Problem alcohol use among problem drug users: development and content of clinical guidelines for general practice.

BACKGROUND: Problem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment. AIMS: This paper aims to describe the development and content of clinical guidelines for the management of problem alcohol use among this population. METHODS: The guidelines were developed in three stages: (1) identification of key stakeholders, (2) development of evidence-based draft guidelines, and (3) determination of a modified 'Delphi-facilitated' consensus among the group members. RESULTS: The guidelines incorporate advice for physicians on all aspects of care, including (1) definition of problem alcohol use among problem drug users, (2) alcohol screening, (3) brief intervention, and (4) subsequent management of patients with alcohol dependence. CONCLUSIONS: Primary care has an important role to play in the care of problem alcohol use among problem drug users, especially opiate substitution patients. Further research on strategies to inform the implementation of these guidelines is a priority.

Construct validity of the short inventory of problems among Spanish speaking Hispanics.

OBJECTIVE: Research on ethnic health disparities requires the use of psychometrically sound instruments that are appropriate when applied to ethnically diverse populations. The Short Inventory of Problems (SIP) assesses alcohol-related consequences and is often used as a measure to evaluate intervention effectiveness in alcohol research; however, whether the psychometric properties of this instrument are comparable across language and ethnicity remains unclear. METHOD: Multi-group confirmatory factor analysis (MGCFA) was used to test for the invariance of the measurement structure of the SIP across White Non-Hispanic English speaking (N=642), Hispanic English speaking (N=275), and Hispanic Spanish speaking (N=220) groups. RESULTS: The MGCFA model in which factor loadings, measurement intercepts, and item residuals were constrained to be equal between English speakers and Spanish speakers exhibited a reasonable fit to the data, χ(2)(221)=1089.612 p<.001, TLI=.926; CFI=.922, RMSEA=.059 (90% CI=.055-.062). The ΔCFI supported strict factorial invariance, ΔCFI=.01, across groups; no significant group differences were found between factor loadings, measurement intercepts, or item residuals between English speakers and Spanish speakers. CONCLUSIONS: This study extends the existing confirmatory factor analysis results of the SIP by providing additional data to inform the utility of the SIP among Hispanics. Strict factorial invariance between Spanish and English speakers is necessary to: conclude that the underlying constructs have the same meaning across groups; test for group differences in the latent variables across groups; and presume that group differences are attributable only to true differences between groups. Thus, the SIP is strongly supported for evaluating the effectiveness of alcohol treatment among Hispanics.

Investigation and quantification of key periodontal pathogens in patients with type 2 diabetes.

BACKGROUND AND OBJECTIVE: Diabetes is a recognized risk factor for periodontitis. There are conflicting data regarding whether healthy diabetic patients or diabetic patients with chronic periodontitis have an altered subgingival microbiota compared with nondiabetic individuals. The aim of the present study was to detect quantitative differences in selected periodontopathogens in the subgingival plaque of diabetic patients using TaqMan quantitative PCR. MATERIAL AND METHODS: Type 2 diabetes mellitus patients with (n=9) or without chronic periodontal disease (n=15) were recruited and matched to nondiabetic control subjects (n=12 periodontally healthy, n=12 chronic periodontitis). Subgingival plaque samples were collected from deep (>4 mm probing depth) and shallow sites (≤3 mm probing depth) using paper points, and Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum and Porphyromonas gingivalis were quantified. RESULTS: Forty-eight subjects (69 samples) were recruited. Marked differences were seen in the levels of all three bacterial species, relative to the total bacterial population, according to periodontal health status. Using real-time quantitative PCR, bacterial counts for P. gingivalis were significantly higher in deep pockets of diabetic and nondiabetic subjects compared with periodontally healthy subjects (p<0.05) but did not differ significantly between diabetics and nondiabetics. A. actinomycetemcomitans was detected in all groups in low quantities, and counts did not differ significantly between groups (p>0.05). F. nucleatum was abundant in all groups, with no clear significant differences between groups. P. gingivalis was found in higher quantities in periodontitis than in periodontally healthy subjects (p<0.05). Statistically significant positive correlations were identified between pocket depth and counts for all three species tested (p<0.05). CONCLUSION: A. actinomycetemcomitans, F. nucleatum and P. gingivalis were present in significantly different quantities and proportions in subgingival plaque, according to periodontal disease status. No significant differences were identified between the subgingival microbiota of type 2 diabetes mellitus patients compared with nondiabetic subjects.

Alcohol screening and brief intervention among drug users in primary care: a discussion paper.

BACKGROUND: Problem alcohol use is common among problem drug users (PDU) and associated with adverse health outcomes. Primary care has an important role in the overall stepped approach to alcohol treatment, especially screening and brief intervention (SBI). AIM: To discuss three themes that emerged from an exploration of the literature on SBI for problem alcohol use in drug users attending primary care. METHODS: Material for this discussion paper was gathered from three biomedical databases (PubMed, PsycINFO and Cochrane library), conference proceedings and online resources of professional organisations or national health agencies. RESULTS: Themes discussed in this paper are: (a) the potential of primary care for delivery of alcohol SBIs to PDUs, (b) screening methods and (c) application of brief interventions to PDUs. CONCLUSIONS: Although SBI improves health outcomes associated with problem alcohol use in the general population, further research is needed among high-risk patient groups, especially PDUs.

Marginally specified generalized linear mixed models: a robust approach.

Longitudinal data modeling is complicated by the necessity to deal appropriately with the correlation between observations made on the same individual. Building on an earlier nonrobust version proposed by Heagerty (1999, Biometrics 55, 688-698), our robust marginally specified generalized linear mixed model (ROBMS-GLMM) provides an effective method for dealing with such data. This model is one of the first to allow both population-averaged and individual-specific inference. As well, it adopts the flexibility and interpretability of generalized linear mixed models for introducing dependence but builds a regression structure for the marginal mean, allowing valid application with time-dependent (exogenous) and time-independent covariates. These new estimators are obtained as solutions of a robustified likelihood equation involving Huber's least favorable distribution and a collection of weights. Huber's least favorable distribution produces estimates that are resistant to certain deviations from the random effects distributional assumptions. Innovative weighting strategies enable the ROBMS-GLMM to perform well when faced with outlying observations both in the response and covariates. We illustrate the methodology with an analysis of a prospective longitudinal study of laryngoscopic endotracheal intubation, a skill that numerous health-care professionals are expected to acquire. The principal goal of our research is to achieve robust inference in longitudinal analyses.

Association of alcohol use and other high-risk behaviors among trauma patients.

BACKGROUND: Risk behaviors and psychological problems may limit recovery after trauma, may be related to injury recidivism, and may limit the effectiveness of alcohol interventions in trauma patients. The aim of the current study was to evaluate the prevalence of behaviors associated with injury and their relationship with alcohol use in adult trauma patients. METHODS: A prospective cohort of 301 adult patients admitted to a single Level I trauma center were interviewed regarding risk behaviors and alcohol use. RESULTS: There was evidence of acute and/or chronic alcohol use in 48.2% of cases. Over three fourths of patients (77%) engaged in one or more high-risk driving practices, 40% engaged in one or more violence-related behaviors, and 19% reported suicidal ideation in the last year. These risk behaviors were more common in patients who evidenced acute and/or chronic alcohol use. CONCLUSION: Behaviors that place an individual at greater risk for traumatic injury are common among seriously injured adult patients admitted to an urban Level I trauma center and frequently coexist with alcohol use. Their importance to injury, injury recidivism, and recovery after trauma requires further investigation.

Effects of antipyretics on mortality due to influenza B virus in a mouse model of Reye's syndrome.

OBJECTIVES: To determine the effects of acetylsalicylic acid (ASA) and acetaminophen on mortality due to influenza B infection in neonatal and weanling mice, as well as any synergistic, antagonistic or indifferent effects of the combined antipyretic and virus on mortality in mice pretreated with low doses of an industrial surfactant, Toximul MP8, which has been shown to reproduce many of the features of Reye's syndrome. In vitro studies were done to determine whether ASA or acetaminophen altered the normal, interferon-mediated antiviral responses of mammalian cells. The involvement of ASA or other commonly used xenobiotics in the induction of Reye's syndrome following virus illness has not been resolved; to do so, and to elucidate the underlying metabolic mechanism, requires these studies in an animal model. DESIGN: Prospective animal study. ANIMALS: Newborn (945) and weanling (840) Swiss white mice, divided into 12 subgroups. INTERVENTIONS: Some groups received Toximul MP8 before inoculation with a dose of mouse-adapted human influenza B that produces 30% mortality (LD30); after infection, each subgroup received either placebo, ASA or acetaminophen. Mortality counts were taken daily. The in vitro effects of the antipyretics on interferon response were determined using standard virology techniques. OUTCOME MEASURE: Mortality, analyzed by survival curves (log rank test) or cumulative daily mortality (chi 2 analysis). Plaque-reducing dose (PRD50) was used to determine the outcome of the in vitro analyses. RESULTS: In neonatal mice, only subgroups given combined treatment with acetaminophen and Toximul MP8 had a statistically significant higher mortality rate than with the mice given influenza B alone. In weanling mice, it appeared that ASA shortened the time until death; however, this difference was not statistically significant. In vitro studies demonstrated that both ASA and acetaminophen decreased the interferon-induced antiviral responses of cultured mammalian cells. CONCLUSION: Antipyretics have the potential to exacerbate the consequences of a viral infection, although the specific effects are subtle and appear to be age-related.

Relationship between neurological and urological status in patients with multiple sclerosis.

The relationship between neurological urinary symptoms and urodynamic findings in patients with multiple sclerosis was examined. The duration of multiple sclerosis was significantly longer in patients with urinary symptoms. The presence of urinary symptoms correlated with the severity of the pyramidal or sensory lesions and the total disability score. Cystometrograms revealed detrusor hyperreflexia in 67 per cent of the patients, areflexia in 21 per cent and a normal detrusor in 12 per cent. Somatic dyssynergia was found in 20 of the 39 patients whose examination revealed clear-cut results. Positive correlation was found between urge incontinence and detrusor hyperreflexia, and between hesitancy and detrusor areflexia but no relationship was found between urological symptoms and sphincter function. Analysis of the neurological lesions in relation to the cystometric findings revealed a positive correlation among pyramidal lesions, detrusor hyperreflexia and detrusor areflexia, and between cerebellar lesions and detrusor areflexia. The correlation between detrusor dysfunction and high total disability score disappeared when patients with high pyramidal scores were excluded. No correlation could be detected between somatic dyssynergia and the various neurological lesions.

Biliary lipid, bile acid composition, and dietary correlations in Micmac Indian women. A population study.

The precursor state for cholesterol gallstone formation is cholesterol-saturated bile. We studied a high-risk group for cholesterol gallstones to determine whether dietary variables affect bile cholesterol. Bile samples were analyzed from 46 Micmac Indian women without gallstones and 13 with gallstones for molar percentage cholesterol (MPC) and bile acid composition. The data were analyzed by multiple regression analysis with MPC as the dependent variable and the dietary variables, obtained from four consecutive-day food records, and biliary bile acid composition as the independent variables. In the 46 women without gallstones, obesity, calorie range/calorie intake, and iron and calcium intake were, in their order of importance, significant factors. In normal weight subjects (ponderal index > 12.5) relative obesity was still a significant correlate. Obesity and iron intake were positive correlates while calorie range/calorie intake and calcium intake varied inversely. When the effect of obesity was controlled, these factors were still significant in this group, as they were in the gallstone group. In addition, the duration of overnight fast obtained by history, together with the proportions of deoxycholic and chenodeoxycholic acids in bile were correlates of the biliary molar percentage cholesterol.