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Addiction Medical Alcohol and Alcoholism - current issue
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Aims</div>Alcohol misuse may adversely impact health-promoting behaviors. Our objective was to evaluate health-related behaviors in people with HIV with alcohol misuse during the early phase of the COVID-19 pandemic, aiming to understand how alcohol misuse influences these behaviors during health-related emergencies.<div class="boxTitle">Methods</div>Eighty people with HIV (64% male, 51 ± 11 years of age), enrolled in the ALIVE-Ex Study (NCT03299205), consented to a cross-sectional phone survey during the Louisiana stay-at-home order. Alcohol use, dietary intake, physical activity (PA), and emotional well-being over the previous week were assessed. Based on their pre-pandemic Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) score, participants were categorized into having alcohol misuse (AUDIT-C ≥ 3 female (F)/4 male (M)) or having no/low use (AUDIT-C < 3F/4M). Descriptive statistics, Spearman correlations, and crude and adjusted logistic regression models were estimated.<div class="boxTitle">Results</div>Participants with alcohol misuse reported more alcohol use, more frequent meat and salty snack intake, and higher frequency of feeling tense and panicked over the previous week than people with HIV having no/low use (<span style="font-style:italic;">P</span> < .05). Higher alcohol use was associated with more meat and salty snack intake, more frequent vigorous PA, higher PA level, and more emotional distress (<span style="font-style:italic;">P</span> < .05).<div class="boxTitle">Conclusions</div>Overall, participants having alcohol misuse and those reporting higher alcohol use during the stay-at-home order reported less healthy dietary patterns and more emotional distress, while engaging in more PA, compared to participants with lower alcohol use. These data suggest that during health-related emergencies, consideration of patients’ prior and current alcohol use is necessary when encouraging healthy behavioral patterns.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Aims</div>Problem drinking in healthcare workers (HCWs) is highly relevant to study as it could result in personal suffering, as well as inefficiencies in health service delivery. This study aims to investigate the prevalence of nondrinking, drinking, and problem drinking and to investigate the comorbidity between drinking alcohol and mental illness (burnout and depression) among HCWs in Sweden.<div class="boxTitle">Methods</div>This cross-sectional study draws on the 2022 Longitudinal Occupational Health survey in Healthcare Sweden of physicians, nurses, and nurse assistants in Sweden (<span style="font-style:italic;">N</span> = 5966). Measures include levels of alcohol use assessed by the Cut, Annoyed, Guilty, and Eye Opener questionnaire, the 12-item Burnout Assessment Tool, and the Symptom CheckList–Core Depression. Multinomial Logistic regressions were used to investigate the likelihood of reporting nondrinking and problem drinking compared to drinking.<div class="boxTitle">Results</div>The prevalence of problem drinking among Swedish HCWs was 3.7%. Only sex differences were observed for those with a problem drinking, with male nurses and nurse assistants being more likely to report problem drinking. Comorbidity was found between problem drinking and depression but not between problem drinking and burnout.<div class="boxTitle">Conclusions</div>This study demonstrated that ~3.7% of Swedish HCWs had problem drinking and that those also had a higher likelihood of reporting depression but not burnout. Results contribute to new knowledge about the use of alcohol and comorbidities with depression and burnout among HCWs in Sweden. Findings could benefit employers in implementing preventive and tailored strategies to preserve the psychosocial well-being of HCWs.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Aims</div>We sought to explore how acute alcohol exposure alters decision-making in rats performing an approach-avoid decision-making task. Increasing concentrations of alcohol were mixed with decreasing concentrations of sucrose to mimic mixed/sweetened alcoholic beverages.<div class="boxTitle">Methods</div>Rats were trained on an apparatus in which different concentrations of sucrose were available in four different corners of the arena. During daily sessions, a tone signaled each trial start, followed by illumination (15 lux, blue LEDs) of a single corner port, indicating the potential availability of sucrose at that location. The rat (one rat per arena, both females and males) then chose to approach the lit corner to have the solution dispensed or avoid it, with no solution being dispensed. We examined how the decisions to pursue sucrose rewards shifted with the addition and subsequent removal of ethanol from the sucrose ports.<div class="boxTitle">Results</div>Males were greatly affected by the introduction of alcohol into the task environment, shifting their approach preference to solutions containing higher alcohol concentrations rather than maintaining the prior preference for high-sucrose-concentration solutions. In contrast, females’ choice patterns and task performance remained largely unchanged. We also explore a method for identifying changes in decision-making tendencies during and after alcohol consumption within individual subjects.<div class="boxTitle">Conclusions</div>This research explores the introduction of alcohol in varying concentrations with sucrose solutions during an approach-avoid task, with male decision-making and behavioral patterns significantly impacted. We also explore a novel approach for identifying individual adaptations of decision-making behavior when alcohol becomes available, which could be expanded upon in future research.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Introduction</div>Empirical evidence of the buffering effect of social capital and its underlying psychosocial mechanisms on socio-economic inequalities in alcohol use disorder (AUD) symptoms is limited. As socio-economic disadvantages often go together with deficits in resources and considering social capital’s beneficial effects on health, we hypothesized a stronger buffering (at high scores) and a cumulative disadvantaged effect (at low scores) of social capital on AUD symptoms among people reporting higher socio-economic disadvantage compared with their more advantaged counterparts. Additionally, we investigated whether this moderation effect was associated with drinking motives.<div class="boxTitle">Method</div>Three-hundred and sixty-five young adults participated in a cross-sectional online questionnaire measuring all model variables. First, we tested a moderation model, including AUD symptoms (DV), perceived socio-economic disadvantage (IV), and social capital (moderator). Secondly, we tested a moderated mediation model, additionally including drinking motives as mediators of the moderation effect tested in the first model.<div class="boxTitle">Results</div>In the case of high social capital, young adults reporting higher socio-economic disadvantage reported fewer AUD symptoms than their advantaged counterparts, which was associated with their lower endorsement of coping, enhancement, and social motives. When social capital was low, those reporting higher socio-economic disadvantages showed higher AUD symptoms than their advantaged counterparts, which was associated with their higher endorsement of coping motives only.<div class="boxTitle">Conclusion</div>Social capital can buffer (at high levels) or aggravate (at low levels) socio-economic inequalities in AUD symptoms, and drinking for coping, enhancement, and social motives may explain why this happens.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Cytochrome P450 (CYPs) superfamily of enzymes metabolize thousands of endogenous and exogenous substrates including ethanol. Results: Cytochrome P4502E1 (CYP2E1) is involved in ethanol metabolism as part of the so-called microsomal ethanol metabolizing system, in the metabolism of fatty acids and some drugs such as acetaminophen and isoniazid, and in the activation of a variety of procarcinogens (PCs). Chronic ethanol consumption induces CYP2E1 which may result in an enhanced metabolism of these drugs to their toxic intermediates, and in the generation of carcinogens. In addition, ethanol oxidation increases and is associated with the generation of reactive oxygen species (ROS). This oxidative stress is an important driver for the development of alcohol-associated liver disease (AALD) and alcohol-mediated cancer (AMC). ROS may bind directly to proteins and to DNA. ROS may also lead to lipid peroxidation (LPO) with the generation of LPO products. These LPO products may bind to DNA forming etheno-DNA adducts. Cell culture studies as well as animal experiments have shown that CYP2E1 knock-out animals or the inhibition of CYP2E1 by chemicals results in a significant improvement of liver histology. CYP2E1 is also involved in pathogenesis of hepatic steatosis and fibrosis. More recent studies in patients with AALD have demonstrated an improvement of serum transaminase activities when CYP2E1 was inhibited by clomethiazole. In addition to its role in the generation of ROS, CYP2E1 also enhances the activation of PCs and decreases the level of retinol and retinoic acid in the liver. Conclusion: Inhibition of CYP2E1 may improve AALD and may inhibit AMC.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>To understand the need for addiction treatment across the spectrum of adult age, this study evaluated the age of individuals with alcohol/substance use disorder (<span style="font-style:italic;">N</span> = 541) who sought treatment in a local center in Rhode Island. Data extracted from the community showed a need for clinical research to support future addiction medicine that is age-inclusive (e.g. including older adults in clinical trials).</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Aims</div>This study compared individuals with hazardous alcohol consumption who used the web-based intervention “Ohne Alkohol mit Nathalie” (OAMN) with individuals who relied exclusively on traditional support to enhance the understanding of OAMN user characteristics.<div class="boxTitle">Methods</div>A cross-sectional online survey included 2460 treatment-seeking participants with Alcohol Use Disorders Identification Test scores ≥8 indicating hazardous alcohol use. The OAMN group (<span style="font-style:italic;">n</span> = 1825) included individuals who had used OAMN programs, while the non-OAMN group (<span style="font-style:italic;">n</span> = 635) relied exclusively on traditional support. Analyses compared sociodemographic characteristics, psychiatric comorbidities, the extent to which OAMN was used as a standalone or complementary tool, alcohol consumption, and abstinence motives.<div class="boxTitle">Results</div>Both groups were predominantly female and highly educated, but these characteristics were more pronounced among OAMN users. About one-third of OAMN users relied exclusively on the examined intervention, while two-thirds combined it with other forms of support. Non-OAMN users exhibited higher psychiatric comorbidities and had higher Alcohol Use Disorders Identification Test scores. Intrinsic motives were key drivers for abstinence in both groups, while these motives were more pronounced among OAMN users and extrinsic motives were more frequently reported by non-OAMN users.<div class="boxTitle">Conclusion</div>These findings show that OAMN primarily attracts well-educated women and that it’s used as both a standalone and complementary intervention. OAMN users were more likely to report intrinsic motives such as improving well-being and autonomy as key drivers for abstinence and less likely to report extrinsic motives such as external expectations and fear. These insights enhance understanding of the characteristics and abstinence motives of individuals engaging with OAMN.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Aims</div>The goal of the present study was to determine the effect of prior experience with ethanol drinking and changes in session duration on the acquisition and maintenance of operant ethanol self-administration.<div class="boxTitle">Methods</div>Adult male and female Long-Evans rats were trained to operantly self-administer ethanol. A subset of rats underwent 3 weeks of intermittent-access two-bottle choice drinking in the home cage prior to operant training. Controls were given access to two bottles of water. Once fully trained in 30-min operant sessions, the session duration was reduced to 15 min for all rats. Differences between 30- and 15-min sessions were also assessed in a separate group of rats trained to self-administer sucrose.<div class="boxTitle">Results</div>No differences were observed in acquisition rates, the magnitude of responding for ethanol, or total ethanol consumed between rats allowed to drink ethanol in the home cage and those that remained ethanol naïve prior to operant training. A significant decrease in appetitive and consummatory behaviors was observed in rats trained to lever press for either ethanol or sucrose when session length was reduced from 30 to 15 min. Assessment of within-session drinking patterns suggests that this is driven primarily by missed drinking opportunities occurring during the second half of 30-min sessions.<div class="boxTitle">Conclusions</div>These data suggest that prior short-term home cage ethanol drinking offers little advantage as an initiation procedure over no initiation procedure at all. Moreover, reducing operant session duration from 30-min to 15-min has the potential to decrease, rather than increase, levels of ethanol intake.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Aims</div>Magnetic resonance imaging (MRI) studies have identified brain structural predictors of treatment response in individuals with alcohol use disorder (AUD) but with varying findings and primarily in male veterans. The present study investigated cortical surface area and thickness (CT) as predictors of brief intervention response in community-based adults with AUD.<div class="boxTitle">Methods</div>Sixty-five non-treatment-seeking adults with AUD (44.6% male, aged 33.2 ± 1.3 years) underwent an MRI and received a brief intervention comprising personalized feedback and motivational interviewing, with follow-up ~6–8 weeks later to quantify changes in drinks/week (DPW), the primary outcome. Eighteen bilateral <span style="font-style:italic;">a priori</span> regions of interest (ROIs) were used to predict DPW at follow-up, adjusting for baseline drinking. Significant predictors were examined with secondary outcomes, percent drinking and heavy drinking days, and in relation to out-of-scanner measures of impulsivity and comorbidities.<div class="boxTitle">Results</div>Participants exhibited significant decreases in alcohol consumption in response to the brief intervention. Eight bilateral CT ROIs in the frontal, temporal, and occipital lobes, most notably medial orbitofrontal, middle temporal, and lateral occipital gyri, predicted DPW; however, only three predicted the secondary outcomes. Significant associations were observed between CT in frontal and occipital regions and impulsivity (delay discounting, lack of premeditation), executive functioning, anxiety, and stress.<div class="boxTitle">Conclusions</div>Thinner frontal, temporal, and occipital ROIs predicted poorer brief intervention response, with notable overlap with brain regions previously implicated in AUD. Clarifying whether these regions reflect premorbid or acquired differences and, if the latter, the potential for recovery of cortical gray matter following drinking reductions are future priorities.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Gabapentin, an anticonvulsant medication, has been proposed as a treatment for alcohol use disorder (AUD). A multisite study tested gabapentin enacarbil extended-release (GE-XR; 600 mg/twice a day), a prodrug formulation, combined with a computerized behavioral intervention, for AUD. In this multisite trial, the gabapentin GE-XR group did not differ significantly from placebo on the primary outcome of percent of subjects with no heavy drinking days. Despite the null findings, there is considerable interest in using machine learning methods to identify responders to GE-XR. The present study applies interaction tree machine learning methods to identify positive and iatrogenic (i.e. individuals who responded better to placebo than to GE-XR) treatment responders in the trial.<div class="boxTitle">Methods</div>Baseline characteristics taken from the multisite trial were examined as potential moderators of treatment response using qualitative interaction trees (QUINT; <span style="font-style:italic;">N</span> = 338; 223 M/115F). QUINT models are an exploratory decision tree approach that iteratively splits the data into leaves based on predictor variables to maximize a specific criterion.<div class="boxTitle">Results</div>Analyses identified key factors that are associated with the efficacy (or iatrogenic effects) of GE-XR for AUD. Such factors are baseline drinking levels, motivation for change, confidence in their ability to reach drinking goals (i.e. self-efficacy), cognitive impulsivity, and baseline anxiety levels.<div class="boxTitle">Conclusion</div>Baseline drinking levels and anxiety levels may be associated with the protracted withdrawal syndrome, previously implicated in the clinical response to gabapentin. However, these analyses underscore motivation for change and self-efficacy as predictors of clinical response to GE-XR, suggesting these established constructs should receive further attention in gabapentin research and clinical practice. Multiple studies using different machine learning methods are valuable as these novel analytic tools are applied to medication development for AUD.</span>
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