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The strong presence of Binge Drinking (BD) amongst university students, as well as the consequences associated with the same and the changes taking place over recent years regarding its conceptualization make it necessary to examine the usefulness of screening instruments used to detect this drinking pattern. This study examines the usefulness of a briefer adaptation of the AUDIT proposed by Cortés, Giménez, Motos, and Sancerni (2017a).College students self-administered the AUDIT, the revised items 2 and 3 (A2r and A3r), and completed a weekly self-report of their alcohol intake. BD was classified according to the amount consumed and the frequency of that consumption over the past six months. The AUDIT, AUDIT-C and items A2r+A3r (AR2I) were examined. The results obtained from a sample of 605 college students (18-21 years old/55.2% female) indicate that 449 meet the BD criteria. Items A2r and A3r, adapted to the most consensual definition of BD, were found to identify 98% of BD college students when using a cut-off point of ≥ 3 in females and ≥ 4 in males with optimum levels of sensitivity and specificity. The new adaptation, which includes fewer items, identifies BD college students more accurately. This confirms the need to adjust both consumption items from the model according to the pattern of consumption in college students to detect BD more precisely and as soon as possible.
La importante presencia del Binge Drinking (BD) entre estudiantes universitarios, junto con las consecuencias asociadas al mismo y los cambios experimentados en los últimos años en su conceptualización, hacen necesario revisar la utilidad de los instrumentos de cribado para detectar este patrón de consumo. Este estudio examina la utilidad de una adaptación del AUDIT propuesta por Cortés, Giménez, Motos y Sancerni (2017a).Una muestra de estudiantes universitarios cumplimentó el AUDIT, los ítems 2 y 3 revisados (A2r y A3r), y un autoinforme semanal de su consumo de alcohol. A partir de la cantidad máxima de alcohol consumido en una ocasión y de la frecuencia de dicho consumo en los últimos seis meses se clasificaron los jóvenes como BD o no-BD. Se examinaron las puntuaciones del AUDIT, AUDIT-C y de los ítems A2r+A3r (AR2I).Los resultados obtenidos con 605 universitarios (18-21 años/55,2% mujeres) indican que 449 cumplen criterios de BD. Los ítems A2r y A3r, adaptados a una definición más consensuada de BD, identifican el 98% de los estudiantes BD cuando se usa un punto de corte ≥ 3 en mujeres y ≥ 4 en varones, con valores óptimos de sensibilidad y especificidad.Esta adaptación realizada, que incluye menor número de ítems, identifica a los universitarios BD de manera más precisa. Se confirma la necesidad de ajustar ambos ítems de consumo de acuerdo al patrón de ingesta BD que realizan los estudiantes universitarios mejorando notablemente su detección y facilitando un abordaje temprano.
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Consumo de Álcool na Faculdade , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Consumo Excessivo de Bebidas Alcoólicas/diagnóstico , Autorrelato , Adolescente , Feminino , Humanos , Masculino , Estudantes , Universidades , Adulto JovemRESUMO
OBJECTIVES: . The 28-joint DAS (DAS28), clinical disease activity index (CDAI) and simplified disease activity index (SDAI) are indices frequently used to assess disease activity in RA patients. Cut-off values were defined to classify the states of RA disease activity: remission, low, moderate and high. The aim of this work was to assess disease activity states classified by DAS28, CDAI and SDAI and to analyse their agreement in the Rheumatic Diseases Portuguese Register Reuma.pt. METHODS: . A total of 2795 patients and 14 440 visits were selected from Reuma.pt for analysis. Pearson's correlation coefficients (PCCs) were calculated for the three indices. McNemar's chi-squared tests, PCCs and kappa statistics were performed to analyse and compare the distribution of visits among all disease activity states and indices. RESULTS: A strong correlation was found between the three indices throughout the 14 440 visits: r = 0.874 for DAS28/CDAI, r = 0.877 for DAS28/SDAI and r = 0.984 for CDAI/SDAI (all PCCs with P < 0.0001). However, when categorization in the different disease activity states was analysed, McNemar's chi-squared tests and PCCs revealed significant disagreement between the cut-offs of the three indices. CONCLUSION: DAS28, CDAI and SDAI cut-offs do not translate into the same clinical information in Reuma.pt. Although this might be expected for the original DAS28 cut-offs, when compared with CDAI and SDAI significant disagreement was also found for the DAS28 modified cut-offs. For visits where patients are in CDAI or SDAI remission, we also find disagreement between these two indices, which may contradict previous conclusions that acute phase reactants add little to composite disease activity indices for RA.
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Artrite Reumatoide/diagnóstico , Índice de Gravidade de Doença , Proteínas de Fase Aguda/metabolismo , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Portugal , Sistema de Registros , Tempo para o TratamentoRESUMO
The important implications generated by binge drinking among university students justify the interest to determine which factors predict its occurrence. Specifically, this study aims to assess the role of personality and drinking onset in predicting weekly alcohol consumption, and the impact of the whole set of variables in predicting the number of consequences associated with consumption in undergraduates. Two hundred and thirteen freshmen who were intensive consumers (binge drinkers) from the University Complutense of Madrid were evaluated. All of them filled in a self-registration of consumption, the BIS-11, the NEO-FFI and the IECI consequences associated with intake. The hierarchical regression analysis shows that the drinking onset appears to be a relevant predictor variable in explaining weekly consumption and the number of consequences. The same can be said of the weekly consumption variable with regard to the number of consequences. In general, the influence of personality is quite limited. It is interesting to point out that responsibility and impulsivity, along with age, explain most of the weekly consumption behavior among males. With respect to the consequences of consumption, only impulsivity and neuroticism contribute to explain them, but with less strength than age and weekly consumption. Our results justify the need to plan tighter interventions and consider new predictors that help to explain further weekly consumption in women.
Las importantes implicaciones que genera el consumo intensivo de alcohol entre los jóvenes justifican el interés por determinar qué factores predicen su aparición. Concretamente, en este estudio se analiza el papel de la personalidad y edad de inicio en el consumo de alcohol en la predicción del consumo semanal de alcohol, y de todas estas variables en la predicción del número de consecuencias asociadas al consumo en jóvenes universitarios.Se evalúan 213 consumidores intensivos de primer curso de la Universidad Complutense de Madrid. Todos ellos cumplimentaron un autoregistro de consumo, el BIS-11, el NEO-FFI y el IECI de consecuencias asociadas a la ingesta.Los análisis de regresión de orden jerárquico muestran que la edad de inicio resulta ser una variable predictora relevante tanto en la explicación del consumo semanal como del número de consecuencias. Lo mismo puede decirse de la variable consumo semanal respecto a la del número de consecuencias.En líneas generales, el influjo de las variables de personalidad es bastante limitado. Tan sólo mencionar la responsabilidad e impulsividad, que junto con la edad, llegan a explicar gran parte de la conducta de consumo semanal entre varones. En lo que respecta a las consecuencias derivadas del consumo, sólo resultan explicativas, aunque en menor medida que la edad y el consumo semanal, la impulsividad y el neuroticismo.Esto justifica la necesidad de planificar intervenciones más ajustadas y de analizar nuevos predictores en el caso de las mujeres que permitan explicar en mayor medida su conducta de consumo semanal.
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Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Adolescente , Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Consumo Excessivo de Bebidas Alcoólicas/psicologia , Feminino , Humanos , Masculino , Personalidade , EstudantesRESUMO
OBJECTIVES: Adalimumab, etanercept and infliximab are effective TNF inhibitors (TNFis) in the treatment of RA, but no randomized clinical trials have compared the three agents. Prior observational data are not consistent. We compared their effectiveness over 1 year in a prospective cohort. METHODS: Analyses were performed on subjects' first episode of TNFi use in the Rheumatic Diseases Portuguese Register, Reuma.pt. The primary outcome was the proportion of patients with European League Against Rheumatism good response sustained at two consecutive observations separated by 3 months during the first year of TNFi use. Comparisons were performed using conventional adjusted logistic regression, as well as matching subjects across the three agents using a propensity score. In addition, baseline predictors of treatment response to TNFi were identified. RESULTS: The study cohort included 617 RA patients, 250 starting etanercept, 206 infliximab and 161 adalimumab. Good response was achieved by 59.6% for adalimumab, 59.2% for etanercept and 51.9% for infliximab (P = 0.21). The modelled probability of good response did not significantly differ across agents (etanercept vs adalimumab OR = 0.97, 95% CI 0.55, 1.71; etanercept vs infliximab OR = 1.25, 95% CI 0.74, 2.12; infliximab vs adalimumab OR = 0.80, 95% CI 0.47, 1.36). Matched propensity score analyses also showed no significant treatment response differences. Greater educational attainment was a predictor of better response, while smoking, presence of ACPA, glucocorticoid use and worse physician assessment of disease activity at baseline each predicted a reduced likelihood of treatment response. CONCLUSION: Over 1 year, we found no difference in effectiveness between adalimumab, etanercept and infliximab.
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Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Imunoglobulina G/uso terapêutico , Receptores do Fator de Necrose Tumoral/uso terapêutico , Adalimumab , Adulto , Análise de Variância , Etanercepte , Feminino , Humanos , Infliximab , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Prospectivos , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
The increasing presence of women, especially university women, in risky alcohol consumption such as Binge Drinking (BD), which is associated with gender-specific biopsychosocial problems, makes it necessary to analyze the variables underlying BD in order to adjust possible interventions more in line with their reality. The motives and expectancies of this pattern of consumption, as well as the consequences derived from it, are some of the variables that are shown to have the greatest weight in the prediction of BD. In the present study we analyze, on the one hand, the performance of these variables among college women with alcohol use, and on the other hand, which of these variables allow us to classify BD. A total of 501 female university consumers of alcohol (mean age 19.02 years) were assessed. Specifically, they completed a self-report of alcohol consumption (77.1% engage in BD), the Expectancy Questionnaire (EQ), the Drinking Motives Questionnaire (DMQ-R) and the Alcohol Consumption Consequences Evaluation (ACCE). BD female students scored significantly higher on these instruments, except for compliance motives. The logistic regression analysis carried out to estimate the probability of performing BD using the social and conformity motives, the ACCE and positive expectancies correctly estimated (χ2 8 = 9.149, p < 0.33) 88.6% of the cases and explained 26.2% of the BD. Thus, young women with a level of consequences classified as high risk (>25 in ACCE) have a 3.55-fold increase in the probability of having BD, compared to women classified as low risk by the ACCE. On the other hand, women classified as moderate risk by the ACCE have a 4.77-fold increase in the probability of having BD. In the case of social motives and positive expectancies, their increase multiplies by 1.165 and 1.024, respectively, the probability of having BD. The results of this study highlight the importance of adapting preventive measures to the consequences experienced by BD university students, especially in relation to the social motives and positive expectancies that modulate decision-making when engaging in this pattern of consumption.
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We conducted a review to analyze the 100 most-cited studies on binge drinking (BD) in the Web of Science (WoS) database to determine their current status and the aspects that require further attention. We carried out a retrospective bibliometric analysis in January 2021. The year of publication, authors, design, subject, journal, institution and lead author's country, as well as the definition of BD, were extracted from the articles. The data on the country, year, thematic category of the journals and their rank were obtained from the Institute for Scientific Information (ISI) Journal Citation Reports 2020. The number of citations was collected from the WoS, and the h index was collected from the Scopus database. The citation density and Bradford's law were calculated. The majority of the articles were empirical quantitative studies with a cross-sectional design published between 1992 and 2013 in 49 journals. There were 306 authors, mostly English-speaking and from the USA. The definitions used to describe BD are not homogeneous. The most-cited topics were the analysis of consequences, determinants and epidemiology. There is a need to unify the definitions of BD and base them on scientific evidence. The multidisciplinary nature of BD is not well reflected in each of the thematic areas discussed in this work.
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Consumo Excessivo de Bebidas Alcoólicas , Bibliometria , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Estudos Transversais , Bases de Dados Factuais , Humanos , Estudos RetrospectivosRESUMO
BACKGROUND AND OBJECTIVES: The purpose of the present study was to assess the relationship of arterial stiffness with other markers of target organ damage, and the clinical factors related to it. PATIENTS AND METHODS: Cross-sectional study that included 208 (115 men) never treated hypertensive, non-diabetic patients (mean age, 49+/-12 years). In addition to a full clinical study, 24h ambulatory blood pressure (BP), and determination of left ventricular hypertrophy (LVH) and microalbuminuria were performed. Clinical arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV) obtained with applanation tonometry (SphygmoCor-System). RESULTS: PWV was 8.3 (7.3-9.9)m/s (median, interquartile range). Stepwise regression analysis revealed that age (beta=0.086, p<0.001), 24-h pulse pressure (beta=0.058, p<0.001), and low-density lipoprotein (LDL) cholesterol (beta=0.009, p<0.013) were independent determinants of PWV. PWV>12m/s (indicating target organ lesion) was present in only 16 (7.7%) patients, less frequent than LVH (28% of the patients) and microalbuminuria (16%). However, of the 16 patients with elevated PWV, 10 (62%) had neither LVH or microalbuminuria. In a logistic multivariate regression analysis the factors related to elevated PWV were age > or =45 in man and > or =55 in women (OR: 23.8, 95% CI: 2.7-195.5; p=0.004), LDL cholesterol > or =160mg/dl (OR: 10.6, 95% CI: 2.6-42.7; p=0.001) and increased 24-h pulse pressure > or =55mmHg (OR: 3.9, 95% CI: 1.2-12.9; p=0.03). CONCLUSIONS: In untreated middle age hypertensives arterial stiffness assessed by PWV is less frequent than LVH or microalbuminuria. PWV is mainly related to age, LDL cholesterol, and pulse pressure values.
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Pressão Sanguínea , Sangue , Artérias Carótidas/fisiopatologia , Colesterol/sangue , Artéria Femoral/fisiopatologia , Hipertensão/fisiopatologia , Pulso Arterial , Adolescente , Adulto , Fatores Etários , Albuminúria/diagnóstico , LDL-Colesterol , Estudos Transversais , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico , Modelos Logísticos , Masculino , Manometria , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Fatores Sexuais , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
Instruments that evaluate alcohol use consequences among young people do not consider the intensive alcohol consumption pattern that is so characteristic during these ages. Some of these instruments are even ineffective in the Spanish population. Hence the interest in developing an instrument more adapted to the reality of our young people. A total of 601 university students (35.9% male and 64.1% female) from 18 to 20 years old were recruited. All of them answered a total of 77 items obtained from the review of both the scientific literature and the different scales used to measure consequences derived from alcohol consumption. In addition, they completed the AUDIT and the Timeline Followback for self-reported consumption. The data were analyzed using factor analysis and a two-parameter logistic model. ROC curve analysis was used to establish cut-off points for different risk levels of alcohol consumption distinguishing between genders. The final 43-item scale Alcohol Consumption Consequences Evaluation (ACCE) (Evaluación de Consecuencias derivadas del Consumo de Alcohol [ECCA]) shows adequate psychometric properties: α = 0.94; unidimensionality through exploratory factor analysis (EFA) (26.25% of explained variance) and confirmatory factor analysis (CFA) (RMSEA = 0.39; TLI and CFI > 0.90). In addition, ROC analyses, both at a global scale and distinguishing between genders, were able to characterize consumers with different levels of risk, obtaining areas under the curve between 0.82 and 0.88. A scale has been obtained that enables the establishment of cut-off points to distinguish between the consequences of low, moderate and high risk alcohol consumption. The clinical utility of the ACCE is highlighted by using one single instrument to perform the screening of a possible alcohol risk consumption as well as identifying the consequences that need to be worked on in the evaluated person's or group's intervention.
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OBJECTIVES: After consultations, the physician's perceptions differ from the patient's perceptions concerning illness level, cause, and nature of the problem and content of the consultation. Agreement on problems requiring follow-up was associated with a better outcome. The primary aim of this study was to build and validate an instrument that could assess physician-patient agreement in the rheumatology consultation. The secondary objective was to assess agreement association with patient's clinical and sociodemographic data. MATERIALS AND METHODS: A ten-item questionnaire - "Consultation Assessment Instrument" (CAI) - was developed for this study to assess the physician-patient agreement. Ten physicians and 102 patients diagnosed with an inflammatory joint disease under biological therapy were included. The items were evaluated and the index of proportional agreement for the dichotomized answers "agree" (Ppos) and "disagree" (Pneg) was calculated. RESULTS: Consultation satisfaction was the item with the highest agreement. On the opposite end, the item about the explanation of treatment importance was the item with the lowest agreement between patient and physician. Except for one item, the high level of agreement between patient and physician was due to a higher Ppos. Index of proportional agreement was high for 9 of the 10 items (0.816≤ Iv ≤0.990). Patients with lower disease activity scores had a more positive experience. A good internal consistency was obtained for both patient's and physician's questionnaire (α = 0.88 and α = 0.80, respectively). CONCLUSIONS: Both patient and physician showed a positive experience towards Rheumatology consultation. Physician-patient agreement was high in the majority of the consultation aspects (mean Iv = 0,93). A good internal consistency was obtained for both patient's and physician's questionnaire. CAI could be useful as a mental checklist in daily practice or as an educational tool for training consultation skills.
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Artrite , Visita a Consultório Médico , Relações Médico-Paciente , Autorrelato , Adulto , Artrite/diagnóstico , Artrite/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The objective was to assess the impact of weight changes on blood pressure (BP), lipids and glucose goals in a cohort of hypertensive subjects. DESIGN: Prospective follow-up. SETTING: Hypertension clinic. PATIENTS: 326 hypertensive non-diabetic subjects, 46% with metabolic syndrome (MS). INTERVENTIONS: Usual care treatment, which included diet, physical exercise and drugs prescribed when indicated. All patients were observed for up to 1 year. MAIN OUTCOME MEASURES: BP and low-density lipoprotein-cholesterol (LDL-C) goal were those in ESH/ESC and ATP III recommendations, respectively. The glucose goal was to delay progression to type 2 diabetes mellitus, or to achieve blood glucose <100 mg/dl for non-diabetics. According to body weight changes, patients were categorized using adjusted ROC curves models. RESULTS: Overall, there was a significant weight increment of 0.5 kg (95% CI 0.1-0.9 kg); 28 patients (8.6%) lost more than 5 kg, and only four (1.2%) lost more than 10 kg. BP, LDL-C and glucose goals were achieved in 56%, 78% and 61% of patients, respectively. To lose or not gain weight was an independent prognostic factor to achieve the BP goal in all the patients and the LDL goal in the presence of MS. For glucose control, being treated with beta-blockers and/or diuretics was a negative factor. CONCLUSIONS: In hypertensive subjects, even small changes in weight may have an important impact on achieving cardiovascular goals, mainly in those with MS.
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Doenças Cardiovasculares/etiologia , Hipertensão/complicações , Aumento de Peso/fisiologia , Redução de Peso/fisiologia , Adulto , Glicemia , Pressão Sanguínea , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Estudos de Coortes , Dieta , Terapia por Exercício , Feminino , Seguimentos , Humanos , Lipídeos/sangue , Masculino , Síndrome Metabólica , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
Colorectal perforation after barium enema it is a rare complication, but has a high mortality rate. With the emergence of endoscopic examinations, barium enemas have fallen into disuse and doctors are less aware of its complications. This case is of the utmost importance as failure to recognize it could be fatal.
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Physicians should look more carefully for the potential reversible causes of acute heart failure, namely hypoparathyroidism. The recovery of left ventricular function with the treatment of hypoparathyroidism underlines the importance of calcium and the reversibility of this type of cardiomyopathy.
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With an increasingly aging population, it is of extreme importance to exclude potentially reversible dementias, such as hyperparathyroidism with hypercalcemia, in the differential diagnosis of a rapidly progressive dementia. According to literature, this entity is undervalued and it is highly relevant to be aware of it.
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This paper aims to explore causes of binge drinking in young people and the effects that they seek when they drink alcohol, based on age and alcohol intake. 4,083 questionnaires were administered to 1,361 university students and 2,722 adolescents at their educational institutions. The findings corresponding to those who reported practising binge drinking -2,917 subjects- are presented in the paper. Taking into account the regularity of the practice and the alcohol intake, cluster analysis differentiated two consumer types in each group: the radical type (21.2% university students-18.2% adolescents): 10-11 drinks 3 days a week and for more than 10 months a year; and the average type (78.7% university students-81.7% adolescents): 4-5 drinks twice a week and for 8-9 months. Drinking as a way of having fun (75.2%) and drinking for the sake of drinking (81.9%) are two of the main causes underlying binge drinking, economical reasons being secondary for adolescents As for the expected effects, the short-term positive aspects of moderate consumption (being more talkative, euphoric...) stand out. Adolescents also expect to improve some of their personal skills (more self-confidence...). These results corroborate and increase the information currently available and allow us to propose alternatives adapted to young people's real needs.
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Alcoolismo/epidemiologia , Alcoolismo/psicologia , Transtornos Cognitivos/epidemiologia , Adolescente , Adulto , Transtornos Cognitivos/diagnóstico , Feminino , Humanos , Incidência , Masculino , Testes Neuropsicológicos , Grupo Associado , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: The classification of disease activity states in rheumatoid arthritis (RA) can be achieved through disease activity indices, such as the Disease Activity Score in 28 joints erythrocyte sedimentation rate (DAS28-ESR), the Simplified Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI). Subjective measurements, such as patient reported outcomes have been incorporated into several of these indices alongside more objective assessments, such as increases in the ESR and C-reactive protein. Moreover, while they use similar criteria, different indices weight these criteria to different extents. Therefore, the classifications based on each evaluation may not always be the same. We aim to compare the performance of the three indices and their individual components in two different populations. METHODS: Data from Dutch and Portuguese adherent centers were extracted from the METEOR database, a multinational collaboration on RA. We included a total of 24,605 visits from Dutch centers (from 5,870 patients) and 20,120 visits from Portuguese centers (from 3,185 patients). We compared the disease activity states as evaluated by the DAS28-ESR, CDAI, and SDAI across the two populations. In addition, we analyzed the individual components of each evaluation, including their respective contributions to the outcome, in each population. RESULTS: We found significant differences in the disease activity states classified with the DAS28-ESR between the two populations. SDAI and CDAI had more congruous results. While the proportion of visits to Dutch and Portuguese centers that were classified as "in remission" was very similar between the CDAI and SDAI, the DAS28-ESR gave discordant results. Dutch patients had lower ESRs, which is more heavily weighted in the DAS28-ESR. In addition, even though the mean physicians' global assessment values did not vary significantly for Dutch vs Portuguese physicians, we found that doctors at Portuguese centers overall scored the physician's global assessment lower than Dutch physicians for patient visits classified by disease activity state. CONCLUSION: While the CDAI and SDAI assigned disease activity states that were largely similar, the DAS28-ESR was often discordant across the two populations. Moreover, we found that physicians, more than patients, evaluated disease activity differently among the Portuguese and Dutch populations.
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This paper presents some of the main parameters in the behaviour pattern of young people in their binge drinking practices, seeking to improve the somewhat inaccurate view emerging from field studies. A total of 4083 questionnaires were administered to young people in Valencia aged 14-25 during the academic year 2005/2006, from a random sample of schools and other educational institutions. The survey was conducted in the institutions themselves and participation was anonymous and voluntary. The findings confirm a progressive reduction in the age at which this practice begins, 13 having been the starting age for those adolescents who are currently 14 years old. Likewise, the results contradict the assertion that binge drinking is practised mainly by boys, as it is found to an equal extent in either sex. The European trend towards radicalisation of consumption is also confirmed: a considerable increase in the use of drinks with high alcohol content regardless of age and gender, resulting in mean blood alcohol levels of 1.5 gr. twice a week on average for more than 6 months a year. All of this is commonly combined with a misleading perception of the effects of alcohol consumption, the positive aspects being overestimated. These results underline the need to design selective or even indicated prevention programmes for approximately 20% of the most extreme cases, with a view to overcoming the current constraints of universal prevention. Nor should interventions overlook the issue of parental permissiveness--reflected in aspects such as early age of onset of binge-drinking or lack of controls on the time young people come home after partying.
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Consumo de Bebidas Alcoólicas/epidemiologia , Comportamento Cooperativo , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Masculino , Espanha/epidemiologiaRESUMO
BACKGROUND: Arterial stiffness, measured with pulse wave velocity (PWV), is now classified as a marker of target organ damage (TOD) alongside left ventricular hypertrophy and moderately increased albuminuria. Interventional studies on treated hypertensive patients have shown that PWV could be improved. Our aim was to assess changes in arterial stiffness after 1 year of routine clinical practice in never-treated hypertensive patients. PATIENTS AND METHODS: We studied 356 never-treated patients with suspected hypertension. After standard clinical assessment during which presence of TOD was evaluated, hypertension diagnosis was confirmed in 231 subjects who subsequently received standard routine care. Both hypertensive and the 125 controls came back for a follow-up visit after 1 year. RESULTS: Hypertensive patients were slightly older (46 ± 12 vs. 50 ± 12 years, P < 0.001), with higher mean arterial pressure (MAP)-adjusted PWV compared to controls (8.6 ± 2.0 vs. 8.0 ± 1.7 m/s, P < 0.001) and 47% of them presented 1 or more TOD. After 1 year of treatment, MAP was similar in both groups (94.9 vs. 96.2 mm Hg; P = ns), but adjusted PWV remained significantly higher in the hypertensive patients (7.8 ± 1.4 vs. 8.3 ± 1.7 m/s, P = 0.004). The prevalence of elevated PWV was reduced from 20% to 12%. All antihypertensive drugs achieved the same blood pressure (BP) and PWV reduction with the exception of vasodilating beta-blockers which gave slightly better results probably due to heart rate reduction. CONCLUSION: BP reduction in newly diagnosed hypertensive patients improves arterial stiffness within a year of real-life clinical practice. Patients with the highest PWV and the largest reduction of BP "destiffened" the most whatever antihypertensive class was used.
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Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Rigidez Vascular/efeitos dos fármacos , Adulto , Estudos de Casos e Controles , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Onda de Pulso , Espanha/epidemiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
This study analyzes the appropriateness of an improved version of one of the most frequently used instruments for the screening of high-risk alcohol consumption. This adaptation was created in accordance with certain limitations recognized by other researchers and in an attempt to adjust the content and scales of some items to a more consensual definition of binge drinking. After revising items 2 and 3, the areas under the ROC curves of the AUDIT and of different abbreviated versions were calculated. A total of 906 minors (468 females) between the ages of 15 and 17 were evaluated. Stratified sampling was conducted on a population of high school students in the city of Valencia (Spain). One school was randomly chosen from each of the city's 16 school districts. Information was collected on sociodemographic aspects, consumption patterns and the AUDIT containing the improved items. The percentage of underage BD reached 36%, regardless of gender or age. BD groups have been differentiated by different intensity levels, both in males and females. Upon comparing the effectiveness of the distinct versions of the AUDIT, it is recommended that researchers and clinics use the combination of the revised items 2 and 3 to ensure a more precise identification of underage BD. A cut-off point of 5 for this test would permit identification of 94% of the underage BD and would notably reduce false positives.
RESUMO
BACKGROUND: The changes experienced in recent years in the conceptualization of binge drinking (BD) make it necessary to revise the usefulness of the existing instruments for its detection among minors. The AUDIT and its abbreviated versions have shown their utility in different populations and consumption ranges, but there has been little research into their use in the detection of BD among adolescents. This study tests the capacity of the AUDIT, AUDIT-C and AUDIT-3 to identify BD adolescents, indicating the optimal cut-off points for each sex. METHODS: High school students self-administered the AUDIT and completed a weekly self-report of their alcohol intake. BD is classified into different groups according to parameters like the quantity consumed and its frequency in the past six months, adjusting the cut-off points for each case. RESULTS: The results obtained with a sample of 634 adolescents (15-17 years old/52.2% female) indicate that cut-off points of 4 on the AUDIT and 3 on the AUDIT-C show the best fit. Dividing the sample by sexes, the AUDIT and the AUDIT-C would detect BD males with scores of 5 and 4, respectively (with the AUDIT-C being more sensitive), and BD females with a score of 3 on both (the more sensitive being the AUDIT). CONCLUSIONS: All three versions are adequate to classify BD adolescents but none of them made it possible to safely differentiate binge drinkers with different consumption intensities.
Assuntos
Consumo Excessivo de Bebidas Alcoólicas/diagnóstico , Consumo Excessivo de Bebidas Alcoólicas/epidemiologia , Inquéritos e Questionários/normas , Consumo de Álcool por Menores , Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Consumo Excessivo de Bebidas Alcoólicas/psicologia , Feminino , Humanos , Masculino , Autorrelato/normas , Estudantes/psicologia , Consumo de Álcool por Menores/psicologiaRESUMO
Evidence gained from animals and humans suggests that the encephalic opioid system might be involved in the development of drug addiction through its role in reward. Our aim is to assess the influence of genetic variations in the opioid receptor mu 1 on alcohol and tobacco consumption in a Spanish population. 763 unrelated individuals (465 women, 298 men) aged 18-85 years were recruited between October 2011 and April 2012. Participants were requested to answer a 35-item questionnaire on tobacco and alcohol consumption, as well as to complete the AUDIT and Fagerström tests. Individuals were genotyped for three polymorphisms in the opioid receptor mu 1 (OPRM1) gene, using a TaqMan protocol. In males, the rs10485057 polymorphism was associated with total pure ethanol intake and with the risk of being an alcohol consumer. Also, this polymorphism was significantly associated with higher Fagerström scores. Rs1799971 had a different influence on adaptive and maladaptive patterns of alcohol use. Despite the limited sample size, our study might enrich current knowledge on patterns of alcohol use, because it encompasses both extreme and adaptive phenotypes, providing thus a wider perspective on this subject.