% CI €11 529 to €12 147) were caused by direct excess costs of €4349 (95% CI €4129 to €4566) and indirect costs of €7490 (95% CI €5124 to €9856). In particular, costs of inpatient treatment, formal long-term care, absenteeism and unemployment were high. CONCLUSIONS: Alcohol dependence causes substantial direct and indirect excess costs. Cost-effective interventions to prevent and treat alcohol dependence are urgently needed. TRIAL REGISTRATION NUMBER: DRKS00005035.


Assuntos
Alcoolismo/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Absenteísmo , Adulto , Alcoolismo/terapia , Instituições de Assistência Ambulatorial , Estudos de Casos e Controles , Etanol/efeitos adversos , Feminino , Alemanha , Hospitalização/economia , Humanos , Assistência de Longa Duração/economia , Masculino , Serviços de Saúde Mental , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Psicoterapia , Qualidade de Vida , Estudos Retrospectivos , Desemprego , Universidades
19.
Aust J Prim Health ; 24(5): 385-390, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30032738

RESUMO

The Drug and Alcohol Withdrawal Network (DAWN) is a home-based withdrawal service based in Perth, Western Australia. Literature on outcomes, costs and client attitudes towards this type of home-based detoxification in Australia is sparse. Therefore, this study assessed these factors for clients enrolled over a 5-year period (July 2011-June 2016). Client experience was explored through semi-structured interviews with 10 clients. Over the study period, 1800 clients (54% male, mean age 38 years) were assessed, and there were 2045 episodes of care. Although most first-episode clients (52%) listed alcohol as the primary drug of concern, the proportion listing methamphetamine increased from 4% in 2011-12 to 23% in 2015-16. In 94% (n=639) of withdrawal detoxification episodes with completed surveys, clients used their 'drug of primary concern' most days or more often at baseline; this had reduced to 23% (n=149) at the conclusion of detoxification. Five-year direct costs were A$4.8million. Clients valued the person-centred holistic approach to care, including linking with other health providers. Barriers included low awareness of the program and difficulties finding an appropriate support person. Further exploration of cost-effectiveness would substantiate the apparently lower per client cost, assuming medical suitability for both programs, for home-based relative to inpatient withdrawal.


Assuntos
Análise Custo-Benefício/economia , Serviços de Assistência Domiciliar/economia , Avaliação de Programas e Projetos de Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Alcoolismo/economia , Alcoolismo/terapia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Austrália Ocidental
20.
Riv Psichiatr ; 53(3): 141-148, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29912216

RESUMO

The development of a treatment for alcohol use disorder (AUD) is a crucial and complex moment. Indeed, the information gathered by a team of professionals (physicians, psychologists and social workers) (bio-psycho-social model of AUD) interact to choose the most appropriate cure. As for AUD psychological treatment, it is of considerable importance to avoid clinical treatments leading to drop-out for improving the patients quality of life. Psychoanalytic and behavioral techniques were early utilized as psychological treatment of AUD, however, evidence-based approaches as motivational interviewing (MI) and cognitive behavioral therapy (CBT) are recently used in AUD. In this work we review the more effective and appropriate AUD psychological treatments.


Assuntos
Alcoolismo/terapia , Psicoterapia/métodos , Alcoolismo/economia , Alcoolismo/prevenção & controle , Alcoolismo/psicologia , Ensaios Clínicos como Assunto , Terapia Cognitivo-Comportamental , Efeitos Psicossociais da Doença , Relações Familiares , Humanos , Entrevista Motivacional , Cooperação do Paciente , Psicanálise , Psicoterapia/economia , Psicoterapia Breve , Psicoterapia de Grupo , Recidiva , Autocontrole , Grupos de Autoajuda , Habilidades Sociais , Comunidade Terapêutica , Resultado do Tratamento
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