Prevention of alcohol exposed pregnancies in Europe: the FAR SEAS guidelines.

INTRODUCTION: Drinking during pregnancy is the leading cause of birth defects and child developmental disorders in Europe. The adverse effects of drinking during pregnancy may include physical, behavioural and cognitive problems, known collectively as fetal alcohol spectrum disorders (FASD). Evidence-based comprehensive recommendations at the European level on how to implement preventive and treatment policies to reduce alcohol-exposed pregnancies are needed. FAR SEAS, a tendered service contract (number 20,187,106) awarded by the European Commission, aimed at developing guidelines to respond to this knowledge gap. METHODS: FAR SEAS recommendations were built on (1) a two-phase review of interventions, (2) an international expert consultation, and (3) a pilot study on prevention of FASD conducted in the Mazovia region of Poland. The review of interventions included nineteen electronic open access databases, several repositories of grey literature and a key informant consultation covering most European Union (EU) countries and an additional guidelines search. After triangulating sources, 94 records were collected. Experts contributed in the design of the research questions, addressing the gaps in the literature and reviewing the recommendations formulated. The Polish pilot added nuances from real world practice to the formulated recommendations, resulting in the final set of guidelines for dissemination. RESULTS: The FAR SEAS Guidelines comprise 23 recommendations grouped into different topics areas of policies, communication strategies, screening, brief intervention and referral to treatment, treatment and social services. The recommendations highlight the need to respect women's autonomy and avoid discrimination and stigmatization; using universal screening for women of childbearing age, including detection of other psychosocial risks (such as domestic violence); and individualized, comprehensive and multidisciplinary supportive interventions for those who require it, such as those with alcohol use disorders, including women's partners. Policies to prevent FASD should be multicomponent, and public health communication should combine information about the risks together with self-efficacy messages to promote changes. CONCLUSIONS: The FAR SEAS guidelines are a tool to support policy-makers and service managers in implementing effective programmes to reduce prenatal alcohol exposure among general and at-risk population groups. FASD prevention has to involve comprehensive and multi-level evidence-based policies and practice, with services and activities tailored to the needs of women at differing levels of risk, and with due attention to reducing stigma.

Reducing the risk of prenatal alcohol exposure and FASD through social services: promising results from the FAR SEAS pilot project.

Introduction: Within FAR SEAS, a multi-component evidence-based community intervention was implemented and evaluated in Mazovia (Poland), with the aim of preventing alcohol-exposed pregnancies, and therefore preventing FASD. Methods: Multi-disciplinary professionals from different services (social, addiction, and psychology), recruited women of child-bearing age (pregnant and not pregnant) in local communities, screened them for alcohol risk, and allocated participants (n = 441) to groups for low- (70%), moderate- (23%), or high-risk (7%) of alcohol exposed pregnancy, to provide interventions tailored to their needs. The non-parametric sign test, testing differences between pairs of observations before and after intervention was used to evaluate the outcomes. Results: Follow-up data (collected from 93% of participants) indicated positive changes in the key outcome variables: risky alcohol consumption dropped by 81%, contraception use increased by 15% and visiting a gynecologist increased by 39%; as well as in associated psychosocial risk factors (decrease in cigarette and drug use, domestic violence and depressive symptoms). No changes were noted in frequency of other service use (medical, psychological, or social). The most prominent changes were observed in the moderate-risk group. Discussion: Changing risky behaviors (alcohol consumption and sex without contraception) to prevent alcohol exposed pregnancies is feasible at the local level, even without engagement of medical professionals. Key challenges, related to engaging professionals and local authorities, must be addressed; and procedures should be adapted to local contexts and needs.

Assessing the impact of providing digital product information on the health risks of alcoholic beverages to the consumer at point of sale: A pilot study.

INTRODUCTION: There is an ongoing policy debate in the European Union regarding the best method of providing information to consumers on the health risks of alcohol use. One of the proposed channels is via the provision of QR codes. This study tested the usage rate of QR codes placed on point-of-sale signs in a supermarket in Barcelona, Catalonia over a 1-week period. METHODS: Nine banners with beverage-specific health warnings in large text were prominently displayed in the alcohol section of a supermarket. Each banner provided a QR code of relatively large image size that linked to a government website providing further information on alcohol-related harms. A comparison was made between the number of visits to the website and the number of customers in the supermarket (number of unique sales receipts) in a single week. RESULTS: Only 6 out of 7079 customers scanned the QR code during the week, corresponding to a usage rate of 0.085%, less than 1 per 1000. The usage rate was 2.6 per 1000 among those who purchased alcohol. DISCUSSION AND CONCLUSIONS: Despite the availability of prominently displayed QR codes, the overwhelming majority of customers did not make use of the QR codes to obtain further information on alcohol-related harms. This corroborates the results from other studies investigating customers' use of QR codes to obtain additional product information. Based on the current evidence, providing online access to information through QR codes will likely not reach a significant portion of consumers.

Community pharmacists' roles, attitudes and knowledge regarding provision of screening and brief intervention activities for alcohol use in Catalonia.

INTRODUCTION: Community pharmacists (CP) are among the health professionals with closest contact to the general population. They play a key role in delivering public health programs. The aim of this study was to analyse the attitudes, knowledge, preparedness and ability to screen and advise on alcohol of CP in Catalonia and their perceptions about the provision of alcohol screening and brief interventions (SBI) in community pharmacies. METHODS: This is an observational, cross-sectional study. An online survey on attitudes, knowledge and behaviours was sent to all registered CP in Catalonia, and bivariate and multivariate statistical analyses were conducted. RESULTS: The response rate was 7.96% (639/8027), more than two-thirds of respondents were 41 years of age or older and 79.9% were female. Results showed that CP readiness to offer advice on alcohol problems was higher than their preparedness to screen (37.5% vs. 31.8%, respectively). They also showed that having received 1 h or more of training on alcohol and drug-related health promotion and prevention during the last 5 years increased CP perception of role security and therapeutic commitment related to alcohol. DISCUSSION AND CONCLUSION: This study showed that involving CP in the provision of alcohol SBIs may be feasible in Catalonia. Furthermore, this and previous research show an association between CP training in alcohol or drugs and preparedness to screen and advise on alcohol use. Consequently, promoting alcohol-related training programs to enhance CP skills is recommended to support successful implementation of alcohol SBI in community pharmacy settings.

Brief interventions for alcohol use disorders in low- and middle-income countries: barriers and potential solutions.

Global alcohol consumption and harmful use of alcohol is projected to increase in the coming decades, and most of the increase will occur in low- and middle-income countries (LMICs); which calls for cost-effective measures to reduce alcohol exposure in these countries. One such evidence based measure is screening and brief intervention (BI) for alcohol problems. Some of the characteristics of BI make them a particularly appealing choice of interventions in low-resource settings. However, despite evidence of effectiveness, implementation of BI in LMICs is rare. In this paper we discuss barriers to implementation of BI in LMICs, with examples from Latin America and India. Key barriers to implementation of BI in LMICs are the lack of financial and structural resources. Specialized services for alcohol use disorders are limited or non-existent. Hence primary care is often the only possible alternative to implement BI. However, health professionals in such settings generally lack training to deal with these disorders. In our review of BI research in these countries, we find some promising results, primarily in countries from Latin America, but so far there is limited research on effectiveness. Appropriate evaluation of efficacy and effectiveness of BI is undermined by lack of generalisability and methodological limitations. No systematic and scientific efforts to explore the implementation and evaluation of BI in primary and community platforms of care have been published in India. Innovative strategies need to be deployed to overcome supply side barriers related to specialist manpower shortages in LMICs. There is a growing evidence on the effectiveness of non-specialist health workers, including lay counsellors, in delivering frontline psychological interventions for a range of disorders including alcohol use disorders in LMICs. This paper is intended to stimulate discussion among researchers, practitioners and policy-makers in LMICs because increasing access to evidence based care for alcohol use disorders in LMICs would need a concerted effort from all these stakeholders.

Prevalence of Fetal Alcohol Spectrum Disorders (FASD) among Children Adopted from Eastern European Countries: Russia and Ukraine.

Fetal alcohol spectrum disorder (FASD) is a leading cause of neurodevelopmental disorders. Children adopted internationally from countries where alcohol consumption during pregnancy is very high are at greater risk for FASD. Lack of expertise in diagnosing FASD and mixed neurodevelopmental and behavioral signs due to abandonment complicate a timely diagnosis. The aim of this study was to determine the prevalence of FASD in adopted children. Children between the ages of 8 and 24 adopted from Russia and Ukraine were evaluated for clinical and historical features of FASD. Of the 162 children evaluated, 81 (50%) met FASD diagnostic criteria. Thirty-three (20.4%) children had fetal alcohol syndrome (FAS), 28 (17.2%) had partial FAS, 2 (1.2%) had alcohol-related birth defects (ARBD) and 18 (11.1%) had alcohol-related neurodevelopmental disorder (ARND). Of the 81 children in which fetal alcohol exposure could not be confirmed, many had manifestations that would have established a diagnosis of FASD if a history of maternal alcohol consumption was confirmed. In a population of children with a high risk of prenatal alcohol exposure (adoptees from Eastern European countries), at least 50% showed manifestations associated with FASD. The reported prevalence in this study is in line with the results obtained in a previous study as well as in orphanages of origin.

[Differential health effects of alcoholic beverages: an umbrella review of observational studies.] / Tipos de bebidas alcohólicas y efectos diferenciados en la salud: una revisión paraguas de estudios observacionales.

BACKGROUND: There is great controversy about whether the consumption of different types of alcoholic beverages has different effects on health. The objective was to carry out an umbrella review of the studies that described the association between the consumption of different types of alcoholic beverages and various health indicators. METHODS: Search through PubMed (from January 2000 to February 2019) of systematic reviews and meta-analysis that reported quantitative results of the association between the consumption of different types of alcoholic beverages and health effects. 26 studies were identified: 21 related to cancer, three to cardiometabolic diseases, two to neurodegenerative diseases, and one to general mortality. RESULTS: The results were heterogeneous. The great methodological differences in the estimation of alcohol intake, control of confounding variables, and the evaluation of statistical difference between types of beverages, made it very difficult to conclude whether they cause an unequal effect on health. In general mortality and cardiometabolic diseases, it was suggested that beer and spirits appear to have a greater negative effect than wine, but the differences were not statistically significant. Regarding cancer, in those types where the causal evidence is totally consistent: oropharynx, colorectal and breast (women), the reviews did not show a differentiated effect according to the type of alcoholic beverages. Regarding neurodegenerative diseases, the available information did not allow clear conclusions to be drawn. CONCLUSIONS: The reviewed evidence does not allow to conclude that the consumption of wine, beer or spirits, has a differential effect on cardiometabolic, cancer or neurodegenerative diseases.

OBJETIVO: Existe gran controversia sobre si el consumo de diversos tipos de bebidas alcohólicas tiene efectos diferenciados en la salud. El objetivo de este estudio fue realizar una revisión paraguas de los estudios que describían la asociación del consumo de diferentes tipos de bebidas alcohólicas con diversos indicadores de salud. METODOS: Se realizó una búsqueda a través de PubMed (entre enero de 2000 y febrero de 2019) de revisiones sistemáticas y metaanálisis que reportaban resultados cuantitativos de la asociación entre el consumo de diferentes tipos de bebidas alcohólicas y efectos en salud. Se identificaron 26 estudios: veintiuno estaban relacionados con cáncer, tres con enfermedades cardiometabólicas, dos con neurodegenerativas y uno con mortalidad general. RESULTADOS: Los resultados fueron heterogéneos. Las grandes diferencias metodológicas en la estimación de la ingesta de alcohol, el control de las variables confusoras y el contraste de las estimaciones entre el tipo de bebidas hacían muy difícil concluir sobre si provocaban un efecto desigual en la salud. En la mortalidad general y las enfermedades cardiometabólicas, aunque parece que la cerveza y los licores tenían un mayor efecto negativo que el vino, las diferencias entre tipos de bebidas no eran estadísticamente significativas. Respecto al cáncer, en aquellos tipos cuya evidencia causal era totalmente consistente (orofaringe, colorrectal y de mama [mujeres]), las revisiones no mostraban un efecto diferenciado según los tipos de bebidas alcohólicas. Respecto a las enfermedades neurodegenerativas, la información disponible tampoco permitía establecer claras conclusiones. CONCLUSIONES: La evidencia revisada no permite afirmar que el consumo de vino, cerveza o licores tenga un efecto diferencial en las enfermedades cardiometabólicas, las neurodegenerativas o el cáncer.

[The update of the limits for low risk alcohol consumption. An opportunity for implementing strategies for early intervention and brief interventions in Spain.] / La actualización de los límites de bajo riesgo del alcohol. Una oportunidad para mejorar la implementación de las estrategias de identificación precoz e intervención breve en España.

This work places in context Spain's recent update of the defined limits for low risk alcohol consumption to 20g/day for men and 10g/day for women, and summarises data on the impact on individual health and the social costs of alcohol consumption. Furthermore, it considers the challenges that arise related to awareness of the risks of alcohol consumption, in the general population and among health professionals. The paper also reviews the implications of the new definitions in relation to the most effective policies for reducing alcohol-related harm. It looks at this from a public health perspective with particular emphasis on how to seize the opportunity to better promote the implementation of strategies for early identification and brief interventions in primary care in this country.

Este trabajo pone en contexto la reciente actualización para España de los limites de bajo riesgo del consumo de alcohol, que se sitúa en los 20 g/día en el caso de los hombres, y en 10 g/día en el caso de las mujeres. En este sentido, se resumen algunos datos sobre el impacto en la salud individual y los costos sociales del consumo alcohol. Así mismo, plantea los retos que se derivan en relación a la alfabetización en salud de la población y de los profesionales de la salud en cuanto a los riesgos del consumo de alcohol. El artículo también repasa las implicaciones de la nueva definición en cuanto a las políticas más rentables para disminuir los daños asociados al consumo de alcohol. Este repaso se hace desde una perspectiva de salud pública, haciendo especial hincapié en cómo aprovechar la oportunidad para promover mejor la implementación de las estrategias de identificación precoz e intervención breve en el consumo de alcohol en el ámbito de la atención primaria de salud en nuestro país.

[Binge drinking: the challenges of definition and its impact on health.] / Episodios de consumo intensivo de alcohol "Binge drinking": retos en su definición e impacto en salud.

Heavy episodic drinking, or binge drinking, is a drinking pattern characterized by the intake of large amounts of alcohol in a short period of time, which often leads to alcohol intoxication. There is no consensus on its operational definition, finding large methodological differences between studies in estimating the amount of alcohol consumed, as well as in defining the occasion of drinking and the reference time period. Keep in mind that most drinkers with this pattern have a low risk total average alcohol consumption. Therefore, actively detecting binge drinking is essential to be able to identify and classify all risk drinkers and characterize the global impact of alcohol consumption on health, society or the economy. Its negative effects affect the drinker himself (intoxication, cardiovascular diseases, dependence, neurocognitive and developmental disorders, among others), but also causes harm to others (accidents, violence, harmful effects on fetal and perinatal neuronal development). These effects can be acute or chronic, even among those who adopt binge drinking sporadically. Different thresholds or ways of characterizing this pattern of alcohol consumption could more adequately predict each of the associated acute and chronic effects, especially if we consider the intensity and frequency of the episodes. However, the absence of a safe threshold for alcohol consumption, both regularly and occasionally, is clear; Any intake with a binge drinking pattern, regardless of the threshold we establish, carries significant risks, not only for the health of the drinker, but also for the people around them.

El patrón de episodios de consumo intensivo de alcohol o binge drinking, se caracteriza por la ingesta de grandes cantidades de alcohol concentrada en un corto espacio de tiempo, que comporta con frecuencia una intoxicación alcohólica. No existe consenso en su definición operativa, hallando entre los estudios grandes diferencias metodológicas en la estimación de la cantidad de alcohol consumido, así como en la definición de la ocasión de bebida y el periodo temporal de referencia. Hay que tener en cuenta que una mayoría de los bebedores con este patrón tienen un consumo de alcohol promedio total de bajo riesgo. Por ello, detectar de forma activa el patrón de consumo intensivo episódico, resulta fundamental para poder identificar y clasificar a todos los bebedores de riesgo y caracterizar el impacto global del consumo de alcohol en la salud, la sociedad o la economía. Sus efectos negativos afectan al propio bebedor (intoxicación, enfermedades cardiovasculares, dependencia, alteraciones neurocognitivas y de maduración entre otros), pero también potencialmente a terceras personas (accidentes, violencia, efectos perjudiciales en el desarrollo neuronal fetal y perinatal). Estos efectos se pueden manifestar de forma aguda, pero también crónica, incluso entre los que adoptan el binge drinking de forma esporádica. Distintos umbrales o formas de caracterizar este patrón de consumo de alcohol podrían predecir de forma más adecuada cada uno de los efectos agudos y crónicos asociados, especialmente si consideramos la intensidad y la frecuencia con que se adopta. No obstante, resulta clara la ausencia de un umbral seguro de consumo de alcohol, tanto de forma regular como puntual; cualquier ingesta con un patrón binge drinking, con independencia del umbral que establezcamos, comporta riesgos importantes, no solo para la salud del bebedor, sino también para las personas de su entorno.

Comparing subjective intoxication with risky single-occasion drinking in a European sample.

In most epidemiological literature, harmful drinking-a drinking pattern recognized as closely linked to alcohol-attributable diseases-is recorded using the measure risky single-occasion drinking (RSOD), which is based on drinking above a certain quantity. In contrast, subjective intoxication (SI) as an alternative measure can provide additional information, including the drinker's subjective perceptions and cultural influences on alcohol consumption. However, there is a lack of research comparing both. The current article investigates this comparison, using data from the Standardized European Alcohol Survey from 2015. We analysed the data of 12,512 women and 12,516 men from 17 European countries and one region. We calculated survey-weighted prevalence of SI and RSOD and compared them using Spearman rank correlation and regression models. We examined the role of the required quantity of alcohol needed for the drinker to perceive impairments and analysed additional demographic and sociodemographic characteristics as well as drinking patterns. In the most locations, the prevalence of SI was lower or equal to the prevalence of RSOD. Both prevalence estimates were highly correlated. Almost 8% of the variance in the difference between the individual-level frequencies of the SI and RSOD measures was explained by the individual quantity of alcohol needed to perceive impairments. Sociodemographic characteristics and drinking patterns explained less than 20% in the adjusted perceived quantity of alcohol needed. In conclusion, our results indicated that subjective measures of intoxication are not a preferable indicator of harmful drinking to the more conventional measures of RSOD.

Episodios de consumo intensivo de alcohol "binge drinking": retos en su definición e impacto en salud / Binge drinking: the challenges of definition and its impact on health

El patrón de episodios de consumo intensivo de alcohol o binge drinking, se caracteriza por la ingesta de grandes cantidades de alcohol concentrada en un corto espacio de tiempo, que comporta con frecuencia una intoxicación alcohólica. No existe consenso en su definición operativa, hallando entre los estudios grandes diferencias metodológicas en la estimación de la cantidad de alcohol consumido, así como en la definición de la ocasión de bebida y el periodo temporal de referencia. Hay que tener en cuenta que una mayoría de los bebedores con este patrón tienen un consumo de alcohol promedio total de bajo riesgo. Por ello, detectar de forma activa el patrón de consumo intensivo episódico, resulta fundamental para poder identificar y clasificar a todos los bebedores de riesgo y caracterizar el impacto global del consumo de alcohol en la salud, la sociedad o la economía. Sus efectos negativos afectan al propio bebedor (intoxicación, enfermedades cardiovasculares, dependencia, alteraciones neurocognitivas y de maduración entre otros), pero también potencialmente a terceras personas (accidentes, violencia, efectos perjudiciales en el desarrollo neuronal fetal y perinatal). Estos efectos se pueden manifestar de forma aguda, pero también crónica, incluso entre los que adoptan el binge drinking de forma esporádica. Distintos umbrales o formas de caracterizar este patrón de consumo de alcohol podrían predecir de forma más adecuada cada uno de los efectos agudos y crónicos asociados, especialmente si consideramos la intensidad y la frecuencia con que se adopta. No obstante, resulta clara la ausencia de un umbral seguro de consumo de alcohol, tanto de forma regular como puntual; cualquier ingesta con un patrón binge drinking, con independencia del umbral que establezcamos, comporta riesgos importantes, no solo para la salud del bebedor, sino también para las personas de su entorno

Heavy episodic drinking, or binge drinking, is a drinking pattern characterized by the intake of large amounts of alcohol in a short period of time, which often leads to alcohol intoxication. There is no consensus on its operational definition, finding large methodological differences between studies in estimating the amount of alcohol consumed, as well as in defining the occasion of drinking and the reference time period. Keep in mind that most drinkers with this pattern have a low risk total average alcohol consumption. Therefore, actively detecting binge drinking is essential to be able to identify and classify all risk drinkers and characterize the global impact of alcohol consumption on health, society or the economy. Its negative effects affect the drinker himself (intoxication, cardiovascular diseases, dependence, neurocognitive and developmental disorders, among others), but also causes harm to others (accidents, violence, harmful effects on fetal and perinatal neuronal development). These effects can be acute or chronic, even among those who adopt binge drinking sporadically. Different thresholds or ways of characterizing this pattern of alcohol consumption could more adequately predict each of the associated acute and chronic effects, especially if we consider the intensity and frequency of the episodes. However, the absence of a safe threshold for alcohol consumption, both regularly and occasionally, is clear; Any intake with a binge drinking pattern, regardless of the threshold we establish, carries significant risks, not only for the health of the drinker, but also for the people around them

La actualización de los límites de bajo riesgo del alcohol. Una oportunidad para mejorar la implementación de las estrategias de identificación precoz e intervención breve en España / The update of the limits for low risk alcohol consumption. An opportunity for implementing strategies for early intervention and brief interventions in Spain

Este trabajo pone en contexto la reciente actualización para España de los limites de bajo riesgo del consumo de alcohol, que se sitúa en los 20 g/día en el caso de los hombres, y en 10 g/día en el caso de las mujeres. En este sentido, se resumen algunos datos sobre el impacto en la salud individual y los costos sociales del consumo alcohol. Así mismo, plantea los retos que se derivan en relación a la alfabetización en salud de la población y de los profesionales de la salud en cuanto a los riesgos del consumo de alcohol. El artículo también repasa las implicaciones de la nueva definición en cuanto a las políticas más rentables para disminuir los daños asociados al consumo de alcohol. Este repaso se hace desde una perspectiva de salud pública, haciendo especial hincapié en cómo aprovechar la oportunidad para promover mejor la implementación de las estrategias de identificación precoz e intervención breve en el consumo de alcohol en el ámbito de la atención primaria de salud en nuestro país

This work places in context Spain's recent update of the defined limits for low risk alcohol consumption to 20g/day for men and 10g/day for women, and summarises data on the impact on individual health and the social costs of alcohol consumption. Furthermore, it considers the challenges that arise related to awareness of the risks of alcohol consumption, in the general population and among health professionals. The paper also reviews the implications of the new definitions in relation to the most effective policies for reducing alcohol-related harm. It looks at this from a public health perspective with particular emphasis on how to seize the opportunity to better promote the implementation of strategies for early identification and brief interventions in primary care in this country

Tipos de bebidas alcohólicas y efectos diferenciados en la salud: una revisión paraguas de estudios observacionales / Differential health effects of alcoholic beverages: an umbrella review of observational studies

OBJETIVO: Existe gran controversia sobre si el consumo de diversos tipos de bebidas alcohólicas tiene efectos diferenciados en la salud. El objetivo de este estudio fue realizar una revisión paraguas de los estudios que describían la asociación del consumo de diferentes tipos de bebidas alcohólicas con diversos indicadores de salud. MÉTODOS: Se realizó una búsqueda a través de PubMed (entre enero de 2000 y febrero de 2019) de revisiones sistemáticas y metaanálisis que reportaban resultados cuantitativos de la asociación entre el consumo de diferentes tipos de bebidas alcohólicas y efectos en salud. Se identificaron 26 estudios: veintiuno estaban relacionados con cáncer, tres con enfermedades cardiometabólicas, dos con neurodegenerativas y uno con mortalidad general. RESULTADOS: Los resultados fueron heterogéneos. Las grandes diferencias metodológicas en la estimación de la ingesta de alcohol, el control de las variables confusoras y el contraste de las estimaciones entre el tipo de bebidas hacían muy difícil concluir sobre si provocaban un efecto desigual en la salud. En la mortalidad general y las enfermedades cardiometabólicas, aunque parece que la cerveza y los licores tenían un mayor efecto negativo que el vino, las diferencias entre tipos de bebidas no eran estadísticamente significativas. Respecto al cáncer, en aquellos tipos cuya evidencia causal era totalmente consistente (orofaringe, colorrectal y de mama [mujeres]), las revisiones no mostraban un efecto diferenciado según los tipos de bebidas alcohólicas. Respecto a las enfermedades neurodegenerativas, la información disponible tampoco permitía establecer claras conclusiones. CONCLUSIONES: La evidencia revisada no permite afirmar que el consumo de vino, cerveza o licores tenga un efecto diferencial en las enfermedades cardiometabólicas, las neurodegenerativas o el cáncer

BACKGROUND: There is great controversy about whether the consumption of different types of alcoholic beverages has different effects on health. The objective was to carry out an umbrella review of the studies that described the association between the consumption of different types of alcoholic beverages and various health indicators. METHODS: Search through PubMed (from January 2000 to February 2019) of systematic reviews and meta-analysis that reported quantitative results of the association between the consumption of different types of alcoholic beverages and health effects. 26 studies were identified: 21 related to cancer, three to cardiometabolic diseases, two to neurodegenerative diseases, and one to general mortality. RESULTS: The results were heterogeneous. The great methodological differences in the estimation of alcohol intake, control of confounding variables, and the evaluation of statistical difference between types of beverages, made it very difficult to conclude whether they cause an unequal effect on health. In general mortality and cardiometabolic diseases, it was suggested that beer and spirits appear to have a greater negative effect than wine, but the differences were not statistically significant. Regarding cancer, in those types where the causal evidence is totally consistent: oropharynx, colorectal and breast (women), the reviews did not show a differentiated effect according to the type of alcoholic beverages. Regarding neurodegenerative diseases, the available information did not allow clear conclusions to be drawn. CONCLUSIONS: The reviewed evidence does not allow to conclude that the consumption of wine, beer or spirits, has a differential effect on cardiometabolic, cancer or neurodegenerative diseases

Systematic review of guidelines in estimating social costs on drugs / Revisión sistemática de guías para la estimación de los costes sociales de las drogas

Objective: To systematically review guidance documents for the estimation of the social cost of illegal drugs, and to define standards for this estimation. Method: A systematic literature search was conducted between April and May 2015 and updated in November 2015. Pubmed, Scopus, and Google Scholar were searched. Studies were included only if they provided indications of analytical methods for calculating the social cost of illegal drugs consumption. Results: A total of 21 papers were selected for a final review. Four main areas of discussion were identified: a) alternative theories for the framework design; b) basic concepts definition; c) theoretical issues in the application of the framework and; d) definition of the cost matrix and its elements. The review exercise enabled the definition of two analytical approaches, which are proposed as references for estimation in the field. Conclusions: although social cost is a well-established method in the literature, there is a lack of agreement on the most appropriate approaches in the area of estimation of the social cost of illegal drugs consumption. Moreover, the two analytical approaches proposed are aimed at promoting more research focused at sophisticating the methodology in the field

Objetivo: Revisar sistemáticamente las guías para la estimación del coste social del consumo de drogas ilegales y definir estándares para su estimación. Método: La búsqueda sistemática de la literatura se realizó entre abril y mayo de 2015, y se actualizó en noviembre de 2015. Se realizaron búsquedas en Pubmed, Scopus y Google Scholar. Los estudios se incluyeron solo si explicitaban los métodos analíticos para calcular el coste social del consumo de drogas ilegales. Resultados: Se seleccionaron 21 trabajos para su revisión final. Se identificaron cuatro áreas principales de discusión: a) teorías alternativas para el diseño del marco; b) definición de conceptos básicos; c) aspectos teóricos en la aplicación del marco; y d) definición de la matriz de costes y sus elementos. El ejercicio de revisión permitió la definición de dos enfoques analíticos, que se proponen como referencia para estimación en este campo. Conclusiones: Aunque el coste social es un método bien establecido en la literatura, existe falta de acuerdo sobre los enfoques más apropiados en su aplicación al consumo de drogas ilegales. Los dos enfoques analíticos propuestos tienen como objetivo promover una mayor investigación enfocada a mejorar la metodología en este campo

Systematic review of guidelines in estimating social costs on drugs.

OBJECTIVE: To systematically review guidance documents for the estimation of the social cost of illegal drugs, and to define standards for this estimation. METHOD: A systematic literature search was conducted between April and May 2015 and updated in November 2015. Pubmed, Scopus, and Google Scholar were searched. Studies were included only if they provided indications of analytical methods for calculating the social cost of illegal drugs consumption. RESULTS: A total of 21 papers were selected for a final review. Four main areas of discussion were identified: a) alternative theories for the framework design; b) basic concepts definition; c) theoretical issues in the application of the framework and; d) definition of the cost matrix and its elements. The review exercise enabled the definition of two analytical approaches, which are proposed as references for estimation in the field. CONCLUSIONS: although social cost is a well-established method in the literature, there is a lack of agreement on the most appropriate approaches in the area of estimation of the social cost of illegal drugs consumption. Moreover, the two analytical approaches proposed are aimed at promoting more research focused at sophisticating the methodology in the field.

Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union.

BACKGROUND: Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. METHODS: A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. RESULTS: Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. CONCLUSIONS: The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.

[Detection and handling of alcohol problems in primary care in Catalonia]. / Detección y abordaje de los problemas de alcohol en la atención primaria de Cataluña.

OBJECTIVE: To gain information on how well strategies for alcohol problem detection and interventions are being implemented in primary care in Catalonia, Spain. DESIGN: Longitudinal pre/post study to evaluate the impact of the distribution to primary care professionals of a training programme for detecting alcohol problems and intervening in them. Descriptive analysis of the basic situation, using interviews with patients and professionals and examination of clinical histories (CH). SETTING: Health districts that existed in Catalonia in 2001. PARTICIPANTS: Twenty eight health districts, 973 patients, 80 professionals, and 852 clinical histories examined. MAIN MEASUREMENTS: Data were collected, by means of questionnaires for professionals and patients and of ad-hoc instruments for examining clinical histories, on the levels of primary care screening for alcohol consumption and of intervention. RESULTS: There was a major disparity in the data between the 3 sources. Thus the screening of consumption and counselling was recorded much less in the CHs than amounts that patients said they received and that professionals said they performed. In addition, most of the at-risk drinkers that were seen in PC were not detected. On comparing them with non-risk drinkers we found significant differences in sex, job, familiarity with the centre and having been asked or not about their alcohol consumption. CONCLUSIONS: Given the deficiencies found in PC preventive activity on alcohol consumption and as alcohol consumption has such huge social and health repercussions on the general population, we think it is fully justified to introduce into PC specific training programmes on screening and brief intervention techniques for alcohol problems.

Detección y abordaje de los problemas de alcohol en la atención primaria de Cataluña / Detection and handling of alcohol problems in primary care in Catalonia

Objetivo. Conocer el grado de implementación de las estrategias de detección e intervención en los problemas de alcohol en la atención primaria de Cataluña. Diseño. Estudio de evaluación del impacto de la diseminación de un programa de formación de los profesionales de atención primaria (AP) en la detección e intervención en los problemas de alcohol. Análisis descriptivo de la situación basal a partir de las entrevistas a pacientes, profesionales y el vaciado de las historias clínicas. Emplazamiento. Áreas básicas de salud (ABS) de Cataluña en el 2001. Participantes. Participaron 28 ABS seleccionadas aleatoriamente, 973 pacientes, 80 profesionales y 852 historias clínicas auditadas. Mediciones principales. Se recogieron datos sobre el nivel de cribado e intervención en el consumo de alcohol en la atención primaria a través de cuestionarios a profesionales y a pacientes y la auditoría de las historias clínicas. Resultados. Se observa una importante disparidad en los datos obtenidos a partir de las 3 fuentes. Así, el cribado de consumo y el consejo se registran mucho menos en la historia clínica de lo que los pacientes dicen recibirlo y de lo que los profesionales dicen hacerlo. Además, la mayor parte de los bebedores de riesgo atendidos en AP no son detectados y presentan diferencias significativas en cuanto al sexo, la profesión, la familiaridad con el centro y el hecho de haberles preguntado o no sobre su consumo de alcohol, en relación con los no bebedores de riesgo. Conclusiones. Dadas las deficiencias detectadas en la actividad preventiva de AP en relación con el consumo de alcohol y las enormes repercusiones sociales y sanitarias que ocasiona el consumo de alcohol en la población general, creemos que está ampliamente justificado impulsar la implementación en AP de programas específicos de formación sobre técnicas de cribado e intervención breve en los problemas de alcohol

Objective. To gain information on how well strategies for alcohol problem detection and interventions are being implemented in primary care in Catalonia, Spain. Design. Longitudinal pre/post study to evaluate the impact of the distribution to primary care professionals of a training programme for detecting alcohol problems and intervening in them. Descriptive analysis of the basic situation, using interviews with patients and professionals and examination of clinical histories (CH). Setting. Health districts that existed in Catalonia in 2001. Participants. Twenty eight health districts, 973 patients, 80 professionals, and 852 clinical histories examined. Main measurements. Data were collected, by means of questionnaires for professionals and patients and of ad-hoc instruments for examining clinical histories, on the levels of primary care screening for alcohol consumption and of intervention. Results. There was a major disparity in the data between the 3 sources. Thus the screening of consumption and counselling was recorded much less in the CHs than amounts that patients said they received and that professionals said they performed. In addition, most of the at-risk drinkers that were seen in PC were not detected. On comparing them with non-risk drinkers we found significant differences in sex, job, familiarity with the centre and having been asked or not about their alcohol consumption. Conclusions. Given the deficiencies found in PC preventive activity on alcohol consumption and as alcohol consumption has such huge social and health repercussions on the general population, we think it is fully justified to introduce into PC specific training programmes on screening and brief intervention techniques for alcohol problems

Detección y abordaje de los problemas de alcohol en la atención primaria de Cataluña

Objetivo. Conocer el grado de implementación de las estrategias de detección e intervención en los problemas de alcohol en la atención primaria de Cataluña. Diseño. Estudio de evaluación del impacto de la diseminación de un programa de formación de los profesionales de atención primaria (AP) en la detección e intervención en los problemas de alcohol. Análisis descriptivo de la situación basal a partir de las entrevistas a pacientes, profesionales y el vaciado de las historias clínicas. Emplazamiento. Áreas básicas de salud (ABS) de Cataluña en el 2001. Participantes. Participaron 28 ABS seleccionadas aleatoriamente, 973 pacientes, 80 profesionales y 852 historias clínicas auditadas. Mediciones principales. Se recogieron datos sobre el nivel de cribado e intervención en el consumo de alcohol en la atención primaria a través de cuestionarios a profesionales y a pacientes y la auditoria de las historias clínicas. Resultados. Se observa una importante disparidad en los datos obtenidos a partir de las 3 fuentes. Así, el cribado de consumo y el consejo se registran mucho menos en la historia clínica de lo que los pacientes dicen recibirlo y de lo que los profesionales dicen hacerlo. Además, la mayor parte de los bebedores de riesgo atendidos en AP no son detectados y presentan diferencias significativas en cuanto al sexo, la profesión, la familiaridad con el centro y el hecho de haberles preguntado o no sobre su consumo de alcohol, en relación con los no bebedores de riesgo. Conclusiones. Dadas las deficiencias detectadas en la actividad preventiva de AP en relación con el consumo de alcohol y las enormes repercusiones sociales y sanitarias que ocasiona el consumo de alcohol en la población general, creemos que está ampliamente justificado impulsar la implementación en AP de programas específicos de formación sobre técnicas de cribado e intervención breve en los problemas de alcohol.(AU)

[Validation study of the Multidimensional Alcohol Craving Scale (MACS)]. / Estudio de validación de la Escala Multidimensional de Craving de Alcohol.

BACKGROUND AND OBJECTIVE: Craving is a psychobiological phenomenon characteristic of addictive behaviours, which is difficult to assess due to its subjective nature and multidimensionality. The aim of this study was to validate a multidimensional alcohol craving scale (MACS) entirely developed in Spain. MATERIAL AND METHOD: The validation of the MACS was based on an observational study, carried out in 452 alcohol-dependent patients treated with naltrexone. The scales used as standards were an Analogic Visual Scale (AVS) for alcohol craving and the Obsessive-Compulsive Drinking Scale (OCDS). Validity, reliability and sensitivity were studied for the validation process. RESULTS: The factorial analysis (construct validity) showed that the scale had two factors: desire and behavioural disinhibition (lack of resistance). Their correlation values with the assessment scales were r = 0.56 and r = 0.50, respectively. The scale's internal consistency was alpha = 0.94. The correlation of the scores on the scale with the AVS oscillated between 0.56 and 0.46 (p < 0.01) throughout the course of treatment. CONCLUSIONS: The MACS has good psychometric properties: it measures two craving factors --desire and behavioural disinhibition-- and may be considered as an accurate and precise instrument to use in both research studies and medical and psychological clinical practice.