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     

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     

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     

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     

Introduction to personality-biological interactions in alcoholism: 'The Markku Linnoila Memorial Symposium'.

Although a number of specific personality disorders, includinganti-social personality, passive-dependent personality, andexplosive personality, have been associated with the diagnosisof alcoholism, studies of the relationship of underlying personalityand/or temperament to the nature, phenomenology, psychobiology,prognosis, and treatment of alcoholism have occurred much lessfrequently. However, there is a growing body of evidence thatcore or underlying personality and temperament are . . . [Full Text of this Article]FOOTNOTES     

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     

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     

Improving outpatient care of depression by implementing practice guidelines: a controlled clinical trial

Objective. Depressive disorders are of great medical and political significance.Although evidence-based guidelines have been published and educationalinitiatives have been launched to implement them, they are rarelyactually used. The aim of the study was to implement clinicalpractice guidelines for outpatient care of depression usinga practice-oriented and interdisciplinary approach. Design. Controlled clinical trial with a naturalistic design (data collectionwithin routine practice) designed as a prospective pre-poststudy. Setting. Outpatient care. Participants. 29 general practitioners (intervention: 18; control: 11) and15 psychiatrists (intervention: 11; control: 4). Overall, thetreatment of 698 patients (two samples: pre: 361; post: 337)was documented. Intervention(s). Multifaceted intervention combining benchmarking, continuousmedical education and interdisciplinary quality circles forthe diagnosis and treatment of depressive disorders. Main outcome measures. Mixed-effects regression models for cluster-adjusted analysisof patients' symptom reduction. Results. Although physicians in the intervention group improved theirclinical effectiveness (proportion of patients with response/remission)to a greater extent than physicians in the control group (intervention:48.6% to 66.9%; control: 54.9% to 61.5%), cluster-adjusted analysisfailed to prove a statistically significant effect of the interventionon the treatment outcome. Conclusions. Although no statistically significant improvements were foundregarding the outcomes, the action programme provides importantwork, materials and results for an integrated treatment modelfor depression.     

A randomized controlled trial of electromagnetic therapy in the primary care management of venous leg ulceration

OBJECTIVE: The aim was to establish the potential efficacy, tolerabilityand side-effect profile of electromagnetic therapy as an adjunctto conventional dressings in the treatment of venous leg ulcers. METHOD: A prospective, randomized, double blind controlled clinicaltrial was carried out in a dedicated leg ulcer clinic basedin one urban general practice. Nineteen patients with leg ulcersof confirmed venous aetiology were assessed. The main outcomemeasures were rate and scale of venous leg ulcer healing, changesin patient-reported pain levels, quality of life, degree ofmobility, side effect profile and acceptability to patientsand staff. RESULTS: Sixty-eight per cent of patients attending this dedicated clinicachieved improvements in the size of their ulcer (4, 21%, healedfully) and in reduced pain levels (P < 0.05) during the trial,despite the chronicity of ulcer histories. Patients treatedwith electromagnetic therapy at 800 Hz were found at day 50to have significantly greater healing (P < 0.05) and paincontrol (P < 0.05) than placebo therapy or treatment with600 Hz. All patients reported improved mobility at the end ofthe study. The electromagnetic therapy was well tolerated bypatients, with no differences between groups in reporting adverseevents, and proved acceptable to staff. CONCLUSION: Despite the small numbers in this pilot study, electromagnetictherapy provided significant gains in the healing of venousleg ulcers and reduction in pain. Keywords. Electromagnetic therapy, RCT, leg ulcers, primary care.     

Erratum

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

Screening, Detection and Management of Depression in Elderly Primary Care Attenders. II: II: Detection and Fitness for Treatment: a Case Record Study

Case note data were obtained for 186 elderly primary care attenderswho also completed the 15 item Geriatric Depression Scale (GDS15).The presence or absence in the case notes of a current or pastdiagnosis of depression, of current treatment of depression,and of a number of clinical features of depression were noted.Case notes were also rated for the presence or absence of contraindicationsto the use of tricyclic antidepressants (TCAs) and to serotonin-specificreuptake inhibitors (SSRIs). Whereas 65 (35%) patients wererated as ‘cases’ of depression on the GDS15, only28 (15%) had a current case note diagnosis of depression and37 (20%) had one or more current symptoms of depression recordedin the case notes. Patients rated by their GP as having oneor more current symptoms of depression scored higher on theGDS15 (P < 0.05) and were more likely to be categorized asa GDS case (P = 0.05). There was no significant relationshipbetween GDS caseness and a current case note diagnosis of depression.Seventy-three patients (39%) had a past history of depressionand 53 (28.5%) patients had previously been treated with antidepressants.The former was significantly associated with GDS caseness (P< 0.05). Twenty-four patients (13%) were currently on antidepressants,19 of them receiving adequate doses (equivalent to at least75 mg of amitriptyline). Current antidepressant treatment wasnot associated with GDS ‘caseness’. A significantlyhigher proportion of patients (both in the sample as a wholeand in the subgroup of GDS15 depression ‘cases’)had a medical condition or were taking a drug that mitigatedagainst the use of TCAs than was the case for SSRIs.     

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.     

Acute cooling of the feet and the onset of common cold symptoms

Background. There is a common folklore that chilling of thebody surface causes the development of common cold symptoms,but previous clinical research has failed to demonstrate anyeffect of cold exposure on susceptibility to infection withcommon cold viruses. Objective. This study will test the hypothesis that acute coolingof the feet causes the onset of common cold symptoms. Methods. 180 healthy subjects were randomized to receive eithera foot chill or control procedure. All subjects were asked toscore common cold symptoms, before and immediately after theprocedures, and twice a day for 4/5 days. Results. 13/90 subjects who were chilled reported they weresuffering from a cold in the 4/5 days after the procedure comparedto 5/90 control subjects (P = 0.047). There was no evidencethat chilling caused any acute change in symptom scores (P =0.62). Mean total symptom score for days 1–4 followingchilling was 5.16 (±5.63 s.d. n = 87) compared to a scoreof 2.89 (±3.39 s.d. n = 88) in the control group (P =0.013). The subjects who reported that they developed a cold(n = 18) reported that they suffered from significantly morecolds each year (P = 0.007) compared to those subjects who didnot develop a cold (n = 162). Conclusion. Acute chilling of the feet causes the onset of commoncold symptoms in around 10% of subjects who are chilled. Furtherstudies are needed to determine the relationship of symptomgeneration to any respiratory infection. Keywords. Cold exposure, common cold, infection, nose.