The Epidemiology of Alcohol Use and Alcohol Use Disorders among Young People in Northern Tanzania

IntroductionAlcohol use is a global public health problem, including as a risk factor for HIV infection, but few data are available on the epidemiology of alcohol use and alcohol use disorders (AUD) among young people in sub-Saharan Africa.MethodsWe conducted a cross-sectional survey among 4 groups of young people aged 15–24 years old (secondary school students, college/university students, employees of local industries and casual labourers) in two regions (Kilimanjaro and Mwanza) of northern Tanzania. Using a multistage stratified random sampling strategy, we collected information on demographics, alcohol use, and behavioural factors. We screened severity of alcohol use using the Alcohol Use Disorder Identification Test (AUDIT) and estimated the quantity and frequency of alcohol consumption using the timeline-follow-back-calendar (TLFB) method.ResultsA total of 1954 young people were surveyed. The prevalence of reported alcohol use was higher among males (47–70% ever users and 20–45% current users) than females (24–54% ever users and 12–47% current users). Prevalence of use was substantially higher in Kilimanjaro than Mwanza region. In both regions, participants reported high exposure to alcohol advertisements, and wide alcohol availability. College students reported the highest prevalence of current alcohol use (45% among males; 26% among females) and of heavy episodic drinking (71% among males; 27% among females) followed by casual labourers. Males were more likely to have AUD (an AUDIT score ≥8) than females, with 11–28% of males screening positive for AUD. Alcohol use was associated with male gender, being in a relationship, greater disposable income, non-Muslim religion and a higher number of sexual partners.ConclusionsAlcohol use is a significant problem among young people in northern Tanzania. There is an urgent need to develop, pilot and deliver interventions to help young people delay initiation and reduce levels of harmful drinking, particularly among college students and casual labourers.     

Understanding Worry About Risks Associated With Thyroid Hormone Therapy: A National Survey of Endocrinologists,Family Physicians,and Geriatricians

ObjectiveThyroid hormone use is widespread, and prior studies have shown that over- and undertreatment with thyroid hormone are common. Our objective was to understand physician worry regarding risks associated with thyroid hormone therapy, specifically overtreatment or undertreatment.MethodsA nationwide survey was administered to physician members of the Endocrine Society, the American Academy of Family Practice, and the American Geriatrics Society. Participants were asked how often they were worried about various risks that may be associated with thyroid hormone over- or undertreatment, that is, cardiovascular complications, bone complications, and poor quality of life due to overtreatment or undertreatment with thyroid hormone. Multivariable regression analyses were conducted to determine physician characteristics associated with each worry.ResultsThe response rate was 63% (359 of 566); of those who responded, 128 (36%) were primary care physicians, 114 (32%) were endocrinologists, and 113 (32%) were geriatricians. Overall, 74 (21%) physicians reported that they frequently or always worried about cardiovascular complications, 74 (21%) about bone complications, 111 (31%) about the poor quality of life due to symptoms from undertreatment with thyroid hormone, and 87 (24%) about the poor quality of life due to symptoms from overtreatment with thyroid hormone. Endocrinologists were more likely to frequently or always worry about the patients' poor quality of life due to symptoms from overtreatment (odds ratio, 2.05; 95% confidence interval, 1.09-3.93) compared with primary care physicians.ConclusionUp to one third of the physicians frequently or always worried about risks resulting from the thyroid hormone overtreatment or undertreatment. More research is needed across specialties to understand physician perceptions of how thyroid hormone therapy impacts the patients' quality of life.     

Carcinoma of the Colon and Rectum: A Perspective for Practicing Physicians,with Recommendations for Screening

Carcinoma of the colon and rectum is the most common serious type of cancer found in the United States and is second only to lung cancer among causes of death from cancer. Its cause is unknown but several environmental factors—especially low bulk, high fat diets—seem to predispose to its development. The disease is readily treatable by surgical operation if it is diagnosed early. Radiation and chemotherapy may offer some additional benefit in treating advanced disease but the response to all forms of therapy is disappointing in patients in whom disease has spread beyond the bowel wall. Colorectal cancer appears to be a very slowly progressive disease with a long asymptomatic period providing an ideal opportunity for diagnosis at an early treatable stage. Both proctosigmoidoscopy and screening specimens of stool for occult blood have been shown to be effective methods for identifying it before symptoms develop. These procedures should be done routinely in all patients over 40 years old and especially in those patients who have other risk factors such as positive family histories or hereditary conditions known to predispose to colorectal cancer.     

Prenatal and Childhood Growth,and Hospitalization for Alcohol Use Disorders in Adulthood: The Helsinki Birth Cohort Study

Background

Small birth size - an indicator of a sub-optimal prenatal environment - and variation in growth after birth have been associated with non-communicable diseases in later life. We tested whether birth size or growth in childhood associated with the risk of hospital admission for alcohol use disorders (AUDs) from early to late adulthood.

Methods

The sample comprised 6544 men and 6050 women born between 1934 and 1944 in Helsinki, Finland. Data on anthropometric measures were extracted from medical records and diagnoses of AUD from the Finnish Hospital Discharge Register and Causes of Death Register covering a 40-year period from 1969 to 2008.

Results

Altogether 171 women (2.8%) and 657 men (10.0%) were diagnosed at a hospital with AUD. After adjusting for major confounders, shorter length at birth, shorter height up to two years of age, and lower weight at two years associated with hospitalization for AUD in women. In men, slower growth in height, particularly from 2 to 7 years, and slower weight gain from 7 to 11 years as well as shorter height and lower weight at 7 and 11 years associated with a diagnosis of AUD in men.

Conclusions

Pre- and postnatal growth associates with the risk for AUD later in life differently in women than in men: the fetal period and infancy seem to be the sensitive periods for women, whereas those for men the occur from toddlerhood onwards.     

Focus: Addiction: Reflections on How a University Binge Drinking Prevention Initiative Supports Alcohol Screening,Brief Intervention,and Referral for Student Alcohol Use

What’s Your Cap: Know When to Put a Lid on Drinking (WYC) is a student-led and research-based binge-drinking prevention campaign at the University of Saskatchewan, Canada. It was formed to encourage a culture of alcohol moderation on the university campus through peer-to-peer engagement that emphasizes promotional items and activities of interest to students. Since its development in 2011, WYC has been guided by a logic model that promotes: 1) perceived and actual student drinking norms on campus; 2) benefits of a student-led initiative; and 3) merits of working with community partners. With the release of a clinical guide in Canada for alcohol screening, brief intervention, and referral (SBIR) in 2013, WYC was prompted to consider whether it is a form of population-based SBIR. SBIR is commonly undertaken in the substance use field by health care practitioners, and this paper shares the potential for a student-based SBIR modification on a university campus.     

Toxicological Statistics for Barbiturates,Other Sedatives,and Tranquillizers in Ontario: A 10-Year Survey

A steady increase in the number of cases of poisoning due to barbiturates, tranquillizers and non-barbiturate sedatives has been noted for Ontario by the Attorney-General''s Laboratory, Toronto, during the period 1955-1964 on the basis of submitted material. Five cases of poisoning by barbiturates were recorded in 1955 and 193 in 1964.Urine and blood samples from persons charged with driving motor vehicles while under the influence of drugs were also examined. In 1958 only one such case was reported to the Laboratory, whereas 25 cases were recorded in 1964; barbiturates were detected in 18 of these 25. Patients must be warned of the risks of ingesting alcohol while receiving barbiturate treatment.     

Screening for Drug and Alcohol Use Disorders and Their Association with HIV-Related Sexual Risk Behaviors among Men Who Have Sex with Men in Peru

Background

Peru''s HIV epidemic is concentrated among men who have sex with men (MSM). The contribution of alcohol use disorders (AUDs) to known high-risk behaviors associated with HIV transmission in this context has not been well characterized.

Methods

Between June and October 2011, 5,148 sexually active MSM were recruited using convenience sampling in five cities to participate in a cross-sectional bio-behavioral survey. Five high-risk sexual criteria previously associated with incident HIV infection in this setting were selected a priori as the dependent outcomes. Screening for AUDs used the validated Alcohol Use Disorders Identification Test (AUDIT) and AUDS were stratified by severity. Unadjusted and adjusted odds ratios (AOR) were computed to establish the independent correlates of the five dependent outcomes.

Results

The majority (62.8%) of participants met screening criteria for having an AUD, which were independently correlated with each of the following high-risk sexual risk behaviors in the previous 6 months: 1) >5 sexual partners [AOR = 1.76; (1.54–2.02)]; 2) sex with an HIV-infected partner [AOR = 1.29; (1.03–1.62)]; 3) having a sexually transmitted infection [AOR = 1.38; (1.13–1.68)]; 4) being a sex worker [AOR = 1.61; (1.40–1.87)]; and 5) unprotected sex during last encounter [AOR = 1.22; (1.09–1.38)]. Recent drug use was also correlated with having >5 sexual partners [AOR = 1.42 (1.19–1.71)], sex work [AOR = 1.97 (1.63–2.39)] and unprotected sex during last encounter [AOR = 1.31 (1.11–1.54)]. For each dependent variable, the association with AUDs significantly increased with increasing AUD severity.

Conclusions

AUDs are highly prevalent among MSM in Peru and are associated with increased HIV risk-taking behaviors that are associated with HIV transmission. Strategies that target problematic drinking such as medication-assisted therapy, behavioral counseling and structural interventions could potentially reduce risky behaviors and ultimately reduce HIV transmission among MSM in Peru.     

The Response of Physicians to a Mailed Questionnaire: A Study in Ontario,Manitoba and British Columbia

During 1965, 1585 questionnaires were sent to physicians in British Columbia, Manitoba and Ontario to elicit information about persons who had died and in whom a chronic non-specific respiratory disease had been recorded on the registration of death. The response rate to the first letter of enquiry was 54.1%. This was improved to 76.5% when the enquiry was sent by registered mail, and to 90.6% by a registered special appeal. The final response rate was 93.8% for British Columbia, 92.8% for Manitoba and 89.5% for Ontario. Although response varied with the time of the year, there was no evident relationship between response rate and characteristics of the physician. Physician characteristics studied were place and year of graduation and the nature of practice. Acceptable and high response rates to mailed questionnaires eliciting clinical data from physicians can be obtained if the investigator''s concern is demonstrated by sending the request in successive waves to the diminishing group of non-respondents.     

Focus: Addiction: Perceptions of Family Alcohol Use in a Young Adult Sample

Perceptions of family alcohol use have been linked to adolescent alcohol use behaviors, yet there have been no studies that have assessed this relationship in young adults. This study examined perceptions of family alcohol use and their association with participants’ self-reported alcohol use. Participants included 171 undergraduate students (mean age = 21.67, 71.9 percent female, 75.4 percent Caucasian). Participants completed measures assessing quantity and frequency of alcohol use, negative consequences of use, and sibling relationship quality. They also reported their perceptions of alcohol use for siblings and parents during a typical week. Perceptions of siblings’ quantity of weekly alcohol use were significantly associated with participants’ quantity of alcohol use (r = .21, p = .006) and frequency of alcohol use (r = .23, p = .002). Perceptions of parental alcohol use were not related to the participants’ alcohol use patterns.     

非药物干预治疗物质使用障碍

物质使用障碍（substance use disorder,SUD）是一个全球性的卫生和社会问题。针对大多数成瘾性物质,目前还没有有效的治疗药物,普遍还是采用心理治疗和行为矫治。近年来,针刺、深部脑刺激（DBS）、重复经颅磁刺激（rTMS）、经颅直流电刺激（tDCS）和运动等非药物干预手段在治疗神经系统疾病的有效性逐渐得到重视。越来越多的研究也开始关注非药物干预手段在治疗SUD中的应用。本综述在文献检索（如PubMed、Google Scholar等）的基础上总结了针刺、DBS、rTMS、tDCS和运动等非药物干预手段对阿片类药物、精神活性物质、尼古丁、酒精等不同成瘾性物质的心理渴求、戒断时间、使用剂量和成瘾伴随的情绪、认知功能障碍等的影响。研究表明,针刺、DBS、rTMS、tDCS和运动等非药物干预手段可以有效降低成瘾性物质引起的心理渴求、降低物质摄入量、增加戒断时间,同时改善长期使用成瘾性物质引起的认知障碍、焦虑和抑郁样行为等。如果非药物干预手段结合药物、心理等治疗方式,效果更佳。尽管非药物干预方法在现阶段主要作为辅助性治疗手段,未来的研究应注重明确非药物干预手段的神经生物学机制,...     

A Statistical Survey of Leukemia in Ontario and at the Ontario Cancer Foundation Clinics, 1938-1958

In Ontario, leukemia causes about 4% of all cancer deaths, ranging from nearly 50% at under 5 years of age to 1-3% at age 50 and over. Age-specific death rates are highest among older people; at all ages, male deaths exceed female deaths. Only about 20% of all leukemia patients in Ontario are registered at Ontario Cancer Clinics; the proportion changed sharply with the advent of chemotherapy. For 1258 patients registered in 1938-1963, the crude one-year survival rate was 50%, ranging from 9% for acute leukemia to about 60% for non-acute lymphatic and myeloid leukemia. The long-term outlook was much better for non-acute lymphatic leukemia than for non-acute myeloid leukemia. For acute leukemia, the treatment of choice was chemotherapy; for non-acute lymphatic leukemia, radiotherapy was used, followed, if required, by chemotherapy or further radiotherapy. For non-acute myeloid leukemia, the advantage of chemotherapy over radiotherapy was not established.     

Validation of Six Short and Ultra-short Screening Instruments for Depression for People Living with HIV in Ontario: Results from the Ontario HIV Treatment Network Cohort Study

Objective

Major depression affects up to half of people living with HIV. However, among HIV-positive patients, depression goes unrecognized 60–70% of the time in non-psychiatric settings. We sought to evaluate three screening instruments and their short forms to facilitate the recognition of current depression in HIV-positive patients attending HIV specialty care clinics in Ontario.

Methods

A multi-centre validation study was conducted in Ontario to examine the validity and accuracy of three instruments (the Center for Epidemiologic Depression Scale [CESD₂₀], the Kessler Psychological Distress Scale [K₁₀], and the Patient Health Questionnaire depression scale [PHQ₉]) and their short forms (CESD₁₀, K₆, and PHQ₂) in diagnosing current major depression among 190 HIV-positive patients in Ontario. Results from the three instruments and their short forms were compared to results from the gold standard measured by Mini International Neuropsychiatric Interview (the “M.I.N.I.”).

Results

Overall, the three instruments identified depression with excellent accuracy and validity (area under the curve [AUC]>0.9) and good reliability (Kappa statistics: 0.71–0.79; Cronbach’s alpha: 0.87–0.93). We did not find that the AUCs differed in instrument pairs (p-value>0.09), or between the instruments and their short forms (p-value>0.3). Except for the PHQ_2, the instruments showed good-to-excellent sensitivity (0.86–1.0) and specificity (0.81–0.87), excellent negative predictive value (>0.90), and moderate positive predictive value (0.49–0.58) at their optimal cut-points.

Conclusion

Among people in HIV care in Ontario, Canada, the three instruments and their short forms performed equally well and accurately. When further in-depth assessments become available, shorter instruments might find greater clinical acceptance. This could lead to clinical benefits in fast-paced speciality HIV care settings and better management of depression in HIV-positive patients.     

Biofeedback Treatment for Headache Disorders: A Comprehensive Efficacy Review

The aim of the present review was to critically evaluate the documented evidence regarding the efficacy of biofeedback for the two most prevalent headache conditions––migraine and tension-type headache. Drawing upon two recently published meta-analyses, data from 150 outcome studies, including randomized controlled trials as well as uncontrolled quasi-experimental designs, were screened. Of these, 94 studies were selected for inclusion according to predefined criteria. Meta-analytic integrations were carried out separately for the two conditions of interest. The main results were medium-to-large mean effect sizes for biofeedback in adult migraine and tension-type headache patients. Treatment effects remained stable over an average follow-up period of 14 months, both in completer and intention-to-treat analyses. Headache frequency was the primary outcome variable and showed the largest improvements. Further significant effects were shown for perceived self-efficacy, symptoms of anxiety and depression, and medication consumption. Reduced muscle tension in pain related areas was observed in electromyographic feedback for tension-type headache. Biofeedback was more effective than waiting list and headache monitoring conditions in all cases, while electromyographic feedback for tension-type headache showed additional significant effects over placebo and relaxation therapies. Levels of efficacy (migraine: efficacious, level 4; tension-type headache: efficacious and specific, level 5) and recommendations for future research are provided.