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Saturday, August 21, 2010

Substance abuse and movement disorders

An array of movement disorders is associated with ethanol, illicit drugs, and tobacco.

Heavy ethanol users experience withdrawal tremor and, less often, withdrawal parkinsonism, chorea, and myoclonus. Asterixis is a feature of hepatic failure. On the other hand, ethanol can ameliorate essential tremor and myoclonus-dystonia.

Among opioid drugs, meperidine can precipitate myoclonus. Severe parkinsonism affected users of a synthetic meperidine analog contaminated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Spongiform leukoencephalopathy, sometimes with chorea and myoclonus, occurred in inhalers of heroin vapor (chasing the dragon).

Psychostimulants including cocaine acutely cause stereotypies and dyskinesias. Phencyclidine toxicity causes myoclonus.

Tobacco use, on the other hand, protects against Parkinson's disease.

Clinicians need to consider substance abuse in patients with unexplained movement disorders.

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Acute Prenatal Exposure To Ethanol And Social Behavior: Effect Of Age, Sex, And Timing Of Exposure

During development of the central nervous system, neurons pass through critical periods of vulnerability to environmental factors. Exposure to ethanol during gastrulation or during neuronal generation results in a permanent reduction in the number of neurons in trigeminal-associated cranial nerve nuclei.

Normal functioning of the trigeminal system is required for social behavior, the present study examined the effects of acute prenatal exposure to ethanol on social interactions across ontogeny.

Pregnant Long-Evans rats were injected with 2.9 g/kg ethanol (i.p., 20% v/v solution; peak blood ethanol concentrations of not, vert, similar300 mg/dl) or an equivalent volume of saline on gestational day (G) 7 (gastrulation) or G12 (neuronal generation).

Subsequently, social investigation, play fighting, contact behavior, social motivation, and overall locomotor activity in the social context were assessed in male and female offspring during early adolescence, late adolescence, or adulthood, on postnatal day (P) 28, P42, or P75, respectively, using a modified social interaction test.

Ethanol exposure on G7 resulted in mild changes of social behavior evident in young adolescents only. In contrast, animals exposed to ethanol on G12 demonstrated pronounced behavioral deficits throughout ontogeny, with deficits being most robust in male offspring.

Males exposed to ethanol on G12 showed decreases in social investigation, contact behavior, and play fighting, whereas a decrease in social motivation, i.e., transformation of social preference into social avoidance, was evident at P42 and P75 regardless of sex.

These findings show that acute exposure to ethanol alters social behavior, and that the timing of the exposure defines the behavioral outcome.

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Dramatic Increase in Alcoholic Liver Cirrhosis Mortality in Estonia in 1992–2008

The aim of the study was to describe trends in alcoholic liver cirrhosis mortality rates in 1992–2008 and to examine socio-demographic differences in alcoholic liver cirrhosis mortality.

Individual records of deaths from alcoholic liver cirrhosis among 25–64-year olds in 1992–2008 in Estonia were analysed. Age-standardized mortality rates for men and women aged 25–44 and 45–64 were calculated. Association between alcoholic liver cirrhosis mortality and socio-demographic variables (age, education and ethnicity) for the data of the years around the census in 2000 was measured by mortality rate ratios using Poisson regression models.

In 1992–2008, alcoholic liver cirrhosis mortality rates were higher among men than that in women and that in the older than in the younger age group. Over the whole study period, mortality from alcoholic liver cirrhosis increased steeply. The increase was sharper among men and women in the older age group. In 1998–2001, higher alcoholic liver cirrhosis mortality rates occurred in non-Estonians and those with lower levels of education.

Alcoholic liver cirrhosis mortality has increased steadily in Estonia, and is reflected in an increase in heavy drinking. National alcohol policies should address all strata of society. However, in order to reduce alcohol-related damage in the population most effectively, special attention should be paid to non-Estonians and people with low levels of education.

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Substitution and Complementarity in the Face of Alcohol-Specific Policy Interventions

Policy responses to the growing burden of alcohol-related disease fail to consider the interrelated nature of substance misuse and the potential for complex interactions in response to alcohol-specific interventions.

This paper considers possible aggregate level responses to the alcohol policy and whether alcohol policy can be expected to reduce overall harm.

A review and discussion of the relevant literature was conducted.

Evidence indicates that those at greatest risk consume stronger alcoholic beverages more frequently, that they are likely to complement their consumption with a range of intoxicants and that they are more likely to substitute alcohol with other substances.

Policies aimed at reducing alcohol consumption can be successful. However, evidence suggests a significant minority of consumers are likely to substitute or complement consumption with a range of intoxicants suggesting that policy is unlikely to reduce all-cause mortality and morbidity. Further research into the nature of substitution and complementarity is required.

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Reduction of the blood alcohol concentration limit in Norway—Effects on knowledge, behavior and accidents

From January 1, 2001, the legal blood alcohol concentration (BAC) limit in Norway was reduced from 0.5 to 0.2 g/l. A before-and-after telephone survey concerning the effects of the reduced BAC limit was carried out. 3001 driver's license holders were interviewed before and after the amendment.

The percentage of drivers claiming that they will drink no alcohol before driving has increased from 82 to 91 percent, thus the distinction between driving a motor vehicle and drinking alcohol has become clearer. Drivers influenced by alcohol and involved in accidents have on the average much higher BACs than 0.5 g/l.

Statistics on alcohol-related accidents are not available for the years before and after the legal amendment, but single-vehicle night-time and weekend personal-injury and fatal crashes are used as surrogate measures.

There are no significant decreases in these proxies from the six years before to the six years after the reductions of the legal limit.

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Alcohol-related impairment in the Lane Change Task

The Lane Change Task was developed to provide an objective safety criterion for the assessment of driver distraction by in-vehicle information systems (IVIS). It consists of two basic driving tasks, namely lane keeping and lane changes. The LCT has been shown to reliably detect distraction from driving. As this test becomes increasingly important for the assessment of safety the validity of the LCT is crucial.

In order to examine this further, the effect of an alcohol intoxication of 0.08 g/dl on the performance in the LCT was examined in the present study as the negative effects of alcohol on driving are well known. Twenty-three participants were tested under alcohol and placebo in a cross-over design measuring different performance indicators in the LCT.

There were significant effects of alcohol during the lane keeping phase. However, these were much smaller than those typically found with distracting secondary tasks. The lane change phase was only marginally affected by alcohol.

This result gives rise to some caution for interpreting effects in the LCT. The LCT is well able to detect distraction, as other studies have shown. However, our study with intoxicated participants shows that a small effect in the LCT does not necessarily mean that this condition does not impair driving.

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Predictors of driving after alcohol and drug use among adolescents in Valencia (Spain)

Driving under the influence of alcohol and drugs has been identified as a risk factor for road traffic crashes. We have assessed the prevalence and predictor factors for driving after alcohol and drug use by adolescents.

A cross-sectional survey involving 11,239 students aged 14–18 years from 252 private and public schools in the Valencia region of Spain was conducted. The prevalence and predictors of driving after alcohol use, alcohol and drug use, or drug use during the previous 6 months were measured.

Of the students who reported driving (20%), 45.1% indicated driving after alcohol and drug use. The consumption of various drugs was higher among students who drove a vehicle compared with those who did not. The likelihood of driving after consuming alcohol, or alcohol and drugs, increased in line with the number of standard drink units per week, reports of any lifetime alcohol- or drug-related problems, and poor family relationship. In addition, masculine gender and early alcohol use increased the likelihood of driving after consuming alcohol.

Driving after alcohol and drug use is quite prevalent among adolescents in the Valencia region of Spain. There is a need for implementation of targeted policies for adolescents. This should focus on education and information on alcohol/drug use and driving.

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Friday, August 20, 2010

Alcohol consumption and injury risk: A case-crossover study in Sydney, Australia

Alcohol contributes to traumatic outcomes that kill or disable at a relatively young age, resulting in the loss of many years of life or disability. Harm from alcohol consumption can result from chronic or acute alcohol use.

The aims of this study are to determine the prevalence of alcohol-related injury and contextual factors contributing to injury risk in an ethnically diverse population of Sydney.

The study was undertaken in emergency departments of six hospitals between 2005 and 2006 and used a case-crossover design. The 1599 attendees surveyed (response rate 64.2%) were aged over 14 years and had presented with an injury to the emergency department.

Attendees were predominantly male, young, 40% spoke a language other than English at home and 17% had been drinking in the 6 h prior to their injury. Those born overseas drank at lower levels than their Australian born counterparts. The risk of sustaining an injury was 1.42 times greater in attendees consuming alcohol compared with those who had not. At very high intake levels (>90 g) the risk of injury was statistically significant for both men and women (men odds ratio: 1.88, 95% confidence interval: 1.46–2.42; women odds ratio: 1.89, 95% confidence interval: 1.04–3.43). Drinking at a licensed premise and drinking alone or with a group of people also significantly increased the risk of injury.

The results support current Australian policy concerning alcohol but indicate that further restrictions and increased warnings for the community may be warranted.[

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Alcohol Retail Density and Demographic Predictors of Health Disparities: A Geographic Analysis

We examined whether the geographic density of alcohol retailers was greater in geographic areas with higher levels of demographic characteristics that predict health disparities.

We obtained the locations of all alcohol retailers in the continental United States and created a map depicting alcohol retail outlet density at the US Census tract level. US Census data provided tract-level measures of poverty, education, crowding, and race/ethnicity. We used multiple linear regression to assess relationships between these variables and retail alcohol density.

In urban areas, retail alcohol density had significant nonlinear relationships with Black race, Latino ethnicity, poverty, and education, with slopes increasing substantially throughout the highest quartile for each predictor. In high-proportion Latino communities, retail alcohol density was twice as high as the median density. Retail alcohol density had little or no relationship with the demographic factors of interest in suburban, large town, or rural census tracts.

Greater density of alcohol retailers was associated with higher levels of poverty and with higher proportions of Blacks and Latinos in urban census tracts. These disparities could contribute to higher morbidity in these geographic areas.

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Thursday, August 19, 2010

Binge Drinking and Hypertension on Cardiovascular Disease Mortality in Korean Men and Women. A Kangwha Cohort Study

The purpose of this study was to examine combined effects of hypertension and binge drinking on the risk of mortality from cardiovascular disease in Koreans.

This study followed a cohort of 6100 residents in Kangwha County, aged ≥55 years as of March 1985, for cardiovascular mortality for 20.8 years up to December 31, 2005. We calculated hazard ratios (HRs) for cardiovascular mortality by blood pressure and binge drinking habits using the Cox proportional hazard model. Binge drinkers and heavy binge drinkers were defined as having ≥6 drinks on 1 occasion and ≥12 drinks on 1 occasion.

After adjusting for total alcohol consumption, male heavy binge drinkers with Grade 3 hypertension had a 12-fold increased risk of cardiovascular mortality (HR, 12.7; 95% CI, 3.47 to 46.5), whereas male binge drinkers with Grade 3 hypertension had a 4-fold increased risk of cardiovascular mortality (HR, 4.41; 95% CI, 1.38 to 14.1) when compared with nondrinkers with normal blood pressure. However, in considering separate effects of heavy binge drinking and hypertension on the risk of cardiovascular mortality, HRs were rather low (HR of heavy binge drinkers, 1.88, 1.10 to 3.20; HR of hypertensives, 2.00, 1.70 to 2.35) compared with nondrinkers with normal blood pressure.

Binge drinkers and heavy binge drinkers with Grade 3 hypertension showed a marked increase in cardiovascular mortality risk. Even after adjusting for total alcohol consumption, the former revealed 4.41 and the latter indicated 12.7 of HR for the risk of cardiovascular mortality.

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Prenatal alcohol exposure and cortisol activity in 19-month-old toddlers: an investigation of the moderating effects of sex and testosterone

Early exposure to stress and teratogenic substances have an impact on brain structures involved in cognition and mental health. While moderate-to-high levels of prenatal alcohol exposure (PAE) have repeatedly been associated with long-term neurodevelopmental deficits, no consensus has yet been reached on the detrimental effects of low-to-moderate PAE on the children’s functioning, including the limbic–hypothalamic–pituitary–adrenal axis.

The study aims to examine the association between low PAE and cortisol response to unfamiliar situations in 19-month-old children and to determine whether this association was moderated by sex and testosterone levels.

Information regarding PAE, cortisol response to unfamiliar situations, and testosterone activity was available in a total of 130 children participating to the Québec Newborn Twin Study (Montréal, QC, Canada). Mother alcohol consumption during pregnancy was assessed via a semistructured interview conducted when the children were 6 months of age. The contribution of prenatal and postnatal confounds were examined.

Disrupted patterns of cortisol activity were observed only in PAE males. Testosterone tended to be negatively associated with the cortisol response, but not for PAE males, suggesting an altered sensitivity to the inhibitory effects of testosterone in these participants.

Low levels of PAE were associated with disrupted cortisol activity, and males may be at higher risk. These findings challenge the existence of a “safe level” of alcohol. consumption during pregnancy and have public health implications.

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Trajectories of Alcohol Consumption Following Liver Transplantation

Any use of alcohol in the years following liver transplantation (LTX) approaches 50% of patients transplanted for alcoholic liver disease (ALD).

We collected detailed prospective data on alcohol consumption following LTX for ALD to investigate ongoing patterns of use.

Using trajectory modeling we identified four distinct alcohol use trajectories. One group had minimal use over time. Two other groups developed early onset moderate-to-heavy consumption and one group developed late onset moderate use.

These trajectories demonstrate that alcohol use varies based on timing of onset, quantity and duration.

Using discriminant function analysis, we examine characteristics of recipient's pre-LTX alcohol histories and early post-LTX psychological stressors to identify the profile of those at risk for these specific trajectories.

We discuss the relevance of these findings to clinical care and preliminarily to outcomes.

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Familial drinking in Italy: Harmful or protective factors?

This study examined relations between cultural norms and drinking practices in Italian young people using qualitative interviewing techniques. We collected self-report drinking history information from young people including whether or not they were allowed alcohol with meals in a family setting when growing up.

We conducted ethnographic interviews of 80 adolescent (ages 16–18) and 80 young adult (ages 25–30) regular and heavy drinkers in two regions (Abruzzo and Umbria). All 20 Italian regions produce wine. Abruzzo has a high ratio of heavy drinkers while Umbria has a high ratio of regular drinkers. We used the AUDIT to determine eligibility. We queried age at first drink, first 5+, first drunk, context of drinking, drinking with family during meals, availability of alcohol at home, parent's relationship to, attitudes about and discussion about alcohol.

Half of regular and heavy drinkers were allowed alcohol in a family setting while growing up. Those allowed alcohol with meals when growing up consumed less on their first drink occasion and were more likely to never drink 5+ or get drunk than those not allowed. They also had reduced or delayed 5+ or drunk occasions.

In Italy the tradition of incorporating alcohol with meals in a family setting may protect against harmful drinking. Other qualitative research should explore family, other adult and peer relationships to clarify alcohol use and risk-related behaviors. Research in countries with similar and different early age introduction would increase knowledge about the protective aspect of drinking in a family setting.

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Wednesday, August 18, 2010

Privatizing Virginia liquor stores makes sense

When I first heard Virginia Gov. Bob McDonnell boast that by privatizing the state's liquor system he could generate the same amount of revenue and raise $500 million from auctioning off liquor licenses while holding liquor prices where they are now, I assumed this was just a free-market conservative peddling another cockamamie scheme for spinning straw into gold.

It's not that I have great affection for state-run liquor monopolies. Seventy-seven years after the repeal of Prohibition, you'd think we regard the sale of liquor to consenting adults no differently than the sale of any other good. And if Virginians want to discourage liquor consumption while raising money for governmental purposes, there's this thing called the excise tax that would do the trick without forcing on law-abiding consumers the limited variety, service and convenience of a state-run operation. > > > >

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Moderate wine consumption is associated with better cognitive test results: a 7 year follow up of 5033 subjects in the Tromsø Study

The impact of moderate alcohol consumption on cognitive function and dementia is unclear. We examined the relationship between consumption of different alcoholic beverages and cognitive function in a large population-based study.

Subjects were 5033 stroke-free men and women who participated in a longitudinal population-based study in Tromsø, Norway. Alcohol consumption and other cardiovascular risk factors were measured at baseline and cognitive function was assessed after 7 years follow up with verbal memory test, digit–symbol coding test and tapping test.

Moderate wine consumption was independently associated with better performance on all cognitive tests in both men and women. There was no consistent association between consumption of beer and spirits and cognitive test results. Alcohol abstention was associated with lower cognitive performance in women.

Light-to-moderate wine consumption was associated with better performance on cognitive tests after 7 years follow up.

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FOR DEBATE: Sun-downing and integration for the advancement of science and therapeutics: the National Institute on Substance Use Disorders (NISUD)

The National Institutes of Health (NIH) is the most prominent funding source for scientific research in the world. It is also a complex and diverse organization, having multiple institutes, centers and offices. NIH emphasizes the need for innovation and collaboration in research to discover critical knowledge, enhance health and prevent disease.

Advancement in science requires not only sophisticated methods, but also logical organization.

Here, an overview of ‘behavioral research’ (writ large) at NIH is presented, focusing upon the common trinity of ‘alcohol, tobacco/nicotine and other drugs’ and programmatic overlap across entities.

Consideration is also given to the origins of institutes and their historical movement across organizational boundaries. Specific issues, concerns and advantages of integration of the National Institute on Drug Abuse and National Institute on Alcoholism and Alcohol Abuse are addressed.

It is concluded that advances in understanding, treating and preventing substance use disorders would best be served by (1) review and integration of all related research throughout NIH, (2) logical placement of leadership for this activity in a single institute, here entitled the National Institute on Substance Use Disorders, and (3) close collaboration of this institute with its complementary partner, the National Institute on Mental Health.

Thus, NIH can establish an organizational structure and collaborations reflecting the realities of the scientific and disease/health domains.

This would make a prominent statement to the world scientific and health communities regarding NIH recognition of the need for innovation (scientific and organizational) and focus upon these myriad interrelated and costly problems.

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Ethanol-mediated carcinogenesis in the human esophagus implicates CYP2E1 induction and the generation of carcinogenic DNA-lesions

Chronic alcohol consumption is a major risk factor for esophageal cancer. Various mechanisms may mediate carcinogenesis including the genotoxic effect of acetaldehyde and oxidative stress.

Ethanol exerts its carcinogenic effect in the liver among others via the induction of cytochrome P450 2E1 (CYP2E1) and the generation of carcinogenic etheno-DNA adducts.

Here we investigated if such effects can also be observed in the human esophagus. We studied non-tumorous esophageal biopsies of 37 patients with upper aerodigestive tract cancer and alcohol consumption of 102.3 ± 131.4 g/day (range: 15 – 600 g) as well as 16 controls without tumors (12 teetotalers and 4 subjects with a maximum of 25 g ethanol/day). CYP2E1, etheno-DNA adducts and Ki67 as a marker for cell proliferation were determined immunohistologically.

Chronic alcohol ingestion resulted in a significant induction of CYP2E1 (p=0.015) which correlated with the amount of alcohol consumed .

Furthermore, a significant correlation between CYP2E1 and the generation of the carcinogenic exocyclic etheno-DNA adducts εdA and εdC was observed.

Our data demonstrate for the first time an induction of CYP2E1 in the esophageal mucosa by ethanol in a dose dependent manner in man and may explain, at least in part, the generation of carcinogenic DNA lesions in this target organ.

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Density estimation and adaptive bandwidths: A primer for public health practitioners

Geographic information systems have advanced the ability to both visualize and analyze point data. While point-based maps can be aggregated to differing areal units and examined at varying resolutions, two problems arise 1) the modifiable areal unit problem and 2) any corresponding data must be available both at the scale of analysis and in the same geographic units. Kernel density estimation (KDE) produces a smooth, continuous surface where each location in the study area is assigned a density value irrespective of arbitrary administrative boundaries.

We review KDE, and introduce the technique of utilizing an adaptive bandwidth to address the
underlying heterogeneous population distributions common in public health research.

The density of occurrences should not be interpreted without knowledge of the underlying population distribution. When the effect of the background population is successfully accounted for, differences in point patterns in similar population areas are more discernible; it is generally these variations that are of most interest.

A static bandwidth KDE does not distinguish the spatial extents of interesting areas, nor does it expose patterns above and beyond those due to geographic variations in the density of the underlying population. An adaptive bandwidth method uses background population data to calculate a kernel of varying size for each individual case.

This limits the influence of a single case to a small spatial extent where the population density is high as the bandwidth is small. If the primary concern is distance, a static bandwidth is preferable because it may be better to define the “neighborhood” or exposure risk based on distance.

If the primary concern is differences in exposure
across the population, a bandwidth adapting to the population is preferred.

Kernel density estimation is a useful way to consider exposure at any point within a spatial frame,
irrespective of administrative boundaries. Utilization of an adaptive bandwidth may be particularly useful in comparing two similarly populated areas when studying health disparities or other issues comparing populations in public health (alcohol outlets).

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Tuesday, August 17, 2010

An Association Test for Multiple Traits Based on the Generalized Kendall’s Tau

In many genetics studies, especially in the investigation of mental illness and behavioral disorders, it is common for researchers to collect multiple phenotypes to characterize the complex disease of interest. It may be advantageous to analyze those phenotypic measurements simultaneously if they share a similar genetic mechanism.

In this study, we present a nonparametric approach to studying multiple traits together rather than examining each trait separately.

Through simulation we compared the nominal Type I error and power of our proposed test to an existing test, that is, a generalized family-based association test.

The empirical results suggest that our proposed approach is superior to the existing test in the analysis of ordinal traits.

The advantage is demonstrated on a dataset concerning alcohol dependence. In this application, the use of our methods enhanced the signal of the association test.

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Perception of alcohol intoxication shows acute tolerance while executive functions remain impaired.

Several psychological constructs (e.g., subjective perception of intoxication, visuomotor speed) display acute tolerance to alcohol, that is, show improvement at declining blood alcohol concentrations (BACs) relative to equivalent rising BACs.

However, methodological challenges emerge when attempting to make such comparisons across limbs of the BAC curve, which have proven a barrier to advancing research on acute tolerance.

To date, no studies have made multiple comparisons across the entire BAC trajectory.

This study employs experimental procedures that overcome some of these difficulties, offering a clearer picture of recovery of impairment for subjective perception of intoxication and cognitive performance and the relationship between them.

Twenty participants were assessed at multiple time points over 2 days. Continuous subjective perception of intoxication ratings and cognitive data derived from a computerized measure were paired with a novel analytic paradigm, which allowed comparisons at identified BACs.

Results showed acute tolerance for individuals' subjective perception of intoxication and for performance on cognitive tasks measuring visuomotor speed and learning efficiency (recovery from impairment).

In contrast, performance on measures of executive function and short-term memory showed no significant difference between limbs at exact concentrations (no recovery from impairment). Therefore, despite participants feeling less intoxicated over time, many cognitive functions remained impaired.

The implication for these findings in terms of drunken driving behavior are substantial, suggesting that people may be likely to drive once they subjectively perceive that they have recovered from the acute intoxicating effects of alcohol, despite the persistence of “higher order” cognitive impairments.

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Monday, August 16, 2010

Adolescent Propensity to Engage in Health Risky Behaviors: The Role of Individual Resilience

In this paper we create indices of resilience to identify adolescents at risk of smoking, drinking alcohol, and using illegal drugs.

Using data from the National Longitudinal Study of Adolescent Health, three manifestations of resilience were identified: overall-resilience, self/family-resilience, and self-resilience.

Our analysis reveals that the overall-resilient were less likely to engage in risky behaviors. The self/family resilient were more likely to engage in risky behaviors, but consumed less.

The self-resilient had reduced risk for smoking and drinking alcohol but elevated risk for using illegal drugs and being in an addictive stage of smoking and drinking, if participating.

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Moderate Alcohol Use and Cognitive Function in the Guangzhou Biobank Cohort Study.

Observational studies in Western settings show moderate alcohol use associated with better cognitive function, but they are vulnerable to contextual bias. Evidence from non-Western settings may be useful to verify causality. We examined such association in southern China where alcohol use is low.

We used multivariable linear regression in cross-sectional data from the Guangzhou Biobank Cohort Study to assess sex-stratified associations of alcohol use (never, occasional, moderate, heavy and former drinker) with delayed 10-word recall score for all 3 phases (N = 28,537) and Mini-Mental State Examination (MMSE) score in phase 3 (N = 9,571).

Delayed 10-word recall scores were higher in moderate drinkers compared with never drinkers among men (0.30 words, 95% confidence interval [CI]: 0.18 to 0.42) but not women (0.02; 95% CI: –0.12 to 0.17), adjusted for sociodemographic factors. Occasional alcohol users also had higher 10-word recall scores among men (0.27; 95% CI: 0.18 to 0.37) and women (0.30; 95% CI: 0.23 to 0.37). These estimates were little altered by further adjustment for cardiovascular risk factors. Results for MMSE scores were similar.

Alcohol may not drive the association between moderate use and better cognitive function, which instead may be due to confounding by general moderation in lifestyle.

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