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Addiction Medical Alcohol and Alcoholism - current issue
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Aims</div>This study aimed to evaluate national alcohol sales and their association with the number of maxillofacial fractures in Southern Finland.<div class="boxTitle">Methods</div>Patient data of all facial fracture patients admitted to tertiary trauma centers (Helsinki University Hospital, Helsinki, Finland) from January 2014 to October 2020 were reviewed retrospectively. Information on alcohol sales in Finland was obtained from the Finnish Institute for Health and Welfare.<div class="boxTitle">Results</div>The annual number of facial fractures increased, as did the number of facial fractures caused by interpersonal violence. Unexpectedly, we found a mostly inverse association between alcohol sales and facial fractures, although three months were associated positively: April, June, and November.<div class="boxTitle">Conclusion</div>We conclude that although the significance of alcohol use in the etymology of facial fractures has been unmistakably proven neither population-level alcohol use nor interpersonal violence as an injury mechanism explains the increase in facial fractures. However, there are some associations between the seasonality of alcohol consumption and facial fractures, suggesting the same predisposing factors in both. Further, certain groups of users, exceeding a threshold of alcohol use, appear to be responsible for the traumatic presentations in emergency units. Elucidating the associations between alcohol use and facial fractures requires an assessment of patient-specific factors, rather than population-level alcohol use, for a detailed understanding and justification of alcohol policy.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>It seems that diet is one of the main triggers of migraine; one of the most studied is alcohol, and also, over the years, red wine has been shown to trigger headaches. Therefore, this systematic review and meta-analysis aims to examine the strength of the association between wine consumption and migraine.<div class="boxTitle">Methods</div>In this systematic review and meta-analysis, a search of MEDLINE (via PubMed), Scopus, Cochrane, and Web of Science databases was conducted to assess the association between wine consumption and migraine, covering baseline to December 2023. Pooled Odds Ratio (p-OR) were calculated using the DerSimonian and Laird methods. This study was previously registered in PROSPERO (CRD42024511115). The risk of bias was evaluated using The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.<div class="boxTitle">Results</div>Five studies were included in this systematic review, and only four of them were in the meta-analysis. Using the DerSimonian and Laird method, the p-OR for the effect of wine consumption on migraine was 0.63 (95% CI 0.36–1.09). The included studies after the risk of bias assessment showed a moderate risk of bias.<div class="boxTitle">Conclusions</div>The findings of this systematic review and meta-analysis indicate that there is no conclusive evidence to support an increased or decreased risk of migraine associated with wine consumption.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Aims</div>We described the age-specific trajectories of total alcohol consumption and the consumption of different types of beverages among adult Norwegian women as they age, and how these relate to education, lifestyle, and health-related factors.<div class="boxTitle">Methods</div>This study included 76 382 women aged 31–70 years who participated in at least two of the three Norwegian Women and Cancer (NOWAC) study surveys conducted in 1991–97, 1998–2003, and 2004–11. Group-based trajectory modeling was used to identify the trajectories of self-reported alcohol consumption. Multinomial regression models were used to fit the adjusted odds ratios (ORs) of the associations between education, lifestyle, health-related factors, and the trajectory membership. Analysis was stratified into two subcohorts: women aged 31–49 years and women aged 50–70 years at enrolment.<div class="boxTitle">Results</div>Five different trajectories of total alcohol consumption were identified among the two subcohorts: non-drinker stable (12.5%–23.6%), low stable (66.3%–60.1%), light increasing or light unstable (17.8%–12.1%), moderate to high or light to high (2.8%–2.7%), and high to moderate or moderate decreasing (.6%–1.4%). Trajectories were resembled by those of wine consumption. Compared to low stable drinkers, women who sustained or increased their total alcohol consumption showed higher ORs for higher education level, excellent self-rated health, former or current smoking status, and a body mass index (BMI) below 25 kg/m<sup>2</sup>.<div class="boxTitle">Conclusion</div>While most women in this study maintained stable low-light levels of alcohol consumption, certain groups—such as women with higher education and better health—were more likely to increase their drinking with age. Women can particularly increase their drinking around the retirement age. The increasing trends of total alcohol consumption were reflected by those of wine. These findings provide information into groups and beverages that could be targeted in alcohol-reducing interventions.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>The study aimed to summarise the evidence of the association between preoperative alcohol consumption and postoperative complications in gastrointestinal surgeries. Comprehensive searches of MEDLINE, EMBASE, and Cochrane databases were undertaken to identify original studies investigating the association between preoperative alcohol consumption and postoperative complications occurring within 30 days of surgery. The primary outcome was 30-day mortality risk and secondary outcomes included postoperative complications such as surgical site infections and risk of anastomotic leak. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a random effects model. In total, 3601 reports were identified and reviewed for eligibility, then data was extracted from 26 studies that met inclusion criteria. 13 studies were included in the meta-analysis. The total number of patients in the meta-analysis was 686 181 including 20 163 with a high alcohol intake. Clearly defined high preoperative alcohol consumption was associated with an increased risk of postoperative complications including 30-day mortality (OR = 1.56; 95% CI: 1.07–2.28). The risk of anastomotic leak was significantly increased in those undergoing colorectal surgery with a high alcohol intake, OR 2.17 (95% CI: 1.74–2.72). An increase in risk was also found for surgical site infections in those undergoing gastrointestinal surgery with high alcohol intake. (OR = 1.32; 95% CI: 1.15–1.53). Preoperative alcohol consumption was associated with an increased risk of 30-day mortality, anastomotic leak and surgical site infections. Preoperative modulation of alcohol intake may influence post-operative complications after gastrointestinal surgery.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div>Alcohol use disorder has adverse implications for individuals' health, utilisation of healthcare services, and societal costs. There are a group of individuals who frequently attend hospital for alcohol-related issues, have complex co-morbid needs, and experience barriers to engaging with specialised alcohol treatment services. To support these individuals and reduce healthcare system costs, Alcohol Assertive Outreach Treatment (AAOT) has been recommended. However, AAOT is not routinely used in the UK. Understanding the determinants of the implementation of AAOT can increase its utilisation and effectiveness. This study therefore employed the Consolidated Framework for Implementation Research (CFIR) framework to highlight barriers and facilitators to the successful and sustainable implementation of AAOT. Semi-structured interviews were conducted with twenty AAOT team staff members (team managers and outreach workers) from two North West England AAOT teams. Twenty-eight stakeholders (clinicians, commissioners, policy makers and academics across England) were also interviewed, who were considered to be key contributors to AAOT implementation, both within and external to North West England. Framework analysis based on the CFIR was conducted, whilst allowing for inductive coding where appropriate. Overall, participants recognised AAOT as acceptable and beneficial. Three main themes were identified: organisational and individual level factors, including team culture and staff characteristics; systemic partnerships and interagency communication; and an adaptable model driven by research and evaluation. Each theme relates to various CFIR domains and constructs which were perceived to influence the implementation of AAOT. Readers are encouraged to consider the findings in the development and implementation of AAOT teams, new or existing.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Aims</div>We evaluated the safety, efficacy, and patient adherence to oral ANS-6637, a selective, reversible inhibitor of aldehyde dehydrogenase 2 (ALDH2), for treating alcohol use disorder (AUD).<div class="boxTitle">Methods</div>A 3-arm, double-blind, randomized, proof-of-concept human laboratory study embedded in a 5-week multisite clinical trial tested 200 mg and 600 mg daily doses of ANS-6637 compared to placebo in treatment-seeking adults with AUD. After 1 week of medication, participants completed an alcohol cue reactivity session. Drinking and safety assessments were measured during treatment; other exploratory outcomes were measured 1 week after treatment ended.<div class="boxTitle">Results</div>The study was terminated following enrollment of 43 of 81 planned participants due to clinically significant, reversible increases in liver enzymes in three women. Adverse events consistent with ALDH2 inhibition in the presence of alcohol (heart rate/palpitations, flushing, nausea) were dose dependent. Group differences in cue-elicited craving were not significant; effect sizes (Cohen’s d) comparing the 200 mg and 600 mg doses to placebo were .71 and .06, respectively. Secondary endpoints did not differ significantly between groups; Cohen’s d ranged from .31 to .57 for the 600 mg dose compared to placebo for continuous drinking outcomes.<div class="boxTitle">Conclusions</div>Findings of liver toxicity with ANS-6637 led to early termination and reduced power to test hypotheses. Effect size estimates are consistent with the hypothesis that selective ALDH2 inhibition may reduce craving and drinking, however these estimates may be unreliable due to the small sample size. Additional research with non-hepatotoxic selective and reversible ALDH2 inhibitors is needed to evaluate this approach to AUD pharmacotherapy.</span>
<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background and aims</div>Alcohol-associated hepatitis (AH) frequently triggers acute decompensation (AD) in cirrhosis, with severe AH linked to high short-term mortality, especially in acute-on-chronic liver failure. Current corticosteroid treatments have limited efficacy, highlighting the need for new therapies. We hypothesized that severe AH outcomes are influenced by early specialized care; thus, we examined the impact of time-to-tertiary care (TTTc).<div class="boxTitle">Methods</div>Adults with cirrhosis or advanced chronic liver disease were enrolled (RH7, NCT04767945). AH was diagnosed using National Institute on Alcohol Abuse and Alcoholism criteria. Primary admission site, TTTc, and adverse outcomes (death or liver transplantation) were analyzed. Patients admitted directly to tertiary care were assigned a TTTc of zero.<div class="boxTitle">Results</div>Of 221 AD-AH patients, 107 were transferred from secondary care to tertiary care (TTTc >0) and 114 were admitted directly (TTTc = 0). TTTc >0 patients were younger (48.3 vs. 52 years, <span style="font-style:italic;">P</span> = .008) and had more severe disease, as shown by model for end-stage liver disease scores (25.5 vs. 20.8, <span style="font-style:italic;">P</span> < .001) and Maddrey’s discriminant function (59.3 vs. 40.6, <span style="font-style:italic;">P</span> < .001). Propensity-score matching yielded 49 case pairs. The Cox model showed that transfer from secondary care was not associated with increased risk, but delayed transfer (days, hazard ratio = 1.03, 95% confidence interval 1.01–1.05) independently predicted adverse outcomes.<div class="boxTitle">Conclusions</div>Delayed initiation of specialized care adversely impacts outcomes in AD-AH. If validated, timely care bundles could improve AH survival, similar to sepsis or vascular syndromes.<div class="boxTitle">Highlights</div><ul><li class="bullet">AD-AH is a common syndrome associated with high short-term mortality.</li><li class="bullet">There is an unmet need for new prognosis-modifying therapies for AH.</li><li class="bullet">Currently, in real-life hepatology, refining the existing bundle of care is the only practical option to improve the prognosis of AD-AH.</li><li class="bullet">Past experience with acute coronary syndromes, stroke, and sepsis, emphasizing symptoms-to-intervention duration, combined with the recent COVID-19 lockdown finding of increased mortality due to skewed access to specialized liver care indicates that focusing on timely specialized care might be key to improved outcome in certain liver conditions.</li><li class="bullet">In this line, we set out to track the number of days elapsing between admission to SC and referral to TC, coining this interval as “time-to-tertiary care” (TTTc). We examined TTTc as a potential compound surrogate that might influence the prognosis in AD-AH.</li><li class="bullet">After correcting for important baseline differences, we conclude that the delay of transfer to the tertiary care hospital was independently associated with a worse prognosis with each additional day in TTTc increasing adverse outcomes by nearly 3%.</li></ul></span>
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