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1.
Artigo em Inglês | MEDLINE | ID: mdl-32784613

RESUMO

BACKGROUND: In South Africa, interventions are needed to address the impact of hazardous drinking on antiretroviral therapy among people living with HIV (PLWH). Participant feedback about these interventions can identify ways to enhance their acceptability. We interviewed participants in a randomized controlled trial of a brief motivational interviewing and problem-solving therapy (MI-PST) intervention about their perceptions of this alcohol-reduction intervention. METHODS: The trial was conducted in HIV treatment clinics operating from six hospitals in the Tshwane region of South Africa. We conducted qualitative in-depth interviews with a random selection of participants. Twenty-four participants were interviewed after the final intervention session and 25 at the six-month follow up. RESULTS: Participants believed that it was acceptable to offer PLWH, an alcohol reduction intervention during HIV treatment. They described how the MI-PST intervention had helped them reduce their alcohol consumption. Intervention components providing information on the health benefits of reduced consumption and building problem-solving and coping skills were perceived as most beneficial. Despite these perceived benefits, participants suggested minor modifications to the dosage, content, and delivery of the intervention for greater acceptability and impact. CONCLUSIONS: Findings highlight the acceptability and usefulness of this MI-PST intervention for facilitating reductions in alcohol consumption among PLWH.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos Relacionados ao Uso de Álcool/terapia , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/psicologia , Entrevista Motivacional , Psicoterapia/métodos , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Humanos , Entrevistas como Assunto , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , África do Sul , Resultado do Tratamento
2.
BMC Public Health ; 20(1): 332, 2020 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-32171278

RESUMO

BACKGROUND: Alcohol-related hospital admissions have doubled in the last ten years to > 1.2 m per year in England. High-need, high-cost (HNHC) alcohol-related frequent attenders (ARFA) are a relatively small subgroup of patients, having multiple admissions or attendances from alcohol during a short time period. This trial aims to test the effectiveness of an assertive outreach treatment (AOT) approach in improving clinical outcomes for ARFA, and reducing resource use in the acute setting. METHODS: One hundred and sixty ARFA patients will be recruited and following baseline assessment, randomly assigned to AOT plus care as usual (CAU) or CAU alone in equal numbers. Baseline assessment includes alcohol consumption and related problems, physical and mental health comorbidity and health and social care service use in the previous 6 months using standard validated tools, plus a measure of resource use. Follow-up assessments at 6 and 12 months after randomization includes the same tools as baseline plus standard measure of patient satisfaction. Outcomes for CAU + AOT and CAU at 6 and 12 months will be compared, controlling for pre-specified baseline measures. Primary outcome will be percentage of days abstinent at 12 months. Secondary outcomes include emergency department (ED) attendance, number and length of hospital admissions, alcohol consumption, alcohol-related problems, other health service use, mental and physical comorbidity 6 and 12 months post intervention. Health economic analysis will estimate the economic impact of AOT from health, social care and societal perspectives and explore cost-effectiveness in terms of quality adjusted life years and alcohol consumption at 12-month follow-up. DISCUSSION: AOT models piloted with alcohol dependent patients have demonstrated significant reductions in alcohol consumption and use of unplanned National Health Service (NHS) care, with increased engagement with alcohol treatment services, compared with patients receiving CAU. While AOT interventions are costlier per case than current standard care in the UK, the rationale for targeting HNHC ARFAs is because of their disproportionate contribution to overall alcohol burden on the NHS. No previous studies have evaluated the clinical and cost-effectiveness of AOT for HNHC ARFAs: this randomized controlled trial (RCT) targeting ARFAs across five South London NHS Trusts is the first. TRIAL REGISTRATION: International standard randomized controlled trial number (ISRCTN) registry: ISRCTN67000214, retrospectively registered 26/11/2016.


Assuntos
Transtornos Relacionados ao Uso de Álcool/economia , Transtornos Relacionados ao Uso de Álcool/terapia , Utilização de Instalações e Serviços/economia , Utilização de Instalações e Serviços/estatística & dados numéricos , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/prevenção & controle , Protocolos Clínicos , Análise Custo-Benefício , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Londres/epidemiologia , Masculino , Medicina Estatal/economia , Medicina Estatal/estatística & dados numéricos , Resultado do Tratamento
3.
BMC Fam Pract ; 21(1): 33, 2020 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054450

RESUMO

BACKGROUND: Unhealthy alcohol use involves a spectrum from hazardous use (exceeding guidelines but no harms) through to alcohol dependence. Evidence-based management of unhealthy alcohol use in primary health care has been recommended since 1979. However, sustained and systematic implementation has proven challenging. The Continuing Quality Improvement (CQI) process is designed to enable services to detect barriers, then devise and implement changes, resulting in service improvements. METHODS: We conducted a systematic review of literature reporting on strategies to improve implementation of screening and interventions for unhealthy alcohol use in primary care (MEDLINE EMBASE, PsycINFO, CINAHL, the Australian Indigenous Health InfoNet). Additional inclusion criteria were: (1) pragmatic setting; (2) reporting original data; (3) quantitative outcomes related to provision of service or change in practice. We investigate the extent to which the three essential elements of CQI are being used (data-guided activities, considering local conditions; iterative development). We compare characteristics of programs that include these three elements with those that do not. We describe the types, organizational levels (e.g. health service, practice, clinician), duration of strategies, and their outcomes. RESULTS: Fifty-six papers representing 45 projects were included. Of these, 24 papers were randomized controlled trials, 12 controlled studies and 20 before/after and other designs. Most reported on strategies for improving implementation of screening and brief intervention. Only six addressed relapse prevention pharmacotherapies. Only five reported on patient outcomes and none showed significant improvement. The three essential CQI elements were clearly identifiable in 12 reports. More studies with three essential CQI elements had implementation and follow-up durations above the median; utilised multifaceted designs; targeted both practice and health system levels; improved screening and brief intervention than studies without the CQI elements. CONCLUSION: Utilizing CQI methods in implementation research would appear to be well-suited to drive improvements in service delivery for unhealthy alcohol use. However, the body of literature describing such studies is still small. More well-designed research, including hybrid studies of both implementation and patient outcomes, will be needed to draw clearer conclusions on the optimal approach for implementing screening and treatment for unhealthy alcohol use. (PROSPERO registration ID: CRD42018110475).


Assuntos
Alcoolismo/diagnóstico , Alcoolismo/terapia , Atenção Primária à Saúde , Melhoria de Qualidade , Gestão da Qualidade Total , Consumo de Bebidas Alcoólicas , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/terapia , Humanos , Ciência da Implementação , Programas de Rastreamento
4.
J Intensive Care Med ; 35(3): 244-250, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29105539

RESUMO

BACKGROUND: Long-term excessive use of alcohol leads to severe complications, which often require treatment in an intensive care unit (ICU). The aim of this study was to report on the associations between alcohol-related health problems and treatment profile, as well as 1-year mortality among patients with nontrauma-related ICU admissions. METHODS: Information on the history of alcohol-related health problems or excessive alcohol use and ICU treatment was collected retrospectively from electronic medical records and ICU patient data management systems at Oulu University Hospital, Finland. Information on 1-year mortality was obtained from the Finnish Population Register Center. RESULTS: According to the medical records, in a total of 899 admissions, 32.9% (n = 296) of patients had a history of alcohol-related problems. In the alcohol group, intoxications were more frequent and respiratory and cardiovascular causes were less frequent, compared to those without alcohol-related problems. Patients without alcohol-related problems had a higher rate of previous comorbidities compared with the alcohol group. There were no differences concerning age, severity of illness scores, length of stay, or intensive care outcome. Mortality during the 1-year follow-up was 32.8% in total: 35.1% among those without alcohol-related history and 28.0% in the alcohol group (P = .041). The difference in mortality appeared during the first month following admission and remained throughout the follow-up period. The highest 1-year mortality (59.3%) was observed among patients with alcohol-related liver disease. CONCLUSION: Every third patient admitted to ICU used alcohol excessively or had alcohol-related diseases, and those patients with alcohol-related liver disease had the poorest 1-year survival rate. We found higher long-term mortality in nonalcohol-related admissions, which can be explained by the case mix, including a lower rate of chronic diseases, such as malignancies and coronary artery disease, and a higher rate of low-risk admission diagnoses in the alcohol group.


Assuntos
Transtornos Relacionados ao Uso de Álcool/mortalidade , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , APACHE , Idoso , Transtornos Relacionados ao Uso de Álcool/terapia , Cuidados Críticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
5.
Int J Epidemiol ; 49(1): 94-102, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31335950

RESUMO

BACKGROUND: Potential benefits of preventing continued alcohol intake in individuals presenting at the hospital with an alcohol problem can be highlighted by studying their excess risk of subsequent morbidity and mortality. METHODS: All Danish residents with a first-time hospital contact with alcohol problems (intoxication, harmful use or dependence) in 1998-2002 were followed through 2012 using healthcare registries. We compared their cause-specific rates of hospital admission and mortality to the expected rates derived from the general population by calculating standardized incidence rate ratios. RESULTS: The 26 716 men and 12 169 women who were hospitalized with alcohol problems (median age 44 years) had more than 10 times the rate of subsequent admission to psychiatric departments and three times the rate of subsequent admission to somatic departments compared with the general population. In particular, the hospital admission rates for gastroenterological disease and injuries were high. The cumulative all-cause 10-year mortality risk was 29% [95% confidence interval (CI), 28-30] in men and 26% (95% CI, 24-27) in women with alcohol problems. The ratios of observed to expected death rate for all-cause mortality were 4.0 (95% CI, 3.8-4.1) in men and 4.3 (95% CI, 4.0-4.7) in women and, for causes of death fully attributable to alcohol, 16 (95% CI, 15-17) in men and 33 (95% CI, 29-38) in women. CONCLUSIONS: Individuals hospitalized with alcohol problems have much higher rates of subsequent alcohol-related hospital admission and mortality than the general population. Increased focus on preventing continued alcohol consumption in these individuals may reduce their subsequent morbidity and mortality.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos Relacionados ao Uso de Álcool/mortalidade , Doença Crônica/epidemiologia , Hospitalização/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Adulto , Distribuição por Idade , Idade de Início , Idoso , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/terapia , Alcoolismo/diagnóstico , Causas de Morte , Estudos de Coortes , Comorbidade , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
6.
Cyberpsychol Behav Soc Netw ; 22(12): 794-798, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31794239

RESUMO

This study aimed to reduce the approach tendency toward alcohol among heavy social drinkers using the Virtual Alcohol Approach-Avoidance Training Task training. A total of 28 heavy social drinkers were randomly assigned to either the training group (n = 14) or the control group (n = 14). The training group was implicitly trained to avoid situations that involved drinking alcohol and to approach situations that involved drinking nonalcoholic beverages. On the other hand, the control group received a sham training condition with the same ratio of approach or avoidance of drinking either alcohol or a nonalcoholic beverage. All participants made three visits in a period of 2-3 weeks to participate in either the training or sham training. As a result, the training group showed a decrease in implicit approach tendencies toward alcohol, but not in explicit craving for alcohol. In contrast, the control group showed an increase in both implicit approach tendencies and explicit craving toward alcohol. These results indicate that the virtual reality training to avoid alcohol-related stimuli or environments might reduce automatic action tendencies toward alcohol, while simply being exposed to alcohol-related stimuli or environments might increase craving for alcohol in the sham training group. Our findings also suggest that, including not only visual stimuli but also auditory stimuli in a virtual environment might be a tool for changing approach bias.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Aprendizagem da Esquiva , Terapia Comportamental/métodos , Terapia de Exposição à Realidade Virtual/métodos , Adulto , Transtornos Relacionados ao Uso de Álcool/psicologia , Fissura , Sinais (Psicologia) , Feminino , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
7.
BMJ Open ; 9(11): e030909, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31712335

RESUMO

INTRODUCTION: Indigenous peoples who have experienced colonisation or oppression can have a higher prevalence of alcohol-related harms. In Australia, Aboriginal Community Controlled Health Services (ACCHSs) offer culturally accessible care to Aboriginal and Torres Strait Islander (Indigenous) peoples. However there are many competing health, socioeconomic and cultural client needs. METHODS AND ANALYSIS: A randomised cluster wait-control trial will test the effectiveness of a model of tailored and collaborative support for ACCHSs in increasing use of alcohol screening (with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)) and of treatment provision (brief intervention, counselling or relapse prevention medicines). SETTING: Twenty-two ACCHSs across Australia. RANDOMISATION: Services will be stratified by remoteness, then randomised into two groups. Half receive support soon after the trial starts (intervention or 'early support'); half receive support 2 years later (wait-control or 'late support'). THE SUPPORT: Core support elements will be tailored to local needs and include: support to nominate two staff as champions for increasing alcohol care; a national training workshop and bimonthly teleconferences for service champions to share knowledge; onsite training, and bimonthly feedback on routinely collected data on screening and treatment provision. OUTCOMES AND ANALYSIS: Primary outcome is use of screening using AUDIT-C as routinely recorded on practice software. Secondary outcomes are recording of brief intervention, counselling, relapse prevention medicines; and blood pressure, gamma glutamyltransferase and HbA1c. Multi-level logistic regression will be used to test the effectiveness of support. ETHICS AND DISSEMINATION: Ethical approval has been obtained from eight ethics committees: the Aboriginal Health and Medical Research Council of New South Wales (1217/16); Central Australian Human Research Ethics Committee (CA-17-2842); Northern Territory Department of Health and Menzies School of Health Research (2017-2737); Central Queensland Hospital and Health Service (17/QCQ/9); Far North Queensland (17/QCH/45-1143); Aboriginal Health Research Ethics Committee, South Australia (04-16-694); St Vincent's Hospital (Melbourne) Human Research Ethics Committee (LRR 036/17); and Western Australian Aboriginal Health Ethics Committee (779). TRIAL REGISTRATION NUMBER: ACTRN12618001892202; Pre-results.


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Grupo com Ancestrais Oceânicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/etnologia , Austrália , Protocolos Clínicos , Competência Cultural , Assistência à Saúde/métodos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Pediatr Clin North Am ; 66(6): 1063-1074, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31679597

RESUMO

Alcohol use during adolescence is an important and modifiable health risk behavior given the significant acute consequences and long-term impacts on the developing brain. Alcohol is the most common substance used by young adults 12 to 17 years old, with binge drinking, polysubstance use, and co-occurring mental health disorders posing particular concerns in this age group. Physicians can play a crucial role in screening and responding to alcohol use, with targeted brief interventions designed to delay or decrease use.


Assuntos
Transtornos Relacionados ao Uso de Álcool , Adolescente , Comportamento do Adolescente/psicologia , Desenvolvimento do Adolescente , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/etiologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Humanos , América do Norte/epidemiologia , Fatores de Risco
9.
Aust N Z J Public Health ; 43(6): 532-537, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31577862

RESUMO

OBJECTIVE: This paper provides a case study of the responses to alcohol of an Aboriginal Community Controlled Health Service (The Service), and investigates the implementation of comprehensive primary health care and how it challenges the logic of colonial approaches. METHODS: Data were drawn from a larger comprehensive primary health care study. Data on actions on alcohol were collected from: a) six-monthly service reports of activities; b) 29 interviews with staff and board members; c) six interviews with advocacy partners; and d) community assessment workshops with 13 service users. RESULTS: The Service engaged in rehabilitative, curative, preventive and promotive work targeting alcohol, including advocacy and collaborative action on social determinants of health. It challenged other government approaches by increasing Aboriginal people's control, providing culturally safe services, addressing racism, and advocating to government and industry. CONCLUSIONS: This case study provides an example of implementation of the full continuum of comprehensive primary health care activities. It shows how community control can challenge colonialism and ongoing power imbalances to promote evidence-based policy and practice that support self-determination as a positive determinant for health. Implications for public health: Aboriginal Community Controlled Health Services are a good model for comprehensive primary health care approaches to alcohol control.


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde do Indígena/organização & administração , Atenção Primária à Saúde/métodos , Transtornos Relacionados ao Uso de Álcool/etnologia , Colonialismo , Humanos , Grupo com Ancestrais Oceânicos , Racismo , Determinantes Sociais da Saúde
10.
Lancet Psychiatry ; 6(12): 1054-1067, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31630982

RESUMO

Heavy drinking and alcohol use disorder are major public health problems. Practitioners not specialising in alcohol treatment are often unaware of the guidelines for preventing, identifying, and treating heavy drinking and alcohol use disorder. However, a consensus exists that clinically useful and valuable tools are available to address these issues. Here, we review existing information and developments from the past 5 years in these areas. We also include information on heavy drinking and alcohol use disorder among individuals with co-occurring psychiatric disorders, including drug use disorders. Areas covered include prevention; screening, brief intervention, and referral for treatment; evidence-based behavioural interventions; medication-assisted treatment; technology-based interventions (eHealth and mHealth); and population-level interventions. We also discuss the key topics for future research.


Assuntos
Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/terapia , Programas de Rastreamento , Saúde Pública , Encaminhamento e Consulta , Comorbidade , Saúde Global , Humanos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários
11.
Epidemiol Health ; 41: e2019041, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31623424

RESUMO

OBJECTIVES: Previous research has found that greater income inequality is related to problematic alcohol use across a variety of geographical areas in the USA and New York City (NYC). Those studies used self-reported data to assess alcohol use. This study examined the relationship between within-neighborhood income inequality and alcohol-related emergency department (ED) visits. METHODS: The study outcome was the alcohol-related ED visit rate per 10,000 persons between 2010 and 2014, using data obtained from the New York Statewide Planning and Research Cooperative System. The main predictor of interest was income inequality, measured using the Gini coefficient from the American Community Survey (2010-2014) at the public use microdata area (PUMA) level (n=55) in NYC. Variables associated with alcohol-related ED visits in bivariate analyses were considered for inclusion in a multivariable model. RESULTS: There were 420,568 alcohol-related ED visits associated with a valid NYC address between 2010 and 2014. The overall annualized NYC alcohol-related ED visit rate was 100.7 visits per 10,000 persons. The median alcohol ED visit rate for NYC PUMAs was 88.0 visits per 10,000 persons (interquartile range [IQR], 64.5 to 133.5), and the median Gini coefficient was 0.48 (IQR, 0.45 to 0.51). In the multivariable model, a higher neighborhood Gini coefficient, a lower median age, and a lower percentage of male residents were independently associated with the alcohol-related ED visit rate. CONCLUSIONS: This study found that higher neighborhood income inequality was associated with higher neighborhood alcohol-related ED visit rates. The precise mechanism of this relationship is not understood, and further investigation is warranted to determine temporality and to assess whether the results are generalizable to other locales.


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Renda/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Adulto Jovem
12.
J Addict Med ; 13(5): 385-395, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31589181

RESUMO

OBJECTIVES: The medical sequalae of alcohol and other drug (AOD) problems exact a prodigious personal and societal cost, but little is known about the specific prevalence of such medical problems, and their relationship to quality of life and indices of well-being among those recovering from problematic AOD use. To better characterize the lifetime physical disease burden, this study investigated the prevalence of medical conditions commonly caused or exacerbated by excessive and chronic AOD exposure in a nationally representative sample of US adults in AOD problem recovery. Comparisons were made to the general US population. Demographic and clinical correlates of disease prevalence were also investigated along with the relationship between distinct medical conditions and indices of quality of life/well-being. METHODS: Cross-sectional nationally representative survey of the US adult population who report resolving an AOD problem (n = 2002). Weighted lifetime prevalence of common medical conditions were estimated and compared to the US population. Demographic and clinical correlates of medical conditions, and also overall disease burden, were estimated using logistic regression. RESULTS: Relative to the general population, prevalence of hepatitis C, chronic obstructive pulmonary disease, heart disease, and diabetes were elevated. Likelihood of having a lifetime diagnosis of a specific disease was related to primary substance used and sex. Quality of life was lower among those with physical disease histories relative to those without. CONCLUSIONS: Findings highlight the increased medical burden associated with AOD problems, and speak to the need for earlier and more sustained intervention for AOD problems, greater integration of addiction treatment and primary health care, and longitudinal research to explore the complex, dynamic relationships between AOD use and physical disease.


Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/terapia , Efeitos Psicossociais da Doença , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Idoso , Procedimentos Clínicos/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Inquéritos e Questionários , Estados Unidos/epidemiologia , Adulto Jovem
13.
Psychol Addict Behav ; 33(7): 637-643, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31486660

RESUMO

Research has shown links between interpersonal conflict and problematic drinking behaviors as a way to cope. The present research examined the effects of a brief interpersonal conflict cognitive reappraisal intervention on short-term reductions in alcohol-related problems in a sample of college student drinkers. Undergraduates who were regular drinkers (N = 190) participated in a randomized control online study, completing self-reported measures of alcohol consumption and alcohol-related problems at baseline and 2 weeks later. After completing the baseline survey, participants completed a brief writing intervention during which they were asked to reflect on a recent interpersonal conflict and write about it from 1 of 3 possible perspectives, 2 of which were targeting cognitive reappraisal (i.e., a neutral, third-party perspective and the other party's perspective), their own perspective, or to reflect on their activities that day (control). Results from negative binomial regression models supported both reappraisal conditions: Compared with control, those who thought about the conflict from a neutral third-party perspective and those who thought about the conflict from the other party's perspective reported significantly fewer drinking problems at follow-up. Results from this study suggest preliminary efficacy of a single-session writing intervention aimed at reappraising interpersonal conflict. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas/terapia , Transtornos Relacionados ao Uso de Álcool/terapia , Conflito Psicológico , Relações Interpessoais , Psicoterapia Breve/métodos , Teoria da Mente , Adolescente , Adulto , Consumo de Álcool na Faculdade/psicologia , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Feminino , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
14.
Psychiatr Danub ; 31(Suppl 3): 418-420, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488764

RESUMO

BACKGROUND: A reformation of psychiatry was set up in Belgium with the establishment of mobile crisis teams. SUBJECTS AND METHODS: We performed a retrospective analysis of the patients referred to the mobile team "Pharos" in the period between December 2013 and December 2018. RESULTS: The number of patients is growing over the years and the most common referral reasons are suicidal thoughts and depressive mood. We have a high percentage of inclusions, maybe because the main referrers are GPs. Alcohol withdrawal at home is feasable and safe. CONCLUSION: Many psychiatric crisis situations can be managed at home with support of mobile teams, but further research is needed to provide evidence on outcome and cost effectiveness.


Assuntos
Intervenção na Crise/estatística & dados numéricos , Serviços de Emergência Psiquiátrica/provisão & distribução , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Psiquiatria/métodos , Psiquiatria/organização & administração , Transtornos Relacionados ao Uso de Álcool/terapia , Bélgica/epidemiologia , Depressão/epidemiologia , Depressão/terapia , Humanos , Estudos Retrospectivos , Ideação Suicida
15.
J Subst Abuse Treat ; 106: 97-106, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31540617

RESUMO

BACKGROUND: There is no known safe level of alcohol use among patients with HIV and liver disease. We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use, HIV, and liver outcomes among patients with HIV and liver disease. METHODS: In this multi-site, randomized trial conducted between January 28, 2013 through July 15, 2016, we enrolled 95 patients with HIV and liver disease [defined as having active hepatitis C infection or FIB-4 score > 1.45]. ISAT (n = 49) involved: Step 1- Brief Negotiated Interview with telephone booster, Step 2- Motivational Enhancement Therapy, and Step 3- Addiction Physician Management. Treatment as usual (TAU) (n = 46) involved receipt of a health handout plus routine care. Analyses were conducted based on intention to treat. RESULTS: Among ISAT participants, 55% advanced to Step 2, among whom 70% advanced to Step 3. Participants randomized to ISAT and TAU increased abstinence (primary outcome) over time. Abstinence rates were non-significantly higher by self-report (38% vs. 23%, adjusted odds ratio [AOR] [95% CI] = 2.6 [0.8, 9.0]) and phosphatidylethanol (43% vs. 32%, AOR [95% CI] = 1.8 [0.5, 6.3] among those randomized to ISAT vs. TAU at week 24. VACS Index scores (AMD [95% CI] = 1.1 [-3.2, 5.5]) and the proportion with an undetectable HIV viral load (AOR [95% CI] = 0.3 [0.1, 1.3]) did not differ by group at week 24 (p values >0.05). ISAT had non-significantly lower FIB-4 scores (adjusted mean difference [AMD] [95% CI] = -0.2 [-0.9, 0.5]), ALT (AMD [95% CI] = -7 [-20, 7]) and AST (AMD [95% CI] = -4 [-15, 7]) at week 24 compared to TAU. CONCLUSION: ISAT is feasible and potentially effective at enhancing delivery of evidence-based alcohol treatment to promote alcohol abstinence and improve liver biomarkers among patients with HIV and liver disease.


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Infecções por HIV/terapia , Hepatite C/terapia , Cirrose Hepática/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Abstinência de Álcool , Consumo de Bebidas Alcoólicas/prevenção & controle , Prestação Integrada de Cuidados de Saúde/organização & administração , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional , Resultado do Tratamento
16.
BMC Public Health ; 19(1): 1010, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357967

RESUMO

BACKGROUND: Alcohol related homicide, suicide and aggravated assault represent the largest costs for the state of Illinois. Previous research has examined the impact of some alcohol-related policies on youth alcohol use and alcohol-related harm in the United States but findings have been mixed. To our knowledge, no study has provided a detailed epidemiology of the relationship between the impacts of alcohol policies on unintentional injury in Illinois. Therefore, the purpose of this study is to determine whether a legislation that prohibit minors under 21 years old in establishments that serve alcohol is more salient than individual level factors in predicting hospitalization for traumatic unintentional injuries. METHODS: A retrospective observational study of data abstracted from 6,139 patients aged 10 to 19 hospitalized in Illinois Level I and Level II trauma centers. Patient data from 2006 to 2015 was linked with the city-level alcohol-related legislation (n = 514 cities). The response variable was whether a patient tested positive or negative for blood alcohol concentration (BAC) at the time of admission. Mixed-effects logistic regression analyses were conducted to model the patient and city level legislation effect of having a positive BAC test result on hospitalizations after adjusting for the legislation and patient factors. RESULTS: After adjustment, patients aged 15 to 19 and white patients who tested positive for BAC at the time of admission had the greater odds of hospitalization for traumatic alcohol-related unintentional injuries compared to patients who had a negative BAC test result. However, odds of hospitalization decreased for female patients and for those with private insurance, and over time, but a significant decrease in such hospitalizations occurred during 2010, 2014 and 2015. The alcohol-related legislation of interest was not a significant predictor of traumatic alcohol-related unintentional injury hospitalization. CONCLUSIONS: Patient-level covariates were significant predictors of traumatic alcohol-related unintentional injury hospitalization; an alcohol-related legislation may not reduce hospitalizations for young patients aged 10 to 19. Therefore, to prevent underage drinking and consequences, interventions should target sex/gender, race/ethnicity and focus on both individual and environmental strategies.


Assuntos
Acidentes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Álcool/terapia , Comércio/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Menores de Idade/legislação & jurisprudência , Consumo de Álcool por Menores/legislação & jurisprudência , Ferimentos e Lesões/terapia , Adolescente , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Concentração Alcoólica no Sangue , Criança , Feminino , Humanos , Illinois/epidemiologia , Masculino , Menores de Idade/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
17.
Int J Behav Med ; 26(4): 401-414, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31161592

RESUMO

BACKGROUND: Smartphone-based interventions are a potentially effective way to minimize alcohol-related harm in young adult, non-dependent drinkers. This pilot study is the first to evaluate the benefits and feasibility of a personalized alcohol harm-minimization intervention delivered via smartphones. METHODS: Within a single-blind, randomized controlled design, 45 young adults were randomly assigned to either the intervention app (n = 25; 18 females; Mage = 21.36 years, SDage = 4.15 years) or the control app (n = 20; 18 females; Mage = 22.75; SDage = 4.41). The two primary outcomes were frequency of risky drinking and drinking-related harms, and the secondary outcome was frequency of protective behavioral strategies (PBS) use. All outcomes were measured at baseline and immediately post-intervention. Using the Enlight framework [1], usability was evaluated via structured one-on-one phone interviews with a subgroup of six participants from the intervention group (3 females; Mage = 19.5 years, SDage = 1.64). RESULTS: There was no significant reduction in the primary outcomes from baseline to post-intervention across the groups. For the secondary outcome, the application of PBS within drinking contexts increased at follow-up for those in the intervention group but not for control participants. End-users rated the app as highly usable but had some concerns with repetition of the app-recommended strategies. CONCLUSIONS: This intervention, designed to reduce risky drinking behaviors among young adults, was rated as highly usable and was shown to increase the application of harm minimization strategies within drinking contexts. While the intervention and its delivery show promise, it did not appear to mitigate risky drinking behaviors. Implications of this research and future directions are discussed. TRIAL REGISTRATION: This trial is registered at the Australian New Zealand Clinical Trials Registry: BLINDED.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Terapia Comportamental/métodos , Smartphone , Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos Relacionados ao Uso de Álcool/psicologia , Austrália , Feminino , Humanos , Masculino , Projetos Piloto , Método Simples-Cego , Adulto Jovem
18.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31235608

RESUMO

Alcohol use continues to be a major concern from preadolescence through young adulthood in the United States. Results of recent neuroscience research have helped to elucidate neurobiological models of addiction, substantiated the deleterious effects of alcohol on adolescent brain development, and added additional evidence to support the call to prevent and reduce underage drinking. This technical report reviews the relevant literature and supports the accompanying policy statement in this issue of Pediatrics.


Assuntos
Transtornos Relacionados ao Uso de Álcool , Consumo de Álcool por Menores , Adolescente , Desenvolvimento do Adolescente/efeitos dos fármacos , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Bebidas Alcoólicas/efeitos adversos , Encéfalo/efeitos dos fármacos , Humanos , Fatores de Risco , Consumo de Álcool por Menores/prevenção & controle , Consumo de Álcool por Menores/psicologia , Consumo de Álcool por Menores/estatística & dados numéricos , Estados Unidos/epidemiologia
19.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31235610
20.
Artif Intell Med ; 98: 87-108, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31204191

RESUMO

Clinical guidelines (GLs) are widely adopted in order to improve the quality of patient care, and to optimize it. To achieve such goals, their application on a specific patient usually requires the interventions of different agents, with different roles (e.g., physician, nurse), abilities (e.g., specialist in the treatment of alcohol-related problems) and contexts (e.g., many chronic patients may be treated at home). Additionally, the responsibility of the application of a guideline to a patient is usually retained by a physician, but delegation of responsibility (of the whole guideline, or of a part of it) is often used\required (e.g., delegation to a specialist), as well as the possibility, for a responsible, to select the executor of an action (e.g., a physician may retain the responsibility of an action, but delegate to a nurse its execution). To manage such phenomena, proper support to agent interaction and communication must be provided, providing agents with facilities for (1) treatment continuity (2) contextualization, (3) responsibility assignment and delegation (4) check of agent "appropriateness". In this paper we extend GLARE, a computerized GL management system, to support such needs. We illustrate our approach by means of a practical case study.


Assuntos
Transtornos Relacionados ao Uso de Álcool/terapia , Continuidade da Assistência ao Paciente/organização & administração , Guias de Prática Clínica como Assunto , Terapia Assistida por Computador , Humanos , Disseminação de Informação , Comunicação Interdisciplinar , Designação de Pessoal
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