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     

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,     

'Only connect': the centrality of doctor-patient relationships in primary care

EM Forster's call in A Passage to India to ‘only connect’is a shorthand for the hundreds of ways in which doctor–patientrelationships have been discussed in the literature. As Chew-Grahamstates, in the parallel editorial, this relationship, and thepatient-centred ideology which underpins it, is seen as intrinsicallytherapeutic. The evidence base for such an assumption is wellestablished, most notably in the literature on quality and continuityof care. The centrality of relationship-based primary care There is a strong association between personal continuity, enablementand patient satisfaction.¹ Since personal continuity impliesboth empathy and personal responsibility,^2,3 the studies overallshow a strong correlation between quality relationships andpatient satisfaction. Reviews of     

Occupational Mortality in the Armed Services

This article intends to show that the Services mortality experiencehas been somewhat misrepresented in recent publications, andthe reasons for this. I have also pointed out some areas wherewe are well aware that our experience is below average, andhave highlighted accidental deaths mainly due to road trafficaccidents and deaths in soldiers from ischaemic heart disease,as areas of concern. Accepted        1 October 1981 Requests for reprints should be addressed to: Col. P. J. Blackburn, Ministry of Defence (AMO 5), First Avenue House, High Holborn, London. ^*Paper presented at the Joint Services and Faculty of OccupationalMedicine Conference held at the Institute of Naval Medicine,Alverstoke, 29-30 January 1981.     

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     

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     

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     

Erratum

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

The WONCA World Congress 2004 did not meet academic standards

Introduction Encouraged by participating in the world's largest gatheringever of family doctors and of having fruitful academic profits,we travelled the long way from Denmark to the WONCA 2004 WorldCongress in Orlando, Florida.¹ We had all prepared posters andoral presentations, the weather was perfect and the settingideal. Aim of the WONCA World Congress Among other missions WONCA seeks to "foster and maintain highstandards of care in general practice/ family medicine by ...representing the educational, research and service     

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     

INVOLVEMENT OF GENETIC POLYMORPHISM OF ALCOHOL AND ALDEHYDE DEHYDROGENASES IN INDIVIDUAL VARIATION OF ALCOHOL METABOLISM

The involvement of genetic polymorphism at the alcohol dehydrogenase2 (ADH2) and aldehyde dehydrogenase 2 (ALDH2) loci in determiningblood acetaldehyde levels and the rate of ethanol eliminationafter ethanol intake was investigated. Sixty-eight healthy subjectsingested 0.4 g of ethanol per kg of body weight over 10 min.Blood acetaldehyde levels scarcely increased in the subjectshomozygous for ALDH2^*I, regardless of their ADH2 genotypes (ADH2^*1/^*1,ADH2^*1/^*2 and ADH2^*2/^*2). The acetaldehyde levels in the subjectswith the ALDH2^*1/^*2 heterozygote increased to 23.4 µMon average, and no significant differences were observed betweenthe three ADH2 genotype groups. Subjects homozygous for ALDH2^*2showed very high levels of blood acetaldehyde, and the averagevalue was 79.3 µM. The values of Widmark's ß₆₀(mg/ml/hr)and ethanol elimination rate (mg/kg/br) showed significant differencesamong the three ALDH2 genotypes, and in decreasing order thevalues were ALDH2^*1/^*1, ALDH2^*1/^*2, ALDH2^*2 However, no significantdifferences were seen among the ADH2 genotypes.     

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     

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 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     

RELATIONSHIP BETWEEN GENETIC POLYMORPHISM OF CYP2E1 AND ALDH2, AND POSSIBLE SUSCEPTIBILITY TO ALCOHOLISM

In 45 healthy Japanese volunteers, it was found that personsheterozygous for ALDH2 (ALDH2^*1/ALDH2^*2), and also either heterozygousor mutant homozygous for CYP2E1 (C₂/C₂ or C₁/C₂ can drink muchmore alcohol, even with (slight) flushing, than persons heterozygousfor ALDH2 (ALDH2^*1/ALDH2^*2) and normal homozygous for CYP2E1(C₁/C₁)     

ALCOHOL DEHYDROGENASE POLYMORPHISMS IN NATIVE AMERICANS: IDENTIFICATION OF THE ADH2*3 ALLELE

Alcohol dehydrogenase (ADH) polymorphisms were evaluated among95 Native American Mission Indians. Approximately equal frequenciesof ADH3^*1 and ADH3^*2 alleles were found. Twelve individualswere heterozygous for ADH2^*3, an allele previously identifiedonly in persons of African origin. None of the individuals withADH2^*3 alleles was of purely Native American descent, althoughnone had known African ancestry. These results suggest thatthese candidate genes deserve broader study among Native Americansand may provide increased understanding of the likely polygeniccontributions to alcohol-related disorders in this population.     

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     

Cerebral Damage Following a Single High Exposure to Carbon Disulphide

A formerly healthy 48-year-old man was accidentally exposedfor approximately 20 minutes to a high concentration of carbondisulphide (minimum concentration, 400 parts/10⁶; maximum, 470000 parts/10⁶), and was unconscious for approximately 10 minutes.Serious persistent cerebral deterioration developed. Computerizedtomography scanning showed cerebral atrophy, neuro-psychologicalexamination established dementia, and measurement of cerebralflow showed reduced cortical flow in the right hemisphere. Possible mechanisms for the cerebral damage are discussed, andpersons who are at risk from such accidental poisoning are listed. Accepted        1 August 1981     

Environmental and biological monitoring of occupational exposure to 1,1,1 -trichloroethane

Fifty workers involved in various degreasing and cleaning processesusing 1,1,1-trichioroethane (1,1,1-TCE) were studied with respectto personal and static exposures. In addition, end-of-shiftexpired air and venous blood samples were taken for analysisof the parent compound. Urinary samples were also obtained atthe same time for analysis of its metabolites - trichioroethanol(TCOH) and trichloroacetic acid (TCA). The results show thatopen/manual degreasing processes generate the highest environmentalsolvent levels (mean = 819.9 mg/m³; SD = 781.9 mg/m³) followedby jet-spray cleaning (mean = 460.5 mg/m³; SD = 292.4 mg/m³),vapour degreasing (mean = 365.3 mg/m³; SD = 279.9 mg/m³) andultrasonic degreasing (mean = 134.7 mg/m³; SD = 121.0 mg/m³).Personal exposure levels were well correlated with concentrationsof 1,1,1-TCE in end-of-shift expired air (r = 0.81) and venousblood samples (r = 0.88) but only moderately correlated withconcentrations of its metabolites in urine (r = 0.49 for TCOH;r = 0.58 for TCA). Static (area) samples were poorly correlatedwith the biological exposure indices studied.