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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
3.
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
4.
J Clin Psychiatry ; 81(4)2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32757504

RESUMO

Alcohol use disorders (AUD) are common and impairing. Many pharmacologic interventions have been approved for AUD; baclofen is one among these. More than a dozen randomized controlled trials (RCTs) have examined the safety and efficacy of baclofen in AUD; these RCTs have been pooled in 4 recent meta-analyses, each with different study selection criteria, different objectives, different methods, and different results. The general impression from these meta-analyses is that the benefits with baclofen are unimpressive in patients with AUD. With the background that individualized, rather than fixed, high dosing with baclofen could be critical for success, a large (n = 320), industry-independent, 62-center French RCT (the Bacloville trial) examined whether individually uptitrated, high-dose baclofen could reduce alcohol consumption in heavy drinkers across a year of treatment. The study design, the high dropout rate, and the statistical methods of this trial threw up several complexities; in consequence, the main primary and secondary outcomes could not be satisfactorily interpreted. However, there were many other secondary outcomes that seemed to favor baclofen over placebo, though certain concerns remained. This RCT is explained and its findings are carefully dissected and interpreted. It is concluded that individualized treatment with high-dose baclofen (30-300 mg/d) may be a useful second-line approach in heavy drinkers who wish to reduce levels of alcohol intake; baclofen may be particularly useful in patients with liver disease, for whom certain other pharmacologic interventions are relatively contraindicated. However, the risk of serious adverse events with high-dose baclofen, and its pharmacodynamic interaction with alcohol, must both be kept in mind. Practical issues are discussed.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Alcoolismo/tratamento farmacológico , Baclofeno/administração & dosagem , Baclofeno/uso terapêutico , Alcoolismo/prevenção & controle , Agonistas dos Receptores de GABA-B/administração & dosagem , Agonistas dos Receptores de GABA-B/uso terapêutico , Humanos , Metanálise como Assunto
5.
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
6.
Can J Public Health ; 111(3): 392-396, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32557350

RESUMO

Evidence indicates associations between exposure to mass traumatic events and increased alcohol consumption and related harms following the crises. However, there is limited evidence available to inform alcohol policies during such events. In this commentary, we present the range of government actions to control public access to alcohol during the novel coronavirus disease 2019 pandemic in provinces and territories across Canada. Liquor retailers, including both private and government-run retailers, have been designated as essential services in all jurisdictions, operating under an evolving set of rules. From a public health perspective, keeping liquor retailers open during pandemic-related lockdown restrictions is a delicate decision which poses new risks and considerations about the best strategy for minimizing alcohol-related harms. We discuss the need to strike a balance between supplying public access to alcohol, particularly to those living with dependence, and unintentionally sending the message that alcohol is essential in our lives and encouraging consumption. Given the far-reaching effects of alcohol on health, social, psychological, economic, and work safety outcomes, we describe international guidance for minimizing alcohol-related harms and suggest that a nuanced and evidence-informed discussion about the considerations and impacts of alcohol control measures during a public health emergency should be undertaken.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Saúde Pública , Consumo de Bebidas Alcoólicas/prevenção & controle , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Canadá/epidemiologia , Humanos , Política Pública
7.
N Z Med J ; 133(1515): 89-96, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32438380

RESUMO

Adolescence marks a developmental period with heightened vulnerability to alcohol use and its consequences. In this viewpoint paper, we examine the involvement of the alcohol industry in alcohol and other drug (AoD) education from both an alcohol harm reduction and a school-based health education perspective, using the example of the Smashed programme to illustrate our critique. We issue caution to schools that are invited to participate.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Indústria Alimentícia , Educação em Saúde/métodos , Avaliação de Programas e Projetos de Saúde , Adolescente , Consumo de Bebidas Alcoólicas/efeitos adversos , Etanol , Redução do Dano , Humanos , Nova Zelândia , Instituições Acadêmicas
8.
Am J Geriatr Psychiatry ; 28(7): 780-783, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32359882
9.
Artigo em Inglês | MEDLINE | ID: mdl-32429171

RESUMO

Since the early 1990s, Lithuania has experienced an increasing level of alcohol consumption and a heavy burden of alcohol-related harm, which is associated with the development of alcohol policies. The aim of this analysis was to provide a chronology of change of Lithuanian alcohol control legislation and to present several other detailed examples of the political processes. The data were collected using document reviews. During the last three decades, the Lithuanian alcohol control policies have undergone several cycles of stricter control and liberalizations. Some of the limitations of the study are the exceptional focus on the public health perspective and the inclusion of policies targeting the population as a whole. The strength of the study is in providing a detailed background for future policy effectiveness studies. Some of the recent periods when a series of 'best buy' interventions were implemented during a short period are of particular importance, constituting a natural experiment, whose effects need to be studied in more detail in the future.


Assuntos
Consumo de Bebidas Alcoólicas , Etanol , Política Pública , Controle Social Formal , Consumo de Bebidas Alcoólicas/prevenção & controle , Política de Saúde , Lituânia , Saúde Pública
10.
J Stud Alcohol Drugs ; 81(2): 135-143, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32359042

RESUMO

OBJECTIVE: The purpose of this randomized controlled study was to examine sex as a moderator of the efficacy of a brief, web-based personalized feedback intervention (eCHECKUP TO GO) on decreasing cognitive risk factors for alcohol use, increasing protective behavioral strategies, and reducing alcohol use among high school seniors. METHOD: Participants (n = 311) were high school seniors randomized by class period to the eCHECKUP TO GO intervention or assessment-only control group. Participants completed online surveys at baseline and 30-day follow-up (91.0%; n = 283). RESULTS: Students in the intervention group reported a significant reduction in normative perceptions of peer drinking, positive alcohol expectancies, and alcohol use relative to those in the control group. Intervention effects for perceptions of frequency of peer drunkenness and frequency of alcohol use were moderated by sex, with results favoring females. In contrast, we did not find evidence for sex as a moderator of intervention effects for normative perceptions of peer drinking frequency, sex-specific perceptions of peer heavy episodic drinking, positive alcohol expectancies, or peak drinking quantity. Further, we did not find significant intervention or moderator effects for protective behavioral strategies. CONCLUSIONS: Results of this study extend the literature by demonstrating the efficacy of the eCHECKUP TO GO for both males and females on reducing cognitive risk factors and alcohol use, although results were significant for a broader range of variables for females. Results also indicate that program content regarding normative feedback and protective behavioral strategies may need modification to be more effective for this age group.


Assuntos
Caracteres Sexuais , Estudantes/psicologia , Telemedicina/métodos , Consumo de Álcool por Menores/prevenção & controle , Consumo de Álcool por Menores/psicologia , Adolescente , Consumo de Bebidas Alcoólicas/prevenção & controle , Consumo de Bebidas Alcoólicas/psicologia , Consumo de Bebidas Alcoólicas/tendências , Intoxicação Alcoólica/prevenção & controle , Intoxicação Alcoólica/psicologia , Feminino , Humanos , Masculino , Grupo Associado , Fatores de Proteção , Fatores de Risco , Inquéritos e Questionários , Resultado do Tratamento , Consumo de Álcool por Menores/tendências
11.
J Stud Alcohol Drugs ; 81(2): 249-261, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32359056

RESUMO

OBJECTIVE: This study tested the initial and continued effects of cancer warning labels on drinkers' recall and knowledge that alcohol can cause cancer. METHOD: A quasi-experiment was conducted to examine changes in the intervention versus comparison site for three outcomes: unprompted and prompted recall of the cancer warning, and knowledge that alcohol can cause cancer. The intervention site applied cancer warning labels to alcohol containers in its liquor store for 1 month, and the two liquor stores in the comparison site did not apply cancer labels. In total, 2,049 unique cohort participants (1,056 male) were recruited at liquor stores in the intervention and comparison sites to participate in surveys 4 months before labels were applied and 2 and 6 months after the cancer label was halted because of alcohol industry interference. Generalized estimating equations tested differences in outcomes between sites over time adjusting for socio-demographics and other covariates. RESULTS: Two months after the cancer label, unprompted (+24.2% vs. +0.6%; adjusted odds ratio [AOR] = 32.7, 95% CI [5.4, 197.7]) and prompted (+35.7% vs. +4.1%; AOR = 6.2, 95% CI [3.6, 10.9]) recall increased to a greater extent in the intervention versus comparison site. There was a 10% greater increase in knowledge (+12.1% vs. +11.6%; AOR = 1.1, 95% CI [0.7, 1.5]) 2 months after the cancer label in the intervention versus comparison site. Similar results were found 6 months after the cancer label for all three outcomes. CONCLUSIONS: In a real-world setting, cancer warning labels get noticed and increase knowledge that alcohol can cause cancer. Additional cancer label intervention studies are required that are not compromised by industry interference.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/prevenção & controle , Bebidas Alcoólicas/efeitos adversos , Comunicação , Neoplasias/prevenção & controle , Rotulagem de Produtos/normas , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Feminino , Humanos , Masculino , Rememoração Mental/fisiologia , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Territórios do Noroeste/epidemiologia , Fatores de Risco , Inquéritos e Questionários , Yukon/epidemiologia
12.
J Stud Alcohol Drugs ; 81(2): 262-272, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32359057

RESUMO

OBJECTIVE: Alcohol labels are one strategy for communicating health information to consumers. This study tested the extent to which consumers recalled alcohol labels with national drinking guidelines and examined the impact of labels on awareness and knowledge of the guidelines. METHOD: A quasi-experimental study was conducted in two jurisdictions in northern Canada examining the impact of labels on the following outcomes: unprompted and prompted recall of the drinking guideline label message, awareness of the drinking guidelines, and knowledge of the daily and weekly recommended drink limits. The intervention site applied labels with national drinking guidelines, a cancer warning, and standard drink information to alcohol containers in its liquor store, whereas the comparison site did not apply these labels. In total, 2,049 cohort participants in both sites were recruited to complete surveys before and at two time points after the intervention. Changes in outcomes were examined using generalized estimating equations. RESULTS: After the intervention, unprompted and prompted recall of the drinking guideline label message increased more in the intervention versus comparison site (adjusted odds ratio [AOR] = 10.8, 95% CI [0.9, 127.6]; AOR = 7.0, 95% CI [3.3, 14.9], respectively). Awareness of the drinking guidelines increased 2.9 times more in the intervention versus comparison site (AOR = 2.9, 95% CI [2.0, 4.3]). In addition, knowledge of the daily and weekly drink limits increased 1.5 and 1.4 times more in the intervention versus comparison site, respectively (daily: AOR = 1.5, 95% CI [1.0, 2.1]; weekly: AOR = 1.4, 95% CI [1.0, 2.0]). CONCLUSIONS: Enhanced alcohol labels get noticed and may be an effective population-level strategy for increasing awareness and knowledge of national drinking guidelines.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/prevenção & controle , Bebidas Alcoólicas/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias/prevenção & controle , Rotulagem de Produtos/normas , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Conscientização/fisiologia , Estudos de Coortes , Feminino , Guias como Assunto/normas , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Estudos Prospectivos , Inquéritos e Questionários , Yukon/epidemiologia
13.
J Stud Alcohol Drugs ; 81(2): 273-283, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32359058

RESUMO

OBJECTIVE: Media coverage of alcohol-related policy measures can influence public debate and is often more aligned with interests of the alcohol industry than public health. The purpose of this study was to examine the framing of news coverage of alcohol warning label (AWL) initiatives that included a cancer message on alcohol containers in two different countries. Policy contexts and industry perspectives were also evaluated. METHOD: We identified and systematically reviewed news articles published between 2017-2019 covering an AWL academic study in Yukon, Canada, and labeling provisions in a Public Health (Alcohol) Bill in Ireland. Both included a cancer message. News stories were coded for media type and topic slant; inclusion of alcohol industry perspectives was examined using content analysis. RESULTS: Overall, 68.4% of media articles covering the Yukon Study (n = 38) and 18.9% covering the Ireland Bill (n = 37) were supportive of AWLs with a cancer message. The majority of articles in both sites presented alcohol industry perspectives (Yukon, 65.8%; Ireland, 86.5%), and industry arguments opposing AWLs were similar across both contexts. In articles with statements from industry representatives, the label message was frequently disputed by distorting or denying the evidence that alcohol causes cancer (n = 33/43). CONCLUSIONS: News coverage of AWLs with a cancer message was more supportive in Canada than Ireland, where alcohol industry perspectives were consistently foregrounded. Industry arguments opposing the cancer label bore similarities across contexts, often distorting or denying the evidence. Increasing awareness of industry messaging strategies may generate more critical coverage of industry lobbying activities and increase public support for alcohol policies.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/prevenção & controle , Bebidas Alcoólicas/efeitos adversos , Meios de Comunicação de Massa/normas , Neoplasias/prevenção & controle , Rotulagem de Produtos/normas , Consumo de Bebidas Alcoólicas/epidemiologia , Canadá/epidemiologia , Humanos , Irlanda/epidemiologia , Neoplasias/epidemiologia , Saúde Pública/normas
14.
Rev Lat Am Enfermagem ; 28: e3262, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32401905

RESUMO

OBJECTIVE: to know the effects of a nursing intervention to reduce alcohol use and risk factors for transmission of human immunodeficiency virus (HIV). METHOD: randomized single-blinded clinical trial performed by nurses with young women. The study included 66 participants in the intervention group and 66 participants in the control group. The instruments were the Alcohol Use Disorders Identification Test, the HIV Risk Behavior Knowledge and the Condom Use Self-efficacy Scale. Analysis of variance was used. RESULTS: alcohol involvement decreased in the intervention group (F (1.119) = 50.28; p < 0.001; η2p = 0.297), while HIV knowledge (F (1.130) = 34.34; p < 0.001; η2p = 0.209) and condom use self-efficacy increased (F (1.129) = 27.20; p < 0.001; η2p = 0.174). In addition, less participants consumed alcohol in the past week compared to the control group (χ2 = 15.95; p < 0.001). CONCLUSION: the nursing intervention had positive effects, which could help young women stay away from alcohol use and the risk of sexually transmitted infections. NCT: 02405481.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Infecções por HIV/prevenção & controle , HIV , Educação em Saúde/métodos , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/psicologia , Preservativos , Feminino , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Hispano-Americanos/educação , Humanos , México , Fatores de Risco , Comportamento Sexual , Método Simples-Cego , Adulto Jovem
15.
JAMA ; 323(20): 2067-2079, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32453373

RESUMO

Importance: Illicit and nonmedical (use in ways other than instructed) drug use is common in adolescents and young adults and increases the risk of harmful outcomes such as injuries, violence, and poorer academic performance. Objective: To review the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMED, PsycINFO, and the Cochrane Central Register of Controlled Trials (January 1, 2013, to January 31, 2019 [children and adolescents]; January 1, 1992, to January 31, 2019 [young adults <25 years]); surveillance through March 20, 2020. Study Selection: Clinical trials of behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among young people. Data Extraction and Synthesis: Critical appraisal was completed independently by 2 investigators. Data were extracted by 1 reviewer and checked by a second. Random-effects meta-analysis was used to estimate the effect sizes associated with the interventions. Main Outcomes and Measures: Number of times illicit drugs were used; any illicit drug or any cannabis use. Results: Twenty-nine trials (N = 18 353) met inclusion criteria. Health, social, or legal outcomes such as mental health symptoms, family functioning, consequences of drug use, and arrests were reported in 19 trials and most showed no group differences. The effects on illicit drug use in 26 trials among nonpregnant youth (n = 17 811) were highly variable; the pooled result did not show a clinically important or statistically significant association with illicit drug use (standardized mean difference, -0.08 [95% CI, -0.16 to 0.001]; 24 effects [from 23 studies]; n = 12 801; I2 = 57.0%). The percentage of participants using illicit drugs ranged from 2.3% to 38.6% in the control groups and 2.4% to 33.7% in the intervention groups at 3 to 32 months' follow-up. The median absolute risk difference between groups was -2.8%, favoring the intervention group (range, -11.5% to 14.8%). The remaining 3 trials provided a perinatal home-visiting intervention to pregnant Native American youth. One trial (n=322) found a reduction in illicit drug use at 38 months (eg, cannabis use in the previous month, 10.7% in the intervention group and 15.6% in the control group) but not at earlier follow-up assessments. Across all 29 trials, only 1 trial reported on harms and found no statistically significant group differences. Conclusions and Relevance: The evidence for behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements.


Assuntos
Terapia Comportamental , Aconselhamento , Educação em Saúde , Drogas Ilícitas , Medicamentos sob Prescrição , Atenção Primária à Saúde , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Consumo de Bebidas Alcoólicas/prevenção & controle , Criança , Ensaios Clínicos como Assunto , Humanos , Abuso de Maconha/prevenção & controle , Guias de Prática Clínica como Assunto , Uso de Tabaco/prevenção & controle , Adulto Jovem
16.
JAMA ; 323(20): 2060-2066, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32453374

RESUMO

Importance: In 2017, an estimated 7.9% of persons aged 12 to 17 years reported illicit drug use in the past month, and an estimated 50% of adolescents in the US had used an illicit drug by the time they graduated from high school. Young adults aged 18 to 25 years have a higher rate of current illicit drug use, with an estimated 23.2% currently using illicit drugs. Illicit drug use is associated with many negative health, social, and economic consequences and is a significant contributor to 3 of the leading causes of death among young persons (aged 10-24 years): unintentional injuries including motor vehicle crashes, suicide, and homicide. Objective: To update its 2014 recommendation, the USPSTF commissioned a review of the evidence on the potential benefits and harms of interventions to prevent illicit drug use in children, adolescents, and young adults. Population: This recommendation applies to children (11 years and younger), adolescents (aged 12-17 years), and young adults (aged 18-25 years), including pregnant persons. Evidence Assessment: Because of limited and inadequate evidence, the USPSTF concludes that the benefits and harms of primary care-based interventions to prevent illicit drug use in children, adolescents, and young adults are uncertain and that the evidence is insufficient to assess the balance of benefits and harms. More research is needed. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care-based behavioral counseling interventions to prevent illicit drug use, including nonmedical use of prescription drugs, in children, adolescents, and young adults. (I statement).


Assuntos
Terapia Comportamental , Aconselhamento , Educação em Saúde , Drogas Ilícitas , Medicamentos sob Prescrição , Atenção Primária à Saúde , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Consumo de Bebidas Alcoólicas/prevenção & controle , Criança , Humanos , Abuso de Maconha/prevenção & controle , Programas de Rastreamento , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Uso de Tabaco/prevenção & controle , Adulto Jovem
17.
BMC Public Health ; 20(1): 467, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32264848

RESUMO

BACKGROUND: The marketing of alcohol influences patterns of alcohol consumption. Existing studies have focused, for the most part, on adolescents and the links between exposure to marketing and alcohol initiation. In France, the Evin law, a French exception, was set up in 1991 with the aim of regulating this exposure to marketing, but since 2009 it has been severely compromised. Alcohol consumption causes severe damage, which may be seenfrom 1 standard unit per day and mostly among adults who are regular users of alcohol. In this at-risk population, studies analysing the impact of marketing are sparse. The specific objectives include (i) the evaluation of the perception of alcohol marketing by patients with an AUD (ii) gaining understanding of the links between alcohol marketing and patients with AUD behaviours (iii) the development of alcohol demarketing strategy in patients receiving AUD coaching. METHODS: Our main objective isto evaluate the impact of marketing on a population with an AUD. The methodology was in 4 steps: step 1 is a pre-test (N = 100) selecting type of alcohol consumed and type of marketing stimuli identified by patients aged 18 + with an AUD. Step 2 is a qualitative study (N = 20), with in-depth interview, to understand links between alcohol marketing and patients with AUD behaviours. Step 3 is a quantitative study(N = 600) to confirm these links and the impact of alcohol marketing on patients with AUD behaviours. Step 4 is an interventional step, including and testing the impact of demarketing intervention on patients with AUD while using the results of the three first steps (N = 120). DISCUSSION: This study will contribute to a better definition of the impact of alcohol marketing on patients with AUD and will enable identification of the determinants of this impact. These data will inform the development of interventions that take into account demarketingstrategies on patients under AUD management. TRIAL REGISTRATION: The Trial registrationregistration number is NCT03876132, and it was registered on the 15th march 2019.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Alcoolismo/prevenção & controle , Comportamento de Busca de Informação , Marketing/métodos , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Projetos de Pesquisa , Fatores de Risco , Adulto Jovem
18.
Actas esp. psiquiatr ; 48(2): 54-63, mar.-abr. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-191905

RESUMO

El consumo nocivo de alcohol en los jóvenes es un problema de salud pública sobre el que es necesario actuar. La intervención sobre los casos que acuden a urgencias es una actuación en crisis que puede ser efectiva. Se presentan los resultados iniciales del Programa Ícaro-Alcohol (detección de menores de 22 años atendidos en Urgencias/Emergencias por consumo de alcohol, Intervención Motivacional Breve (IMB) y derivación al Servicio de Referencia de Prevención (SRP) y a los programas preventivos, para reducir este consumo. Participaron los Hospitales Universitarios Río Hortega (HURH) y Clínico (HCUV) y Unidades Medicalizadas de Emergencias (UME) de Valladolid capital. El 53,8% (n = 27) de los profesionales recibieron formación sobre el programa (73,3% HURH vs 45,6% HCU) y el 17,4% (n = 41) entrena-miento en IMB para realizarla in situ, aprovechando la situación "de crisis" derivada de la urgencia (26,7% HURH vs 12,6% HCUV).Entre junio y diciembre de 2017 se atendieron 93 urgencias relacionadas con alcohol, las UME derivaron todas a los hospitales; 49 cumplían el criterio de caso, se intervino en 21 (43%) y se derivaron 8 casos al SRP (38% de los que se intervino, 16% del total de casos). La intervenciones y derivaciones fueron mayores en el hospital con mayor participación en la formación. Los casos de mayor edad acudían a horas más tardías, presentaron problemática asociada y accedieron menos a la derivación. Los tiempos de derivación a prevención indicada se cumplieron, pero no a los programas universales y selectivos Se mejora el protocolo de actuación centrándose en los menores 18 años, simplificando el consentimiento, mejorando la formación en IMB simplificando la intervención de los profesionales y realizando la intervención preventiva individual desde los SRP de forma inmediata. El programa se implantará progresivamente en el resto de provincias de Castilla y León


Harmful alcohol consumption among young people is a public health problem that needs important measures. Interventions in emergency department cases, such as crisis action, could be effective. The initial results of the Icaro-Al-cohol Program (detection of young people under 22 years attended in the emergency department for alcohol consumption, a Brief Motivational Intervention (BMI) and referral to a prevention reference service (PRS) and prevention programs) are presented. The program objective is to reduce the harmful use of alcohol. Río Hortega University Hospital (HURH), Clínico Hospital (HCUV) and Medical Emergency Units (MEUs) were involved in the study developed in the city of Valladolid (Castilla y León, Spain). Training in program implementation was given to 53.8% of professionals (n = 27) (73.3% HURH vs 45.6% HCUV), while 17.4% (n = 41) were trained to develop BMI in the critical situation derived from the emergency (26.7% HURH vs 12.6% HCUV). A total of 93 cases were treated by the hospital emer-gency services, and all the cases treated by the MEUs were referred to the hospital, between June and December 2017. There were 49 urgent cases, and interventions were carried out in 21 of them (43%). Afterwards, 8 cases were referred to the PRS (38% of 21 intervened; 16% of the total number of cases). Interventions and referrals were greater in the hospital with more trained professionals. The older youth cases arrived last at night. They had other health problems associated and were less likely to agree to referral. The refer-ral times to indicated prevention programs were met, but not to universal and selective programs.The action protocol is improved by focusing on children under 18, simplifying consent, improving BMI training, sim-plifying the intervention of professionals and carrying out individual preventive intervention from the PRSs immediately. The program will be implemented progressively in the rest of the provinces in Castilla y León


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Avaliação de Resultado de Ações Preventivas , Intoxicação Alcoólica/terapia , Consumo de Bebidas Alcoólicas/prevenção & controle , Tratamento de Emergência , Índice de Gravidade de Doença , Avaliação de Programas e Projetos de Saúde , Prática Clínica Baseada em Evidências , Fatores de Risco
19.
Acta Med Port ; 33(4): 229-236, 2020 Apr 01.
Artigo em Português | MEDLINE | ID: mdl-32238236

RESUMO

INTRODUCTION: Sao Tome and Principe is an African low-and-middle-income country, where extreme poverty causes major health inequalities. No systematic research has been done on the consumption of alcohol and drugs in Sao Tome and Principe, and only overall statistics are available based on the importation of alcoholic drinks and their distribution among the population. There are also no studies on consumption of alcohol and illicit substances in children and youth and no preventive measures being undertaken. Besides that, manual databases present significant limitations, considering the lack of causes associated with mortality rates (0 - 5 years and > 5), and the difficulty to establish a cause/effect relation between diseases, deaths and life expectancy. No relevant data with burden of life was found in the reports of Centro Nacional de Endemias or the non-governmental, organization Instituto Marques de Valle Flor, a facilitator on healthcare clinical specialties selected on a voluntary basis by doctors from Portuguese hospitals. So, we proposed to provide a first overview of family and housing conditions, and above all, the consumption of alcohol and illegal drugs in young people. Thus, a project, the National Survey on Harmful Consumption of Alcohol and Drugs in Schools of Sao Tome and Principe, will be realized in order to better characterize the situation among children and young students and test public health communication strategies and preventive interventions aimed at this target-population. Interventions were designed taking into consideration local sociocultural realities of target audiences. We considered dialect language, single-parent families (matriarchal structure) and polygamy (mostly) in men and a country and governments led by men (patriarchal structure) and, in which the woman's role, as Food and Agriculture Organization of the United Nations reports, remains overlooked. Subsequently, we will collect traditional alcohols samples from the two main islands for analysis (at Laboratório de Estudos Farmacêuticos and Laboratório Nacional de Engenharia Civil - Portugal) and to determine heavy metals in the production process and impact on burden of life. MATERIAL AND METHODS: In order to characterise the country's situation in terms of alcohol and illicit substances consumption a literature review was carried out through a search in several international electronic databases, such as those of the World Health Organization, World Health Organization Africa, United Nation, The Lancet and Lancet Global Health, etc. Available data of the following institutions of Sao Tome and Príncipe was also analyzed: National Institute of Statistics, Ministry of Education, Culture and Training and Ministry of Health and Social Affairs. Several interviews with community and church leaders as well as with members of catholic missions were carried out to better understand the local situation. Following this, a nationwide cross-sectional survey of a sample of 2064 students will be carried out. This will include a questionnaire on socio-demographic characteristics, lifestyles, health behaviors/attitudes, alcohol and illicit substances consumption. Finally, based on the overall diagnosis obtained, some edutainment health communication preventive interventions will be tested in the primary schools of three districts (EDUCA_TURTLE) and on the radio journalists (EDUCA_PRESS). These were evaluated by primary school teachers and by radio journalists.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Causas de Morte , Estudos Transversais , Características Culturais , Coleta de Dados , Bases de Dados Factuais/normas , Características da Família , Feminino , Inquéritos Epidemiológicos , Habitação/normas , Humanos , Expectativa de Vida , Masculino , Saúde Pública , São Tomé e Príncipe , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
20.
Arch Sex Behav ; 49(4): 1231-1250, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32189096

RESUMO

This exploratory trial determined the feasibility, acceptability, and preliminary efficacy of a brief intervention (BI), supplemented with text messaging and a curated Web site, on alcohol use and sexual risk behavior among young women. Young women seeking care at a reproductive health clinic were screened for alcohol misuse and sexual risk behavior. Those who screened positive and who agreed to participate (N = 48; M = 22.67 years) were randomized to either (a) a brief in-person session during which personalized feedback regarding alcohol use and sexual risk taking was provided and discussed, or (b) a control condition. Feasibility was assessed by recruitment and retention rates. Acceptability was assessed with participant ratings of their intervention. Efficacy was measured using self-reported alcohol use and sexual behavior at baseline and during a 3-month follow-up. We supplemented the quantitative data with qualitative data from semi-structured interviews. Feasibility data indicated that 64% of eligible women agreed to participate, 74% of eligible women were enrolled, and 86% of enrolled women were retained through follow-up. Acceptability data showed that women who received the BI reported strong satisfaction with their intervention (M = 4.65 vs. 3.98 on a five-point scale) and also reported that text messaging was helpful (M = 4.73 on a seven-point scale) and acceptable (M = 5.27 on a seven-point scale). Qualitative data provided additional support for BI feasibility and acceptability. Efficacy data showed that women in both conditions reduced alcohol use and sexual risk behavior over time; women who received the BI reduced their maximum daily alcohol intake more than controls (BI from 7.68 to 4.82 standard drinks vs. control from 6.48 to 5.65; Wald χ2 = 4.93, p < .05). Women in the BI reported fewer occasions of condomless sex (median = 2.50) than controls (median = 5.00) at the follow-up, but this difference was not statistically significant (OR = 0.61, 95% CI [0.32, 1.15]). A brief intervention, supplemented with text messaging and a Web site, that targeted alcohol use and sexual behavior was feasible and acceptable to young women and led to lower levels of alcohol misuse and sexual risk behavior.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Comportamento Sexual/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Assunção de Riscos , Adulto Jovem
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