Population pharmacokinetics of alcohol on Chinese subjects using breath measures.

WHAT IS KNOWN AND OBJECTIVE: Alcohol is a widely used drug. Our objective was to examine alcohol pharmacokinetics in Chinese subjects through the breath measurement of blood alcohol concentration (BAC) to identify any measurable covariates that may help explain variability between subjects. METHODS: Breath-alcohol measurements of 184 healthy Chinese subjects were collected. Compartmental models including one- and two-compartment process were examined. First-order kinetics was applied to model alcohol absorption and elimination phases. For the sake of simplicity, only the subject's body weight, sex and stomach condition were investigated as covariates in our random effects modelling. RESULTS AND DISCUSSION: The body as a whole behaves as a single compartment, with the suggested one-compartment model being good enough to characterize the biological process. In line with other studies, food ingestion before/with the dose slowed down alcohol absorption into the central compartment. Female subjects exhibited a significantly higher BAC elimination rate than that of males. Body weight also contributed to the observed inter-subject variability in alcohol clearance. WHAT IS NEW AND CONCLUSION: We present a model for estimating blood-alcohol levels from breath-alcohol measurements. The results of our study are useful particularly in relation to drink-driving prosecutions because of the routine use of breath-alcohol measurements as evidence in such cases through the world.

Influenza-attributable deaths, Canada 1990-1999.

The number of deaths attributable to influenza is believed to be considerably higher than the number certified by vital statistics registration as due to influenza. Weekly mortality data for Canada from the 1989/1990 to the 1998/1999 influenza seasons were analysed by cause of death, age group, and place of death to estimate the impact of influenza on mortality. A Poisson regression model was found to accurately predict all-cause, as well as cause-specific mortality, as a function of influenza-certified deaths, after controlling for seasonality, and trend. Influenza-attributable deaths were calculated as predicted less baseline-predicted deaths. In summary, throughout the 1990s there were on average just under 4000 deaths attributable to influenza annually (for an influenza-attributable mortality rate of 13/100,000 persons), varying from no detectable excess mortality for the 1990/1991 influenza season, to 6000-8000 influenza-attributable deaths for the more severe influenza seasons of 1997/1998 and 1998/1999. On average, 8% (95% CI 7-10) of influenza-attributable deaths were certified as influenza, although this percentage varied from 4% to 12% from year to year. Only 15% of the influenza-attributable deaths were certified as pneumonia, and for all respiratory causes, 40%. Deaths were distributed over most causes. The weekly pattern of influenza-certified deaths was a good predictor of excess all-cause mortality.

Characterization of Neisseria meningitidis strains isolated from invasive meningococcal disease cases in Canada in 2001.

With the recent introduction of polysaccharide-protein conjugated vaccines for the control of serogroup C meningococcal disease and the emergence of different variants of serogroup C meningococci, it is likely the epidemiology of meningococcal disease in many countries may be affected. We have therefore analysed and reported the characteristics of Neisseria meningitidis strains collected in 2001 from the Canadian surveillance program on invasive meningococcal disease. Only strains collected from normally sterile clinical sites of patients were studied. Of the 289 isolates obtained from individual patients, 173 (59.9%) were serogroup C, 76 (26.3%) were serogroup B, 30 (10.4%) were serogroup Y, and 10 (3.5%) were serogroup W135. Ninety-six percent of the serogroup C isolates belonged to the ET-15 clone, with an additional 2.3% belonging to other electrophoretic types within the ET-37 clonal complex. Different antigenic variants of the endemic serogroup C ET-15 clone were responsible for localized outbreaks in different parts of the country. One novel variant with the antigenic composition of C:2a:P1.1,7 was reported in two provinces, Quebec and Ontario. Eighteen percent of the meningococci isolated from patients in Ontario belonged to serogroup Y, compared with only 8% in the rest of Canada. The current data highlight the importance of strain characterization by serogroup, serotype, and serosubtype antigens in providing useful information for the surveillance of meningococcal disease in Canada.

Variables associated with DUI offender status among whites and Mexican Americans.

OBJECTIVE: Arrests of Hispanics have been found to be overrepresented among arrests for driving under the influence of alcohol (DUI) in California. Variables associated with offender status (first vs multiple) among Mexican-American and white DUI arrestees are analyzed to test the hypothesis that acculturation will be related to DUI among Mexican Americans while risk-taking dispositional variables will be related to DUI among whites. METHOD: A sample of 249 Mexican-American clients (with an oversampling of foreign-born) and 250 white clients were interviewed in all five DUI treatment programs in one northern California county. RESULTS: In univariate analysis, risk taking/impulsivity and sensation seeking were positively associated with multiple offender status among Mexican Americans, but not among whites. Multiple logistic regression found age as the only significant predictor of offender status in either ethnic group; however, path models found significant indirect effects on offender status of attitudes regarding DUI arrest through alcohol consumption, with those reporting having little chance of being arrested for DUI if stopped being less likely to report consuming five or more drinks at a sitting at least weekly, and with Mexican Americans being more likely than whites to believe they will not be arrested and to consider that DUI is not a problem. CONCLUSIONS: The data suggest that there are significant ethnic differences in attitudes and norms toward DUI that are related to frequency of drinking large amounts at one sitting, and future research is needed to determine how these variables along with dispositional and acculturation variables may be associated with DUI offender status.

Cruise ships: high-risk passengers and the global spread of new influenza viruses.

In 1997, passengers on North American cruises developed acute respiratory illnesses (ARIs); influenza was suspected. We reviewed 1 ship's medical records for 3 cruises: cruise 1 (31 August to 10 September 1997), cruise 2 (11-20 September 1997), and cruise 3 (20-30 September 1997). Medically attended ARI was defined as any 2 of the following symptoms: fever (temperature, > or =37.8 degrees C) or feverishness, sore throat, cough, nasal congestion, chills, myalgia, and arthralgia. During cruise 2, we collected nasopharyngeal swabs for viral culture from people with ARI and surveyed passengers for self-reported ARI (defined as above except feverishness was substituted for fever). The outbreak probably began among Australian passengers on cruise 1 (relative risk, 3.3; 95% confidence interval, 1.89-5.77). Of 1284 passengers on cruise 2, 215 (17%) reported ARI, 994 (77%) were aged > or =65 years, and 336 (26%) had other risk factors for respiratory complications. An influenza strain not previously identified in North America was isolated. We concluded that an "off-season" influenza outbreak occurred among international travelers and crew on board this cruise ship.

The effect of screening on prevalence estimates of alcohol dependence and social consequences.

OBJECTIVE: Screener items are often used in surveys to identify individuals who are at high risk of experiencing alcohol dependence or alcohol-related problems. The purpose of this study is to determine the effect of two screener items (5 or more drinks ever and > or = 12 drinks last year) on prevalence estimates of alcohol dependence and negative social consequences. METHOD: The 1995 National Alcohol Survey data were analyzed. Differences in prevalence estimates between the unscreened current drinkers (n = 2,817) and the two screened samples: 5+ ever (n = 2,186) and > or = 12 drinks last year (n = 2,126) were compared. For each screened sample, prevalence estimates obtained from two base populations (screened positives only and all current drinkers assuming no alcohol-related problems among screened negatives) were examined. RESULTS: Comparisons of prevalence estimates of alcohol dependence and negative social consequences across the screened and unscreened samples revealed little bias in estimates with one exception. The only significant difference between the unscreened and screened samples was found among women when prevalence rates were obtained from data of screened positive respondents only. CONCLUSIONS: The effect of screening on national prevalence estimates of alcohol dependence and social consequences is small. Less bias in prevalence estimates is found when negatively screened light drinkers were assumed to report no alcohol-related problems rather than excluded from the estimation sample.

Demographic characteristics, life context, and patterns of substance use among alcohol-dependent treatment clients in a health maintenance organization.

BACKGROUND: Although individuals dependent only on alcohol and those dependent on both alcohol and drugs typically are not studied together in clinical trials, they are treated together in most treatment programs. In this study we compared epidemiological characteristics of the alcohol-only and alcohol-and-drug dependents in a treatment sample to assess differential treatment needs. METHOD: Patients admitted to treatment at a health maintenance organization's chemical dependency program were sampled and interviewed by using a structured questionnaire. The sample included 491 alcohol-only and 217 alcohol-and-drug dependents. Demographic characteristics, lifetime and current substance use, Addiction Severity Index composite scores, and DSM-IV criteria for alcohol and drug dependence were assessed at admission. RESULTS: The odds of alcohol-and-drug dependence were higher among males, African Americans (when compared with whites), those who were younger, and those with less than college education. The risk was also higher among those who initiated heavy drinking or drug use before the age of 18. Increased psychiatric and family/social problems also were associated with combined dependence. CONCLUSIONS: Even in this relatively homogeneous socioeconomic status population, demographic characteristics were important predictors of type of dependence. Treatment programs which provide services that address prevention and psychosocial problems should pay attention to age of initiation as well as psychiatric and social problems.

Risk functions for alcohol-related problems in a 1988 US national sample.

To assess the relationship of alcohol use and three types of alcohol-related problems (ICD-10 dependence syndrome, work problems and drunk driving), risk curves were developed for average number of drinks per day during last year (volume) and number of days drinking five or more drinks during one day (5+). Using data from the 1988 National Health Interview Alcohol Supplement, risk curves were derived from data on 22,102 current drinkers who consumed at least 12 drinks in the last year. The emphasis in this analysis was on the proportion of drinkers at lower levels reporting different types of problems. The results indicate that even at lower levels of drinking (volume averaging one or fewer drinks/day) there is considerable risk for drunk driving and less risk for work problems and alcohol dependence. The risk for all types of problems at lower and moderate levels of drinking was significantly higher for respondents who had five or more drinks during one day in the last year. These findings underscore the importance of examining risk (physical and social) at lower levels of drinking and for using both overall volume and heavier quantity per occasion drinking measures when assessing risk for any alcohol-related problem.

Patterns in the institutional encounters of problem drinkers in a community human services network.

It is useful to view the social handling of alcohol problems in US communities from the perspective of a whole network of human service systems that share in the burden of identifying and responding to problem drinkers. This analysis examines the management of alcohol problems in different community service systems by mapping patterns in the institutional encounters of problem drinkers across alcohol treatment, drug treatment, mental health treatment, social welfare and criminal justice systems in a single US community. Findings highlight the prominence of large bureaucratic systems for social welfare and criminal justice as sources of referrals for smaller service systems offering treatment for alcohol problems. However, large proportions of problem-drinking service recipients in the community remain exclusive clients of the welfare and criminal justice systems, making no contact with therapeutically orientated service settings. Compared with problem drinkers who obtain treatment services, problem drinkers on the case-loads of criminal justice and welfare agencies tend to be younger, of higher socio-economic status, are more likely to be male, and tend to drink less heavily and to experience fewer symptoms of alcohol dependence. Given the distinctive characteristics of problem drinkers found exclusively in criminal justice and welfare settings, it may be advisable for communities to introduce early intervention programs in these systems that target services to this particular subgroup of problem drinkers.

Selection bias in national surveys due to screening: implications from a county general population survey.

National alcohol surveys using face-to-face interviews, such as the US 1988 National Health Interview Survey Alcohol Supplement and the 1990 US National Alcohol Survey, for reasons of efficiency often use screener items to identify individuals who are likely to have experienced alcohol-related problems and only those individuals are chosen to respond to a list of alcohol-related problem questions. The consequence of screening is that only a subset of the current drinkers have complete data on such items. This paper examines the bias introduced by the exclusion of cases with incomplete information due to screening. Data from a regional general population survey were used to investigate possible bias due to screening because it included the screening questions used in NHIS and NAS but did not screen on those items. Risk curves and estimated probabilities from logistic regressions of three alcohol dependence symptom items and two problem indices were compared by gender across three subsamples: (1) all current drinkers (without screening); (2) those who passed the screener item for the NHIS and (3); the NAS, respectively. Results indicate that the effect of the screener items on the estimated prevalence of the measures concerned are minimal, supporting the practice, judiciously applied, when greater survey efficiency is required.