Screening and Initial Management of Alcohol Misuse in Primary Care

Nurse practitioners play a vital role in the screening and management of alcohol use disorders in primary care. Despite the prevalence and health impact of alcohol misuse, and recommendations for use of regular screening, many providers report lack of preparation and confidence in the identification, treatment, and referral. Several validated and evidence-based screening, assessment, intervention, and treatment options are available, including the Alcohol Use Disorders Identification Test, Alcohol Use Disorders Identification Test-Consumption, and the single-question screen. Similar to screening for other adverse health behaviors, screening and brief intervention for alcohol misuse is a preventive service that nurse practitioners can provide to their patients.     

Measures That Identify Prescription Medication Misuse,Abuse, and Related Events in Clinical Trials: ACTTION Critique and Recommended Considerations

Accurate assessment of inappropriate medication use events (ie, misuse, abuse, and related events) occurring in clinical trials is an important component in evaluating a medication's abuse potential. A meeting was convened to review all instruments measuring such events in clinical trials according to previously published standardized terminology and definitions. Only 2 approaches have been reported that are specifically designed to identify and classify misuse, abuse, and related events occurring in clinical trials, rather than to measure an individual's risk of using a medication inappropriately: the Self-Reported Misuse, Abuse, and Diversion (SR-MAD) instrument and the Misuse, Abuse, and Diversion Drug Event Reporting System (MADDERS). The conceptual basis, strengths, and limitations of these methods are discussed. To our knowledge, MADDERS is the only system available to comprehensively evaluate inappropriate medication use events prospectively to determine the underlying intent. MADDERS can also be applied retrospectively to completed trial data. SR-MAD can be used prospectively; additional development may be required to standardize its implementation and fully appraise the intent of inappropriate use events. Additional research is needed to further demonstrate the validity and utility of MADDERS as well as SR-MAD.

Alcohol and Drug Abuse in Sexual and Nonsexual Violent Offenders

According to a literature review by Marshall (1996), presently available data have not clarified the proportion of sexual offenders who would meet diagnostic criteria for addictive problems. Our own literature review failed to find published studies comparing sexual offenders to nonsexual violent offenders on standardized measures of substance abuse. Our study is a preliminary investigation of the differences between sexual offenders (rapists: n = 72; child molesters: n = 34) and nonsexual violent offenders (n = 24) on measures of alcohol and drug abuse. The findings indicate that sexual offenders were more likely to abuse alcohol than were nonsexual violent offenders. Nonsexual offenders were significantly more likely to have had a history of other forms of substance abuse. The results are considered in terms of theories of alcohol's contribution to aggressive behavior and sexual aggression. Implications for assessment and treatment of sexual offenders are discussed.     

Alcohol and Opioid Use in Chronic Pain: A Cross-Sectional Examination of Differences in Functioning Based on Misuse Status

Opioid misuse is regularly associated with disrupted functioning in those with chronic pain. Less work has examined whether alcohol misuse may also interfere with functioning. This study examined frequency of opioid and alcohol misuse in 131 individuals (61.1% female) prescribed opioids for the treatment of chronic pain. Participants completed an anonymous survey online, consisting of measures of pain, functioning, and opioid and alcohol misuse. Cut scores were used to categorize individuals according to substance misuse status. Individuals were categorized as follows: 35.9% (n?=?47) were not misusing either opioids or alcohol, 22.9% (n?=?30) were misusing both opioids and alcohol, 38.2% (n = 50) were misusing opioids alone, and only 3.0% (n?=?4) were misusing alcohol alone. A multivariate analysis of variance was performed to examine differences in pain and functioning between groups (after excluding individuals in the alcohol misuse group due to the small sample size). Group comparisons indicated that individuals who were not misusing either substance were less disabled and distressed in comparison to those who were misusing opioids alone or both opioids and alcohol. No differences were indicated between the latter 2 groups. Overall, the observed frequency of opioid misuse was somewhat higher in comparison to previous work (approximately 1 out of every 3 participants), and misuse of both alcohol and opioids was common (approximately 1 out of every 5 participants). While these data are preliminary, they do suggest that issues of substance misuse in those with chronic pain extends beyond opioids alone.

大学生控制饮酒行为对饮酒量的影响

目的了解大学生在日常饮酒过程中控制饮酒的行为,分析这些行为对饮酒量的实际控制效果。方法在某校2005-2008级学生中选择1413名进行饮酒情况及控制饮酒行为的问卷调查,并对调查结果进行量化评分,然后运用分层回归分析方法分析控制饮酒行为对实际饮酒量的影响。结果有近70％的学生承认在最近1个月周期内饮酒,最常采取的控制饮酒行为包括：饮酒前或饮酒中进食,记录饮酒量,避免赌酒。饮酒前或饮酒中进食、请朋友监督控制的方法不能有效控制饮酒量,而记录饮酒量、避免赌酒、尽量延长饮酒间隔时间则能对饮酒控制起到积极的作用。结论学校和社会应在加强宣传饮酒危害的同时探索一些有效方法以控制大学生的酒精摄入量,减少酒精对大学生的伤害,促进大学生建立健康的生活方式。     

Alcohol Abuse/Dependence in Motor Vehicle Crash Victims Presenting to the Emergency Department

Objective: 1) To determine the prevalence of current alcohol abuse/alcohol dependence (AA/AD) among the full injury range of ED motor vehicle crash (MVC) patients; and 2) compare AA/AD and non-AA/AD patient characteristics.
Methods: This was a prospective cohort study using a stratified random sample of MVC patients aged ≥18 years presenting to a university hospital and university-affiliated community hospital ED from May 1, 1992, to August 30, 1994. A diagnosis of current AA/AD was based on the alcohol section of the Diagnostic Interview Survey (DIS). Other measurements included the presence of blood alcohol (BAC +), Injury Severity Score (ISS-85), occupant status (driver/passenger), age, gender, seat belt use, culpability for crash, and ED disposition (admitted vs released). A weighted prevalence was determined; subgroups were compared using t-tests, χ². 2-factor analysis, and logistic regression modeling; α = 0.05.
Results: 1,161 patients were studied. The weighted prevalence of current AA/AD was 22.5%; 53% of these patients were released from the ED. Almost 45% of the patients with current AA/AD were BAC —. When controlling for BAC and AA/AD, greater injury severity and culpability were associated with a BAC +, but not with current AA/AD.
Conclusion: Almost 23% of ED MVC patients have current AA/AD; BAC testing does not accurately identify these patients. Intervention strategies must be directed to both admitted and released patients.     

Range of Motion in Older Women

This study had three purposes: to compare the active neck and upper extremity range of motion (ROM) in healthy older women with expected estimates; to consider if right and left side measures were similar; and to determine the degree of ROM loss with advancing age. Sixty-one older women, living independently in the community, were measured at the neck, shoulder, elbow, forearm, and wrist on the right and left sides using a standard protocol. ROM was less than expected by 14_ to 30_ for neck lateral flexion (26.00_ ?8.72_ on right; 26.41_ ?7.67_ on left), shoulder abduction (154.62_D 21.37_ on right; 150.25_ ?21.65_ on left), shoulder flexion (158.23_ ?19.55_ on right; 159.20_ ?8.73_ on left), shoulder internal rotation (52.92_ ?8.99_ on right; 53.74_ ?9.94_ on left), and shoulder external rotation (76.05_ ?16.31_ on right; 72.44_ ?15.37 on left). Some differences were noted between right and left side ROM. Linear regression for age and range suggested that range decreased with age by an average of approximately 1_ per year in right shoulder abduction, right shoulder flexion, and right and left shoulder external rotation.     

工作作为药物及酒精滥用者有效的干预策略和治疗方法

1Introduction Substanceabusecontinuestobeamongthemostsevereso cialandcostlyhealthproblemsdevastatingindividualsandtheir familiesintheUnitedStates.Initssimplestdefinition,sub stanceabuseisthecontinueduseofalcoholorotherdrugsde spiteknowledgeofhavingapersistentsocial,vocational,psy chologicalorphysicalproblemthatiscausedorexacerbatedby theuseofalcoholorotherdrugs(DSMIV TR,1994).All drugsofabuse,includingalcohol,aretoxicandcannegatively impacteverysysteminthehumanorganism.Protractedsub stance…     

Living Arrangements,Social Networks,Health, Mobility,and Balance of Older Women

ABSTRACT

Background: The aim of this study is to add to the literature research-based documentation by comparing a variety of characteristics of older women of 75 years or more in Oslo who live alone with women who live with a partner regarding demographic factors, their social networks, health, and mobility. Methods: In a cross-sectional study, a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) and living at home were interviewed and tested regarding demographic factors, their social networks, health, mobility, and balance. Results: The mean age of the women was 80.8 years, and 76.5% of them were living alone. Fewer years of education, less frequent outdoor walking, difficulty in keeping their balance while walking, more frequently feeling their hearts pounding and suffering from shortness of breath, feeling lonely, and having a low score on the Timed Up and Go (TUG) test are factors independently associated with living alone. The strongest independent relationship existed between feelings of loneliness and living alone. Conclusion: Women living alone reported more frequently feeling lonely, have less years of education, were frailer, and had worse mobility problems than women living with a partner.     

Overview of Health Issues of Older Women with Intellectual Disabilities

Health researchers, educators and providers have begun to address the health needs of women and girls with disabilities in the U.S. Older women with intellectual disabilities, however, remain underrepre-sented in the national health research agenda. As this population becomes more visible and empowered through policies that support greater community integration and longevity, they and their families, professionals and advocates need more accurate information about their health concerns and options. A critical problem is that professionals receive little training regarding the health concerns and experiences of women with intellectual disabilities who are growing older. This paper provides an overview of primary health issues related to aging for women with intellectual disabilities in the following areas: (1) general health, (2) reproductive health, (3) mental health, and (4) access to health services. The paper concludes with a discussion of implications for practice and research, and recommendations for future research and health service provision for women with intellectual disabilities.     

Action Responses of Congolese Refugee Women

PURPOSE: To describe Congolese refugee women's action responses to difficult living situations. DESIGN: Interpretive qualitative. METHODS: Narrative data were collected from 14 Congolese refugee women using minimally structured interviews and were analyzed for patterns in their responses to their difficult situations. FINDINGS: The narratives about participants' difficult circumstances indicated six action responses: refiguration, advocacy, resistance, resignation, sorrow, and faith. CONCLUSIONS: When encountering difficult life circumstances, refugee participants demonstrated actions with varying influence on their agency.     

Coping Responses and Alcohol Outcome Expectancies in Alcohol Abusing and Nonabusing Social Phobics

This study examined coping responses and alcohol outcome expectancies in alcohol abusing and nonabusing social phobics. The sample consisted of social phobics with current alcohol abuse or dependence (SPAs, n = 19), social phobics without lifetime alcohol use disorders (SPs, n = 19), and normal controls (NCs, n = 21). As predicted, SPs reported less problem-focused coping than did NCs in nonalcohol social situations and rated themselves as less skillful in interpersonal role-plays. However, observers did not rate SPs as less skillful than NCs in these role-plays. Consistent with the predicted situation-specific effects, SPAs reported less problem-focused coping than did SPs during alcohol-accessible social situations, but not during alcohol-inaccessible social situations. However, observer-rated and self-report results from role-plays of high-risk alcohol situations did not show the predicted lower drink refusal skills among SPAs compared to SPs. SPAs reported higher positive alcohol expectancies of tension reduction than did SPs but did not differ in negative alcohol expectancies of cognitive and behavioral impairment. These results are in several ways consistent with cognitive and social-learning theories of social phobia and alcohol abuse.     

The Hispanic Americans Baseline Alcohol Survey (HABLAS): Alcohol consumption and sociodemographic predictors across Hispanic national groups

Objective: To examine differences in alcohol consumption among Hispanic national groups in the United States [Puerto Ricans, Mexican, Cuban, and Dominican South Central (D/SC) Americans] and identify sociodemographic predictors of drinking and binge drinking (four drinks for women and five for men in a 2-hr period).

Method: The study used a household probability sample of adult Hispanics in five metropolitan areas in the United States. Comprehensive data on alcohol consumption were collected. Analyses included bivariate and multivariate regression techniques.

Results: Puerto Rican and Mexican American men reported higher drinking rates, weekly consumption, and binge drinking than D/SC and Cuban Americans. Women drank significantly less than men. Mexican American women reported the highest abstention rate (61%); Puerto Rican women drank more per week and binged more frequently compared with their counterparts in other groups. Puerto Rican origin, initiating drinking during high school years (<18), and male gender (US- or foreign-born) were significant predictors of weekly alcohol consumption. Being younger, being single, Puerto Rican or D/SC American origin, initiating drinking at <18 years, being a US- or foreign-born male and being a US-born female were significant predictors of binge drinking.

Conclusions: There are considerable differences in drinking behavior across Hispanic national groups as well as between men and women. Results underscore the need to recognize heterogeneity in drinking practices while designing effective prevention interventions in the community.