Efficacy of brief alcohol screening intervention for college students (BASICS): a meta-analysis of randomized controlled trials.

BACKGROUND: Many studies reported that brief interventions are effective in reducing excessive drinking. This study aimed to assess the efficacy of a protocol of brief intervention for college students (BASICS), delivered face-to-face, to reduce risky alcohol consumption and negative consequences. METHODS: A systematic review with meta-analysis was performed by searching for randomized controlled trials (RCTs) in Medline, PsycInfo, Web of Science and Cochrane Library databases. A quality assessment of RCTs was made by using a validated scale. Combined mean effect sizes, using meta-analysis random-effects models, were calculated. RESULTS: 18 studies were included in the review. The sample sizes ranged from 54 to 1275 (median=212). All studies presented a good evaluation of methodological quality and four were found to have excellent quality. After approximately 12 months of follow-up, students receiving BASICS showed a significant reduction in alcohol consumption (difference between means=-1.50 drinks per week, 95% CI: -3.24 to -0.29) and alcohol-related problems (difference between means=-0.87, 95% CI: -1.58 to -0.20) compared to controls. CONCLUSIONS: Overall, BASICS lowered both alcohol consumption and negative consequences in college students. Gender and peer factors seem to play an important role as moderators of behavior change in college drinking. Characteristics of BASICS procedure have been evaluated as more favorable and acceptable by students in comparison with others interventions or control conditions. Considerations for future researches were discussed.

Prevalence of alcohol-related problems in an elderly population and their association with cognitive impairment and dementia.

BACKGROUND: Studies investigating the association between alcohol use and cognitive disorders in the elderly population have produced divergent results. Moreover, the role of alcohol in cognitive dysfunction is not clear. The aims of this study were to estimate the prevalence of alcohol-related problems in an elderly population from Brazil and to investigate their association with cognitive and functional impairment (CFI) and dementia. METHODS: A community-based cross-sectional study was performed. A sample of 1,145 elderly people was examined in 2 phases. Several instruments were utilized in the first phase: the CAGE questionnaire was used to identify potential cases of alcohol-related problems, and a screening test for dementia was used to estimate CFI. The CAMDEX interview (Cambridge Examination) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria were used for the clinical diagnosis of dementia in the second phase. RESULTS: "Heavy alcohol use" (CAGE > or = 2) was found in 92 subjects (prevalence: 8.2%). It was associated with gender (males, p < 0.001), low education (only in females, p = 0.002), and low socioeconomic level (p = 0.001, in females; p = 0.002, in males). The Mini Mental State Examination exhibited a nonlinear relationship with alcohol-related problems in females; "mild-moderate alcohol use" (CAGE < 2) presented the highest score. A significant association between alcohol-related problems and cognitive dysfunction was found only in females. "Heavy alcohol use" was associated with higher CFI and dementia rates compared to "mild-moderate alcohol use" (p = 0.003 and p < 0.001, respectively). "Mild-moderate alcohol use" had a tendency of association with lower CFI and dementia rates when compared to "no alcohol use" (p = 0.063 and 0.050, respectively). CONCLUSION: Our findings suggest that alcohol use does not have a linear relationship with cognitive decline.

Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil.

This study reports on the views of Primary Health Care (PHC) providers in Southeast Brazil on the use of alcohol and other drugs which reflect stigma, moralization, or negative judgment. Six hundred nine PHC professionals from the Brazilian states of São Paulo and Minas Gerais took part in the study. The majority (86.5%) of these professionals were female. Attitudes toward the use of alcohol and other drugs were evaluated in comparison to Hansen's disease, obesity, depression, schizophrenia, HIV/AIDS, and tobacco use. The use of tobacco, marijuana/cocaine, and alcohol were the most negatively judged behaviors (p < 0.05). Nursing assistants and community health care workers demonstrated the severest judgment of alcohol use. In addition, marijuana/cocaine addicts and alcoholics suffered the highest rate of rejection by professionals. The hypothesis that the use of alcohol and other drugs is a behavior stigmatized by health professionals being confirmed, it is important to develop strategies for changing provider attitudes in order to provide a higher quality of service to these patients. This study is important as a first study among PHC professionals about social stigma of alcohol and other drugs users.

Consumo de álcool na gestação: desempenho da versão brasileira do questionário T-ACE / Alcohol consumption in pregnancy: performance of the Brazilian version of the questionnaire T-ACE / Alcohol consumption in pregnancy: performance of the Brazilian version of the questionnaire T-ACE

OBJETIVO: Avaliar as características de desempenho da versão brasileira do questionário Tolerance, Annoyed, Cut down e Eye-opener (T-ACE), para rastreamento do consumo de álcool na gestação. MÉTODOS: Estudo observacional, transversal, em amostra seqüencial de 450 mulheres no terceiro trimestre de gestação, assistidas em maternidade no município de Ribeirão Preto, estado de São Paulo, em 2001. Foram aplicados: questionário para coleta de dados sociodemográficos, T-ACE, questionário para levantamento da história de consumo de álcool ao longo da gestação e entrevista clínica para identificação de uso nocivo e dependência ao álcool, segundo critérios diagnósticos da CID-10. Foram feitos testes de concordância entre diferentes entrevistadores e de confiabilidade teste/re-teste. RESULTADOS: Do total, 100 gestantes (22,1 por cento) foram consideradas positivas pelo T-ACE. Os índices kappa para concordância e confiabilidade foram 0,95, com 97 por cento de respostas concordantes. Quando comparado aos parâmetros da CID-10 e ao padrão de consumo, o T-ACE com ponto de corte igual ou acima de dois pontos, apresentou coeficientes de sensibilidade e especificidade de 100 por cento e 85 por cento e de 97,9 por cento e 86,6 por cento respectivamente. CONCLUSÕES: A versão brasileira do T-ACE mostrou preencher adequadamente os critérios de desempenho que a qualificam ao papel de instrumento básico para o rastreamento do consumo de álcool durante a gravidez. Sua utilização é recomendável nas rotinas e práticas dos serviços obstétricos devido à tendência de aumento do consumo alcoólico feminino, dificuldades para identificação do abuso de álcool pela gestante e riscos de problemas de desenvolvimento nos filhos.

OBJECTIVE: To assess the performance characteristics of the Brazilian version of the Tolerance, Annoyed, Cut down and Eye-opener (T-ACE) questionnaire to screen alcohol consumption during pregnancy. METHODS: Observational, cross-sectional study in a sequential sample of 450 women in the third trimester of pregnancy, attended in a maternity ward in a city of Southeastern Brazil, in 2001. The following instruments were used: a questionnaire to gather sociodemographic data, the T-ACE, a questionnaire to verify history of alcohol consumption throughout gestation, and a clinical interview to identify the harmful use of and dependence on alcohol, according to ICD-10 diagnostic criteria. Concordance tests among different interviewers as well as test-/re-test reliability tests were performed. RESULTS: A total of 100 women (22.1 percent) were identified as positive by the T-ACE. The kappa indexes for concordance and reliability were 0.95, with 97 percent of concordant responses. When compared to the ICD-10 criteria and to the pattern of consumption, the T-ACE, with a cut-off point of two or higher, presented sensitivity and specificity coefficients of 100 percent and 85 percent, and of 97.9 percent and 86.6 percent, respectively. CONCLUSIONS: The Brazilian version of the T-ACE seemed to appropriately meet the performance criteria that qualify it as a basic instrument for the screening of alcohol consumption during pregnancy. Its use in the routine and practice of obstetric services is recommended in view of the tendency for increased alcohol consumption among women, the difficulties to identify alcohol abuse by pregnant women, and the risk of developmental problems in children.

[Alcohol consumption in pregnancy: performance of the Brazilian version of the questionnaire T-ACE]. / Consumo de álcool na gestação: desempenho da versão brasileira do questionário T-ACE.

OBJECTIVE: To assess the performance characteristics of the Brazilian version of the Tolerance, Annoyed, Cut down and Eye-opener (T-ACE) questionnaire to screen alcohol consumption during pregnancy. METHODS: Observational, cross-sectional study in a sequential sample of 450 women in the third trimester of pregnancy, attended in a maternity ward in a city of Southeastern Brazil, in 2001. The following instruments were used: a questionnaire to gather sociodemographic data, the T-ACE, a questionnaire to verify history of alcohol consumption throughout gestation, and a clinical interview to identify the harmful use of and dependence on alcohol, according to ICD-10 diagnostic criteria. Concordance tests among different interviewers as well as test-/re-test reliability tests were performed. RESULTS: A total of 100 women (22.1%) were identified as positive by the T-ACE. The kappa indexes for concordance and reliability were 0.95, with 97% of concordant responses. When compared to the ICD-10 criteria and to the pattern of consumption, the T-ACE, with a cut-off point of two or higher, presented sensitivity and specificity coefficients of 100% and 85%, and of 97.9% and 86.6%, respectively. CONCLUSIONS: The Brazilian version of the T-ACE seemed to appropriately meet the performance criteria that qualify it as a basic instrument for the screening of alcohol consumption during pregnancy. Its use in the routine and practice of obstetric services is recommended in view of the tendency for increased alcohol consumption among women, the difficulties to identify alcohol abuse by pregnant women, and the risk of developmental problems in children.

Lower P300 amplitude in eight-year-old offspring of alcoholic fathers with a delinquent history.

The aim of the present study was to investigate the P300 amplitude as a possible vulnerability marker in children of alcoholic (COA) fathers with and without paternal delinquency. Event-related potentials (ERPs) of 122 children aged 8 years (63 boys, 59 girls) were compared depending on father's alcoholism subtype: 30 COAs without paternal delinquency, 10 COAs with paternal delinquency, and 82 children of non-alcoholic and non-delinquent fathers. ERPs were recorded from Fz, Cz, and Pz, using an auditory oddball paradigm. Sinus tones of 60 dB HL were presented binaurally at 1,000 Hz (standard stimulus) and 2,000 Hz (target stimulus), at a relative frequency ratio of 80:20. Two trial blocks of 250 stimuli each were collected. Results indicated that only COAs with paternal delinquency displayed significant differences from the control group, characterized by reduced P300 amplitude at frontal site and in the second trial block. Thus, the combination of fathers' alcoholism and delinquency was more likely to relate to attenuated P300 amplitude in the offspring than paternal alcoholism alone. Our results suggest that both alcoholic and delinquent family history appear to play a role in P300 amplitude reduction in the offspring.

[Psychiatric morbidity and alcohol use by pregnant women in a public obstetric service]. / Morbidade psiquiátrica e uso de álcool em gestantes usuárias do Sistema Unico de Saúde.

OBJECTIVE: To investigate the relationship between alcohol consumption and emotional distress in pregnant women, and to verify whether women with problematic alcohol consumption (abuse or dependence) have more emotional distress than those with non-problematic alcohol consumption. METHODS: A cross-sectional observational study was carried out in a clinical sample from a public obstetric service in Ribeirão Preto, Brazil. A non-probabilistic convenience sample of patients who were consecutively recruited comprised 450 pregnant women. Three questionnaires were applied: a sociodemographic profile, followed by the Psychiatric Morbidity Questionnaire (QMPA) and a standardized questionnaire for collecting data on alcohol-related problems (abuse or dependence) according to ICD-10 criteria. Univariate analysis (ANOVA) was used for comparison between groups using central distribution measures and 95% confidence intervals. RESULTS: There were found 172 (38.2%) problematic pregnant women with positive score (score >7) in the QMPA. A group of 41 (9.1%) pregnant women with problematic alcohol consumption was detected according to ICD-10 criteria, 27 (6.0%) of them diagnosed as alcohol abuse and 14 (3.1%) as alcohol dependence. Alcohol abuse or dependence syndrome was related to greater emotional distress, i.e. higher mean scoring in anxiety, depression and alcohol QMPA subscales. CONCLUSIONS: Given the prevalence of emotional distress and alcohol consumption during pregnancy and high risk of mother-child health problems, careful evaluations in this population should be conducted by health professionals.

Morbidade psiquiátrica e uso de álcool em gestantes usuárias do Sistema Unico de Saúde / Psychiatric morbidity and alcohol use by pregnant women in a public obstetric service

OBJETIVO: Investigar a relação entre consumo de álcool e problemas emocionais em gestantes, verificando se as gestantes com consumo problemático de álcool (uso nocivo ou dependência) tiveram mais problemas emocionais quando comparadas àquelas cujo consumo não era problemático. MÉTODOS: Estudo transversal, observacional, sobre uma amostra clínica de um serviço obstétrico público de Ribeirão Preto, SP. A amostra foi não probabilística, de conveniência, do tipo consecutiva, composta por 450 gestantes. Foram aplicados três questionários: para dados sociodemográficos, o Questionário de Morbidade Psiquiátrica (QMPA) e um questionário padronizado como parte da anamnese para avaliação de problemas relacionados ao uso de álcool (uso nocivo ou síndrome de dependência) de acordo com os critérios da CID-10. Foram utilizados testes univariados (ANOVA) para o exame comparativo entre grupos utilizando medidas de distribuição central e intervalo de confiança de 95 por cento. RESULTADOS: Foram encontradas 172 gestantes (38,2 por cento) problemáticas (escore >7) pelo QMPA. Detectaram-se conforme critérios da CID-10, 41 (9,1 por cento) gestantes com consumo problemático de álcool, sendo 27 (6,0 por cento) com diagnóstico de uso nocivo e 14 (3,1 por cento) com dependência ao álcool. A presença de diagnóstico de uso nocivo ou síndrome de dependência ao álcool relacionou-se à maior intensidade de sofrimento emocional das gestantes, ou seja, maior média de pontuação nas subescalas ansiedade, depressão e álcool do QMPA. CONCLUSÕES: Considerando a prevalência de problemas emocionais, o consumo de álcool durante a gestação e os riscos de problemas à saúde materno-infantil sugere-se que sejam realizadas avaliações mais criteriosas pelos profissionais de saúde.

Perfil dos cuidados maternos em mães deprimidas e não-deprimidas no período puerperal / Maternal care profiles of depressed and non-depressed mothers in puerperium

Objetvos: Avaliar a relação entre depressão pós-parto (DPP) e cuidados maternos prestados ao bebê em mães no período puerperal. Metodologia: Estudo observacional, transversal, sobre uma amostra de 22 mães de um centro médico comunitário de Ribeirão Preto. Foram cmparados os perfis de cuidados maternos entre mães deprimidas (n=10) e não-deprimidas (n=12). Foi empregada uma entrevista estruturada de variáveis sociodemográficas. Utilizaram-se a Edinburgh Postnatal Depression Scale (EPDS) para a identificação de mães deprimidas (ponto de corte: 11/12) e o Inventário de Atividades de Prestação de Cuidados ao Lactente (IAPCL), que é auto-aplicável, para o registro de atividades de prestação de cuidados ao lactente. Resultados: As mães que já não amamentavam ao seio exclusivamente apresentaram escores mais elevados de depressão (F=6,93; p<0,05). Uma variável composta relacionada à prestação de cuidados de saúde foi formada com a soma de eventos de febre, assaduras, cólicas, acidentes e não dar remédios. Verificou-se um escore mais elevado de depressão entre as mães do grupo com maior freqüência desses eventos de negligência (F=6,81; p<0,05). Conclusão A partir dos resultados analisados verificou-se que algumas áreas de cuidados maternos, tais como amamentação e saúde, são influenciadas pela DPP e podem indicar um risco maior para a ocorrência de negligência

Consumo materno de álcool e outras substâncias psicoativas e seus efeitos sobre o desenvolvimento infantil / Alcoholism and drug use by pregnant and the effect on the infant and child development

O trabalho aqui apresentado constitui-se em uma revisäo sistemática da literatura atual sobre o tema: alcoolismo e drogas na gravidez e seu impacto sobre o desenvolvimento infantil. Säo relatados os mecanismos de açäo do álcool sobre o embriäo e o feto, as principais síndromes e os critérios disgnósticos atuais, e ainda, säo relatados os achados mais recentes sobre os prejuízos do desenvolvimento das funçöes mentais e do comportamento nos filhos de mäes usuárias de substâncias psicoativas