The case for liver transplantation in end-stage alcoholic liver disease

Liver transplantation is now a routine procedure and is seen as a valid treatment option for end-stage liver disease. Alcoholism has been regarded as a relative or absolute contraindication to liver transplantation in many transplant units. Recent data document a success rate for transplantation in alcoholic patients that equals that in other patient groups. Issues relating to the ethical and scientific arguments surrounding this complex area of treatment are discussed. It is concluded that individual patients should be assessed in their own right for this treatment option. It is argued that patient groups should not be denied access to specific life-saving treatments.     

Patterns of family responses to alcohol and tobacco problems

Patterns of family response to drinking and smoking were studied in a sample of 1034 adults in Ontario in 1993. Concerning tobacco smoking, 69% of respondents reported having said something to a relative and 82% to a friend; concerning drinking, 46% had said something to a relative and 65% to a friend. Having said something did not vary much with the respondent's age, educational level and smoking or drinking status, except that current smokers were less likely than others to have said something to a friend or acquaintance, while heavier drinkers were more likely to have said something to a friend or acquaintance, and ex-drinkers were more likely to have said something to a relative. About half of all who had ever smoked reported a family member (57%) or a friend (47%) had said something to them about their smoking, compared with much smaller proportions of ever-drinkers who reported that a family member (14%) or a friend (8%) had ever said anything about their drinking. Both drinking and smoking are recognized by many respondents as imposing burdens on the family. Family members often comment on drinking and smoking, and make suggestions about cutting down or quitting.     

Interstate tourists and the estimation of per capita alcohol consumption

A telephone survey of domestic Australian tourists was conducted to determine the relative contribution they make to estimates of per capita alcohol consumption. The overall drinking patterns of interstate tourists were examined, along with contrasts between those who visit the Northern Territory and those who visit other parts of the country. The results show that drinking generally increased when people were on holiday. Amount of alcohol consumed did not differ by destination, but destination did distinguish the prevalence of holiday drinkers and the amounts of alcohol usually consumed by tourists when they are at home. The self-reported reasons for increased or decreased drinking by people when they are on holidays are also presented. The implications of these various findings for the calculation of per capita consumption estimates for the Northern Territory and other jurisdictions are discussed.     

Neovascular glaucoma. Current management

Neovascular glaucoma is one the most difficult forms of glaucoma to treat successfully. Recent advances modifying filtration surgery can result in up to 77% success. Utilization of anterior and posterior segment photocoagulation can maintain an open angle in up to 80% of eyes when they are treated prior to angle closure by peripheral anterior synechiae. Destruction of the ciliary body can be performed more selectively utilizing argon and ruby lasers. This paper presents a rational approach to the management of neovascular glaucoma incorporating these recent advances.     

Drug use patterns in Northern Territory Aboriginal communities 1986-1987

During April to November 1986 and May to October 1987, a systematic survey of patterns of use of alcohol, kava, tobacco and analgesics by Northern Territory Aboriginal people aged 15 years and older was conducted. The objectives of the study were to ascertain the prevalence of drug use, the frequency of drug use and the quantity of drugs used. In addition, information about Aboriginal people's perceptions of the drugs, their beliefs about drug use and the value of drugs in their culture was collected. This paper describes only the quantitative aspects of drug use of this population. A stratified sampling procedure was used to sample 10 per cent of the target population. Using two survey instruments, an individual questionnaire and a group questionnaire, data were gathered from 1764 Aboriginal people living in the Northern Territory. As a whole, the Northern Territory Aboriginal people have a drug consumption pattern quite distinct from urban Australians.     

Australian Aborigines and alcohol: A review

Following a summary of the relevant historical and legislative background, this article reviews the literature on: (i) rates of alcohol usage and problem drinking in Aboriginal populations; (ii) adverse effects of drinking; (iii) suggested causes of problem drinking among Aborigines; and (iv) treatment and preventive initiatives. The need to examine Aboriginal alcohol use in the wider context of socio-economic deprivation and rapid social change is emphasized. Key issues warranting further research attention are identified and, while recognizing the difficulties inherent in doing so, suggestions are made as to how the quality of research in the area might be raised. It is concluded that, without long-term planning and commitment of the necessary resources by government, little progress will be made in reducing the problems associated with Aboriginal use of alcohol.     

The measurement of harmful outcomes following drinking on licensed premises

The relationships between five potential indicators of alcohol-related harm following drinking on licensed premises in Perth were explored. These were annual purchases made by individual licensees of 'high' (>=3.8%) and 'low' (<3.8%) alcohol content drinks, the number of times a particular licensed establishment is cited by drivers as the last place of drinking prior to failing a roadside breath-test (including after accidents) and the annual number of assaults occurring either on or in the vicinity of particular licensed premises. The study area selected was a central part of the Perth metropolitan area with 367 licensed premises serving a residential population of 400 000. Highly significant correlations were found between each of the five variables. The correlations involving purchases of low alcohol drinks, however, were small. When purchases of alcohol were controlled, significant, though lower, correlations, were still evident between the other three variables. This suggests that there are risk factors other than extent of alcohol sales which further research will need to identify, and that these indicators of harm can be of value in monitoring the impact of future intervention strategies.     

Prodigious alcohol consumption by Australian rugby league footballers

As an incidental finding in a general 'life-style' survey, amateur rugby footballers were found to drink prodigious (12-24 schooners per session) quantities of beer. Such drinking was regarded by the players as part of the traditions of mateship associated with the game. The need for intervention is discussed.     

Relationship between the number and type of alcohol outlets and mortality due to liver cirrhosis and traffic accidents

The aim of the study was to determine the effect on liver cirrhosis and driver and motorcyclist mortality of changing the alcohol outlet rates in New South Wales relative to the adjacent control State of Victoria. A longitudinal study design with a six year before period (1968-1973) and a nine year after period (1974-1982) was used. A 10.5% relative increase in the total outlet rate for New South Wales during the after period was associated with significant increases in liver cirrhosis mortality (males + 22.1%, females + 17.7%) and driver and motorcyclist mortality (males + 19.8%, females + 18.9%) in comparison to the control state. The analyses also indicated that the increases in the dependent variables were apparently due to the higher outlet rates for restaurants and stores rather than for hotels and taverns. Attention is drawn to a number of limitations of the study design.     

Effect of television advertising of alcohol on alcohol consumption and intentions to drive

The alcohol consumption of 120 male and female college students was measured as they viewed a 90-min videotape of popular prime-time television programmes. Independent measures were the sex of the student, their drinker classification (light or moderate-heavy) and the number of alcohol advertisements (0, 6, 12) shown during the screening of the television programmes. Dependent measures were the number of drinks consumed, and the intentions of students to drive a motor vehicle after viewing the videotaped programmes. As predicted, males consumed more alcohol than females, and moderate-heavy drinkers consumed more than light drinkers. Male and female students who viewed six alcohol advertisements consumed more alcohol than students shown no alcohol advertisements or 12 alcohol advertisements. Analysis of intentions to drive after viewing the programmes revealed that the number of drinks consumed was not a significant covariate of driving intentions. Rather light drinkers of both sexes were less likely to intend to drive than moderate-heavy drinkers. Males exposed to alcohol advertisements were less likely to intend to drive than males who did not view alcohol advertisements. Different levels of exposure to alcohol advertisements did not influence the driving intentions of college females.