Effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis

Background and objective:   Although pulmonary rehabilitation is effective for patients with COPD, its efficacy in patients with IPF is unknown. The purpose of this study was to evaluate the effects of pulmonary rehabilitation in IPF.
Methods:   Thirty patients diagnosed with IPF, according to the consensus statement, were randomly assigned to the rehabilitation group or the control group. The pulmonary rehabilitation mainly consisted of a 10-week programme of exercise training. Pulmonary function, blood gas analysis, 6MWD, dyspnoea rating with the baseline dyspnoea index and health-related quality of life score on the St George's Respiratory Questionnaire were evaluated at baseline and after the programme.
Results:   Assessment of efficacy was carried out on 13 patients who completed the programme and 15 patients in the control group. There were no significant effects of the programme on measures of pulmonary function, values of arterial blood gas analysis or dyspnoea rating. Although there were some differences in the baseline 6MWD and total health-related quality of life score which were not statistically significant, marked improvements were observed in the 6MWD (mean difference 46.3 m (95% CI: 8.3–84.4), P  < 0.05) and the total health-related quality of life score (−6.1 (95% CI: −11.7 to −0.5), P  < 0.05).
Conclusions:   Pulmonary rehabilitation improves both exercise capacity and health-related quality of life in patients with IPF.     

Visceral fat loss induced by a low-calorie diet: a direct comparison between women and men

Aim:  No studies have assessed if changes in visceral adipose tissue (VAT) during weight loss differ between women and men with comparable amounts of VAT at baseline. The aim of this study was to assess if changes in VAT induced by a low-calorie diet (LCD) differ between women and men.
Methods:  In this post hoc analysis of an existing database, abdominal adipose tissue was evaluated before and after an 8-week LCD (800–1000 kcal/day) by a single-slice magnetic resonance scan performed at the abdominal level. Body composition was measured by dual X-ray energy absorptiometry.
Results:  Data from 111 obese subjects (85 women and 26 men) were available. Relative changes in VAT were found to be more pronounced in men [mean (95% CI): −32.6% (−38.7 to −26.6)] than in women [−21.9% (−25.0 to −18.8)] (p = 0.003) after correction for relative changes in fat mass (FM). When analysing only the data from a subgroup of 23 women and 23 men who were matched for similar visceral to abdominal subcutaneous fat ratio at baseline, these differences could not be observed anymore: the change in VAT was −33.7% (−38.7 to −28.7) in men and −26.8% (−31.8 to −21.8) in women (p = 0.07).
Conclusions:  This study suggests that relative changes in VAT during a LCD may be greater in men than in women even after taking relative changes in FM into account. However, these differences disappear when properly matching the subjects for baseline amounts of VAT.     

The Overlap in Predicting Alcohol Outcome for Two Measures of the Level of Response to Alcohol

Background:  Two different measures have been used to establish a person's level of response (LR) to alcohol as a risk factor for alcohol use disorders. LR values established by the alcohol challenge protocol and the Self-Report of the Effects of Ethanol (SRE) questionnaire usually correlate at 0.3 to 0.4, up to 0.6. However, it is not clear how this correlation relates to the ability of each measure to predict alcohol outcomes. This paper evaluates that overlap.
Methods:  Sixty-six Caucasian males (mean age = 22 years) from 2 protocols participated in alcohol challenges with 0.75 ml/kg of ethanol, filled out the SRE, and were followed with a structured interview ∼5 years later. The relationship between the subjective feelings of intoxication at the time of peak breath alcohol levels from the alcohol challenge and the SRE score for a time early in the drinking career were evaluated regarding predicting the drinks per occasion in the 6 months prior to follow-up.
Results:  Cross-sectional correlations between alcohol challenge and SRE LR's ranged from −0.25 ( p  < 0.05) to −0.32 ( p  = 0.02) for the full sample, and the 2 LR measures correlated with drinking at follow-up (−0.26 and 0.41, respectively). The SRE measure was more robust than the challenge in a regression analysis predicting the outcome in the context of other baseline predictors (e.g., drinking at baseline). As much as 60% of the ability of the more well established (gold standard) alcohol challenge LR to predict outcome was shared with the SRE. The alcohol challenge accounted for as much as 44% of the ability of the SRE to predict outcome.
Conclusions:  The SRE-generated LR overlapped considerably with the alcohol challenge LR in the ability to predict future heavier drinking.     

Anemia and 9-Year Domain-Specific Cognitive Decline in Community-Dwelling Older Women: The Women's Health and Aging Study II

OBJECTIVES: To test the hypothesis that anemia (hemoglobin <12 g/dL) is associated with a faster rate of cognitive decline over 9 years in a community-dwelling sample of women aged 70 to 80 at baseline.
DESIGN: A population-based, prospective cohort study.
SETTING: East Baltimore, Maryland.
PARTICIPANTS: Four hundred thirty-six women sampled to be representative of the two-thirds least-disabled women aged 70 to 80 at baseline (1994–1996).
MEASUREMENTS: Nine-year trajectories of cognitive decline, analyzed using linear random effects models, in the domains of immediate verbal recall, delayed verbal recall, psychomotor speed, and executive function.
RESULTS: At baseline and after adjustment for demographic and disease covariates, women with anemia were slower to complete a test of executive function; the difference in baseline function between women with anemia and those without was −0.43 standard deviations (SDs) (95% confidence interval (CI)=−0.74 to −0.13) on the Trail Making Test Part B. During follow-up, anemia was associated with a faster rate of decline in memory. Between baseline and Year 3, the difference in the rates of decline between women with anemia and those without was −0.18 SDs per year (95% CI=−0.29 to −0.06) on the Hopkins Verbal Learning Test (HVLT) and −0.15 SDs per year (95% CI=−0.26 to −0.04) on the HVLT-Delayed.
CONCLUSION: Anemia was associated with poorer baseline performance on a test of executive function and with faster rates of decline on tests of immediate and delayed verbal recall. If this relationship is causal, it is possible that treatment of anemia could prevent or postpone cognitive decline.     

Polypharmacy management among Australian veterans: improving prescribing through the Australian Department of Veterans' Affairs' prescriber feedback programme

Background:  Older patients are potentially at risk from the effects of polypharmacy (PP) and/or drug–drug interactions.
Aims:  To examine the effects of a targeted patient-specific prescriber feedback programme on patients prescribed more than 19 individual medications over the 3-month study period.
Methods:  The Commonwealth Department of Veterans' Affairs commissioned a review of Repatriation Pharmaceutical Benefit Scheme claims data to identify patients potentially at risk of drug injury through either PP (≥20 unique medications during 3 months) or clinically significant drug interactions (DI). Dispensing information for the patient at risk, relevant clinical guidelines and a personalized covering letter were mailed to the main prescribing general practitioner of the identified veteran patient. The claims data were then re-analysed after the programme.
Results:  There was a significant reduction in the mean number of unique medications prescribed over a 3-month period 1 year after the prescriber feedback (mean change = −2.22; 95% confidence interval −3.54 to −0.90; P  = 0.0013) for patients identified with ongoing PP. There was also a significant reduction in the number of DI pairs (mean change = −0.73; 95% confidence interval −0.77 to −0.69; P  < 0.0001) for the patients identified with an ongoing DI. The number of patients dispensed one or more DI pairs decreased from 836 to 318 after the feedback.
Conclusion:  A targeted prescriber feedback programme can influence general practitioner prescribing at an individual patient level and, therefore, contribute to the quality use of medicines.     

Trazodone and alcohol relapse: a retrospective study following residential treatment

Trazodone is one of the most commonly prescribed hypnotic medications in patients with sleep disturbances in alcohol recovery. A recent study concluded that treating insomnia with trazodone in patients with alcohol dependence might impede improvements in alcohol consumption and lead to increased drinking when trazodone is stopped. We set out to investigate the relationship between trazodone use during alcoholism treatment and relapse rates in patients who were discharged from a residential alcohol treatment program. We retrospectively reviewed records of patients with a diagnosis of alcohol dependence in a residential addiction treatment center from 2005 to 2008 and analyzed the association of trazodone use at discharge and alcohol relapse at 6 months. We also assessed the association between trazodone use and relapse at 6 months adjusting for sex, drug dependence, nonsubstance use Axis I psychiatric diagnoses, patient self-report of difficulties with sleep, and anti-dipsotropic medication use at discharge and evaluated pair-wise interactions of trazodone use with the adjustment variables. Of 283 patients eligible for inclusion, 85 (30%) were taking trazodone at discharge. Older age, self-reported sleep problems, and having a nonsubstance use Axis I psychiatric diagnosis were associated with trazodone use. After discharge, 170 (60%) subjects responded to follow-up efforts. Neither intent to treat nor responder only analysis revealed any association between trazodone use and relapse. Our retrospective study of a complex patient population discharged from a residential treatment setting did not find an association between trazodone use at discharge and relapse rates at 6 months.     

Effect of Fish Oil Supplementation on Quality of Life in a General Population of Older Dutch Subjects: A Randomized, Double-Blind, Placebo-Controlled Trial

OBJECTIVES: To investigate the effect of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation on quality of life (QOL).
DESIGN: Randomized, double-blind, placebo-controlled trial.
SETTING: Independently living individuals from the general older Dutch population.
PARTICIPANTS: Three hundred two individuals aged 65 and older without depression or dementia.
INTERVENTION: 1,800 mg/d EPA-DHA (n=96), 400 mg/d EPA-DHA (n=100), or placebo capsules (n=106) for 26 weeks.
MEASUREMENTS: QOL was assessed using the short version of the World Health Organization QOL questionnaire (WHOQOL-BREF). The WHOQOL-BREF covers four domains: physical health, psychological health, social relationships, and satisfaction with environment. The total score range is 26 to 130, with higher scores indicating a more favorable condition.
RESULTS: Mean age of the participants was 70, and 55% were male. Plasma concentrations of EPA-DHA increased 238% in the high-dose and 51% in the low-dose EPA-DHA group, reflecting excellent adherence. Median baseline total WHOQOL scores ranged from 107 to 110 in the three groups and were not significantly different from each other. After 26 weeks, the mean difference from placebo was −1.42 (95% confidence interval (CI)=−3.40–0.57) for the high-dose and 0.02 (95% CI=−1.95–1.99) for the low-dose fish oil group. Treatment with 1,800 mg or 400 mg EPA-DHA did not affect total QOL or any of the separate domains after 13 or 26 weeks of intervention.
CONCLUSION: Supplementation with high or low doses of fish oil for 26 weeks did not influence the QOL of healthy older individuals.     

Lower risk of hypoglycemia with insulin detemir than with neutral protamine hagedorn insulin in older persons with type 2 diabetes: a pooled analysis of phase III trials

OBJECTIVES: To compare the safety and efficacy of insulin detemir with that of neutral protamine Hagedorn (NPH) insulin in older (aged ≥65) and younger (aged 18–64) persons with type 2 diabetes mellitus (DM).
DESIGN: Pooled, post hoc analysis of data from three open-label, randomized studies.
SETTING: Three multinational Phase III trials.
PARTICIPANTS: Four hundred sixteen older and 880 younger persons with DM, treated for 22 to 26 weeks with basal insulin plus mealtime insulin or oral agents.
MEASUREMENTS: Hemoglobin A_1c (HbA_1c), fasting plasma glucose, glucose variability, hypoglycemic episodes.
RESULTS: Mean treatment difference for HbA_1c (insulin detemir–NPH insulin) indicated that insulin detemir was not inferior to NPH insulin for both age groups (0.035%, 95% confidence interval (CI)=−0.114–0.183 and 0.100%, 95% CI=−0.017–0.217, for older and younger persons, respectively). Relative risk of all hypoglycemic episodes (insulin detemir/NPH insulin) was 0.59 (95% CI-0.42–0.83) for older persons and 0.75 (95% CI-0.59–0.96) for younger persons. Adverse events were similar between treatments. Fasting plasma glucose was similar between treatments (mean treatment difference 0.97 mg/dL, 95% CI=−8.01–9.95, and 4.69 mg/dL, 95% CI=−2.30–11.67, for older and younger persons, respectively). Mean treatment difference for weight was −1.02 kg (95% CI −1.61 to −0.42) and −1.13 (95% CI −1.58 to −0.69) for older and younger persons, respectively.
CONCLUSION: Previously reported benefits of insulin detemir, particularly less hypoglycemia and less weight gain, compared with NPH insulin, were the same for older and younger persons with DM at similar levels of HbA_1c.     

Non-invasive ventilation during arm exercise and ground walking in patients with chronic hypercapnic respiratory failure

Background and objective:   People with chronic hypercapnic respiratory failure (HRF) often have a ventilatory limitation to exercise with difficulty performing activities of daily living. Although non-invasive ventilation (NIV) appears to reduce the ventilatory limitation and improve exercise performance in people with severe COPD, the effect of NIV during functional activities such as unsupported arm exercise (UAE) and ground walking in people with chronic HRF is unclear.
Methods:   Seventeen patients with chronic HRF (PaCO₂ 52.1 ± 5.3 mm Hg) performed a series of UAE tests, and 15 patients (PaCO₂ 51.7 ± 3.8 mm Hg) performed a series of endurance shuttle walk tests, with and without NIV in a randomized cross-over design.
Results:   NIV during UAE increased endurance time by a mean of 91 s (95% confidence interval (CI): 10–172, P  = 0.031) and reduced dyspnoea by a mean of 2.3 on the Borg scale (95% CI: 1.0–3.7, P  = 0.002) compared with exercise without NIV. There was a non-significant increase in walking endurance time with NIV during exercise (119 s, 95% CI: −17 to 254, P  = 0.081); however, isotime dyspnoea was unchanged compared with walking without NIV (−1.0, 95% CI: −3.0 to 1.0, P  = 0.29).
Conclusion:   NIV during UAE increased endurance time and reduced dyspnoea compared with exercise without NIV in patients with chronic HRF. Investigation of the role of NIV as an adjunct to UAE training is warranted. In contrast, NIV during ground walking did not improve exercise capacity. However, the pressure support provided may have been inadequate as dyspnoea was not reduced.     

Efficacy of the 'tennis ball technique' versus nCPAP in the management of position-dependent obstructive sleep apnoea syndrome

Background and objective:   Avoidance of sleep in the supine position is recommended in the management of position-dependent OSA hypopnoea syndrome (OSAHS). Our aim was to evaluate the efficacy of a thoracic anti-supine band (TASB), designed to mimic the so-called 'tennis ball technique', compared with nasal CPAP (nCPAP).
Methods:   Twenty adults with mild to moderately severe position-dependent OSAHS (mean AHI ± SD) 22.7 ± 12.0/H (range 6.0–51.2); AHI supine, 59.6 ± 27.5/H, were included in a randomized cross-over trial. Portable sleep studies were undertaken at baseline and after 1 month on each treatment. A successful treatment outcome was defined as AHI ≤ 10/H.
Results:   Mean AHI was 12.0 ± 14.5/H with the TASB and 4.9 ± 3.9/H with nCPAP ( P  = 0.02; 95% confidence interval for the difference: −13.1 to −1.0). With the TASB, treatment 'success' was achieved in 13/18 subjects, whereas 'success' was achieved in 16/18 subjects using nCPAP ( P  = 0.004). In the two subjects with baseline AHI < 10/H, AHI remained below 10 for both therapies. The TASB successfully reduced time spent in the supine position. Mean percentage supine sleep time was 6.3 ± 5.9% with the TASB, and 35.4 ± 34.1% with nCPAP ( P  < 0.001). No significant differences in sleep efficiency or subjective responses were observed between treatments.
Conclusions:   Control of body position during sleep using an anti-supine device mimicking the so-called 'tennis ball technique' provides benefit in the management of position-dependent OSAHS in subjects who meet strict inclusion criteria. The overall improvement is, however, less than for nCPAP.     

Glycaemic control and adverse events in patients with type 2 diabetes treated with metformin + sulphonylurea: a meta-analysis

Aim:  The aim of this study was to quantify the effect of a sulphonylurea on glycaemic control and the risk adverse events when incorporated into the treatment regimen of patients with type 2 diabetes inadequately controlled on metformin.
Methods:  A systematic review was carried out to identify randomized controlled trials of sulphonylurea therapy in patients with type 2 diabetes whose glycaemic control was inadequate after maximal treatment with metformin. Data on reductions in haemoglobin A_1C (HbA_1C), fasting plasma glucose (FPG) and risk of hypoglycaemic events were extracted from each study and pooled in meta-analyses. Data on weight change were also extracted and tabulated.
Results:  Six studies including 1364 patients were identified. Based on random effects meta-analysis, the pooled estimate of change in HbA_1C from baseline was 0.9% (95% CI 0.7–1.1, p = 0.00011 vs. baseline) and for change in FPG from baseline was 1.8 mmol/l (95% CI 1.1–2.5, p = 0.0026 vs. baseline). The odds of experiencing a hypoglycaemic event was significantly higher in sulphonylurea-treated patients than in those on comparator treatments (OR = 5.3, 95% CI 1.7–16.3, p = 0.03). Mean weight change ranged from +2.5 to −0.1 kg, depending on the comparator treatment.
Conclusions:  This analysis has demonstrated that, in patients with type 2 diabetes whose control is inadequate on metformin monotherapy, the magnitude of incremental HbA_1C reduction achieved by the addition of a sulphonylurea is unlikely to exceed 1%, even after titration to maximum tolerated doses. Additionally, clinically relevant side-effects such as symptomatic hypoglycaemia and weight gain may be experienced.     

Progressive stage transition does mean getting better: a further test of the Transtheoretical Model in recovery from alcohol problems

Aims   To test two central assumptions of the Transtheoretical Model (TTM) regarding recovery from alcohol problems: (i) individuals making a forward transition from pre-action to action stages will show greater drinking improvements than those remaining in pre-action stages; and (ii) individuals remaining in pre-action stages will not demonstrate improvements in drinking outcomes.
Design and setting   Large, multi-centre, randomized controlled trial of treatment for alcohol problems [United Kingdom Alcohol Treatment Trial (UKATT)].
Measurements   Stage of change, drinks per drinking day and percentage days abstinent at baseline, 3- and 12-month follow-ups.
Findings   In support of TTM assumption 1, improvements in drinking outcomes were consistently greater among clients who showed a forward stage transition (Cohen's d  = 0.68) than among those who did not ( d  = 0.10). Two tests of assumption 2 showed a significant improvement in drinking outcomes in non-transition groups, inconsistent with the TTM; one test showed a significant deterioration and the other showed equivalent drinking outcomes across time. An explanation is offered as to why, under the relevant assumption of the TTM, clients in non-transition groups showed small changes in drinking outcomes.
Conclusions   In contrast to a previous study by Callaghan and colleagues, our findings largely support the TTM account of recovery from alcohol problems in treatment. The discrepancy can be explained by the use in our study of a more reliable and valid method for assigning stage of change.     

Facilitating involvement in Alcoholics Anonymous during out-patient treatment: a randomized clinical trial

Aim   This study evaluated two strategies to facilitate involvement in Alcoholics Anonymous (AA)—a 12-Step-based directive approach and a motivational enhancement approach—during skills-focused individual treatment.
Design   Randomized controlled trial with assessments at baseline, end of treatment and 3, 6, 9 and 12 months after treatment.
Participants, setting and intervention   A total of 169 alcoholic out-patients (57 women) assigned randomly to one of three conditions: a directive approach to facilitating AA, a motivational enhancement approach to facilitating AA or treatment as usual, with no special emphasis on AA.
Measurements   Self-report of AA meeting attendance and involvement, alcohol consumption (percentage of days abstinent, percentage of days heavy drinking) and negative alcohol consequences.
Findings   Participants exposed to the 12-Step directive condition for facilitating AA involvement reported more AA meeting attendance, more evidence of active involvement in AA and a higher percentage of days abstinent relative to participants in the treatment-as-usual comparison group. Evidence also suggested that the effect of the directive strategy on abstinent days was mediated partially through AA involvement. The motivational enhancement approach to facilitating AA had no effect on outcome measures.
Conclusions   These results suggest that treatment providers can use a 12-Step-based directive approach to effectively facilitate involvement in AA and thereby improve client outcome.     

Nephrotoxic effects of iodixanol and iopromide in patients with abnormal renal function receiving N-acetylcysteine and hydration before coronary angiography and intervention: a randomized trial

Background:  The use of contrast agents during coronary intervention can result in nephropathy, particularly in patients with renal dysfunction. We aimed to determine whether the use of iso-osmolar iodixanol is less nephrotoxic than that of low-osmolar iopromide when patients are adequately prehydrated and have received N -acetylcysteine.
Methods:  We conducted a randomized, double-blind, multicentre study of patients with impaired renal function undergoing a coronary interventional procedure. Primary end-point was the incidence of contrast-induced nephropathy (CIN) on day 2, defined as an increase in serum creatinine concentration of ≥44 μmol/L (0.5 mg/dL) or by a relative increase of ≥25% from baseline. Secondary end-points included peak increase in serum creatinine between baseline and day 7.
Results:  Of 191 patients recruited, 15% (95% CI: 8–22) of the patients receiving iopromide and 12% (95% CI: 5–19) of the patients receiving iodixanol developed CIN (95% CI of the difference: 13 to −7, P  = 0.56). When including peak serum creatinine on day 7, CIN developed in 23% of patients receiving iopromide and in 27% of patients receiving iodixanol (95% CI of the difference: 8 to −16, P  = 0.48). The peak increase in serum creatinine concentration at day 7 was similar in both groups (patients receiving iopromide, 18.4 ± 24.4 μmol/L, vs patients receiving iodixanol, 21.9 ± 24.2 μmol/L; P  = 0.33).
Conclusion:  There remains a high incidence of CIN despite prehydration and routine use of N -acetylcysteine in patients with pre-existing renal dysfunction undergoing coronary interventional procedures. Although our study is underpowered, iodixanol was not associated with a statistically significant lower incidence of CIN when compared with iopromide.     

Varenicline in prevention of relapse to smoking: effect of quit pattern on response to extended treatment

Aim   While older behavioural and pharmacological approaches to preventing relapse to smoking show little efficacy, a recent randomized trial of an extended course of varenicline reported positive results. In this secondary analysis, trial data were examined to see whether smokers who manage to achieve abstinence only later in the original course of treatment are more likely to benefit from having the course extended.
Methods   A total of 1208 patients abstinent for at least the last week of 12 weeks' treatment with varenicline were randomized to 3 months continued varenicline or placebo. Overall, 44% of the 12-week abstainers were abstinent from the target quit date (TQD), while the rest stopped smoking later. We examined the relationship between quit pattern and the varenicline versus placebo difference in continuous abstinence rates at week 52 and contributions of baseline patient characteristics.
Results   With increasing delay in initial quitting, 12-month success rates declined. Participants who had their last cigarette at week 11 of open-label treatment had quit rates at 52 weeks of 5.7% compared with 54.9% in those who last smoked in week 1 [odds ratio (OR) 20.3 (6.3, 65.9); P  < 0.0001]. Patients who failed to initiate abstinence in the first week benefited more from extended treatment than patients continuously abstinent from week 1 [OR 1.7 (1.2, 2.4); P  = 0.0015 versus OR 1.1 (0.8, 1.5); P  = 0.6995, respectively; with the interaction of the quit pattern with treatment effect reaching borderline significance ( P  = 0.0494)]. No other patient characteristics were related to treatment effect.
Conclusions   Compared with smokers who quit smoking on their TQD, those who have an initial delay in achieving sustained abstinence have increased risk of relapse even several months later, and may be more likely to benefit from extended treatment with varenicline.     

Comparison of vildagliptin and thiazolidinedione as add-on therapy in patients inadequately controlled with metformin: results of the GALIANT trial – a primary care, type 2 diabetes study

Aim: To assess the efficacy and tolerability of vildagliptin compared with thiazolidinediones (TZDs) as an add on to metformin treatment in a primary care patient population with type 2 diabetes.
Methods: This was a randomized, 12-week, open-label study comparing vildagliptin (100 mg, n = 1653) and TZD (agent and dose at the investigators' discretion, n = 825) add-on therapy in patients inadequately controlled [haemoglobin A_1C (HbA_1c): 7–10%] on a stable dose of metformin (≥1000 mg/day). The primary objective was to test non-inferiority of vildagliptin to TZDs for the difference in change in HbA_1c from baseline [established if the upper limit of the two-sided 95% confidence intervals (CI) did not exceed 0.4%].
Results: Mean (± s.e.) change in HbA_1c from baseline to study endpoint was –0.68 ± 0.02% in the vildagliptin group and −0.57 ± 0.03% in the TZD group. The difference between groups was −0.11% (95% CI: −0.17% and −0.04%), establishing the non-inferiority of vildagliptin (p = 0.001) after 3 months of treatment. Vildagliptin was non-inferior to TZDs for subgroups of race, age and body mass index. Body weight increased in the TZD group (0.33 ± 0.11 kg) and decreased in the vildagliptin group (mean: −0.58 ± 0.09 kg; p < 0.001 for difference). Adverse events occurred in similar proportions of patients in both groups (vildagliptin: 39.5% and TZD: 36.3%) Hypoglycaemia and abnormal changes in liver enzymes were uncommon.
Conclusions: This short-term study suggests that vildagliptin is as effective as TZDs after 3-month treatment as an add-on to metformin in a primary care population that included diverse patient subgroups.     

Adult transition from at-risk drinking to alcohol dependence: the relationship of family history and drinking motives

Background:  Prospective studies have not previously examined whether a family history of alcoholism and drinking motives conjointly predict a diagnosed DSM-IV alcohol abuse or dependence in adults, despite a large literature that each is associated with alcohol consumption. The focus of this study is the conjoint, prospective examination of these risk factors in a 10-year longitudinal study of adults who were at-risk drinkers at baseline.
Methods:  Prospective, population-based cohort of drinkers aged 18 or older from a Northeastern U.S. area initially evaluated for history of alcohol use disorders and drinking motives in 1991 to 1992. New onset dependence was studied in those who never met the criteria for alcohol dependence at baseline ( n  = 423), and new onset abuse was studied in those who never met the criteria for alcohol abuse at baseline ( n  = 301) and who did not develop dependence during the follow-up.
Results:  Family history significantly interacted with 2 baseline drinking motives in predicting new onsets of DSM-IV alcohol dependence: drinking to reduce negative affect (OR 3.38; 95% CI 1.05, 10.9) and drinking for social facilitation (OR 3.88; CI 1.21, 12.5). Effects were stronger after conditioning the drinking motives on having a positive family history of alcoholism. In contrast, in predicting new onsets of alcohol abuse, drinking motives did not have direct effects or interact with family history.
Conclusions:  Those who drank to reduce negative affect or for social facilitation at baseline were at greater risk of alcohol dependence 10 years later if they also had a family history of alcoholism. These results suggest an at-risk group that can be identified prior to the development of alcohol dependence. Further, the findings suggest utility in investigating the interaction of drinking motives with measured genetic polymorphisms in predicting alcohol dependence.     

Patterns of alcohol consumption and alcohol-impaired driving in the United States

Background:  Alcohol-related motor vehicle crashes kill approximately 17,000 Americans annually and were associated with more than $51 billion in total costs in 2000. Relatively little is known about the drinking patterns of alcohol-impaired (AI) drivers in the United States.
Methods:  2006 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed for alcohol consumption and self-reported AI driving among U.S. adults aged ≥18 years for all states. Alcohol consumption was divided into 4 categories: binge/heavy, binge/nonheavy, nonbinge/heavy, and nonbinge/nonheavy. Binge drinking was defined as ≥5 drinks for men or ≥4 drinks for women on one or more occasions in the past month, and heavy drinking was defined as average daily consumption of >2 drinks/day (men) or >1 drink/day (women). The prevalence of AI driving was examined by drinking pattern and by demographic characteristics. Logistic regression analysis was used to assess the association between drinking patterns and AI driving.
Results:  Five percent of drinkers were engaged in AI driving during the past 30 days. Overall, 84% of AI drivers were binge drinkers and 88% of AI driving episodes involved binge drinkers. By drinking category, binge/nonheavy drinkers accounted for the largest percentage of AI drivers (49.4%), while binge/heavy drinkers accounted for the most episodes of AI driving (51.3%). The adjusted odds of AI driving were 20.1 (95% CI: 16.7, 24.3) for binge/heavy, 8.2 (6.9, 9.7) for binge/nonheavy, and 3.9 (2.4, 6.3) for nonbinge/heavy drinkers, respectively.
Conclusions:  There is a strong association between binge drinking and AI driving. Most AI drivers and almost half of all AI driving episodes involve persons who are not heavy drinkers (based on average daily consumption). Implementing effective interventions to prevent binge drinking could substantially reduce AI driving.     

Reactivity to alcohol assessment measures: an experimental test

Aims   Previous research has suggested that alcohol screening and assessment may affect drinking.
Design   This study was a randomized test of reactivity to alcohol assessment questionnaires among a group of heavy drinking college students.
Setting and participants   A total of 147 university students completed a screening questionnaire and were randomized to either immediate assessment or delayed assessment. The immediate assessment group completed a set of drinking questionnaires at baseline, 3, 6 and 12 months, while the delayed assessment group completed questionnaires only at 12 months.
Measurements   Primary outcomes included overall volume of drinking, risky drinking and use of risk reduction behaviors.
Findings   We found a significant effect of assessment on measures of risky drinking and risk reduction behaviors, but not on overall volume of drinking. Specifically, at 12 months, participants who had previously completed drinking assessments had a lower peak blood alcohol concentration (BAC) ( d  = −0.373), were more likely to report a low score on the Alcohol Use Disorders Identification Test (AUDIT; odds ratio = 2.55) and tended to use more strategies to moderate their alcohol consumption ( d  = 0.352). Risk reduction behaviors that were affected tended to be those that limited alcohol consumption, rather than those that minimized consequences.
Conclusions   These results may have implications for the development of brief interventions.