CORK database search
in Primary Care
Alcoholic drinks and asthma.
Vally H; Thompson PJ. Clinical and Experimental Allergy 32(2):
186-191, 2002. (67 refs.)
Alcoholic drinks appear to play an important role in the triggering
of asthma in certain individuals. Alcohol itself seems to play a
relatively minor role, but is important in certain ethnic groups. In
Caucasians, the nonalcohol components of alcoholic drinks, or
congeners, seem to be the most important triggers for asthma, with
the chemically more complex drinks appearing to be more often
associated with these sensitivities. Wine is clearly the most
commonly reported trigger for asthma, however, our understanding of
the mechanisms underlying wine induced asthma is not clear. Wine
induced asthma appears to be a multifactorial phenomenon, and
evidence suggesting a role for IgEmediated allergy, as well as
sensitivities to histamine and the sulfite additives in certain
individuals have been reported. In many individuals, however,
confirmation of sensitivity to wine in the challenge laboratory has
proven difficult, suggesting a complex pathophysiology. It has been
speculated that baseline asthma stability, as well as environmental
cofactors, may play a role in sensitivity to wine in many
individuals, and that this may explain the paucity of responses to
challenge in clinical settings. Consequently, more sophisticated
challenge strategies, as well as techniques which may provide more
sensitive measurements of changes in airway function following wine
challenge, may need to be explored if we are to further our
understanding of asthmatic responses to wine.
Copyright 2002, Blackwell Science, Ltd.
Alcohol intake in rheumatic disease: Good or
Sofat N; Keat A. Rheumatology 41(2): 125-128, 2002. (38
Alcohol is a major cause of morbidity and mortality. Recent
developments in basic science and clinical research have led to an
improved understanding of the mechanisms of the effects of alcohol on
musculoskeletal diseases. Alcohol can have harmful effects on the
musculoskeletal system. It is associated with osteoporosis and an
increased incidence of fractures. The strongest link is seen in
spinal osteoporosis, where alcoholic men are most at risk. Ethanol
promotes bone loss in both men and women. Excessive alcohol intake
can lead to myopathies, which could lead to increased susceptibility
to falls, possibly resulting in osteoporotic fractures, as described
above. However, alcohol-induced myopathies themselves can exist in
acute and chronic forms. In acute muscle injuries such as are seen in
rhabdomyolysis, alcohol accounts for at least 20% of cases. Ethanol
triggers muscle necrosis, resulting in derangement of oxidative or
glycolytic energy production and ATP depletion. Animal and human
studies have shown that chronic alcohol use results in negative
nitrogen balance resulting from net catabolism of skeletal muscle
proteins. A prolonged imbalance of protein metabolism leads to the
erosion of lean body mass and the proximal myopathy seen in
alcoholics. Although alcohol affects all muscle groups to some
extent, the fast-twitch type-II fibres appear to be particularly
vulnerable. The rate of protein synthesis in skeletal muscle has been
examined by stimulating alcohol intoxication, showing that the rate
of protein synthesis was reduced in humans In other rheumatic
diseases, such as ankylosing spondylitis, alcohol has also been shown
to have a detrimental effect. Alcohol also requires consideration in
some of the treatments used for rheumatic diseases. Most guidelines
recommend abstention from alcohol with the use of certain
disease-modifying therapy. The most notable example is methotrexate.
The risk of serious adverse hepato-toxicity is increased with
concomitant alcohol intake.
Copyright 2002, Oxford University Press.
Pediatric Clinics of North
America 49(2): entire issue
2002. Thirteen article in this thematic issue.
¥ Prevention and risk of adolescent substance abuse: The
role of adolescents, families, and communities. (39 refs.)
Reviews prevalence of substance use among adolescents,
theoretical constructs to explain engagement in risk behaviors, and
risk and protective factors for substance use.
¥ Adolescent substance abuse: Assessment in the office.
Discussion of screening and evaluation; outlines
clinical clues and laboratory assessment, reviews individual, family,
and environmental risk factors. Useful mnemonics
¥ Adolescent substance abuse: Confidentiality and consent.
Describes the legal and ethical basis of adolescent
confidentiality and consent.
¥Urine drug screening in adolescents. (31
Considers urine drug screen as part of comprehensive
evaluation, procedures for obtaining a valid and helpful urine drug
screen, interpreting positive and negative results.
¥Office-based intervention for adolescent substance
abuse. (51 refs.)
Outlines a number of strategies and clinical tools
that appear promising with adolescents
¥Treatment and relapse prevention for adolescent
substance abuse. (93 refs.)
Reviews treatment: family treatments, cognitive
behavioral techniques, motivation interviewing and 12-step approaches
¥Alcohol advertising and adolescents. (93
Teens view an average of 2,000 beer and wine ads per
year in the US É.
¥Reducing tobacco use among youth. (22
Discusses strategies to prevent young people from
taking up the habit, and approaches to cessation
¥Marijuana use among adolescents. (review).
Reviews prevalence, acute actions, and long term
¥Supplements and drugs used to enhance athletic
performance. (review). (141 refs.)
Reviews the physiology, clinical usage patterns, and
efficacy, dosages, and adverse side effects of the use of drugs and
¥Adolescent substance use disorders and
comorbidity. (87 refs.)
Comprehensive literature review of risk factors.
¥ MDMA ('ecstasy') and other 'club drugs' - The new
epidemic. (116 refs.)
Discusses epidemiologic and neuropharmacologic data on
acute and long term effects.
Medicaid patients in a private health maintenance
organization: Patterns of chemical dependency treatment.Walter LJ; Parthasarathy S; Allen S; Ackerson L.
Journal of Behavioral Health Services & Research 29(1):
1-14, 2002. (33 refs.)
Although many Medicaid beneficiaries receive health care through
commercial health maintenance organizations (HMOs), the impact of
private managed care on low-income individuals seeking treatment for
substance abuse has rarely been studied. This study examined
treatment patterns of 234 Medicaid recipients who presented for care
at an HMO between 1995 and 1997. After adjustment for demographic
factors and duration of health plan membership, the Medicaid
patients returned to start treatment after intake less often (odds
ratio = 0.60) and dropped out of treatment sooner (median = 14 versus
28 days) than non-Medicaid patients. While many Medicaid patients
received significant amounts of substance abuse treatment, further
research is needed to explain the observed treatment gap and to
identify areas where HMOs can improve services for some of their most
Copyright 2002, Sage Publications. Inc.
Caught in the middle: Receptionists and their
dealings with substance misusing patients.Heuston J; Groves P; Al Nawad J; Albery I; Gossop M;
Strang J. Journal of Substance Use 6(3): 151-157, 2001. (32
This study examined the primary healthcare receptionist and their
behavior, reactions, and interactions with substance abusing
patients. The receptionist is an integral part of the primary
healthcare team, however, the role of the receptionist with substance
misusing patients has not been previously examined. Questionnaires
were given to 72 receptionists in general practices in southeast
London, of which 57 responded (76 percent). Almost half had
experienced difficulties with substance misusing patients and thought
they were the most difficult sort of patients. About a quarter of the
receptionists thought that these patients should not be treated in
general practice and just over half wanted some form of training or
support. If substance misusing patients are to be treated in general
practice, further consideration needs to be given to receptionists,
who may benefit from training, support and a fuller appreciation of
their contribution in the management of patients.
Copyright 2001, Radcliffe Medical Press Ltd.
Problem drinking and alcoholism: Diagnosis and
treatment.Enoch MA; Goldman D. American Family Physician
65(3): 441-448, 2002. (35 refs.)
Alcoholism is one of the most common psychiatric disorders with a
prevalence of 8 to 14 percent. This heritable disease is frequently
accompanied by other substance abuse disorders (particularly
nicotine), anxiety and mood disorders, and antisocial personality
disorder. Although associated with considerable morbidity and
mortality; alcoholism often goes unrecognized in a clinical or
primary health care setting. Several brief screening instruments are
available to quickly identify problem drinking, often a
pre-alcoholism condition. Problem drinking can be successfully
treated with brief intervention by primary care physicians. Alcohol
addiction is a lifelong disease with a relapsing, remitting course.
Because of the potentially serious implications of the diagnosis,
assessment for alcoholism should be detailed. Alcoholism is treated
by a variety of psychosocial methods with or without newly developed
pharmacotherapies that improve relapse rates. Screening for problem
drinking and alcoholism needs to become an integral part of the
routine health screening questionnaire for adolescents and all
adults, particularly women of child-bearing age, because of the risk
of fetal alcohol syndrome.
Copyright 2002, American Academy of Family Physicians.
Used with permission.
Changing patient characteristics with increased
methadone maintenance availability.Brands B; Blake J; Marsh D. Drug and Alcohol
Dependence 66(1): 11-20, 2002. (18 refs.)
Over the past several years there have been repeated calls for
expansion of availability of methadone maintenance in several
jurisdictions. Important stakeholders in the expansion of methadone
maintenance treatment (MMT) are existing treatment providers. This
study describes the impact of the rapid expansion in treatment
availability in Ontario on the long-standing MMT program of the
Centre for Addiction and Mental Health (CAMH). This expansion
occurred through enlarging existing treatment programs. The provision
of MMT in private physicians' offices and the establishment of new
clinics. With expansion in the community demand for the clinic-based
treatment of the CAMH MMT program did not drop. In fact the patient
population was able to continue to grow. There was a broadening of
the patient profile in the program including patients who were better
educated. more likely to be employed and less likely to be currently
injecting (although with a significant history of past injection drug
use). Moreover, in the face of these changes, excellent treatment
retention was maintained. This suggests that the expansion in
treatment availability did not impact negatively on the existing
program but rather enabled access for a group of higher 9 functioning
opioid dependent patients who were preciously being deterred from
treatment entry by the large waiting lists and the need for priority
access for pregnant and HIV positive heroin users. These findings
should provide encouragement for MMT providers in jurisdictions
anticipating or undergoing expansion of treatment availability.
Copyright 2002, Elsevier Scientific Ltd.
Primary health care professionals' activity in
intervening in patients' alcohol drinking: A patient perspective.Aalto M; Pekuri P; Seppa K. Drug and Alcohol
Dependence 66(1): 39-43, 2002. (30 refs.)
Aim: To test the hypothesis that primary health care professionals'
activity in intervening in patients' alcohol drinking is low. Method:
A patient questionnaire Survey after Consultation blind to the
primary health care professionals. Subjects were 1000 16-65-year-old
consecutive patients consulting a general practitioner. The response
rate was 66.5%. Results: Of all participants 6.3% and of excessive
drinkers 11.9% were asked about alcohol drinking in the consultation
in question. Of all 64.7% and of excessive drinkers 52.4% had never
been asked about drinking. Of all 6.0% and of excessive drinkers
19.0% were advised about alcohol drinking at the consultation in
question. Conclusion: Alcohol drinking is rarely brought up in
discussion by primary health care professionals, even in the case of
Copyright 2002, Elsevier Scientific Publishers Ireland,
Anabolic steroids: A review for the clinician.Kutscher EC; Lund BC; Perry PJ. Sports Medicine
32(5): 285-296, 2002. (54 refs.)
The number of athletes self-administering ergogenic pharmacological
agents to increase their competitive edge continues to be a problem.
Most athletes using anabolic steroids (AS) have acquired a crude
pharmacological database regarding these drugs. Their opinions
regarding steroids have been derived from their subjective
experiences and anecdotal information. For this reason, traditional
warnings regarding the lack of efficacy and potential dangers of
steroid misuse are disregarded. A common widely held opinion among
bodybuilders is that the anabolic steroid experts are the athletic
gurus who for years have utilised themselves as the experimental
participants and then dispensed their empirical findings. This
review will address the common anabolic steroid misconceptions held
by many of today's athletes by providing an evaluation of the
scientific literature related to AS in athletic performance.
Copyright 2002, Adis International Ltd.
Alcohol, breastfeeding, and development at 18
months.Little RE; Northstone K; Golding J. Pediatrics
109(5): NIL_9-NIL_14, 2002. (14 refs.)
Objective. We aimed to replicate a previous study of 1-year-olds that
reported a deficit in motor development associated with moderate
alcohol use during lactation, using a different but comparable
population. Methodology. The mental development of 915 18-month-old
toddlers from a random sample of a longitudinal population-based
study in the United Kingdom was measured using the Griffiths
Developmental Scales. Frequent self-administered questionnaires
during and after pregnancy provided maternal data. The dose of
alcohol available to the lactating infant was obtained by
multiplying the alcohol intake of the mother by the proportion of
breast milk in the infant's diet. We compared this dose with the
Griffiths Scales of Mental Development, taking into account
potentially confounding variables. Result. Three of the Griffiths
scales increased slightly but significantly with increasing infant
alcohol exposure; there was no association in the remaining 2 or
average of the scales. Discussion. We were unable to replicate the
earlier deficit in motor skills associated with lactation alcohol
use. One reason may be that the tests dose of alcohol reaching the
lactating infant is small, and infants and toddlers have limited
ability to pick up small effects. Studies of older children may
resolve the question of the safety of drinking while nursing.
Copyright 2002, American Academy of Pediatrics
Treatment of heroin dependence with buprenorphine
in primary care.Fiellin DA; Pantalon MV; Pakes JP; O'Connor PG; Chawarski
M; Schottenfeld RS. American Journal of Drug and Alcohol Abuse
28(2): 231-241, 2002. (27 refs.)
Buprenorphine is an effective treatment for heroin dependence. The
feasibility and potential efficacy of buprenorphine with brief
counseling in primary care is unknown. We enrolled 14 heroin
dependent patients in a 13-week clinical trial using thrice weekly
buprenorphine along with brief counseling in the primary care center
of an urban medical center. Primary outcomes included urine
toxicology and treatment retention. Opioid-positive urine toxicology
tests reduced over the 13-week period from 95 to 25% (p < 0.05).
Eleven patients (79%) had greater than or equal to one week of
opioid-free urine toxicologies. Nine patients (64%) had greater than
or equal to three weeks of opioid-free urine toxicologies. Eleven
patients (79%) were retained through the maintenance phase. We
conclude that buprenorphine maintenance is feasible in a primary care
Copyright 2002, Marcel Dekker, Inc.
Excess alcohol consumption and health outcomes: A
6-year follow-up of men over age 50 from the Health and Retirement
Study.Perreira KM; Sloan FA. Addiction 97(3): 301-310,
2002. (50 refs.)
Aims This study examined the association of problem drinking history
and alcohol consumption with the onset of several health conditions
and death over a 6-year follow-up period. Setting We analyzed two
waves of longitudinal data on men over 50 who participated in the
Health and Retirement Study, a nationally representative sample of
people aged 51-61 and their spouses living in the United States in
1992. Measurements Five types of health outcomes-mortality. general
health, functional status. cognitive status, and mental health-were
examined. Drinking categories were based on average drinks per day
(0, <1, 1-2, 3-4, 5+) with 5 + defined as 'very heavy drinking'.
Problem drinking history was identified as 2+ affirmative responses
to the CAGE questionnaire. We controlled for smoking and other
factors at baseline. Findings Over the 6-year follow-up period. very
heavy drinking at baseline quadrupled the risk of developing
functional impairments (OR: 4.21 95% CI: 1.67. 10.61). A problem
drinking history increased the onset of depression (OR: 1.67 95%, CI:
1.02, 2.74), psychiatric problems (OR: 2.15 95% CI: 1.47. 3.13) and
memory problems (OR: 1.71 95%. CI: 1.14, 2.56). Heavy drinking among
mature adults was not associated with increased incidence of other
adverse health events (i.e. angina, cancer, congestive heart failure,
diabetes, myocardial infraction, lung disease or stroke). Conclusion:
Very heavy drinking and a problem drinking history greatly increased
rates of onset of functional impairments, psychiatric problems and
memory loss in late middle age for men who had not experienced these
impairments at their initial interview.
Copyright 2001, Society for the Study of Addiction to
Alcohol and Other Drugs.
Smoking cessation. (review).
Karnath B. American Journal of Medicine 112(5): 399-405, 2002.
Smoking is a risk factor for the four leading causes of death in the
United States, yet 48 million Americans-24% of the U.S. adult
population-continue to smoke. Approximately 70% of people who smoke
visit a physician each year, yet only half report ever being advised
to quit smoking by their physician. Smoking cessation is difficult
due to nicotine addiction and withdrawal symptoms. Expert groups such
as the National Cancer Institute and the Agency for Health Care
Policy and Research offer protocols for smoking cessation that
primary care physicians can use in their office practice. Recent
developments in the pharmacotherapy of smoking cessation has led the
U.S. Public Health Service to update the practice guidelines for
treating tobacco use and dependence. Pharmacotherapy, which includes
nicotine replacement therapy, offers assistance to patients who want
to stop smoking. However, the cost of pharmaco-therapy may be a
barrier for some. Other nonpharmacologic therapies, such as
counseling, are also effective.
Copyright 2002, Exerpta Medica, Inc. Used with