Comparison between the WHO and NIAAA criteria for binge drinking on drinking features and alcohol-related aftermaths: Results from a cross-sectional study among eight emergency wards in France.

BACKGROUND: Binge drinking (BD) consists of heavy episodic alcohol use. Whereas the World Health Organization (WHO) defines BD as 60g of alcohol or more per occasion, the National Institute on Alcoholism and Alcohol Abuse (NIAAA) conceives BD as drinking 70g (men) or 56g (women) in less than two hours. We compared the subjects delineated by each definition. METHODS: Eight-center cross-sectional study among 11,695 subjects hospitalized in emergency wards. Participants completed the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C), CAGE and Rapid Alcohol Problem Screen 4 (RAPS4-QF) questionnaires. The WHO criteria were investigated using the RAPS4-QF. Independent questions assessed the NIAAA criteria. The main medical admission motive was noted. The characteristics of subjects meeting respectively: 1) the exclusive WHO criteria (BD1); 2) the NIAAA criteria (BD2); and 3) no BD criteria (noBD) were compared using multinomial regression analyses. Binary age- and gender-adjusted regression analyses directly compared BD1 and BD2. Subjects with at least four drinking occasions per week were excluded from the analyses, to withdrawn regular heavy drinking. RESULTS: Compared to BD1, BD2 subjects were more frequently males (OR=1.67 [1.39-2.0]), single (aOR=1.64 [1.36-1.98]) and unemployed (aOR=1.57 [1.27-1.90]). BD2 reported significantly more drinks per occasion, and higher heavy drinking frequencies. Previous alcohol-related remarks from family (aOR=3.00 [2.53-3.56]), ever drinking on waking-up (aOR=2.05 [1.37-2.72]), and admission for psychiatric motive (aOR=2.27 [1.68-3.07]) were more frequent among BD2 subjects. CONCLUSIONS: Compared to WHO criteria, NIAAA criteria for BD delineate subjects with more concerning drinking patterns and alcohol aftermaths.

[Fever as a prognostic factor for heat stroke]. / L'hyperthermie est un facteur pronostique des coups de chaleur climatiques.

OBJECTIVES: Classic heatstroke that is, due to very hot weather, rare in Europe. Its clinical characteristics and course in temperate zones are not well known. The objective of this study was to assess the influence of initial fever on prognosis in heatstroke. METHODS: All patients admitted through the emergency department from 8-13 August 2003 for heatstroke (defined by fever > or = 40 degrees C, with neurologic symptoms in the absence of sepsis) were included in the study. Patients' clinical and laboratory indicators were recorded at admission. Follow-up took place at D28 and 1 year. The influence of fever on survival was assessed with the Kaplan-Meier method. RESULTS: During the study period, 63 patients, aged 78+/-9 years, were admitted for heatstroke, with a SAPS II (Simplified Acute Physiology Score) of 61+/-24. Core body temperature was 41.4+/-1.2 degrees C. Mortality was 59% at D28 and 67% at 1 year. Prognosis was influenced from admission by temperature, with a higher probability of survival for patients with temperature < 41 degrees C, compared with those whose temperature > or = 41 degrees C (log-rank test: p<0.001). DISCUSSION: Prognosis is poor for classic heatstroke. Rapid temperature reduction, especially when it exceeds > 41 degrees C, must be considered a priority. Fever > or = 41 degrees C at admission for heatstroke is a poor prognostic factor that is simple to identify and may modify treatment strategies in the future.