Translation problems of the Spanish version of the Readiness to Change Questionnaire

The Readiness to Change Questionnaire instrument by Rollnicket al. (1992) has become a standard in assessing stages of changeamong substance users. It has found such widespread acceptancethat recently it has been translated into Spanish by Rodriguez-Martoset al. (2000). . . . [Full Text of this Article]FOOTNOTESREFERENCES     

Reversal of ethanol-induced hepatic steatosis and lipid peroxidation by taurine: a study in rats

We read with interest the study reported by Kerai et al. inthe July–August (1999) issue of Alcohol and Alcoholism.The authors concluded that hepatic steatosis and lipid peroxidationcaused by chronic alcohol consumption in rats can be reversedby administration of taurine. Furthermore, . . . [Full Text of this Article]FOOTNOTESREFERENCES     

Secondary depression in weaned alcoholics: implications of Lesch's typology of chronic alcoholism

Schuckit (1983) described two types of alcohol-related depression:(1) the common type, in which secondary depression disappearswithout treatment within the first few weeks of abstinence;(2) a less frequent type, primary depression, requiring specifictreatment. It is difficult to anticipate whether an alcoholicpatient needs antidepressive treatment or whether depressionwill remit spontaneously. A potential guide to differentiatedepressed alcoholic patients who might need specific treatmentfor depression could be the typology of Lesch et al. (1990).Based on . . . [Full Text of this Article]ConclusionFOOTNOTESREFERENCES     

Is daily single dosage of diazepam as effective as chlordiazepoxide in divided doses in alcohol withdrawal--a pilot study

We report on a pilot double-blind study on the effectivenessof divided doses of chlordiazepoxide and a single daily doseof diazepam in the treatment of the alcohol-withdrawal syndrome.While a variety of drugs (chlormethiazole, propranolol and clonidine)have been used for treatment of alcohol-withdrawal symptoms,benzodiazepines remain the drugs of choice for alcohol detoxification(Mayo-Smith, 1997). Diazepam and chlordiazepoxide are both . . . [Full Text of this Article]APPENDIXFOOTNOTESREFERENCES     

The value of oral thiamine

Cook (2000) advocated parental replacement of thiamine as aroutine accompaniment to in-patient alcohol detoxification.The justification is . . . [Full Text of this Article]REFERENCES     

Intravenous injection of alcohol by drug injectors: report of three cases

The injection of psychoactive drugs, usually by the intravenousroute, has been recognized for more than a century, and hasbecome more widespread over recent decades (Golding, 1993; Derricotet al., 1999). We have been unable to identify any publishedexamples of the recreational injection of alcohol. We describehere three cases in which intravenous injection of alcohol isreported. Case 1 was a 29-year-old, single, unemployed and homeless man,admitted to hospital for alcohol and diazepam detoxification.He fulfilled ICD-10 criteria . . . [Full Text of this Article]FOOTNOTESREFERENCES     

ON INTRACELLULAR FORMATION OF ETHANOL AND ITS POSSIBLE ROLE IN ENERGY METABOLISM

Despite a great number of papers devoted to studies of the influenceof alcohol on man's health, very few of them discuss the issueof the presence of ethanol in the human body not connected withalcohol consumption. Such ethanol is commonly called endogenous.It is believed to originate from the microbial fermentationof the carbohydrates in the gastro-intestinal tract (Krebs andPerkins, . . . [Full Text of this Article]REFERENCES     

Alcohol exposure in utero and breast cancer risk later in life

Since the pioneering work of Hiatt and Bawol (1984), there hasamassed a considerable amount of evidence that moderate-to-heavyalcohol consumption increases risk of breast cancer in women(Willett et al., 1987; Longnecker, 1999). A plausible mechanismis by alcohol's effects on circulating hormone levels. Alcoholadministration has been reported to increase circulating oestradiollevels in pre-menopausal women (Reichman et al., 1993); theevidence is mixed in . . . [Full Text of this Article]FOOTNOTESREFERENCES     

Determination of ethyl glucuronide in hair samples

Ethyl glucuronide (EtG) is a non-volatile, water-soluble, stable-upon-storage,direct metabolite of ethanol and can be detected in body fluidsand tissues (and also in post-mortem material) for an extendedtime period after the complete elimination of alcohol from thebody (Alt et al., 1997; Schmitt et al., 1997; Seidl et al.,1998; Wurst et al., 1999a,b). The aim of the present Letteris to emphasize . . . [Full Text of this Article]FOOTNOTESREFERENCES     

Alcohol-dependent patients with neuroendocrine evidence for reduced dopamine d(2) receptor function have decreased platelet monoamine oxidase-B activity

This letter is a report of a re-evaluation of the results obtainedin an earlier study of ours (Balldin et al., 1994) of plateletmonoamine oxidase (MAO)-B activity in alcoholics with reduceddopamine (DA) D₂ receptor function, as assessed by the growthhormone (GH) response to the D₁/D₂ agonist apomorphine (APO),which was published in this journal. The reason for the re-evaluationof the results in our study is a Letter to the Editors of thisjournal by Farren and Dinan (1996) reporting on platelet MAO-Bactivity in alcoholics with reduced DA D₂ receptor function,as assessed by the GH response to the DA D₂ receptor agonistbromocriptine. In the report by Farren and Dinan (1996), fourof eight alcoholics had no increase in GH above baseline, whereasall eight subjects in the control group had the expected GH. . . [Full Text of this Article]FOOTNOTESREFERENCES     

The volume of the liver in patients correlates to body weight and alcohol consumption

The measurement of liver volume has gained practical use inrelation to liver transplantation (Kawasaki et al., 1993). Livervolume may also relate to the many metabolic processes in whichthe liver is engaged (Homeida et al., 1979; Marchesini et al.,1988; Murry et al., 1995; Reichel et al., 1997; Kwo et al.,1998; Andersen et al., 1999). The present study was undertakento measure liver . . . [Full Text of this Article]FOOTNOTESREFERENCES     

Lipid-lowering drugs and erectile dysfunction

Lipid-lowering drugs and erectile dysfunction We have serious concerns about the review on lipid-loweringdrugs and erectile dysfunction (ED) reported by Rizvi et al.¹Although the authors mention that the technique of systematicreviews     

The Attitudes of British Methodist Ministers Towards Alcoholism

"The Alcoholism Questionnaire" was sent to 100 Methodist ministersby post. On the basis of the 67 replies received, it is concludedthat the respondents hold healthy and positive attitudes towardsalcoholism at a cognitive level, although it is not known howthey feel or behave in relation to alcoholism. Their views aregenerally in agreement with the experts on alcoholism, but theydiffer on two factors from the views of the general public.Ministers who were abstainers did not have attitudes which wereless healthy than those who were social drinkers. It is suggestedthat ministers who hold such positive attitudes may be instrumentalin altering public opinion about alcoholism.     

Erratum

Every defect is a treasure Flawed communication systems result in patient harm. Int J QualHealth Care     

Screening for alcohol misuse

Aira et al.'s constructive paper¹ identifies seven categoriesinfluencing the physician:patient dialogue for alcohol consumption.We recently have completed a study of Senior House Officer (SHO)attitudes to screening for alcohol misuse in Accident and Emergency(A&E) (127 SHOs over 5 years)². Briefly, we compare theexperiences of GPs and A&E staff under the headings identified. Sensitive nature of alcohol drinking     

THE RELIABILITY OF ALCOHOLISM HISTORY IN PATIENTS WITH ALCOHOL-RELATED CIRRHOSIS

Alcoholic liver disease is considered an indication for livertransplantation when a candidate is felt to have a high likelihoodof abstinence following transplantation. Historical variablessuch as duration of sobriety, duration and quantity of drinking,and treatment history are commonly used to estimate alcoholismprognosis, yet their reliability and validity in patients withalcoholic cirrhosis has received limited study. Fifty subjects(9 women and 41 men) with alcoholic cirrhosis underwent an alcoholismhistory interview. Each subject had a collateral source (usuallya spouse) who was interviewed by a second interviewer blindto the subject's alcoholism history. The two histories werecompared for duration of abstinence in months and estimatedalcoholism relapse risk was calculated using the High-risk AlcoholismRelapse scale (HRAR). Duration of sobriety correlated highlybetween subject and collateral source (Spearman r=0.96, P=0.0001)as did HRAR total score (Spearman r=0.72, P=0.0001). Categoricalassignments also showed high correlations with duration of sobriety(k=0.97) and HRAR category (k=0.63). When disagreements werepresent, collateral sources tended to underestimate severityof alcoholism. We conclude that patients with alcoholic liverdisease provide a reliable history for alcoholism variableswhen compared with a collateral source, and that, when disagreementsare present, subjects tend to report a more acute or severealcohol problem. The results support the clinical use of patienthistory information in making decisions about medical interventionsfor alcoholic liver disease.     

Effect of Helicobactor pylori eradication therapy on dyspeptic symptoms in primary care

OBJECTIVE: The aim was to explore the effect of eradication therapy ondyspeptic symptoms in patients with known peptic ulcer disease(PUD). METHOD: A total of 164 known dyspeptics and 147 non-dyspeptic attendersat six UK general practices were recruited. The Helisal RapidBlood test was performed in the practices and eradication therapyleft to the preference of the general practitioner. Patientswere followed prospectively by a Likert scaled symptom questionnaireand record review. The symptom questionnaire distinguished betweenpatients known to have dyspepsia and those not. RESULTS: There was a statistically significant decrease in dyspepticsymptoms in patients with known PUD who received eradicationtherapy (n = 43, Z = –2.63, P = 0.009). CONCLUSIONS: Eradication of Helicobacter pylori in primary care can leadto a reduction in consumption of H2 receptor antagonists andhence cost savings. This study demonstrates that dyspeptic symptomsalso decrease. The questionnaire could be used in further studiesto evaluate the effect of management on dyspeptic symptoms inthe primary care setting. Keywords. Dyspepsia, Helicobactor pylori, primary care, therapy, outcome measures.     

Costing in primary care--is the truth out there?

In this edition of Family Practice, Beale et al.,¹ estimatethe annual medical, nursing and administration costs in twogeneral practices as a function of patient age, sex and CouncilTax valuation band used as a surrogate marker of socio-economicstatus. They report that these costs increase with age and reducingtax valuation band and conclude that costing exercises are difficultbut important for NHS planning and resource allocation. Howrelevant are these claims? Deriving and presenting cost data In market systems what something costs is determined by itsmarket price, a result of the interplay of supply and demand.In non-market systems such as health care,     

A clustered randomized trial of the effects of feedback using academic detailing compared to postal bulletin on prescribing of preventative cardiovascular therapy

Background. Interventions to promote prescribing of preventivetherapies in patients with cardiovascular disease (CVD) or diabeteshave reported variable success. Objective. (i) To evaluate the effect of prescribing feedbackon GP practice using academic detailing compared to postal bulletinon prescribing of CVD preventive therapies in patients withCVD or diabetes at 3 and 6 months post intervention and (ii)to evaluate the intervention from a GP's perspective. Methods. Volunteer GP practices (n = 98) were randomized toreceive individualized prescribing feedback via academic detailing(postal bulletin plus outreach visit) (n = 48) or postal bulletin(n = 50). The proportion of CVD or diabetic patients on statinsand antiplatelet agents/warfarin pre- and post-interventionwas calculated for each GP practice. Multivariate regressionwith a random effects model was used to compare differencesbetween the groups adjusting for GP clustering and confoundingfactors. ß-Coefficients and 95% confidence intervals(CIs) are presented. Results. There was a 3% increase in statin prescribing in CVDpatients at 6 months post-intervention for both randomized groups,but there was no statistical difference between the groups (ß= 0.004; 95% CI = –0.01 to 0.02). Statin and antiplatelet/warfarinprescribing also increased in the diabetic population; therewas no significant differences between the groups. GPs participatingin the project expressed a high level of satisfaction with bothinterventions. Conclusion. Prescribing of preventive therapies increased inboth randomized groups over the study period. But academic detailingdid not have an additional effect on changing prescribing overthe postal bulletin alone. Keywords. Academic detailing, feedback, prescribing, primary care.