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1.
Trials ; 21(1): 809, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993779

RESUMO

BACKGROUND: Early reports indicate that COVID-19 may require intensive care unit (ICU) admission in 5-26% and overall mortality can rise to 11% of the recognised cases, particularly affecting the elderly. There is a lack of evidence-based targeted pharmacological therapy for its prevention and treatment. We aim to compare the effects of a World Health Organization recommendation-based education and a personalised complex preventive lifestyle intervention package (based on the same WHO recommendation) on the outcomes of the COVID-19. METHODS: PROACTIVE-19 is a pragmatic, randomised controlled clinical trial with adaptive "sample size re-estimation" design. Hungarian population over the age of 60 years without confirmed COVID-19 will be approached to participate in a telephone health assessment and lifestyle counselling voluntarily. Volunteers will be randomised into two groups: (A) general health education and (B) personalised health education. Participants will go through questioning and recommendation in 5 fields: (1) mental health, (2) smoking habits, (3) physical activity, (4) dietary habits, and (5) alcohol consumption. Both groups A and B will receive the same line of questioning to assess habits concerning these topics. Assessment will be done weekly during the first month, every second week in the second month, then monthly. The composite primary endpoint will include the rate of ICU admission, hospital admission (longer than 48 h), and mortality in COVID-19-positive cases. The estimated sample size is 3788 subjects per study arm. The planned duration of the follow-up is a minimum of 1 year. DISCUSSION: These interventions may boost the body's cardiovascular and pulmonary reserve capacities, leading to improved resistance against the damage caused by COVID-19. Consequently, lifestyle changes can reduce the incidence of life-threatening conditions and attenuate the detrimental effects of the pandemic seriously affecting the older population. TRIAL REGISTRATION: The study has been approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (IV/2428- 2 /2020/EKU) and has been registered at clinicaltrials.gov ( NCT04321928 ) on 25 March 2020.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Comportamento de Redução do Risco , Ensaios Clínicos Adaptados como Assunto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Exercício Físico , Comportamento Alimentar , Feminino , Nível de Saúde , Interações Hospedeiro-Patógeno , Humanos , Hungria , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Ensaios Clínicos Pragmáticos como Assunto , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos
2.
Cochrane Database Syst Rev ; 9: CD010022, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32960976

RESUMO

BACKGROUND: High blood pressure constitutes one of the leading causes of mortality and morbidity all over the world. At the same time, heavy drinking increases the risk for developing cardiovascular diseases, including cardiomyopathy, hypertension, atrial arrhythmias, or stroke. Several studies have already assessed specifically the relationship between alcohol intake and hypertension. However, the potential effect on blood pressure of alcohol intake reduction interventions is largely unknown. OBJECTIVES: To assess the effect of any intervention to reduce alcohol intake in terms of blood pressure decrease in hypertensive people with alcohol consumption compared to a control intervention or no intervention at all. To determine additional effects related to mortality, major cardiovascular events, serious adverse events, or quality of life. SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to June 2020: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 5, 2020), MEDLINE Ovid (from 1946), MEDLINE Ovid Epub Ahead of Print, and MEDLINE Ovid In-Process, Embase Ovid (from 1974), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. Trial authors were contacted when needed and no language restrictions were applied. SELECTION CRITERIA: We included randomised controlled trials with minimum 12 weeks duration and including 50 or more subjects per group with quantitative measurement of alcohol consumption and/or biological measurement of the outcomes of interest. Participants were adults (16 years of age or older) with systolic blood pressure (SBP) greater than 140 mmHg and diastolic blood pressure (DBP) greater than 90 mmHg, and SBP ≥ 130 or DBP ≥ 80 mmHg in participants with diabetes. We included any intervention implemented to reduce their alcohol intake. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed search results and extracted data using standard methodological procedures adopted by Cochrane. MAIN RESULTS: A total of 1210 studies were screened. We included one randomised controlled trial involving a total of 269 participants with a two-year follow-up. Individual patient data for all participants were provided and used in this review. No differences were found between the cognitive-behavioural intervention group and the control group for overall mortality (RR 0.72, 95% CI 0.16 to 3.17; low-certainty evidence), cardiovascular mortality (not estimable) and cardiovascular events (RR 0.80, 95% CI 0.36 to 1.79; very low-certainty evidence). There was no statistical difference in systolic blood pressure (SBP) reduction (Mean Difference (MD) -0.92 mmHg, 95% confidence interval (CI) -5.66 to 3.82 mmHg; very low-certainty evidence) or diastolic blood pressure (DBP) decrease (MD 0.98 mmHg, 95% CI -1.69 to 3.65 mmHg; low-certainty evidence) between the cognitive-behavioural intervention group and the control group. We also did not find any differences in the proportion of subjects with SBP < 140 mmHg and DBP < 90 mmHg (Risk Ratio (RR) 1.21, 95% CI 0.88 to 1.65; very low-certainty evidence). Concerning secondary outcomes, the alcohol intake was significantly reduced in the cognitive-behavioural intervention compared with the control group (MD 191.33 g, 95% CI 85.36 to 297.30 g). We found no differences between the active and control intervention in the proportion of subjects with lower-risk alcohol intake versus higher-risk and extreme drinkers at the end of the study (RR 1.04, 95% CI 0.68 to 1.60). There were no estimable results for the quality of life outcome. AUTHORS' CONCLUSIONS: An intervention for decreasing alcohol intake consumption did not result in differences in systolic and diastolic blood pressure when compared with a control intervention, although there was a reduction in alcohol intake favouring the active intervention. No differences were found either for overall mortality, cardiovascular mortality or cardiovascular events. No data on serious adverse events or quality of life were available to assess. Adequate randomised controlled trials are needed to provide additional evidence on this specific question.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Terapia Cognitivo-Comportamental , Hipertensão/prevenção & controle , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/mortalidade , Viés , Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32868471

RESUMO

BACKGROUND: Legal performance-enhancing substance(s) (PES) (eg, creatine) are widely used among adolescent boys and young men; however, little is known about their temporal associations with substance use behaviors. METHODS: We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I to IV (1994-2008). Logistic regressions were used to first assess adolescent substance use (Wave I) and use of legal PES (Wave III) and second to assess use of legal PES (Wave III) and subsequent substance use-associated risk behaviors (Wave IV), adjusting for potential confounders. RESULTS: Among the sample of 12 133 young adults aged 18 to 26 years, 16.1% of young men and 1.2% of young women reported using legal PES in the past year. Adolescent alcohol use was prospectively associated with legal PES use in young men (odds ratio 1.39; 95% confidence interval [CI] 1.13-1.70). Among young men, legal PES use was prospectively associated with higher odds of problematic alcohol use and drinking-related risk behaviors, including binge drinking (adjusted odds ratio [aOR] 1.35; 95% CI 1.07-1.71), injurious and risky behaviors (aOR 1.78; 95% CI 1.43-2.21), legal problems (aOR 1.52; 95% CI 1.08-2.13), cutting down on activities and socialization (aOR 1.91; 95% CI 1.36-2.78), and emotional or physical health problems (aOR 1.44; 95% CI 1.04-1.99). Among young women, legal PES use was prospectively associated with higher odds of emotional or physical health problems (aOR 3.00; 95% CI 1.20-7.44). CONCLUSIONS: Use of legal PES should be considered a gateway to future problematic alcohol use and drinking-related risk behaviors, particularly among young men.


Assuntos
Substâncias para Melhoria do Desempenho/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/etiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Intoxicação Alcoólica/complicações , Aminoácidos/efeitos adversos , Atletas/estatística & dados numéricos , Índice de Massa Corporal , Intervalos de Confiança , Creatina/efeitos adversos , Desidroepiandrosterona/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Masculino , Fumar Maconha/efeitos adversos , Razão de Chances , Estudos Prospectivos , Assunção de Riscos , Fatores Sexuais , Fumar/efeitos adversos , Esteroides/efeitos adversos , Consumo de Álcool por Menores , Adulto Jovem
5.
BMC Public Health ; 20(1): 1364, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32891134

RESUMO

BACKGROUND: The co-morbidity of cardiometabolic diseases in patients with Tuberculosis adds a significant burden in current health systems in developing countries including Nepal. The main objective of this study was to explore cardiometabolic risk factors among patients with Tuberculosis. METHODS: This was a cross-sectional study conducted among patients with tuberculosis in 12 tuberculosis treatment centers from eight districts of Nepal between May and July 2017. Interviews with participants were conducted using a structured questionnaire and were supplemented by anthropometric measurements and on-site blood glucose tests. Data were analyzed using descriptive and inferential statistics. RESULTS: Among 221 study participants, 138 (62.4%) had new smear-positive pulmonary tuberculosis, 24 (10.9%) had new smear-negative pulmonary tuberculosis and 34 (15.4%) had new extra- pulmonary tuberculosis. Overall, 43.1% of the patients with tuberculosis had at least one cardiometabolic risk factor. The prevalence of at least one cardiometabolic risk factor was more in male than female (47.8% versus 33.8%). Prevalence of tobacco (18.9% versus 4.8%), and alcohol (12.6% versus 6.5%) use was proportionately higher in male compared to female. The prevalence of hypertension (17% vs. 21%) and obesity (11.9% vs. 12.9%) was lower in male compared to females. Female (AOR = 0.47; CI: 0.23-0.94), those from Gandaki Province (AOR = 0.32; CI: 0.13-0.79) and literate (AOR = 0.49; CI: 0.25-0.96) had reduced risk of cardiometabolic disease risk factors. CONCLUSIONS: This study highlights the role of gender and socio-demographic characteristics associated with the risk of cardiometabolic diseases in patients with Tuberculosis. The findings from this study can guide medical practitioners and policy makers to consider clinical suspicion, diagnosis and treatment. National treatment guideline can benefit by integrating the management of non-communicable diseases in Tuberculosis treatment centers.


Assuntos
Hipertensão/epidemiologia , Obesidade/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Comorbidade , Estudos Transversais , Assistência à Saúde , Feminino , Instalações de Saúde , Humanos , Hipertensão/etiologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Doenças não Transmissíveis/epidemiologia , Obesidade/etiologia , Obesidade/terapia , Prevalência , Fatores de Risco , Fatores Sexuais , Uso de Tabaco/efeitos adversos , Tuberculose/epidemiologia , Tuberculose Pulmonar/terapia
6.
Can J Public Health ; 111(4): 466-468, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32757121

RESUMO

In Canada, and elsewhere, the coronavirus disease 2019 (COVID-19) crisis has resulted in a social, economic, and alcohol policy environment that is likely to contribute to a rise in intentional injuries, whether interpersonal or self-directed violence. Heavy drinking has been identified as an important risk factor for intentional injuries, and with the erosion of alcohol control policies on alcohol availability, heavy drinking is likely to increase. During a time of social isolation, economic loss, psychological distress, and reduced access to health services and support networks, all of which are catalytic factors for both intentional injuries and heavy alcohol use, what is needed is individualized and population-based preventive interventions aimed at reducing alcohol consumption, rather than decisions to increase certain forms of alcohol availability.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Política Pública , Ferimentos e Lesões/epidemiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Canadá/epidemiologia , Humanos , Intenção , Pandemias , Ferimentos e Lesões/psicologia
7.
PLoS One ; 15(8): e0232731, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817640

RESUMO

This study evaluated the effects of the chronic consumption of different concentrations of alcohol on the experimental periodontitis (EP). 160 rats were divided into 4 groups: (EP-NT) rats with EP and no alcohol exposure; (EP-A14) rats with EP exposed to 14% alcohol; (EP-A25) rats with EP exposed to 25% alcohol; (EP-A36) rats with EP exposed to 36% alcohol. The animals from the EP-A14, EP-A25 and EP-A36 groups were subjected to different concentrations of alcohol 30 days before EP induction. The histological characteristics, percentage of bone in the furcation (PBF) and bone metabolism in the furcation region were evaluated. The PBF and tartrate-resistant acid phosphatase (TRAP) data were subjected to statistical analysis. The EP-A14, EP-A25 and EP-A36 groups had lower PBFs compared with the EP-NT group. A more severe inflammatory process and a greater number of TRAP+ cells were also observed. In the EP-A14, EP-A25 and EP-A36 groups, the inflammatory process became more severe as the ingested alcoholic concentration increased. An increase in RANKL immunolabeling and a significantly higher number of TRAP+ cells were also observed. We conclude that chronic alcohol consumption increases the severity of experimental periodontitis in a dose-dependent manner by increasing the magnitude of local inflammatory responses and stimulating alveolar bone resorption.


Assuntos
Perda do Osso Alveolar/patologia , Etanol/efeitos adversos , Periodontite/patologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/fisiopatologia , Animais , Masculino , Ratos , Ratos Wistar , Fosfatase Ácida Resistente a Tartarato/metabolismo
8.
Niger Postgrad Med J ; 27(3): 230-236, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687124

RESUMO

Background: Psychoactive substance use is frequently encountered in hospitals' emergency departments (EDs). It accounts for major health-care problems frequently leading to accident and ED admissions, yet it is frequently unidentified. The aim of this study was to determine the prevalence and pattern of psychoactive substance use among patients presenting in the Accident and EDs and to compare the case detection rate of psychoactive substance use between self-report questionnaire and biochemical markers (e.g., urine toxicology). Methods: To achieve this, 200 consenting participants attending the accident and emergency unit of a tertiary hospital were consecutively enlisted into the study within 2 weeks. They were screened for psychoactive substance use with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the urine drug test (UDT). Results: The lifetime prevalence of psychoactive substance use was 45.5%, while the past 3 months (recent use) prevalence was 27.0%. The pattern of psychoactive substance use revealed that alcohol was the predominant psychoactive substance use with a lifetime prevalence of 13.0% and recent use of 12.0%. The UDT significantly detected more patients who used psychoactive substance compared to self-report (P < 0.001). Conclusion: The prevalence of drug use recorded among attendees of the accident and emergency unit was high in this study. The UDT significantly detected more patients who used psychoactive substances compared to self-report (P < 0.001). Several patients with major health problems as a result of psychoactive substance use were identified with the aid of these screening tools.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Intoxicação Alcoólica/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicamentos sem Prescrição/efeitos adversos , Psicotrópicos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Consumo de Bebidas Alcoólicas/epidemiologia , Intoxicação Alcoólica/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Medicamentos sem Prescrição/uso terapêutico , Prevalência , Transtornos Relacionados ao Uso de Substâncias/psicologia , Centros de Atenção Terciária , Adulto Jovem
9.
Anticancer Res ; 40(7): 3707-3712, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620609

RESUMO

BACKGROUND/AIM: Oral cancer incidence is highest worldwide in Taiwan, and practical markers for personalized therapeutic strategies such as immunotherapies, is lacking. Interleukin-12 (IL12) is a cytokine that is reported to exhibit potent tumoricidal effects, however, its genotypic contribution to oral cancer is still largely unknown. We aimed to examine whether IL12A rs568408 and rs2243115 genotypes are associated with oral cancer risk in Taiwan. MATERIALS AND METHODS: Genotypic characteristics of IL12A were determined among 958 oral cancer cases and age- and gender-matched individuals via typical polymerase chain reaction-restriction fragment length polymorphism methodology. RESULTS: The variant genotypes of IL12A rs568408 and rs2243115 were not found to be significantly associated with elevated oral cancer risk (all p>0.05). Moreover, there was no interaction between IL12A genotypes and personal smoking, alcohol drinking and betel quid chewing behaviors (all p>0.05). CONCLUSION: IL12A rs568408 and rs2243115 genotypes may not serve as good predictors for oral cancer risk.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Predisposição Genética para Doença/genética , Subunidade p35 da Interleucina-12/genética , Neoplasias Bucais/genética , Polimorfismo de Nucleotídeo Único/genética , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/genética , Estudos de Casos e Controles , Feminino , Frequência do Gene/genética , Estudos de Associação Genética/métodos , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Fragmento de Restrição/genética , Fatores de Risco , Fumar/efeitos adversos , Fumar/genética , Taiwan
10.
Orv Hetil ; 161(30): 1252-1259, 2020 07.
Artigo em Húngaro | MEDLINE | ID: mdl-32653868

RESUMO

INTRODUCTION: The combined effect of alcohol consumption and smoking on hypertension in hypertensive patients is still not completely clear, although both are known to be cardiovascular risk factors. AIM: The aim of our study was to compare the blood pressure, the achievement of target blood pressure and heart rate of non-smokers and non-drinkers in the middle-aged hypertensive patients with those who smoke and drink regularly. METHOD: From the database of the Hungarian Hypertension Registry, 12 615 patients (6341 men and 6274 women) aged 45-64 years were included in the current analysis, who self-reported smoking habit and alcohol consumption. RESULTS: The mean age of the patients was 55.8 ± 5.7 years (males) and 56.1 ± 5.5 years (females). The percentage of regular smokers was 40.8% and 27.2% among men and women, respectively. 38.1% of males and 12.5% of females were regular alcohol drinkers. The ratio of patients reaching goal blood pressure values was higher in all investigated groups of females than males (p<0.001). Regular smokers and drinkers have lower percentage of reaching goal blood pressure values: 31.1% versus 46.6% in males (p<0.001) and 41.1% versus 49.8% in females (p<0.01), respectively. The average of pulse rate was higher in patients who are smokers and regular drinkers. CONCLUSION: Regular alcohol consumption and smoking decrease the chance of reaching blood pressure goal values in middle-aged, treated hypertensive patients. Orv Hetil. 2020; 161(30): 1252-1259.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/epidemiologia , Fumar/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hungria/epidemiologia , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumar/epidemiologia
11.
Rev Bras Epidemiol ; 23: e200066, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32667466

RESUMO

OBJECTIVES: To describe the occurrence of simultaneous risk factors for chronic noncommunicable diseases, and factors associated with these prevalences in rural adults of a Southern Brazilian city. METHODS: The design of this study was cross-sectional with a sample of 1,445 adults from the rural area of Pelotas, RS. Four risk factors were considered: smoking, alcohol consumption, physical inactivity and inadequate consumption of vegetables. To verify the simultaneous occurrence of the outcomes, a cluster analysis was used. The association was tested by ordinal regression resulting in odds ratios. RESULTS: Among the four risk factors evaluated, three were the most prevalent among men, and only physical inactivity was greater among women. In the cluster analysis, only the combination of alcohol consumption + smoking + inadequate vegetable consumption presented an observed prevalence that was significantly higher than the expected (O/E = 2.67, 95%CI 1.30, 5.48), and higher than another study in the south of the country. This can be justified because that study included an evaluation of urban dwellers and the consumption of fruits. After adjustment, men, single individuals, non-white people, those with less schooling, those with a worse socioeconomic status, those who reported poor perception of health, and those who do not work in specifically rural activities had a greater probability of having the simultaneity of risk factors. CONCLUSION: The results show the importance of developing priority actions regarding the health of rural populations with special attention to the subgroups with an identified higher risk.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Doenças não Transmissíveis/epidemiologia , População Rural , Comportamento Sedentário , Fumar/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Brasil/epidemiologia , Análise por Conglomerados , Estudos Transversais , Dieta Saudável , Feminino , Humanos , Masculino , Doenças não Transmissíveis/etnologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Verduras
12.
Medicine (Baltimore) ; 99(29): e21265, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702913

RESUMO

OBJECTIVE: To assess the dose-response relationship between alcohol consumption and the progression of MCI to dementia. METHOD: This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta analysis for Protocols. Chinese Biomedical Literature Database (CBM), PubMed, Cochrane Library, EMBASE will be searched for all relevant published articles, with no restrictions on the year of publication or language. Case-control and cohort studies explored the relationship between alcohol exposure and the incidence of dementia in patients with MCI will be included. Study selection, data collection and assessment of study bias will be conducted independently at each level by a pair of independent reviewers. The Newcastle-Ottawa Scale (NOS) tool will be used for the risk of bias assessment. The methodological quality of systematic review will be based on A measurement Tool to Assess Systematic Review (AMSTAR 2). The Grading of Recommendations Assessment Development and Evaluation (GRADE) system will be used to assess the quality of evidence. Stata 15.0 will be used for general meta-analysis and exploring the dose-response relationship. Piecewise linear regression model and the restricted cubic spline model will be used for nonlinear trend estimation, and the generalized least-square method will be used to estimate the parameters. DISCUSSION: This dose-response meta-analysis is the first to investigate the dose-effect relationship between alcohol exposure and the incidence of dementia in patients with MCI, providing a comprehensive understanding of the prevention of alcohol-related cognitive impairment. REGISTRATION: The dose-response meta-analysis is registered in the PROSPERO (CRD42019127226) international prospective register of systematic review.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Disfunção Cognitiva/induzido quimicamente , Relação Dose-Resposta a Droga , Humanos
13.
Medicine (Baltimore) ; 99(29): e20799, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702823

RESUMO

Sessile serrated adenomas (SSAs) are precursors of colorectal cancer (CRC). However, there are limited data on detection rates of this premalignant lesion during colonoscopy surveillance in patients with a history of left side colonic resection for cancer. We aimed to identify the incidence and risk factors of SSAs in post-left side colectomy patients.We retrospectively reviewed the medical records of patients who had undergone left side colectomy for colon and rectal cancer between September 2009 and September 2016 and had at least 1 follow-up colonoscopy. Patient baseline characteristics, SSA diagnoses and characteristics, and colonoscopy information were collected.In total, 539 patients were enrolled. At the first follow-up (mean duration 11.5 months), 98 SSAs were identified (22.2%). At the second follow-up (mean duration 25.8 months), 51 SSAs were identified in 212 patients (24.0%). Multivariate analysis showed that alcohol intake (hazard ratio [HR] 1.524; 95% confidence interval [CI] .963-2.411, P = .041), excellent bowel preparation (HR 2.081; 95% CI 1.214-3.567, P = .049), and use of a transparent cap (HR 1.702; 95% CI 1.060-2.735, P = .013) were associated with higher SSA incidence in the first surveillance colonoscopy, while body mass index (BMI) ≥ 25.0 (HR 1.602; 95% CI 1.060-2.836) was associated with a significantly increased risk of SSAs in the second surveillance.Considering the endoscopic appearance of SSAs, adequate bowel preparation and use of transparent caps during postoperative surveillance colonoscopy can increase the diagnosis rate. Modification of alcohol intake and BMI may reduce the incidence of SSAs in left side colon cancer patients.


Assuntos
Adenoma/epidemiologia , Adenoma/patologia , Neoplasias Colorretais/cirurgia , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Índice de Massa Corporal , Catárticos/efeitos adversos , Colectomia/efeitos adversos , Colonoscopia/métodos , Neoplasias Colorretais/complicações , Neoplasias Colorretais/patologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco
14.
J Oral Sci ; 62(4): 365-370, 2020 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-32624546

RESUMO

This study aimed to clarify the risk factors of head and neck cancer (HNC) mortality, relative to those of all-cause and all-cancer mortalities, using the Korean National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) data set. Data from 238 HNC deaths, 14,769 all-cancer deaths, and 38,086 all-cause deaths were extracted during a median follow-up period of 9.5 years. Baseline characteristics were assessed via chi-square tests, t tests, and multivariable logistic regression. HNC mortality was found to be positively associated with male sex, past and current smoking habits, moderate-to-heavy alcohol consumption, and being underweight. In addition, serum gamma-glutamyltransferase level was found to be significantly elevated in cases of HNC mortality. In contrast, obesity, a history of diabetes, and fasting blood glucose levels were found to be inversely associated with overall HNC mortality. Among the HNC subtypes, mortality due to laryngeal cancer was most strongly associated with past and heavy cigarette smoking, and mortality due to oro-/hypopharyngeal cancer was most strongly associated with heavy alcohol consumption. The present study demonstrates that this nationwide, population-based NHIS-HEALS data set can provide useful information for health research and policy development.


Assuntos
Neoplasias de Cabeça e Pescoço , Consumo de Bebidas Alcoólicas/efeitos adversos , Estudos de Coortes , Humanos , Masculino , Fatores de Risco , Fumar/efeitos adversos
15.
Medicine (Baltimore) ; 99(22): e19731, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481360

RESUMO

INTRODUCTION: Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy defined by the sudden onset of hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). HUS is categorized as either typical, caused by Shiga toxin-producing Escherichia coli infection, or atypical HUS (aHUS), usually complement mediated or secondary to systemic disease. We describe a rare case of aHUS in an adult male patient with recurrent acute pancreatitis. PATIENT CLINICAL FINDINGS: A 32-year-old Caucasian male presented to our institution for his third episode of alcohol-induced pancreatitis. He presented with abdominal pain, elevated lipase and pancreatic inflammation on computed tomography consistent with acute pancreatitis. While admitted, he developed sudden onset severe thrombocytopenia, AKI and hemolytic anemia. DIAGNOSIS, THERAPEUTIC INTERVENTIONS, OUTCOMES: Peripheral blood smear, haptoglobin and hemoglobin level confirmed microangiopathic hemolytic anemia. Worsening anemia, thrombocytopenia and AKI were consistent with the diagnosis of aHUS. The patient's pancreatitis resolved with supportive measures, but resolution of significant thrombocytopenia and AKI was not achieved until administration of eculizumab, a complement inhibiting therapy. Eculizumab therapy provided dramatic improvement in this patient, with platelet count increasing from a low of 11,000 to >100,000 within 48 hours of therapy. Creatinine and hemoglobin levels returned to baseline within 3 weeks. CONCLUSION: Recurrent pancreatitis is suggested as the etiology of atypical HUS in this patient and this condition should be recognized and treated in a timely manner for optimal clinical outcomes.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Inativadores do Complemento/uso terapêutico , Síndrome Hemolítico-Urêmica/etiologia , Pancreatite/complicações , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Síndrome Hemolítico-Urêmica/tratamento farmacológico , Humanos , Masculino , Recidiva
16.
Nutr. hosp ; 37(3): 609-615, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193870

RESUMO

Educar y sensibilizar al consumidor para moderar el consumo de alcohol es clave para potenciar un estilo de vida saludable. Los profesionales de la salud (PS) en general, y los farmacéuticos comunitarios o los médicos y enfermeros de Atención Primaria (AP) en particular, son influenciadores clave en la educación para prevenir conductas de riesgo. El desconocimiento por parte del consumidor de conceptos como la unidad de bebida estándar, las recomendaciones de consumo, o las equivalencias de alcohol en las bebidas consumidas, puede generar consumos de riesgo alto, dado que el alcohol es alcohol y no depende de la bebida que lo contiene. Asimismo, los PS no suelen estar familiarizados con estos conceptos y con el uso de herramientas para la detección precoz, como puede ser el cuestionario AUDIT (Alcohol Use Disorders Identification Test). Proponemos un abordaje multidisciplinar (médicos y enfermeros de AP, farmacia comunitaria, dietistas-nutricionistas) para educar al consumidor sobre el riesgo asociado al consumo de alcohol, sustentado en la elaboración de un protocolo de actuación consensuado entre las sociedades científicas de estos colectivos profesionales, cuyo objetivo fundamental es contribuir a la formación óptima y actualizada de los PS. Este protocolo de actuación pretende, por tanto, prevenir conductas de riesgo mediante la educación del consumidor y la detección de hábitos de consumo de alto riesgo. Asimismo, este abordaje multidisciplinar y coordinado debe servir para impulsar la comunicación entre los distintos colectivos a la hora de proporcionar información relevante para abordar el consumo de riesgo desde la AP de Salud


Educating and increasing awareness in the consumer to achieve a moderate alcohol consumption is key to promote a healthy lifestyle. Health care professionals (HCP), in particular community pharmacists and Primary Care (PC) physicians and nurses, are key influencers in the education to prevent risk behaviors. A consumer's poor knowledge of concepts such as standard unit, the recommendations on alcohol use, or the alcohol equivalence in the drinks consumed, can lead to a high-risk use, since "alcohol is alcohol" no matter what beverage contains it. Moreover, HCPs are usually not familiar with these concepts and with early detection tools such as the AUDIT (Alcohol Use Disorders Identification Test). We propose a multidisciplinary approach (PC physicians and nurses, community pharmacy, dietists-nutritionists) to educate consumers on the risks associated with the use of alcohol, supported by the development of a protocol of action subscribed by the scientific societies of these professional groups, with the main objective of contributing to optimal and updated training for HCPs. Thus, this protocol of action aims to prevent risk behaviors through consumer education, and to detect high-risk alcohol use. Moreover, this multidisciplinary and coordinated approach should help to boost communication between the different collectives involved when providing relevant information to tackle risky alcohol use from PC


Assuntos
Humanos , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Comunicação Interdisciplinar , Pessoal de Saúde/organização & administração , Atenção Primária à Saúde , Estilo de Vida , Assunção de Riscos , Diagnóstico Precoce , Inquéritos e Questionários , Defesa do Consumidor/educação , Informação de Saúde ao Consumidor/métodos , Educação de Pacientes como Assunto/organização & administração , Consumo de Bebidas Alcoólicas/prevenção & controle
19.
Curr Diabetes Rev ; 16(6): 619-627, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32552634

RESUMO

BACKGROUND: There is no data available on the best insulin treatment to counteract the effects of glucose excursions due to a moderate alcohol intake associated with portions of slight fat and protein-containing food, as often the case during social happenings or "happy hours". INTRODUCTION: This study analyzes the glycemic control and quality of life in 8 adult type 1 diabetic (T1D) patients on insulin-pump therapy which were invited to consume a traditional Italian aperitif ("Spritz" and chips). METHODS: Patients consumed Spritz aperitif twice: using their habitual bolus, based on carbohydrates (CHO) counting (V1), or with a personalized, advanced bolus (V2) calculated from insulin/Kcal derived from Fats and Proteins (FPU). Post-prandial glucose was continuously monitored; glucose incremental areas (iAUC), glucose peak and time to peak, and estimated change from V1 to V2 from repeated- measures models were computed. Each patient fulfilled validated questionnaires on quality of life, knowledge about diabetes and CHO counting. RESULTS: After the educational program, a reduced iAUC (0-80 min: -306, p=ns; 40-80 min: -400, p=0.07) due to greater (p=0.03) and prolonged double-wave insulin boluses was observed. Blood glucose peak and time to peak were also reduced. Moreover, improvements in the psycho-affective dimension, as well as in the alimentary knowledge were detected. CONCLUSION: Therefore, a personalized educational program on CHO + FPU counting together with insulin bolus management can improve glycemic control during social consumption of alcohol, with positive reflections on the psycho-affective dimension. Further studies are mandatory to confirm such preliminary results.


Assuntos
Consumo de Bebidas Alcoólicas/metabolismo , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Educação de Pacientes como Assunto , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/psicologia , Glicemia/análise , Estudos Cross-Over , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/psicologia , Carboidratos da Dieta/análise , Gorduras na Dieta/análise , Proteínas na Dieta/análise , Feminino , Humanos , Sistemas de Infusão de Insulina , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial , Qualidade de Vida , Adulto Jovem
20.
Alcohol ; 87: 25-27, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32505493

RESUMO

Methanol poisoning has been a significant public health challenge for several decades in Iran. Even though alcohol use is highly criminalized, people consume illicit alcohol, which tends to be predominantly homemade and often contains methanol. Consequently, thousands of individual poisonings and hundreds of deaths annually are attributable to methanol poisoning. From February 19, 2020 through April 27, 2020, the 2019 coronavirus disease (COVID-19) epidemic rapidly expanded in Iran, and has been associated with 90,481 confirmed cases and 5710 confirmed deaths. Secondary to misinformation about the potential for alcohol to neutralize SARS-CoV-2, there has also been a significant escalation in methanol-related morbidity and mortality, with over 5000 people poisoned and over 500 confirmed deaths for the same period from February through April 2020. In some provinces, the case-fatality rate of methanol poisoning was higher than that from COVID-19. The high morbidity and mortality associated with methanol poisoning preceding and exacerbated by COVID-19 highlight the potential population level health impacts of the implementation of evidence-based education and harm reduction strategies focused on alcohol use across Iran.


Assuntos
Infecções por Coronavirus/epidemiologia , Metanol/envenenamento , Pneumonia Viral/epidemiologia , Saúde Pública , Sindemia , Consumo de Bebidas Alcoólicas/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/mortalidade , Humanos , Irã (Geográfico)/epidemiologia , Pandemias , Pneumonia Viral/mortalidade
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