Health Status and Access to Care for Homeless Adults with Problem Alcohol and Drug Use

Problem alcohol and drug use by adult homeless persons may put them at higher risk for other health problems and impact their access to health care. The purpose of this study was to determine if those with a positive screen for problem alcohol or drug use were at increased odds for having a lower health status and less access to care than those without problem alcohol or drug use. This was a secondary analysis of health survey data from a study related to the health of homeless adults. The survey included the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screening Test 10 (DAST-10) for evaluating problem substance use; health related quality of life, health care utilization, and medical history were also included. The impact of problem alcohol use or drug use on the odds of reporting lower general health status, a history of physical or mental illness, use of the emergency department (ED), and problems getting health care when needed, were estimated using logistic regression. A total of 112 adult homeless participants completed the survey. Participants with problem alcohol use tended to be less likely to obtain health care when needed (OR = 2.3, p = 0.05). Those with problem alcohol or drug use were not at increased odds of reporting a lower general health status, a positive medical history, or ED use. Problem alcohol use was associated with decreased access to health care when needed. Screening for problem alcohol use among homeless adults may not only help to identify those in need of interventions related to alcohol use but also help to identify those in need of help in accessing general health care.     

Recent developments in meconium and hair testing methods for the confirmation of gestational exposures to alcohol and tobacco smoke

The use of alcohol and tobacco is prevalent among pregnant women despite the well-known adverse effects of these substances imposed on the developing fetus and immense public health education efforts. Confirmation of gestational exposures to these compounds have relied mostly on maternal self-reporting, which is often underestimated because of guilt, embarrassment, and fear of punitive action. The presence of fatty acid ethyl esters in various biological matrices as a result of alcohol consumption initiated the development of neonatal screening tests for these emerging biological markers in meconium and hair. The levels of nicotine and cotinine in hair have long been used as objective indices for the quantification of exposure to active and passive smoking. Maternal segmental hair analysis in the study of pharmacokinetic changes in nicotine metabolism in the obstetric population is a novel application of this traditional analytical method. The latest developments and novel applications of meconium and hair testing for the confirmation of prenatal alcohol and tobacco exposure are discussed in this review.     

The Association of Family and Peer Factors with Tobacco, Alcohol, and Marijuana Use Among Chilean adolescents in Neighborhood Context

Research on adolescent use of substances has long sought to understand the family factors that may be associated with use of different substances such as alcohol, tobacco and marijuana. However, scant attention has been focused on these questions in Latin American contexts, despite growing concerns about substance use among Latin American youth. Using data from a sample of 866 Chilean youth, we examined the relationship of family and neighborhood factors with youth substance abuse. We found that in a Latin American context access to substances is an important predictor of use, but that neighborhood effects differ for marijuana use as opposed to cigarettes or alcohol. Age of youth, family and peer relationships, and gender all play significant roles of substance use.The study findings provide additional evidence that the use of substances is complex whereby individual, family, and community influences must be considered jointly to prevent or reduce substance use among adolescents.     

双相情感障碍共病酒精使用障碍患者的临床特征及影响因素

【目的】分析双相情感障碍患者共病酒精使用障碍患者的临床特征及其影响因素。【方法】以河北省精神卫生中心住院的双相情感障碍患者为研究对象,根据是否共病酒精使用障碍将其分为共病组(n=51)和非共病组(n=97)。以美国精神障碍诊断与统计手册-第5版修订版(DSM-5)为诊断标准,对研究对象进行再次诊断。同时采用一般情况调查表、应对方式问卷对研究对象进行调查并进行相关因素分析。【结果】共病组与非共病组在性别、受教育程度、家庭关系、职业、病前性格、嗜酒家族史、起病形式等方面存在差异(P<0.05)。在各种风险评估方面,共病组冲动行为及自伤行为均高于非共病组,差异有统计学意义(P<0.05)。共病组应对方式采用解决问题的评分低于非共病组,而采用自责的应对方式评分高于较非共病组高,差异均有统计学意义(P<0.05)。非条件多因素Logistic回归分析,结果显示男性、有冲动行为、急性及亚急性起病是共病酒精使用障碍的危险性因素(P<0.05);而小学及以下、高中/中专受教育程度、工人、农民、病前性格内向是共病酒精使用障碍的保护性因素(P<0.05)。【结论】住院双相情感障碍患者共病酒精使用障碍的比例不低,共病患者较少采用解决问题的应对方式,发生冲动行为风险较高。     

Alcohol Screening in the Acute Care Hospital

Many people admitted to the acute care hospital routinely use alcohol. Their patterns of drinking may vary widely from being low risk to hazardous. It is known that alcohol plays a part in the etiology of some illnesses and adds risk of further morbidity with the development of withdrawal symptoms. Conducting alcohol screening on patients admitted to the hospital cues the nurse to identify those patients in jeopardy of alcohol withdrawal syndrome. Nurses can be proactive in planning interventions for their patients. Early recognition and a timely response can facilitate healing and form an environment that is caring, protective and respectful of the patient's needs.     

Alcohol dependence and depression: advance practice nurse interventions

PURPOSE: To identify alcohol dependence, depression, and their comorbidity as common health problems in the United States. To emphasize advance practice nurse (APN) interventions including screening, treatment, and outcome evaluations for individuals and their families suffering with alcohol dependence and depression. DATA SOURCES: Scientific literature on alcohol dependence, depression, and their comorbidity as well as general systems theory. CONCLUSIONS: APNs have the opportunity to successfully intervene with individuals and their family with alcohol dependence, depression, and their comorbidity. These complex health conditions need to be screened for, treated, and evaluated to ensure positive outcomes for the individual and their family system. IMPLICATIONS FOR PRACTICE: APNs are in an excellent position to intervene at every contact with the individual and family with alcohol dependence and depression. Interventions aimed at the individual and family system are detailed in order to assist the individual and family to optimal health.     

“5·12”地震后绵阳市新生儿先天性心脏病发病率及危险因素分析

目的了解绵阳地区＂5·12＂地震后新生儿先天性心脏病（CHD）发病情况,探索可能的危险因素。方法采用心脏听诊、呼吸评定、血氧饱和度测定和心脏彩色多普勒超声对绵阳地区2011年12月-2012年12月出生的5 536例新生儿行CHD筛查,对确诊病例采用病例对照研究方法进行分析。结果共筛查出CHD患儿65例,其发病率为11.74‰。发病前3位依次是室间隔缺损、房间隔缺损和动脉导管未闭。CHD发生的可能危险因素依次为：CHD家族史、母孕早期感染史、母孕期用药及饮酒史、高龄产妇和父母吸烟史,而父母地震经历史未显示与CHD相关。结论父母地震经历与CHD的发生无关。孕前加强相关健康知识宣教、避免或减少相关危险因素暴露可降低CHD发病风险。新生儿时期CHD筛查可早期发现CHD,并为后续的随访干预提供宝贵时机,降低病死率,提高患儿生命质量。     

Use of Drugs,Tobacco, Alcohol and Illicit Substances in a French Student Population

ObjectiveTo investigate perceived health status and prevalence of drug use, tobacco smoking, consumption of alcohol and illicit substances in a student population.MethodsData were obtained from an anonymous questionnaire distributed to first-year students of the Toulouse University. Collected data concerned socio-demographic characteristics, perceived health status, and consumption of tobacco, alcohol, illicit substances and drugs.ResultsFifty seven percent of the 3 561 responders declared to have taken at least one drug during the week preceding the questionnaire. Most commonly Anatomical, Therapeutic and Chemical (ATC) classes used were genito-urinary system and sex hormones (29.6%), nervous system (16.4%) and alimentary tract and metabolism (14.1%). Twenty three percent of students were smokers. Differences according to health perception were found for tobacco and cannabis consumption. Anxiety was significantly more prevalent among students reporting that they did not consume alcohol (p < 0.05)ConclusionMore than half of students use drugs. Other consumptions (tobacco, alcohol and illicit substances) are related with perceived health status.     

Alcohol and pregnancy--embryopathy and alcohol effects

Fetal alcohol syndrome (FAS) is a specific polydystrophic pattern of malformations with the following diagnostic criteria: 1. Maternal alcohol dependence or alcohol abuse during pregnancy. 2. Pre- and postnatal deficiency of growth in weight, height and head circumference. 3. Multiple minor and major anomalies recognizable mainly at a typical face. 4. Structural injuries and changes at the central nervous system with complex brain dysfunction combining elements of cognitive impairments, behavioral disturbance and neurological damage. Fetal alcohol effects (FAE) or so-called "alcohol-related neurodevelopmental disorders" (ARND) with predominant neurotoxic effects and a large spectrum of cerebral dysfunctions are manifold more frequent than the full-blown FAS. These remain mostly unrecognized, overlooked and they are difficult to be diagnosed, the symptoms being unspecific. Alcohol in pregnancy is nowadays the most important and the most frequent toxic substance for the embryo and the fetus and one of the most frequent causes of mental retardation. The longlasting and irreversible consequences refer to school development, social maturation, social behaviour and later life-style. The diagnosis is based on the careful maternal history and on the clinical findings; there are no biochemical parameters of assessment. The risk of addiction development in these children is assumed to be more than 20 percent.     

PS1-01: Alcohol and Drug Use Among Chronic Opioid Therapy Patients

Background/Aims Opioid misuse and abuse is a significant public health problem, and there is a need to better identify at-risk individuals. Study aims were to examine patient characteristics associated with alcohol and other drug (AOD) use and aberrant drug related behaviors in chronic opioid therapy (COT) patients. Methods We conducted a telephone survey of a random sample of 972 COT patients in an integrated health care delivery system in 2009. Measures included weekly alcohol use and any illicit drug use in the last three months, and a composite measure of alcohol-only use, drug-only use, both alcohol and drug use, and tobacco only use. We conducted weighted multivariate logistic regressions models of AOD use and of aberrant drug-related behavior. Results Fourteen percent were weekly alcohol users (134/972), 16% used illicit drugs (157/972), 9% (83/972) used both alcohol and drugs, 8% used only drugs (74/972), 34% (334/491) used only alcohol, and 50% (481/972) did not use any substances. Multivariate models indicated illicit drug use was associated with a higher likelihood for weekly alcohol use, while being female, a higher daily opioid dose, and greater pain severity was associate with a lower likelihood of weekly alcohol use. Tobacco use, weekly alcohol use, depression symptoms, being male, and middle age was associated with a higher likelihood of illicit drug use. For aberrant drug related behaviors, drug-only use and both alcohol and drug use (compared to no AOD use) were associated with a higher likelihood of receiving opioids from friends or family in the last year, as were postive depressive symptoms and younger age. Both AOD use and depression symptoms were associated with a higher likelihood of giving opioids to others, while a high daily dose was associated with a lower likelihood of giving opioids to others, compared to the lowest dosage. Polysubstance use gender, and depression were risk factors in this sample. Post hoc analyses of primary care utilization indicated that those with high dosage opioids were more likely to have a certain threshold of primary care visits in the last year, suggesting there is an opportunity to manage these high risk patients.     

Alcohol consumption and related problems: Treatment and policy responses in Nigeria

Although Nigeria has a long history of alcohol production and consumption, recent increase in availability and marketing of alcohol is correlated with heavy drinking and associated health and social problems. Responses to alcohol consumption and related problems have been tepid due to lack of written policy, poor implementation of existing control measures and subversion of regulation by alcohol companies. Efforts should be made to codify evidence-based control measures into policy and to strengthen political commitment towards their implementation. Early identification and intervention on alcohol problems should be integrated into the primary healthcare system and health workers should be trained in screening and intervention in alcohol problems. Furthermore, access to treatment for alcohol use disorder should be improved through the establishment, staffing and equipping of more mental health facilities throughout the country.     

Alcohol Use in the Elderly and the Risk for Wernicke-Korsakoff Syndrome

Two diseases linked with alcohol-related brain damage are Wernicke's encephalopathy (WE) and Korsakoff syndrome (KS) or psychosis, also referred to as Wernicke-Korsakoff syndrome (WKS). Thiamine deficiency is the underlying etiology for alcohol-related WKS. Persons older than 65 who have consumed alcohol at levels exceeding recommendations over a long period, even without a diagnosis of alcohol dependence, are at risk for WKS. Obtaining an alcohol-use history from people over 65 is essential to preventing WKS. The main purpose of this article is to provide the nurse practitioner with strategies for identifying persons over 65 at risk for alcohol-related thiamine deficiency, including screening for alcohol use and obtaining an alcohol-use history. This is followed by a review of the role and physiology of thiamine, laboratory tests that can be used to screen for thiamine deficiency, and prevention and early treatment.     

Alcohol consumption as a risk factor for esophageal adenocarcinoma in North China

The incidence of esophageal adenocarcinoma has been rising in many countries, while esophageal squamous cell carcinoma has remained stable or even declined in the same populations over the identical periods. These differences in trends indicate that these cancer subtypes may have a different etiology, which may be caused by lifestyle factors such as alcohol consumption and cigarette smoking. Therefore, a matched case-control study to clarify the risk factors of alcohol and tobacco intake on the development of esophageal adenocarcinoma was collected in Hebei Province of China. The life expectancy of the study area was around 70 years old. In the present study, 98 patients younger than 65 years who were diagnosed with esophageal adenocarcinoma and had initial surgeries (cases) were matched with 294 healthy adults (controls) at a ratio of 1:3 according to sex and age. We found the proportions of drinkers and smokers among cases were 48.0% and 60.2%, respectively, versus 21.2% and 43.5% among controls. Univariate conditional logistic regression analyses revealed that the odds ratios (ORs) showed a nearly monotonic increase for the duration of alcohol consumption and duration of tobacco smoking. Multivariate conditional logistic regression analysis indicated that only alcohol consumption was a significant risk factor for esophageal adenocarcinoma. Additional analysis of the combination of amount and duration of alcohol consumption indicated that heavy drinkers (> 30 ml/day) had significantly higher ORs, irrespective of the duration of alcohol consumption. In conclusion, heavy alcohol consumption increases the risk for esophageal adenocarcinoma independent of the duration of such consumption.     

Polydrug use during pregnancy and neonatal outcome: Data from a ten-year retrospective French study

ObjectiveTo analyse the modalities and consequences of multiple drug use during pregnancy.Methods170 neonates whose mothers declared using at least two psychoactive substances, in a French hospital, between 1999 and 2008 were studied. Data was obtained from obstetrical, neonatal and addiction file records.ResultsThe identified mothers used on average three products at delivery, mostly tobacco, opiate substitution treatment, cannabis, alcohol and benzodiazepines. The birth cohort effect was very marked. The women using more than four substances experienced significantly more pregnancy terminations in their lives. Their newborns showed significant differences in terms of preterm births (31.3% < 37 weeks), birth weights, sizes and neonatal abstinence syndromes (37.5% had a Lipsitz score >9). They were twice as likely to be taken into foster care. Long hospitalisations were three times more frequent for them (32.8% duration >30 days).ConclusionMultiple drug use in pregnancy is a risk factor resulting in poor outcome whatever the combination of substances.     

PS2-40: Do Women Really Smoke and Drink During Pregnancy: A Detailed Look into Cleaning the Smoking and Alcohol Variables

Background In many epidemiologic studies smoking and alcohol are often examined as an exposure variable when focusing on health conditions associated with these lifestyle factors. Furthermore, smoking and alcohol have almost become standard confounding variables in epidemiologic studies when examining other exposures. We highlight the challenges associated with cleaning and analyzing the smoking and alcohol variables within various sources of administrative data when conducting pregnancy studies. Methods We compared information on smoking and alcohol use among pregnant women from the VDW vitals table, social history table, and birth certificate data from Georgia State. Encounter data for smoking from the social history table was cleaned based the contact dates and quit dates falling within the pregnancy period and various combinations of 'yes', 'no', and 'quit' were examined based on these dates. Categories of smoking were created and compared to data in the VDW and on birth certificates. Similarly, we examined information on alcohol use during pregnancy from the social history table, including information reported in the 'alcohol comment' field. Results (more detailed results will be available at the time of the conference):We found inconsistencies in how smoking during pregnancy was reported in birth certificate data versus the social history table. However, this inconsistency was only among smokers and former smokers, whereas information for non-smokers was consistent across the different sources. Within the social history table there were many pregnant women that had 'yes' for the 'drink alcohol' field, however many of these women had information in the 'alcohol comment' field stating that they did not drink during pregnancy. After creating levels of alcohol use during pregnancy we found inconsistencies with information on the birth certificate. Conclusions While it is important to assess smoking and alcohol during pregnancy for the purposes of either a confounding variable or an exposure variable. We highlighted how these two variables (one from the VDW) are inconsistent across various data sources and both variables must be used with caution. NOTE: In order to present these data we feel a presentation is more suitable than a poster.     

Factors in Childhood Drug and Alcohol Use: A Review of the Literature

TOPIC. Drug and alcohol use in children.
PURPOSE. To identify the prevalence of drug and alcohol use in children 12 and younger and the factors associated with this use.
SOURCE. A review of the literature.
CONCLUSIONS. The identified factors include: a) dijferences in use between boys and girls; b) influence of family members' drug and alcohol use; c) influence of peers; d) the child's self-esteem; and e) the child's knowledge about drug and alcohol use. Awareness by child psychiatric nurses of the identified factors is crucial to prevent, assess, and treat the problem of drug and alcohol use by children.     

Reproductive Risks of Alcohol and Illicit Drugs: An Overview

Some studies suggest that alcohol and illicit substance abuse has an adverse effect on behavior, sexual performance, and reproduction. The aim of the paper is to present an overview of the effects of substance abuse and its risks for reproduction. Alcohol abuse is associated with high-risk behaviors and individuals who abuse alcohol are at risk for sexually transmitted infections and unwanted pregnancy. The primary concern of alcohol misuse in pregnancy is its teratogenic potential result that can in fetal alcohol syndrome and potential miscarriage. Cocaine is associated with perinatal complications and spontaneous abortion following maternal abuse during pregnancy and other risky behaviors. Cannabis also is associated with perinatal complications such as miscarriage, intrauterine growth restrictions, abruptio placentae, pre-term delivery, and neurobehavioral abnormalities. A preventative approach needs to be implemented in order to reduce the risks associated with substance abuse and to provide minimal interventions at primary and community care settings.     

Predicting Teenage Beliefs Concerning the Harm Alcohol and Cannabis Use may do in Eight European Countries

Data are from the European School Survey Project on Alcohol and other Drugs (ESPAD) in eight countries (Sweden, United Kingdom, France, Malta, Slovenia, Hungary, Bulgaria, and the Czech Republic) in spring 2003. Two scales were constructed, measuring beliefs that alcohol and cannabis harm people. Relationships of these scales with measures of parental control, parental attitudes, respondent's own drug use, friend's drug use, and gender were assessed within each country. Both at the country and the individual level, subject's own drug use showed strong inverse relationships with risk perceptions. Parental control and parental attitudes also showed associations with risk perception but these seemed largely mediated by the parental influence on subject's own use and by choice of friends. In countries with low prevalence of drug use the extent to which the predictor variables accounted for risk perceptions was lowest. Also the predictor variables showed greater associations with cannabis risk perception than with alcohol risk perception. For cannabis the explained variance in risk of harm varied from 8.1% in Sweden to 30.4% in the Czech Republic. For alcohol harm this range was from 3.1% in Bulgaria to 15.1% in Malta.     

PS1-07: PSA Test Use in Primary Care

Background/Aims Some professional organizations advocate for PSA testing to screen for prostate cancer while others recommend against it. Regardless of position, each advocates for consideration of individual risk factors and for patients to consult with their physician when deciding. We describe men's use of PSA testing around the time of a periodic health examination (PHE), whether test use varies by patient risk factor status, and the extent to which PSA testing occurs following patient-physician discussion of PSA testing, prostate cancer, or both. Methods Physician and patient subjects were enrolled in an observational study of patient-physician decision making in primary care. Physicians were salaried, general internal and family medicine physicians. Patients were insured, aged 50-80 years, without a history of prostate cancer, and due for colorectal cancer screening at the time of an audio-recorded office visit between 2007-2009. Office visit recordings were joined with data from pre-visit patient surveys and automated laboratory data for the 6 prior and 8 subsequent weeks. Content of patient-physician discussions was coded with a structured coding worksheet (mean Cohen's Kappa = 0.77). Generalized estimating equations were used to evaluate associations among patient-physician screening-related talk, patient risk factors, and PSA use. Results Among N=161 study-eligible men, just over half (53%) presented with at least one risk factor: 11.2% family history; 29.2% aged 65+; and 21.2% black. Eighty-one percent used PSA testing around the time of their PHE (8.3% prior and 72.7% subsequent to visit). Test use did not differ significantly by risk factor status: family history, 94.4% vs. no family history, 79.4%, (p=0.13); aged 65+, 85.1% vs. aged <65, 79.8% (p=0.39); and blacks, 76.5% vs. whites, 82.7%(p=0.49). Prostate cancer, PSA testing, or both was mentioned during 82% of visits: 34.8% mentioned prostate cancer and 79.5% PSA testing. Among men tested subsequent to visit, these percents were 92.9%, 35.0% and 89.3%, respectively. Discussion PSA testing is common among men who schedule a PHE, regardless of risk factor status. Furthermore, 7% of men who receive PSA testing subsequent to their PHE, do so in absence of any mention of prostate cancer or PSA screening during the visit.     

Alcohol Use among Subcritically Injured Emergency Department Patients

Objectives: To determine the incidence of alcohol use in subcritically injured patients presenting to the ED, by using a saliva alcohol test (SAT) at ED triage during the ED initial assessment; to compare the incidence of alcohol use revealed by the SAT with documentation of alcohol use by ED nurses and emergency physicians (EPs) blinded to the SAT results; and to describe the demographics of the SAT-positive, subcritically injured population.
Methods: A blinded, prospective, observational evaluation of ED patients presenting with subcritical injuries was performed. The patients were tested for alcohol use with an SAT, and a subsequent record review was conducted for extraction of demographic data and evidence of documentation of alcohol use by ED nurses and EPs blinded to the SAT results.
Results: During the study. 791 subcritically injured patients had SATs performed. Twenty-one percent of these patients were found to be alcohol-positive by SAT. Either the ED nurse or the EP documented a clinical impression of alcohol use for 52% of the SAT-positive patients. There were higher SAT-positive rates among men (24%), victims of assault (47%), and patients arriving at night (41%).
Conclusions: While the SAT identified 21% of the subcritically injured patient population as alcohol-positive, ED nurse and EP documentation did not identify half of these alcohol-positive patients. Many of these patients may be at risk for additional injuries related to their drinking behavior.