Trauma patients' desire for autonomy in medical decision making is impaired by smoking and hazardous alcohol consumption--a bi-national study.

This cross-sectional investigation studied the association between substance use and patients' desire for autonomy in medical decision making (MDM) in two trauma settings. A total of 102 patients (age 42.7 +/- 17.4 years, 70.6% male) admitted to an orthopaedic service in Warsaw, Poland, and 1009 injured patients (age 34.6 +/- 12.8 years, 62.3% male) treated in an emergency department in Berlin, Germany, were enrolled. Patients' desire for autonomy in MDM was evaluated with the Decision Making Preference Scale of the Autonomy Preference Index. Substance use (hazardous alcohol consumption and/or tobacco use) and educational level were measured. Linear regression techniques were used to determine the association between substance use and desire for autonomy in MDM. Substance use was found to be independently associated with a reduced desire by the patient for autonomy in medical decision making. No differences in patients' desire for autonomy were observed between the study sites. Empowerment strategies that encourage smokers or patients with hazardous alcohol consumption to participate in MDM may increase the effectiveness of health promotion and injury prevention efforts in this population.

Taste responses in alcohol-dependent men.

The aim of the present study was to compare taste responses to sweet, bitter, sour and salty solutions in male alcoholics and control subjects. The groups did not differ in terms of rated intensity or pleasantness of sucrose (1-30%), quinine (0.001-0.005%), citric acid (0.02-0.1%) and sodium chloride (0.18-0.9%) solutions. The proportion of sweet-likers was also similar in both groups.

[Health status of individuals dependent on opiates before and after a year of treatment in a methadone maintenance program]. / Stan zdrowia osób uzaleznionych od opiatów przed i po roku leczenia w programie metadonowym.

UNLABELLED: The aim of this study was to compare physical status of opiate dependent patients before and after one year of participation in the methadone maintenance program (MMP). There were investigated all 113 patients (82 male, 31 female) participating in MMP no shortly then one year. There was been used an especially constructed list of physical disorders and illnesses, where severity of them was scored from 0 to 3 points. We found a great influence of a participation in MMP on an use of forbidden substances, what caused that nobody of our patients overdosed drugs. Reducing of intravenous use of drugs and a change of lifestyle caused that nobody from our 67 HIV-negative patients infected with HIV. Thanks MMP was able the systematic and successful treatment of the most common physical illnesses: superficial venous system and skin infections, internal organs mycoses, lowered body mass index, lack of menstruation, and relatively rarer ones: hypertonia, sexually transmitted diseases, tuberculosis etc. The serious problem was liver impairments of different origin, in majority cases. IN CONCLUSION: MMPs should develop in Poland more quickly and more commonly.

Taste responses in sons of male alcoholics.

The aim of the present study was to compare taste responses (intensity and pleasantness/unpleasantness) to sweet, bitter, sour, and salty solutions in sons of male alcoholics (SOMAs) and control subjects with no family history of alcoholism. In addition, responses to Coca-Cola flavour were evaluated in both groups. Unpleasantness of salty solutions was significantly enhanced and intensity of sour solutions tended to be higher in the SOMAs. There were no other differences between the groups. Thus, contrary to previous suggestions, genetically determined vulnerability to alcohol dependence may not be associated with altered responses to sweet substances. The present findings would rather suggest that increased aversive responses to salt taste may predict future development of alcohol dependence.

The activity of beta-hexosaminidase (uHex) and gamma-glutamyl-transferase (uGGT) in urine as non-invasive markers of chronic alcohol abuse: I. Alcohol-dependent subjects.

It has been demonstrated that in alcohol-dependent men the uHex test is one of the most powerful discriminating tools, while uGGT has a discriminating power similar to that of sHex but worse than that of uHex, sGGT and s%CDT. Receiver Operating Characteristic (ROC) areas under the curves (AUC) for uHex, uGGT, s%CDT, sHex and sGGT were 0.92, 0.79, 0.88, 0.79 and 0.92, respectively. Due to their good parameters, low cost, ease of use and non-invasive character the uHex and uGGT tests are useful tools for the detection of chronic alcohol abuse.

Bitter and sweet components of ethanol taste in humans.

This study examined taste descriptions elicited by ethanol and by other tastants in humans. All subjects described 10% ethanol as bitter and approximately 30% of the subjects described it as sweet and/or sour. Highly significant correlations were found between sweetness of some sucrose solutions (0.6-1%) and intensity of the taste of ethanol. In another experiment, quinine (bitter) solutions were rated as similar to 10% ethanol taste and this effect was potentiated by the addition of sucrose. In contrast, citric acid (sour) tended to decrease similarity ratings when added to the quinine solutions. Taken together, these findings suggest that: (1) in humans ethanol tastes both bitter and sweet; and (2) the relationship between sucrose and ethanol intakes previously found in animals and humans may result, at least partially, from similar taste responses elicited by sucrose and ethanol.

An opioid receptor antagonist, naltrexone, does not alter taste and smell responses in humans.

Several studies have shown that an opioid receptor antagonist, naltrexone, decreases palatable food consumption. Naltrexone has also been reported to reduce ethanol intake in alcohol-preferring rodents and human alcoholics. The aim of the present study was to assess the effects of naltrexone on taste and smell responses in healthy male volunteers. Naltrexone did not alter intensity and pleasantness of sucrose, quinine, citric acid, sodium chloride, and ethanol taste. Similarly, ratings of olfactory stimuli (orange extract and ethanol) and Coca-Cola flavor were not influenced by the opioid antagonist. Our findings may indicate that: (i) naltrexone exerts marginal, if any, effects on gustatory and olfactory responses in humans; (ii) the drug does not alter orosensory responses to ethanol.

[Evaluation of psychomotor agility during the period of withdrawal symptom dissipation in patients with alcohol dependence type 1 and 2 or Cloninger's]. / Ocena sprawnosci psychomotorycznej w okresie ustepowania objawów abstynencyjnych u pacjentów z uzaleznieniem od alkoholu typu 1 i 2 wg Cloningera.

28 alcohol dependent men were examined three times (on the 1st, 3rd or 4th and 7th day of withdrawal). The results confirmed the reported differences in the course of withdrawal syndrome in type 1 and type 2 alcoholics. Patients with type 2 alcoholism had more pronounced psychophysiological and cognitive disturbances. Tremor was more intensive in these patients and their reaction time was slower. Also, impaired estimation of passing time lasted longer, but at the same time their mood improved faster with the diminished intensity of withdrawal symptoms than in patients with type 1 alcoholism. The results confirm the possibility of diverse etiology in alcohol dependence.

[Use of urinary beta-hexosaminidase for diagnosing alcoholism in persons with opiate dependency in a methadone substitution program]. / Zastosowanie oznaczania beta-heksozoaminidazy w moczu do diagnostyki naduzywania alkoholu przez osoby uzaleznione od opiatów biorace udzial w programie substytucyjnego leczenia metadonem.

Usefulness of urinary beta-hexosaminidase determinations in patients on methadone substitution to pinpoint cases of alcohol abuse was studied. It was found that methadone, illegal drugs and HIV seropositivity had no effect upon the activity of this enzyme. The enzyme activity was significantly higher in patients who admitted to occasional heavy drinking than in those who declared abstinence (p = 0.014), and in healthy controls (p = 5*10(-8)), but still lower than in alcohol dependent persons undergoing detoxification (p = 0.024). In the group of opiate dependent persons in methadone substitution program the sensitivity of the test was 87% and the specificity--80%.

[Urinary beta-hexosaminidase activity as a marker for the monitoring of sobriety]. / Aktywnosc beta-heksozoaminidazy w moczu jako maker naduzywania alkoholu u osób uzaleznionych.

The aim of this study was to check the usefulness of urine beta-hexosaminidase activity determination as a tool of monitoring sobriety in alcohol dependent individuals. The examinations were performed in 93 patients undergoing detoxification treatment after heavy drinking and in 29 individuals who were starting psychotherapeutic treatment after declaring at least 2 weeks abstinence period. Enzyme activity was determined using a spectrofluorimetric method and was referred to urine creatinine level. In the detoxification group the abnormally high beta-hexosaminidase activity was decreasing gradually toward normal values within 2 weeks. In less than 10% of the patients atypical increase was observed in the course of treatment, what could be attributed to an, influence of nonspecific factors or possibly to misbehavior (alcohol drinking or urine samples substitution). Among individuals who declared at least 2 weeks abstinence period (psychotherapeutic group) in 25% of cases abnormally high enzyme activity was detected, what suggested their more recent alcohol drinking.

[Assessment of changes in physiological status of alcohol-dependent patients in the course of 10-day detoxication treatment]. / Ocena zmiany stanu fizjologicznego pacjentów uzaleznionych od alkoholu w okresie 10-dniowego leczenia detoksykacyjnego.

Heart rate, respiratory rate, postural muscle tone and tapping in 14 alcohol dependent patients (type II ac. Cloninger) during 10 days of detoxification were investigated. Despite subjective mood increased, no longer observed were tachycardia and clinical symptoms of alcohol withdrawal; increased muscle tonus and faster respiration rhythm were observed. The observed physiological changes in alcohol dependent patients after 10 days of abstinence suggest that continuation of pharmacotherapy and psychotherapy after detoxification in acute alcohol withdrawal is recommended.

[Disability among patients with affective disorders]. / Inwalidztwo w chorobach afektywnych.

In a group of patients with affective disorder it was found that the frequency of formal handicap occurred in 29.8% of those subjects. This was observed mainly in women and mostly with those diagnosed as bipolar affective disorder (43.6%). Patients with an alcohol problem more often were on social security pension.

[Social adaptation of patients with bipolar disorder in relation to the problems of alcoholism (pilot studies)]. / Adaptacja socjalna u osób z choroba afektywna dwubiegunowa w zaleznosci od wystepowania pboblemów alkoholowych (badania pilotazowe).

89 patients (52 women and 37 men) with bipolar affective disorder was separated on two groups: with alcohol problems (n = 30) and without alcohol problems (n = 59). Both groups were tested using Scale of Adaptation and Activity of Puzynski (SAA III). The bipolar affective illness discriminates patient's social functioning (especially married life and emotional relation to the closest relatives). The bipolar patients with alcohol problems did show worse social adaptation than the other group; it concerns mainly masculine patients.