Alcohol health literacy in young adults with type 1 diabetes and its impact on diabetes management.

AIMS: To investigate the knowledge of alcohol and carbohydrate content of commonly consumed alcoholic drinks among young adults with Type 1 diabetes and to explore alcohol consumption while identifying diabetes self-management strategies used to minimize alcohol-associated risk. METHOD: We conducted an open-access, multiple-choice web survey to investigate knowledge of alcohol and carbohydrate content of typical alcoholic drinks using images. Respondents to the survey also recorded their current alcohol consumption and diabetes self-management strategies when drinking. RESULTS: A total of 547 people aged 18-30 years responded to the survey (341 women; 192 men; mean (sd) age 24.5 (3.7) years), of whom 365 (66.7%) drank alcohol. In all, 84 (32.9%) women and 31 (22.6%) men scored higher than the cut-off score for increased-risk drinking. Knowledge accuracy of alcohol units was poor: only 7.3% (n = 40) correctly identified the alcohol content of six or more out of 10 drinks. Knowledge of carbohydrate content was also poor: no respondent correctly identified the carbohydrate content of six or more out of 10 drinks. Various and inconsistent strategies to minimize alcohol-associated risk were reported. CONCLUSIONS: Alcohol consumption was common among the survey respondents, but knowledge of alcohol and carbohydrate content was poor. Greater alcohol-related health literacy is required to minimize alcohol-associated risk. Further research should help develop effective strategies to improve health literacy and support safe drinking for young adults with Type 1 diabetes.

Alcohol-associated risks for young adults with Type 1 diabetes: a narrative review.

AIM: To undertake a narrative review of the impact and pattern of alcohol consumption in young adults with Type 1 diabetes. DATA SOURCES: MEDLINE, EMBASE, PsycINFO, The Cochrane Library, Web of Science, meeting abstracts of the European Association for the Study of Diabetes, the American Diabetes Association and Diabetes UK, Current Controlled Trials, ClinicalTrials.gov, UK Clinical Research Network, scrutiny of bibliographies of retrieved papers and contact with experts in the field. INCLUSION CRITERIA: relevant studies of any design of alcohol consumption and young adults with Type 1 diabetes (age 14-25 years) were included. The key outcomes were the quantity, pattern and impact of alcohol consumption, the effect on diabetes control and the effect of interventions to minimize the risks of alcohol for this population. RESULTS: Six articles and two conference abstracts met the inclusion criteria. There were six cross-sectional studies, one qualitative study and one within-subjects design study. Quality of studies was variable. Alcohol use amongst young adults with Type 1 diabetes was reported to be common and potentially harmful. There was a paucity of evidence on interventions to minimize the risks of alcohol in this target group. CONCLUSIONS: Research is required to understand the social context of alcohol consumption in this population with a view to developing appropriate interventions to minimize the risks associated with its use.

Clinician and service user perceptions of implementing contingency management: a focus group study.

BACKGROUND: Contingency management (CM), despite the evidence base for its effectiveness, remains controversial, with sub-optimal implementation. In 2007, UK guidelines recommended the use of CM in publicly funded services, but uptake has also been minimal. Previous surveys of service providers suggest differences in opinions about CM, but to date there has been no published involvement of service users in this debate. METHOD: Focus group methodology was used to explore systematically the attitudes, concerns and opinions of staff and service users about the use of CM, in publicly funded substance misuse services, to identify the key areas that may be influential in terms of implementation and outcome. Data were analysed thematically using the constant comparative method. RESULTS: 70 staff and service users participated in 9 focus groups. 15 themes of discussion around CM were identified, grouped into four categories: how CM was aligned to the philosophy of substance misuse services; the practicalities of implementation; wider ethical concerns; and how participants perceived the evidence for effectiveness. CONCLUSIONS: Robust process evaluation in different treatment systems is needed to define the active components of CM for implementation. Involvement of service users in this process is essential and is likely to provide valuable insights into the mechanism of action of CM and its effectiveness and uptake within complex treatment systems.

Interventions with potential to improve the mental health and wellbeing of UK veterinary surgeons.

The proportion of UK veterinary surgeons who die by suicide as opposed to other causes is approximately four times that of the general population, and around twice that of other healthcare professionals. Recent research suggests that veterinary surgeons report high levels of psychological distress. This paper proposes a portfolio of evidence-based interventions, for both organisations and individuals, which have the potential to improve mental health and wellbeing in the veterinary profession.

The Wessex Recent In-Patient Suicide Study, 1. Case-control study of 234 recently discharged psychiatric patient suicides.

BACKGROUND: Psychiatric patients have a higher suicide risk following hospital discharge. AIMS: To identify social, clinical and health-care delivery factors in recently discharged patients. METHOD: Retrospective case-control study of 234 patients who died within 1 year of hospital discharge, matched for age, gender, diagnosis and admission period with 431 controls. Odds ratios for identified risk factors were calculated using conditional multiple logistic regression. RESULTS: Independent increased-risk factors were: not being White; living alone; history of deliberate self-harm (DSH); suicidal ideation precipitating admission; hopelessness; admission under different consultant; onset of relationship difficulties; loss of job; in-patient DSH; unplanned discharge; significant care professional leaving/on leave. Reduced-risk factors were: shared accommodation; delusions at admission; misuse of non-prescribed substances; and continuity of contact. CONCLUSIONS: Continuity of contact may reduce suicide risk. Discontinuity of care from a significant professional is associated with increased risk of suicide.

The Wessex Recent In-Patient Suicide Study, 2. Case-control study of 59 in-patient suicides.

BACKGROUND: Psychiatric patients have an elevated risk of suicide while in hospital. AIMS: To compare social, clinical and health-care delivery factors in in-patient and out-patient suicides and their controls. METHOD: Retrospective case-control study of 59 in-patients and 106 controls, matched for age, gender, diagnosis and admission date. Odds ratios were calculated using conditional multiple logistic regression. RESULTS: There were seven independent increased-risk factors: history of deliberate self-harm, admission under the Mental Health Act, involvement of the police in admission, depressive symptoms, violence towards property, going absent without leave and a significant care professional being on leave. When compared with out-patient suicides, in-patients were more often female and male in-patients had a psychotic illness. Unlike the out-patient suicides, social factors were not found to be significant. CONCLUSIONS: The characteristics of in-patient and out-patient suicides differ. Identified risk factors have relatively low sensitivity and specificity.

A test of the concept of "underlying depressive illness" in the treatment of anxiety states.

In order to test the validity of the concept of anxiety states masking an underlying depressive illness, patients clinically diagnosed as suffering from anxiety or tension states were treated on a random double-blind basis for 4 weeks with either a pure anxiolytic, lorazepam, or an anxiolytic/antidepressant preparation, fluphenazine with nortriptyline. Patients' self-ratings were very similar to the physicians' ratings which showed that fluphenazine/nortriptyline was associated with significantly greater overall improvement(p less than 0.01), as well as significantly greater improvements in the group of symptoms specifically related to depression(p less than 0.05). These results suggest that a depressive element is present in an appreciable proportion of patients presenting with apparent anxiety states, and antidepressant as well as anxiolytic treatment is required. Patients selected on the basis that they had improved satisfactorily at the end of the 4-weeks' treatment were followed up for a further 3 months without medication, and the relapse rate was 24%, irrespective of previous treatment. More of the patients treated with lorazepam had to be excluded from the follow-up because of failure to improve, and these probably represented the proportion (19%) of this population with an appreciable depressive element to their illness.

Treatment of anxiety/depressive conditions in the elderly: a double-blind comparative study of Motival and amitriptyline.

A double-blind two-group comparison of fluphenazine/nortriptyline (F/N) with amitriptyline in 72 patients aged 65 or over suffering from mixed states of anxiety and depression, each treated for four weeks, showed F/N to be significantly superior to amitriptyline by Day 7 in terms of patients' self-ratings and clinicians' ratings. Patients' preference for F/N was even more pronounced by Day 28 (P less than 0.001), when the improvement in symptoms relating to depression was rated by the clinicians as significantly greater for the patients receiving F/N (P less than 0.025). The incidence of drowsiness was significantly greater (P less than 0.05) in the amitriptyline group than the F/N group. The implications of these results for the treatment of emotional disturbances in the elderly are discussed.