我国八家医院精神科与消化科就诊者饮酒及相关问题调查

目的:了解我国医院精神科、消化科就诊者饮酒现状;了解精神科就诊者酒精使用障碍检出率及患者接受饮酒相关治疗情况。方法:在2013年2月-2013年10月期间对我国八家医院精神科、消化科28036名连续就诊者进行调查,对其中最近1月饮酒者(n=3209)应用酒精使用障碍筛查量表(AUDIT)进行筛查。根据美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)酒精使用障碍诊断标准对精神科AUDIT筛查阳性者(n=1304)进行诊断,并收集其饮酒相关治疗信息。结果:精神科、消化科、总体1月饮酒检出率依次为12.2%、6.7%、11.4%;AUDIT阳性检出率依次为6.5%、5.6%、6.4%。精神科酒精使用障碍检出率为2.4%,酒依赖为1.7%,酒滥用为0.7%。酒精使用障碍患者接受治疗率为28.0%,酒依赖为39.0%,酒滥用为2.8%。结论:我国医院消化科、精神科就诊者1月酒精使用率不高。精神科就诊者中酒精使用障碍检出率较社区人群低,但酒精使用障碍患者接受治疗率较低,应引起临床医务工作者的重视。     

危险及有害饮酒、酒依赖与适量饮酒引起各种损害的比较

目的：比较危险及有害饮酒组，酒依赖组在酒精所致损害方面与正常饮酒和酒依赖组的区别。方法：使用AUDIT量表和ICD-10诊断标准对420例被测查者进行了筛查和评定。将其分为“危险及有害饮酒”组，酒依赖组和正常饮酒组。比较了三组之间酒精所致损害的差别。结果：三组之间饮酒量，饮酒频率及发生中种损害的情况均有显著性差异。危险及有害饮酒者发生各种损害的机率明显高于正常饮酒组，损害的发生直接与饮酒量和饮酒频度相关。结论：危险及有害饮酒者降低饮酒量，减少饮酒频度已势在必行。不但有望减少一系列躯体损害的相关。结论：危险及有害饮酒者降低饮酒量，减少饮酒频度已势在必行。不但有望减少一系列躯体损害的发生。减少国家的医疗开支；而且可能减少多种社会问题的发生。减少犯罪。这也是使社会安定的因素之一。     

大学生危险和有害饮酒现状及影响因素分析

目的:了解大学生饮酒现状,探讨其影响因素。方法:采用分层整群随机抽样方法,1-4年级每个年级抽取3个班级,共907名学生为调查样本。使用自行编制的一般情况问卷、家庭、同伴及学校环境情况调查表、酒精使用障碍筛查量表(AUDIT)、饮酒期望问卷以及BIS-11量表中文版对所有研究对象进行调查。结果:大学生危险和有害饮酒发生率为11.2%。多因素分析显示,男性(OR=2.855)、年龄大于20岁(OR=1.361)、月均生活费高于1000元(OR=2.527)、吸烟(OR=3.490)、母亲饮酒态度中立(OR=1.439)、同伴态度赞成(OR=2.861)和中立(OR=2.732)、同伴大多数饮酒(OR=2.784)、冲动性水平高(OR=1.202)是大学生危险和有害饮酒的危险因素。结论:性别、年龄、月均生活费用、吸烟、母亲饮酒态度、同伴饮酒态度、同伴是否饮酒、冲动性水平是大学生危险和有害饮酒的影响因素。     

大学生危险和有害饮酒现状及其与成人ADHD症状和压力的关系

目的:探讨大学生危险饮酒、有害饮酒的现状及其与ADHD症状、压力的关系。方法:选取大学生4999名(男2265人,女2734人),采用酒精依赖性疾患识别测验(AUDIT)、成人ADHD症状自评量表(ASRS)、中文版压力知觉量表(CPSS)进行调查,AUDIT≥7分为危险和有害饮酒。结果:危险和有害饮酒的大学生有547人(10.9%),ASRS总分均值为(24.5±9.4),CPSS总分均值为(24.1±6.9),ADHD全量表有症状占比14.2%,有压力占比50.1%。非条件logistic回归分析表明,男性、父亲酗酒、母亲酗酒、有体育锻炼、有ADHD症状、有压力、有多动冲动症状是危险和有害饮酒的危险因素(OR=4.50、1.46、7.58、1.35、2.98、1.91、2.53)。结论:本研究提示,有ADHD症状、多动冲动症状和压力的大学生发生危险和有害饮酒的风险较高。     

湖南省大学生寻求刺激人格与饮酒的关系

目的:探究寻求刺激人格特点与饮酒的关系,为制定饮酒干预措施提供参考依据。方法:采用多阶段分层整群抽样方法,在湖南省8所高校选取大学生5966人(男2180人,女3786人,平均年龄(20±1)岁),采用一般情况表、寻求刺激人格量表、饮酒调查表和酒精使用筛查表进行微信问卷匿名调查。结果:大学生过去一年饮酒、单次大量饮酒、危险和有害饮酒检出率为47. 5%、24. 5%、7. 4%。寻求刺激与饮酒、单次大量饮酒、危险和有害饮酒呈正相关(均P 0. 01)。寻求刺激是饮酒、单次大量饮酒、危险和有害饮酒的独立危险因素。结论:寻求刺激人格特点是饮酒行为的相关因素。     

新疆克拉玛依地区酒精滥用者焦虑、抑郁症状及自杀风险调查

目的:调查新疆克拉玛依地区酒精滥用者的抑郁、焦虑症状及其自杀风险,为此类精神卫生问题的预防和早期干预提供参考依据。方法:采用PPS抽样调查对1992例社区居民进行调查和统计分析,用酒精使用障碍筛查量表(AUDIT)筛查酒精滥用,初级保健精神障碍患者健康问卷中的抑郁分量表(PHQ-9)和焦虑分量表(PHQ GAD-7)筛查抑郁症状和焦虑症状,简明国际神经精神访谈(MINI)自杀筛选问卷筛查自杀风险。结果:筛查出酒精滥用阳性者298例,酒精滥用比为15.1%。酒精滥用者抑郁症状阳性比53.4%、焦虑阳症状性比35.9%、自杀风险比5.7%,均高于非滥用者(阳性比分别是42.3%、27%、3.2%,均P0.05)。结论:本研究提示,在酒精滥用筛查时要注意对相关精神卫生问题的评估和诊断,以便采取及时、有效的干预措施。     

远洋渔民酒精使用、抑郁症状及关联因素的混合结构方程模型分析

目的：探索远洋渔民酒精使用、抑郁症状与工作压力、神经质和功能失调性态度的潜类别及特征。方法：采用酒精依赖疾患识别测验（AUDIT）、流调中心用抑郁量表（CES-D）、舰艇人员心理应激源调查问卷（MSIQ）、大五人格量表-神经质维度（NEO-FFI）、功能失调性态度量表（DAS）对749名远洋饮酒渔民进行问卷调查。使用Mplus进行混合结构方程模型分析。结果：远洋渔民可分为中症状低风险组（5%）、高症状高风险组（8%）和低症状中风险组（87%）3个潜类别。在中症状低风险组，工作压力与酒精使用、抑郁症状均显著正相关（β=0.63、0.75，均P<0.01）。在高症状高风险组，工作压力、神经质、功能失调性态度各自与酒精使用、抑郁症状均显著相关（β=-0.51～0.73，均P<0.05）。在低症状中风险组，工作压力、神经质、功能失调性态度各自与抑郁症状显著正相关（β=0.11～0.42，均P<0.01）。结论：在远洋渔民群体中，工作压力、神经质、功能失调性态度对酒精使用、抑郁症状的作用存在群体异质性。     

男性酒精依赖患者的子女的危险性饮酒与决策能力的相关性

目的:探索男性酒精依赖患者的子女(OFAD)的危险性饮酒与决策能力的相关性。方法:采用病例对照研究方法,根据酒精使用障碍筛查量表得分(AUDIT,划界分为7)将OFAD分为“危险性饮酒组”(n=29)和“非危险性饮酒组”(n=43)。采用爱荷华博弈任务(IGT)评估被试的决策能力。使用协方差分析比较两组间的IGT差异,使用多因素logistic回归探讨决策能力与危险性饮酒的关联性。结果:危险性饮酒组与非危险性饮酒组IGT总成绩差异无统计学意义(P> 0.05);危险性饮酒组较非危险性饮酒组block5选择牌2的试次更少[(3.8±2.5)v.s.(5.7±3.1),P<0.05];控制协变量后,危险性饮酒仍与block5牌2选择试次存在正关联(OR=0.72,95%CI:0.57～0.90,P<0.05)。结论:本研究提示酒精依赖患者的子女(OPAD)中危险性饮酒者决策能力可能更好。     

脑瘫患儿精细运动功能测试量表的单维性和信度研究

目的分析脑瘫患儿精细运动功能测试（FMFM）量表的单维性、内在信度和外在信度。方法共纳入696例脑瘫患儿为研究对象,男481例（69.1%）,女215例（30.9%）;年龄2-183个月,平均（30.0±25.9）个月,0-3岁496例（71.3%）,〉3岁200例（28.7%）;其中痉挛型四肢瘫239例（34.3%）、痉挛型双瘫212例（30.4%）、痉挛型偏瘫185例（包括2例单瘫）（26.6%）、徐动型30例（4.3%）,肌张力障碍型21例（3.0%）,共济失调型9例（1.3%）。由86项测试项目组成FMFM的取样量表,所有研究样本均接受过至少1次FMFM取样量表测试。采用Rasch分析中的局部评分模型（PCM）对696例样本和86项取样量表进行分析,以项目不适合标准（FITI）中的均方来确定量表的单维性,同时确定FMFM量表的最终入选项目,然后分析由这些项目组成的FMFM量表的测试独立性和样本独立性,通过选取研究样本中最初的23例进行重测信度研究（间隔1-7d）,同样选取最初的49例进行评分者间信度研究。结果经过Rasch分析的3轮筛选,从86项取样量表项目中筛除25项,剩余的61项中仅有3项属于不适合项目,占总项目的4.9%（3/61）,表明其中的绝大多数项目具有良好的单维性,由此形成正式的FMFM量表。通过分析不同项目状态下的样本能力分值之间的相关性,显示FMFM量表具有很好的测试独立性;通过在分析了不同样本状态下的项目难度值的相关性后,确定FMFM量表具有很好的样本独立性。FMFM量表还具有良好的重测信度（ICC=0.9893,95%CI：0.9753-0.9954）和测试者间信度（ICC=0.9961,95%CI：0.9932-0.9978）。结论脑瘫患儿FMFM量表具有良好的单维性、内在信度和外在信度,为将来使用FMFM量表评价奠定了良好的基础,FMFM量表的效度和反应度还有待于进一步研究。     

TEG量表中文版的初步测试

目的：引进TEG量表，分析中国高血糖人群性格类型。方法：采用TEG中文版对401名高血糖人群进行了测试，检验量表的信度和效度。结果：大部分调查对象能够理解量表的内容；量表的漏填率很低；量表的重测信度系数在0．73-0．87之间，5个维度内部的Cronbach’s a系数在0．62到0．72之间，各维度之间的相关系数在0到0．40之间。量表所包括的60个条目在5个因子中得到了较为充分的表达。结论：中文版的TEG性格量表的引进和测试达到了预期的要求，值得进一步的探索和研究。     

危险及有害饮酒的早期干预

目的 :对危险及有害饮酒者进行干预教育 ,随访观察干预后的效果。方法 :对 1 4 5例危险及有害饮酒者进行有关饮酒危害性的早期干预教育 ,发放自助手册 ,3个月后随访干预效果。结果 :(1 )干预后饮酒量较干预前下降了约 35% ,日饮 4标准杯的人数较干预前明显下降 (P <0 0 0 0 1 )。干预后饮酒频度从每周平均 4 - 5次降至 2 - 3次。每周饮酒大于 5次的人从 47 5 %降至 2 2 5 % ,下降差异有显著性 (P <0 0 0 0 1 )。干预后AUDIT总分和各因子分均较干预前明显下降 (P均小于 0 0 0 1 )。 (2 )干预后躯体损害、精神损害和社会问题总发生的情况 ,均较干预前明显减少 (P均 <0 0 0 1 )。结论 :对危险及有害饮酒者进行早期简短干预 ,可以明显减少饮酒量和饮酒频度 ,继而减少与酒相关的各种损害的发生     

Acceptability of screening for early detection of liver disease in hazardous/harmful drinkers in primary care

Background

It is estimated that one-quarter of adults in the UK drink at harmful/hazardous levels leading to increased mortality and alcohol liver disease (ALD). The Alcohol Liver Disease Detection Study (ALDDeS) aimed to test out in primary care the feasibility of alcohol misuse screening in adults, using the AUDIT questionnaire, and to assess screening harmful/hazardous alcohol users for ALD using newer non-invasive serum markers of fibrosis.

Aim

To explore patients’ experiences of taking part in ALDDeS and understanding of the delivery and process of screening for ALD using self-report questionnaires and feedback of liver fibrosis risk using levels of non-invasive serum markers.

Design and setting

A nested qualitative study based in five primary care practices in the UK.

Method

From a sample of patients who were identified as drinking at harmful/hazardous levels, 30 participants were identified by maximum variation sampling for qualitative in-depth interviews. Using the principles of constant comparison the transcribed interviews were thematically analysed.

Results

Receiving a postal AUDIT questionnaire was viewed as acceptable by participants. For some completing the AUDIT increased awareness of their hazardous alcohol use and a positive blood test indicating liver fibrosis was a catalyst for behaviour change. For others, a negative blood test result provided a licence to continue drinking at hazardous levels. A limited understanding of safe drinking and of ALD was common.

Conclusion

Educational and training needs of primary care professionals must be taken into account, so that patients with marker levels indicating low risk of fibrosis are correctly informed about the likely risks of continuing to drink at the same levels.     

Feasibility of detection and intervention for alcohol-related liver disease in the community: the Alcohol and Liver Disease Detection study (ALDDeS)

Background

In the past 15 years mortality rates from liver disease have doubled in the UK. Brief alcohol advice is cost effective, but clinically meaningful reductions in alcohol consumption only occur in around 1 in 10 individuals.

Aim

To provide evidence that detecting early liver disease in the community is feasible, practical, and that feedback of liver risk can increase the proportion of subjects reducing alcohol consumption.

Design and setting

A community feasibility study in nine general practice sites in Hampshire.

Method

Hazardous and harmful drinkers were identified by WHO AUDIT questionnaire and offered screening for liver fibrosis.

Results

In total, 4630 individuals responded, of whom 1128 (24%) hazardous or harmful drinkers were offered a liver fibrosis check using the Southampton Traffic Light (STL) test; 393 (38%) attended and test results were returned by post. The STL has a low threshold for liver fibrosis with 45 (11%) red, 157 (40%) amber, and 191 (49%) green results. Follow-up AUDIT data was obtained for 303/393 (77%) and 76/153 (50%) subjects with evidence of liver damage reduced drinking by at least one AUDIT category (harmful to hazardous, or hazardous to low risk) compared with 52/150 (35%, P<0.011) subjects without this evidence; in the subset of harmful drinkers patterns (AUDIT >15), 22/34 (65%) of STL positives, reduced drinking compared with 10/29 (35%, P<0.017) STL negatives.

Conclusion

Detection of liver disease in the community is feasible, and feedback of liver risk may reduce harmful drinking.     

中国五地区饮酒情况及相关问题调查Ⅲ.普通人群的饮酒相关问题

目的：了解我国社区普通人群饮酒相关问题的患病率和主要社会损害。方法：应用半定式健康状况调查表和酒依赖及相关问题筛查问卷，调查24992例受试饮酒相关的心理社会和躯体疾病，应用DSM-Ⅲ-R诊断标准，对1874例问题饮酒者进行酒精所致精神疾病的诊断。结果：酒精所致精神障碍的男性、女性和总体时点患病率分别为9．0％、0．2％和5．1％；酒依赖时点患病率分别为6．625％、0．200％和3．797％；三月急性醉酒率分别是14．237％、0．745％和8．299％，均是男性高于女性。酒依赖者的社会损害严重于问题饮酒者。躯体损害以胃炎或胃溃疡和腰背痛的发生率最高。结论：饮酒相关问题已严重影响着我国人民的身心健康，需要得到政府、社会团体和医务工作者的极大关注，以采取相应措施进行有效防治。     

Alcohol consumption as a risk factor for non-recovery from common mental disorder: results from the longitudinal follow-up of the National Psychiatric Morbidity Survey

BACKGROUND: Alcohol is commonly considered to be associated with persistence of common mental disorder (CMD; anxiety/depression). However no community-based longitudinal studies have investigated the direction of causality. METHOD: We examined the association between alcohol consumption and recovery from CMD using data on 706 community-based subjects with CMD who were followed for 18 months. Alcohol consumption at baseline was defined as hazardous drinking [Alcohol Use Disorders Identification Test (AUDIT) 8], binge drinking (defined as six or more units of alcohol on one occasion, approximately two to three pints of commercially sold beer) and dependence. RESULTS: When compared with a non-binge-drinking group, non-recovery at follow-up was associated with binge drinking on at least a monthly basis at baseline, although the confidence interval (CI) included unity [adjusted odds ratio (OR) 1.47, 95% CI 0.89-2.45]. There was also weak evidence that alcohol dependence was associated with non-recovery (adjusted OR 1.37, 95% CI 0.67-2.81). There was little evidence to support hazardous drinking as a risk factor for non-recovery (adjusted OR 1.12, 95% CI 0.67-1.88). CONCLUSIONS: Binge drinking may be a potential risk factor for non-recovery from CMD, although the possibility of no effect cannot be excluded. Larger studies are required to refute or confirm this finding.     

Clinical impacts of hazardous alcohol use and obesity on the outcome of entecavir therapy in treatment-naïve patients with chronic hepatitis B infection

Background/Aims

The aim of this study was to analyze the clinical impacts of obesity and hazardous alcohol use on the outcome of entecavir (ETV) therapy in chronic hepatitis B (CHB) patients.

Methods

The medical records of 88 treatment-naïve patients who were diagnosed with CHB and received ETV between March 2007 and September 2009 were analyzed retrospectively. Body mass index (BMI) values and Alcohol Use Disorders Identification Test (AUDIT) scores were obtained at 6 months after the initiation of ETV (0.5 mg daily) treatment.

Results

A BMI of 25 kg/m² or more was recognized as an indicator of obesity, and a total AUDIT score of 8 or more was recognized as an indicator of hazardous alcohol use. Of the cohort, 24 patients (27.3%) were obese and 17 (19.3%) were hazardous alcohol users. The rate of seroconversion, alanine aminotransferase (ALT) normalization, and hepatitis B virus (HBV)-DNA negativity (<300 copies/mL) at 3, 6, and 12 months of treatment did not differ significantly between the normal-BMI and high-BMI groups. Moreover, the rate of seroconversion and HBV-DNA negativity at 3, 6, and 12 months of treatment did not differ significantly between the nonhazardous and hazardous alcohol users. However, the frequency of ALT normalization at 12 months was significantly lower among hazardous alcohol users (91.5% vs. 70.6%; P=0.033).

Conclusions

Obesity and hazardous alcohol drinking have no significant impact on the outcome of ETV treatment. However, the ALT normalization rate at 12 months after initiation of ETV treatment was significantly lower among the hazardous alcohol users.     

Evaluation of Relationships among Occupational Stress,Alcohol Dependence and Other Factors in Male Personnel in a Japanese Local Fire Fighting Organization

Recent large-scale disasters have made middle-ranked fire defense officers responsible for routine fire fighting activities, and a tendency of alcohol dependence associated with other stressful problems is noted in Japan. We assessed the alcohol dependence tendency with the alcohol use disorders identification test (AUDIT) in firefighters. Occupational stress, depression and other factors were evaluated with the brief job stress questionnaire, Center for Epidemiologic Studies depression scale, K10 and a face sheet. Subjects were 294 male personnel in a local fire defense headquarters, and 246 of them (83.4%) answered effectively. Data were analyzed first with univariate analysis between the AUDIT score and other items, and then with multivariate analysis of the AUDIT score as a dependent variable and other items as independent variables. The AUDIT score (mean ± SD) in the 246 respondents classified by age ranges was 7.9 ± 5.4 points (the lowest, 0 points; the highest, 27 points). The multivariate analysis showed significant correlations of the AUDIT score with the workplace environment (P = 0.003) and the rank of work (P = 0.019). The present survey was cross-sectional, and we could not clarify the subjects’ past drinking states and applicability of the results to the whole Japan personnel. It is necessary to further investigate the relationship between alcoholism and depression in the present subjects. As a pilot study, we first clarified the state of alcohol dependence in personnel in a Japanese local fire fighting organization, and examined related factors.     

Screening properties of questionnaires and laboratory tests for the detection of alcohol abuse or dependence in a general practice population.

BACKGROUND: Early identification of alcohol abuse or dependence is important in general practice because many diseases are influenced by alcohol. General practitioners, however, fail to recognise most patients with alcohol problems. AIM: To assess the diagnostic performance of the CAGE and AUDIT questionnaires, their derivatives, and laboratory tests in screening for alcohol abuse or dependence in a primary care population (male and female patients), attending their general practitioner (GP). DESIGN OF STUDY: A diagnostic cross-sectional study. SETTING: A random sample of patients who were over 18 years of age (n = 1992) attending 69 general practices situated in the same region in Belgium. METHOD: Alcohol questionnaires (CIDI 1.1, section I, CAGE, AUDIT, AUDIT-C, Five-Shot, and AUDIT Piccinelli) were completed, demographic information was recorded, and patients underwent conventional blood tests, including mean corpuscular volume, liver function tests, the gamma-glutamyl transferase test, and carbohydrate-deficient transferrin (CDT, estimated using %CDT). Calculations of sensitivity, specificity, positive predictive value, negative predictive value, odds ratios with their 95% CIs, and receiver operating characteristic (ROC) curves for different scores of the questionnaires and laboratory tests, using DSM-III-R as the reference standard. RESULTS: The past-year prevalence of alcohol abuse or dependence in this population was 8.9% (178/1992) of which there were 132 male and 45 female patients attending a general practice. The GPs identified 33.5% of patients with alcohol abuse or dependence. Among male patients, all questionnaires had reasonable sensitivities between 68% and 93% and hence at lower cut-points than recommended. Only the sensitivity of the CAGE, even at its lowest cut-point of > or = 1 was lower (62%). In female patients the sensitivities were lower; however, odds ratios were higher for different questionnaires. The receiver operating characteristic (ROC) curves did not differ between the questionnaires. The laboratory tests had low diagnostic accuracy with areas under the ROC curves (AUCs) between 0.60 and 0.67 for female patients and 0.57 and 0.65 for male patients. CONCLUSIONS: This is one of the largest known studies on alcohol abuse or dependence among family care practices. We confirm earlier results that the AUDIT questionnaire seems equally appropriate for males and females; however, screening properties among male patients are higher. Nevertheless, the Five-Shot questionnaire is shorter and easier to use in a general practice setting and has nearly the same diagnostic properties in male and female general practice patient populations. We confirm that conventional laboratory tests are of no use for detecting alcohol abuse or dependence in a primary care setting. Also, the %CDT cannot been used as a screening instrument in this general practice population.