Self Assessment of Warning Symptoms in Upper Gastrointestinal Bleeding

Dtsch Arztebl Int 2008; 105(5):73-7

Alcohol addicted patients are at increased risk of upper gastrointestinal bleeding. Delay to endoscopy is mainly determined by patients´ self assessment.

The authors asked 417 patients with high alcohol consumption from Leipzig (n = 277) and Munich (n = 140) with an average alcohol consumption of 660 g/week about their behaviour when faced with symptoms of acute upper gastrointestinal bleeding.

71% or 51% said they would call the emergency physician if they were to vomit blood or black liquid. Only 32% would call emergentcy medical aid if they were to pass black stools, and only 25% of those surveyed thought urgent medical attention necessary in any of the 3 scenarios. Patients with regular contact with health care providers, and women, were more likely to consider these 3 scenarios as medical emergencies. The authors found no differences by age, educational level, marital status and alcohol consumption.

Knowledge concerning the impact of symptoms of gastrointestinal bleeding was poor, in our study. Patients with high alcohol consumption and infrequent contact with health care providers, in particular, should be informed about symptoms such as melena and hematemesis, as delayed presentation significantly affects prognosis and resource consumption.

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Brazil alcohol ban hard for retailers to swallow
Government tries to limit TV advertising and sales along highways
By Andrew Downie | Correspondent of The Christian Science Monitor

from the February 19, 2008 edition

São Paulo, Brazil - A decade after it introduced some of the toughest antitobacco laws in the world, Brazil is proposing similar legislation aimed at curbing growing rates of alcohol abuse.

President Luiz Inacio Lula da Silva wants to prohibit daytime alcohol advertising on radio and television. His government temporarily banned the sale of alcohol on federal highways earlier this month and aims to implement similar measures at urban gas stations.
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Mapping Estimated County-Level Income and Binge Drinking Among California Men
Psychiatr Serv 2008 59: 138

The California Health Interview Survey (CHIS) (www.chis.ucla. edu) has been conducted biannually since 2001 and is the largest subnational household telephone interview survey in the United States. In 2005 there were completed responses for 43,020 adults, representing 29.7 million Californians. Among men, an estimated 3.2 million (24.7%) engaged in binge drinking.

We conducted an ecological study of CHIS’s estimated binge drinking rates per county and county group.

We asked whether aggregated estimates of individual demographic factors associated with nindividual binge drinking would explain some of the county-level variation in binge drinking rates. From the Web-based system, we extracted estimated binge drinking rates among specific demographic groups of men (less than 300% federal poverty level [FPL], 18–44 years, white, n postsecondary schooling, and married).
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The estimated percentage of men at less than 300% FPL was positively associated with the binge drinking rate at the county or countygroup level. The other four variables were not significant in the model.
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Using the same set of independent ariables, we found a positive multivariate relationship between the county- level percentage of lower-income men and the percentage of binge drinking among lower-income men.
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Figure 1 shows regional variation in income levels and the positive relationship between the percentage of men in a county with lower income and binge drinking rates among lower-income men.

The analyses and map are a unique application of available data that can be used to rapidly determine trends in health risks at county and state levels, which could inform prevention efforts.


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A possible role of social activity to explain differences in publication output among ecologists
Oikos, Online Early 8 Feb 2008


Publication output is the standard by which scientific productivity is evaluated.
Despite a plethora of papers on the issue of publication and citation biases, no study has so far considered a possible effect of social activities on publication output.

One of the most frequent social activities in the world is drinking alcohol. In Europe, most alcohol is consumed as beer and, based on well known negative effects of alcohol consumption on cognitive performance, I predicted negative correlations between beer consumption and several measures of scientific performance.

Using a survey from the Czech Republic, that has the highest per capita beer consumption rate in the world, I show that increasing per capita beer consumption is associated with lower numbers of papers, total citations, and citations per paper (a surrogate measure of paper quality). In addition I found the same predicted trends in comparison of two separate geographic areas within the Czech Republic that are also known to differ in beer consumption rates.

These correlations are consistent with the possibility that leisure time social activities might influence the quality and quantity of scientific work and may be potential sources of publication and citation biases.

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Summer Institute - Alcohol, Drugs and Addiction as a Global Problem
July 13 - July 25, 2008

Introduction

Courses, seminars and dialogues in Amsterdam on theories and concepts as they have been developed in the field of addiction studies. The Summer Institute on Addiction is an intensive two week summer programme, which focuses on the study of addiction across cultures and is taught by an international faculty team.

Professionals have the option to attend either one or both weeks.

The Institute welcomes individuals with a focused interest in addiction research and treatment, Master's and PhD students, NGO staff working on addiction-related issues, professionals in human services, practitioners, advocates and participants in other International School programmes.

Summer Institute Home Page

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Online Course - Drugs, Alcohol and Society

Course Title	Dates
JLS-303 N01L Drugs, Alcohol and Society	6/26/08-8/7/08
Instructor: Jeffrey Schaler

This course will examine the vailidity of ideas about addiction and their implications for public, social, clinical, and legal policy. In addition, it will examine in detail conflicting types of treatment for addiction, the efficacy of addiction treatment in general, First Amendment issues and court-ordered addiction treatment, criminal responsibility, Alcoholics Anonymous and religious-conversion experience, use of mind-altering drugs as religious activities and the ethics of attempts to protect people from themselves advanced by today's public health movement.

Distance Education at American University
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Change factors in depression and substance use treatment: a longitudinal integrative model
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 64 - 83


While psychotherapy efficacy has been largely supported, patient change processes across time are still less clear. This is specially true for complex clinical populations, such as dually diagnosed individuals.

A Latent Growth Model was tested to describe change in depression and substance use in patients from two Randomized Clinical Trials (RTCs). The model tested the impact of the alliance and four evidence-based change principles as predictors of symptomatic change during treatment and follow-up, in addition to advancing the premise that initial treatment matching to non-diagnostic patient characteristics improved the quality of the therapeutic alliance.

A good fit was found for a quadratic change function for both outcome measures, that is, symptoms decreased in a curve shape followed by a small increase. Full predictive models yielded acceptable fit. Patients high on subjective distress at treatment-entry benefited from affective-focused interventions in terms of their substance use. Matching patient coping style (externalizing vs. internalizing) with treatment focus (symptom change vs. insight-oriented) predicted a better alliance.

Effects of both relationship and interventions were found, as well as their interplay.


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Differences in mental health, substance use, and other problems among dual diagnosis patients attending psychiatric or substance misuse treatment services
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 54 - 63


The study investigates differences in dual diagnosis disorders among patients in psychiatric and in substance use treatment services.

Important clinical differences were found between dual diagnosis patients in psychiatry and substance use treatment services. Dual diagnosis patients in psychiatry services were more likely to have a psychotic illness: those in the inpatient psychiatry service had the most severe mental health problems, and were exposed to the greatest risks to their safety. Psychiatric outpatients were least likely to have an alcohol dependence disorder, although a high rate of drug use disorders (mainly involving cannabis) was found among the psychiatric inpatients. High rates of affective disorders and suicide risk were found among patients in all treatment services.

The term 'dual' diagnosis can be misleading. Dual diagnosis patients present with complex mental health, physical health, psychosocial disability, and safety needs, and the pattern of problems presented by dual diagnosis patients varies across different treatment services.

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Request Reprint E-Mail: v.manning@iop.kcl.ac.uk
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Treatment issues with substance use disorder clients who have mood or anxiety disorders
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 44 - 53



Co-occurring substance use and mental health disorders may complicate the impact of treatment. Oftentimes, substance treatment practitioners are not prepared to deal with both issues and may focus primarily on substance use disorders while the untreated mental health issues dilute treatment effectiveness. Research has yet to identify an effective treatment approach for clients with more severe substance use and less severe mental health problems.

To review the treatment literature and uncover the evidence base for clients who have more severe substance use and less severe mental health problems.

We identified 45 studies that met our criteria for inclusion and reviewed them for common themes and variations.

Based on this review of literature, the evidence supports concurrent or integrated treatment for clients with co-occurring substance use and mood or anxiety disorders. Substance treatment practitioners should anticipate that many of their clients have co-occurring disorders, screen for these, and plan on providing comprehensive treatment.

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Request Reprint E-Mail: james-a-hall@uiowa.edu

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When dual diagnosis means no diagnosis: co-occurring mental illness and problematic drug use in clients of alcohol and drug services in eastern metropolitan Melbourne
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 33 - 43


Most previous studies examining the prevalence of co-occurring psychiatric illness and problematic substance use in Australia have been population studies or focused on clients of psychiatric services. There is little literature on the prevalence of psychiatric disorders in persons attending Alcohol and Drug Services (ADS).

This study attempted to estimate the incidence of mental health disorders in people treated at two ADS in Melbourne and to describe the mental disorders with which they present.

Psychiatric diagnoses were recorded in 42% of client records but rarely substantiated by further documentation. The most common diagnoses were mood disorders (31.5%). Only 4.9% clients were diagnosed with drug-induced psychosis. Personality disorders were not recorded. While 52.7% of clients were documented as receiving psychotropic medication (other than benzodiazepines), 29.3% of those had no documentation of a psychiatric diagnosis. Twenty-three per cent of clients had documented involvement with a Psychiatric Service.

An overall prevalence of 60% could be inferred by combining indicators from the records. Previous studies have suggested that recording of substance use in psychiatric histories is notoriously poor. This study indicates that the reverse is true, that is, psychiatric problems are poorly documented in ADS histories. Thus, the true prevalence of the problem is likely to be significantly underestimated.


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The views of consumers and frontline workers regarding coordination among addiction and mental health services
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 21 - 32


Increasing co-ordination among addiction and mental health services is often recommended to improve service delivery for people with co-occurring addiction and mental health disorders.

Regarding their experiences in the addiction and mental health systems, and the development of a model of co-ordination in their community, this study compares the views of 16 consumers and 26 frontline workers to the current literature.

Consumers and frontline workers placed a higher priority on training workers and providing consumers with a welcoming place to go than on co-ordination. Consumers expressed concern about workers sharing client information. Consumers underscored the importance of peer support groups, and the formal system facilitating the development and maintenance of peer supports. Consumers offered suggestions for how the systems could more effectively obtain their input while frontline workers demonstrated disinterest in participating in planning initiatives.

Several of the findings are not reflected in the current literature. Funders and agencies might benefit from obtaining input from their local consumers and frontline workers as their views could influence the focus of community initiatives. Recommendations for future research are provided.

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Request Reprint E-Mail: kcalder@uwindsor.ca
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Dual diagnosis in inpatient physicians: prevalence and clinical characteristics
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 10 - 20



Despite evidence of dual diagnosis (DD) in impaired physicians, few studies have investigated its prevalence and clinical characteristics.

To assess the prevalence and clinical characteristics of DD in a sample of inpatient physicians and to compare physician patients with DD to other inpatient physicians.

60 (20.6%) patients had DD, with the most common form of co-occurring disorders being alcohol dependence with mood disorder (46.4%). DD patients were more likely to be male. DD patients were more similar to patients with substance use disorders with regards to demographic variables and antisocial personality traits, but were more similar to patients with only a psychiatric disorder concerning severity and avoidant traits.

DD is a major cause of impairment in physicians and is associated with particular clinical and demographic characteristics. DD in physicians deserves attention to improve early detection, prevention and treatment strategies.


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Moving away from medicalised and partisan terminology: a contribution to the debate
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 2 - 9



There is a growing awareness within both mental health and substance misuse services of the importance of co-existing problems. Clients with these co-existing problems impact upon a wide range of professionals, and often present major challenges due to their complex needs.

However, there is confusion about both terminology, and many of the underlying and treatment issues, related to these co-existing problems.

This paper examines some of these confusions and debates, arriving at the view that practice in the field will be enhanced by the adoption of a broad and inclusive definition of co-existing problems which avoids medicalised terminology such as 'dual diagnosis' or 'co-morbidity'. We argue that the term 'co-existing mental health and drug and alcohol problems' is consistent with a case formulation driven approach and adoption of this term will thus enhance practitioners' confidence in the detection, assessment and treatment of co-existing problems.

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ACUTE ALCOHOL INTOXICATION POTENTIATES NEUTROPHIL-MEDIATED INTESTINAL TISSUE DAMAGE AFTER BURN INJURY.
Shock. 29(3):377-383, March 2008.

This study examined whether acute alcohol (EtOH) intoxication before burn injury potentiates postburn intestinal tissue damage and whether neutrophils have any role in the damage under those conditions.

Male rats (~250 g) were gavaged with EtOH to achieve a blood EtOH level of approximately 100 mg/dL or with saline and received either approximately 12.5% or approximately 25% total body surface area (TBSA) burn or sham injury. Rats were killed at 4 or 24 h after injury, and various parameters were measured.

As compared with sham animals, burn injury alone (regardless of size) resulted in a significant increase in intestinal tissue myeloperoxidase (MPO; an index of neutrophil infiltration) activity and IL-18 levels 4 h after injury. Furthermore, rats receiving 25% TBSA, but not 12.5%, burn exhibited intestine edema. The IL-18 and MPO activity were normalized at 24 h after injury in rats receiving 12.5% TBSA burn, whereas these parameters remained elevated at 24 h in rats with 25% burn.

The presence of EtOH in rats at the time of burn injury exacerbated the levels of IL-18, MPO activity, and edema at 4 and 24 h after burn injury. Treatment of rats with anti-IL-18 antibodies or with antineutrophil antiserum prevented the increase in the above parameters after EtOH and burn injury, except that the depletion of neutrophils did not prevent the IL-18 increase.

In summary, these findings suggest that acute EtOH intoxication exacerbates postburn intestinal tissue damage after burn injury, and that it is, in part, neutrophil mediated.


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Reprint Request E-Mail: schwacha@uab.edu
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The Dose-Response Relationship of Adolescent Religious Activity and Substance Use: Variation Across Demographic Groups
Health Education & Behavior, Vol. 35, No. 1, 22-43 (2008)

This article addresses two inconsistent findings in the literature on adolescent religious activity (RA) and substance use: whether a dose-response relationship characterizes the association of these variables, and whether the association varies by grade, gender, ethnicity, family structure, school type, and type of substance.

Multinomial logistic regression analyses of a large, diverse data set of high school students in metropolitan Columbus, Ohio ( n = 33,007), found marked differences in alcohol, marijuana, and cigarette use among youths who never, occasionally, or regularly participated in RA.

Weekly RA was consistently associated with less substance use, yet occasional RA sometimes was associated with greater use.

Four groups accounted for variations in the RA-substance use relationship: African American youths, younger White youths, 12th-grade White males, and 12th-grade White females.

Researchers should avoid assuming the RA-substance use relationship is dose-response and consider the implications of this complexity for theory and practice.

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GLOBALIZATION AND HEALTH SESSIONS

American Public Health Association

135^th APHA Conference, Washington, DC Nov. 3-7, 2007

4289.0: Alcohol industry 101: Understanding the major players, Michele Simon, JD, MPH,

Michele Simon micheles@marininstitute.org

Download presentation ( Powerpoint)

Global Trade Events at APHA November 2007

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Quantitative chiral analysis of salsolinol in different brain regions of rats genetically predisposed to alcoholism
Journal of Chromatography B, Article in Press, Corrected Proof 17 Jan 2008


A method to determine the catecholamine content in putamen (CPU) and midbrain (MB) regions of the brain of alcohol-preferring rats (P) is presented with a focus on the low-level detection of S,R-salsolinol, a metabolite of dopamine and a putative alcoholism marker.

The developed strategy allows both quantitative profiling of related catecholamines and the enantiomeric separation and quantification of the S- and R-salsolinol isomers and their ratios. The described LC/MS strategy simplifies the current methodology that typically employs GC–MS by eliminating the need for derivatization.

The data also suggest an increase in the non-enzymatic formation of salsolinol as a consequence of ethanol exposure.

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The Price of Alcohol: A Consideration of Contextual Factors
Alcoholism: Clinical and Experimental Research 30 (10) , 1734–1742


The current study considers the determinants of prices charged for alcoholic beverages by on-premise and off-premise outlets in Alaska.

Alcohol outlet densities, a surrogate measure for local retail competition, are expected to be negatively associated with prices while costs associated with distribution are expected to be positively related to prices. Community demographic and economic characteristics may affect observed local prices via the level of demand, retail costs borne by retailers, or the quality of brands offered for sale.

Outlet density per roadway mile was unrelated to price for both on- and off-premise establishments, either across or between beverage types. In contrast, overall distribution costs did appear to be related to alcohol price. The demographic and economic variables, as a group, were significantly related to observed prices.

More attention needs to be directed to the manner in which sellers and buyers behave relative to alcoholic beverages. Alcohol demand remains responsive to prices; yet, consumers have considerable latitude in determining the price that they pay for alcohol.

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Acute Alcohol Tolerance Is Intrinsic to the BK_Ca Protein, but Is Modulated by the Lipid Environment
J. Biol. Chem., Vol. 283, Issue 8, 5090-5098, February 22, 2008


Ethanol tolerance, in which exposure leads to reduced sensitivity, is an important component of alcohol abuse and addiction. The molecular mechanisms underlying this process remain poorly understood.

The BK_Ca channel plays a central role in the behavioral response to ethanol in Caenorhabditis elegans and Drosophila .

In neurons, ethanol tolerance in BK_Ca channels has two components: a reduced number of membrane channels and decreased potentiation of the remaining channels .

Here, heterologous expression coupled with planar bilayer techniques examines two additional aspects of tolerance in human BK_Ca channels. 1) Is acute tolerance observed in a single channel protein complex within a lipid environment reduced to only two lipids? 2) Does lipid bilayer composition affect the appearance of acute tolerance?

We found that tolerance was observable in BK_Ca channels in membrane patches pulled from HEK cells and when they are placed into reconstituted 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphatidylethanolamine/1-palmitoyl-2-oleoyl-sn-glycero-3-phosphatidylserine membranes. Furthermore, altering bilayer thickness by incorporating the channel into lipid mixtures of 1,2-dioleoyl-3-phosphatidylethanolamine with phosphatidylcholines of increasing chain length, or with sphingomyelin, strongly affected the sensitivity of the channel, as well as the time course of the acute response.

Ethanol sensitivity changed from a strong potentiation in thin bilayers to inhibition in thick sphingomyelin/1,2-dioleoyl-3-phosphatidylethanolamine bilayers.

Thus, tolerance can be an intrinsic property of the channel protein-lipid complex, and bilayer thickness plays an important role in shaping the pattern of response to ethanol. As a consequence of these findings the protein-lipid complex should be treated as a unit when studying ethanol action.

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Request Reprint E-Mail: Steven.Treistman@umassmed.edu
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News Release - Researchers at Guze Symposium to explore links between alcohol and suicide

By Jim Dryden

Feb. 15, 2008 -- Experts in alcoholism and suicide from around the United States will present their research Feb. 21 at the 8th Annual Samuel B. Guze Symposium on Alcoholism at Washington University School of Medicine in St. Louis. This year's event focuses on "Alcohol, Suicide and Suicidality."
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