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...on medical aspects
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www.ProjectCork.org
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Fall 2007
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Cognitive performance in light current users and ex-users of ecstasy (MDMA) and controls.
Golding JF; Groome DH; Rycroft N; Denton Z. American Journal of Drug and Alcohol Abuse 33(2): 301-307, 2007. (13 refs.)
Previous research has shown that heavy users of ecstasy (MDMA) may suffer impaired cognitive functioning, and the present study set out to investigate whether such impairment might also be found in light users or ex-users of MDMA. Sixty subjects, comprising 20 current light users, 20 ex-users, and 20 non-users of ecstasy, were tested on an extensive battery of cognitive tests. Current light users of ecstasy achieved significantly lower scores on the overall cognitive test battery than did the non-users (p = .011), though there were no significant differences on any individual subtests. However, the scores obtained by the ex-users of ecstasy did not differ significantly from those of the non-users. It was concluded that current light users of ecstasy show a small but significant cognitive impairment, but that no such impairment is detectable in ex-users who had abstained from the drug for at least 6 months. Copyright 2007, Taylor & Francis.
Alcohol consumption, mild cognitive impairment, and progression to dementia.
Solfrizzi V; D'Introno A; Colacicco AM; Capurso C; Del Parigi A; Baldassarre G; Italian Longitudinal Study on Aging. Neurology 68(21): 1790-1799, 2007. (44 refs.)
Objective: To estimate the impact of alcohol consumption on the incidence of mild cognitive impairment and its progression to dementia. Methods: We evaluated the incidence of mild cognitive impairment in 1,445 non-cognitively impaired individuals and its progression to dementia in 121 patients with mild cognitive impairment, aged 65 to 84 years, participating in the Italian Longitudinal Study on Aging, with a 3.5-year follow-up. The level of alcohol consumption was ascertained in the year before the survey. Dementia and mild cognitive impairment were classified using current clinical criteria. Results: Patients with mild cognitive impairment who were moderate drinkers, i.e., those who consumed less than 1 drink/day (approximately 15 g of alcohol), had a lower rate of progression to dementia than abstainers (hazard ratio [HR] 0.15; 95% CI 0.03 to 0.78). Furthermore, moderate drinkers with mild cognitive impairment who consumed less than 1 drink/ day of wine showed a significantly lower rate of progression to dementia than abstainers (HR 0.15; 95% CI 0.03 to 0.77). Finally, there was no significant association between higher levels of drinking (>= 1 drink /day) and rate of progression to dementia in patients with mild cognitive impairment vs abstainers. No significant associations were found between any levels of drinking and the incidence of mild cognitive impairment in non-cognitively impaired individuals vs abstainers. Conclusions: In patients with mild cognitive impairment, up to 1 drink/day of alcohol or wine may decrease the rate of progression to dementia. Copyright 2007, Lippincott, Williams & Wilkins.
Alcohol dependence with comorbid drug dependence: Genetic and phenotypic associations suggest a more severe form of the disorder with stronger genetic contribution to risk.
Dick DM; Agrawal A; Wang JC; Hinrichs A; Bertelsen S; Bucholz KK et al. Addiction 102(7): 1131-1139, 2007. (46 refs.)
Background: Twin data suggest that alcohol dependence comorbid with illicit drug dependence represents a more heritable form of the disorder. In the Collaborative Study on the Genetics of Alcoholism sample, approximately half the alcohol-dependent individuals also meet diagnostic criteria for illicit drug dependence. In this study, we tested for heterogeneity in the association between the muscarinic acetylcholine M2 receptor gene (CHRM2) and alcohol dependence, reported previously in the full sample, among the subgroups of alcohol-dependent individuals with and without comorbid drug dependence. Methods Family-based association tests were conducted separately (a) in individuals with alcohol dependence with comorbid drug dependence (n = 477) and (b) in individuals with alcohol dependence without comorbid drug dependence (n = 433). These subgroups were subsequently compared on other phenotypic characteristics. Results The evidence for association between CHRM2 and alcohol dependence came entirely from the subgroup of individuals with comorbid drug dependence. There was no evidence of association with CHRM2 among the alcohol-dependent individuals without drug dependence. Subsequent phenotypic analyses suggest that the subgroup of alcohol-dependent individuals with comorbid drug dependence differ on a number of other phenotypic characteristics, including several measures of the severity of their alcohol problems, personality traits and comorbid psychiatric disorders. Conclusions: These analyses provide specific genetic evidence suggesting that alcohol dependence with comorbid drug dependence represents a particularly severe form of the disorder, with higher genetic contribution to vulnerability. Copyright 2007, Society for the Study of Addiction to Alcohol and Other Drugs.
The effect of health compromising behaviors on preterm births.
Dew PC; Guillory VJ; Okah FA; Cai JW; Hoff GL. Maternal and Child Health Journal 11(3): 227-233, 2007. (45 refs.)
Objectives: The objective of our study was to determine whether there were combined effects of smoking, alcohol, and illicit drug use during pregnancy on the frequency of preterm births, and if so, the magnitude of the association after adjusting for confounding factors. Methods: We conducted a retrospective cohort study of singleton live births in Kansas City, Missouri from 1990-2002. We defined health compromising behaviors as the use of cigarettes, alcohol, and illicit drugs. The effect of these behaviors on preterm births was considered for each substance individually, and in combination. The rates of preterm births for these groups were calculated. Using logistic regression, adjusted odds ratios were used to estimate the relative risk of preterm births among these groups. Results: Over 13% of infants born to women who smoked were preterm, compared to 9.6% for non-smokers. Of infants born to women who reported alcohol use, 17.3% were preterm compared to 10.1% for non-drinkers. Smoking and alcohol use in combination was associated with 18.0% preterm births, while alcohol and drug use in combination was associated with 20.8% preterm births. The use of all three substances was associated with 31.4% preterm births. Conclusion: Women who engaged in health compromising behaviors during pregnancy showed an increased proportion of preterm births compared to those who did not. There is significant interaction between these behaviors leading to higher rates of preterm births than predicted by their additive effects. To decrease preterm births, we must deal with the effects of smoking, drinking, and drug use simultaneously. Copyright 2007, Springer.
Alcohol use in donors is a protective factor on recipients' outcome after heart transplantation.
De La Zerda DJ; Cohen O; Beygui RE; Kobashigawa J; Hekmat D; Laks H. Transplantation 83(9): 1214-1218, 2007. (15 refs.)
Objective. The outcome of heart transplantation is highly influenced by good donor selection. Because a history of alcoholism is prevalent among potential heart donors, we sought to explore the effect of alcohol use in donors on the outcome of heart transplantation in the recipient. Method. A total of 437 consecutive patients underwent heart transplantation from January 2002 through September 2005. Patients' files were retrospectively studied. Mean follow-up period was 3.14-+/- 1.9 years (range, 3 days to 6.5 yrs). The cohort was divided into two subgroups. The alcoholic donor group (ADG) included 98 of 421 patients and the nonalcoholic donor group (NADG) included 323 of 421 patients. Mean age was 35.3 +/- 11.4 yrs (range, 18-66) for the ADG and 33 +/- 12.2 yrs (range, 18-62) for the NADG. Results. Mortality among the ADG was 7 of 98 (7.1%) and for NADG was 55 of 323 (17.1%) (P=0.015). The mean interval time between transplant and mortality was, for ADG, 27.7 +/- 20.6 months (range, 0.07-51) and for NADG, 16.4 +/- 19.6 months (range, 0.14-73) (P=0.031). Survival rate was significantly higher among the ADG at 72.8 +/- 1.9 months compared with NADG at 66.2 +/- 1.5 months (P=0.019). Overall rejection rate was 22 of 421 (5.2%); rejection rate was 17 of 323 (5.2%) in NADG and 5 of 98 (5.1%) in ADG. Rejection free survival was 74.6 +/- 0.85 with no significant difference between the two groups (P=0.85). Conclusion. The chronic alcoholism of donors was found to be a protective factor regarding the outcome after heart transplantation. Significant differences were found in mortality rate and survival after heart transplantation between the ADG and NADG. These data support the fact that it is safe to use donors' hearts regardless of a history of alcoholism. Copyright 2007, Lippincott, Williams & Wilkins.
Combinations of carbohydrate-deficient transferrin, mean corpuscular erythrocyte volume, gamma-glutamyltransferase, homocysteine and folate increase the significance of biological markers in alcohol dependent patients.
Rinck D; Frieling H; Freitag A; Hillemacher T; Bayerlein K; Kornhuber J et al. Drug and Alcohol Dependence89(1): 60-65, 2007. (36 refs.)
Aims: The traditionally used biological markers for alcoholism include a wide range of sensitivity and specificity as single tests. This study focuses on the combination of established laboratory parameters with new meaningful biomarkers to advance the significance regarding alcohol dependence. Design: We analyzed blood samples from alcohol-dependent patients (n = 177) compared with a control group (n = 181). In the statistical calculation we included carbohydrate-deficient transferrin (CDT), mean corpuscular erythrocyte volume (MCV), gamma-glutamyltransferase (GGT), total plasma homocysteine, and folate. Results: None of the examined biomarkers reached sensitivity above 90% while all markers showed a good specificity. Combinations of different markers led to a significant elevation in sensitivity. Best values for men were achieved by using a combination of MCV, CDT, GGT, homocysteine and folate in different weightings (sensitivity: 98.6%, specificity: 86.4%). For women, similar results were yielded by combining MCV and CDT (sensitivity: 94.1%, specificity: 96%). The addition of homocysteine and folate in different weightings did not result in further enhancement. Conclusions: Gender-specific clusters including MCV, CDT, GGT, homocysteine and folate led to an increase in sensitivity compared to single laboratory markers. This is a reliable help to identify patients with regular heavy drinking in clinical practice which might prevent further complications. Copyright 2007, Elsevier Science.
Gamma-hydroxybutyrate reduces both withdrawal syndrome and hypercortisolism in severe abstinent alcoholics: An open study vs. diazepam.
Nava F; Premi S; Manzato E; Campagnola W; Lucchini A; Gessa GL et al. American Journal of Drug and Alcohol Abuse 33(3): 379-392, 2007. (72 refs.)
In 42 alcoholic inpatients we performed an open randomized study to compare the effects of diazepam and gamma-hydroxybutyrate (GHB) on the suppression of severe alcohol withdrawal syndrome and hypercortisolism. Both diazepam (.5mg/kg bodyweight, q.i.d.) and GHB (50 mg/kg bodyweight, q.i.d.) were orally administered for three weeks. During all study period, GHB was more able than diazepam in reducing both withdrawal syndrome and hypercortisolism. These effects were evident during the first week of treatment and persisted throughout the study period. The results confirm a strict correlation between high levels of plasma cortisol and alcohol withdrawal symptoms and they show a slight superiority of GHB over diazepam in the suppression of both ethanol withdrawal and hypercortisolism. Taken together, our data suggest that GHB may act as potent anti-withdrawal agent in severe abstinent alcoholics. Copyright 2007, Taylor & Francis.
Harm, benefits, and net effects on mortality of moderate drinking of alcohol among adults in Canada in 2002.
Rehm J; Patra J; Taylor B. Annals of Epidemiology 17(5, Supplement S): S81-S86, 2007. (28 refs.)
Alcohol is an important risk factor contributing to the burden of chronic diseases and injuries, but is also associated with some health benefits. This study estimates risks and benefits associated with moderate consumption of alcohol in terms of mortality for Canada in 2002 by age and sex. Distribution of exposure was taken from a Canadian survey and corrected for per capita consumption from production and sales data; risk relationships were taken from published literature to calculate alcohol-attributable fractions for moderate consumption. If moderate consumption is based on average volume alone, 866 net deaths in 2002 among those younger than 70 years of age were due to moderate consumption of alcohol (1.3% of all the deaths in this age group, consisting of 1653 deaths caused and 787 deaths prevented). When heavy drinking episodes were excluded, the net effect was beneficial (55 prevented deaths, 0.09% of all deaths); the net burden was higher for younger ages and the net benefits for older ages. The net impact of average moderate alcohol consumption on mortality depends on patterns of drinking. Beneficial net effects are seen only when heavy drinking occasions are excluded. Policies should strive to reduce the burden of moderate alcohol consumption while preserving the beneficial impacts. Copyright 2007, Elsevier Science.
Physical health problems among patients seeking treatment for alcohol use disorders: A study in six European cities.
Gossop M; Neto D; Radovanovic M; Batra A; Toteva S; Musalek M; Skutle A; Goos C. Addiction Biology 12(2): 190-196, 2007. (50 refs.)
The present study investigates physical health problems among patients with alcohol use disorders at alcohol treatment agencies in six European cities. The sample comprised 315 patients with a primary alcohol use disorder. Data were collected at admission to treatment using a structured research protocol, and ratings were made by a medically qualified physician subsequent to a physical examination of the patient. Physical health problems were extremely common: 79% of the sample had at least one problem, and 59% had two or more problems. Health problems were often serious, and 60% had at least one health problem that required treatment. The most common problems were gastrointestinal and liver disorders, but about a quarter of the sample had cardiovascular or neurological problems. Frequency of drinking, duration of alcohol use disorder, and severity of alcohol dependence were associated with increased physical morbidity. Current smoking status and age were also associated with poorer physical health. Older drinkers had more physical health problems although they were less severely alcohol dependent than their younger counterparts. The high prevalence of physical health problems among problem drinkers provides opportunities of screening for alcohol use disorders not only in specialist alcohol treatment services but also in other health-care settings. It is recommended that alcohol treatment agencies should provide a full routine health screen of patients at admission to treatment with provision or referral to appropriate treatment. Copyright 2007, Blackwell Publishing.
Varenicline: The newest agent for smoking cessation.
Potts LA; Garwood CL. American Journal of Health-System Pharmacy 64(13): 1381-1384, 2007. (15 refs.)
Purpose. The pharmacology, pharmacokinetics, clinical efficacy, safety, dosage and administration, and place in therapy of varenicline are reviewed. Summary. Varenicline is the newest therapy approved by the Food and Drug Administration for smoking cessation and the first in its class targeting the neurobiology of nicotine addiction. Varenicline is selective for the alpha 4 beta 2 acetylcholine-receptor subtype as a partial agonist, thus conferring its effect in limiting the reinforcing aspect of the addictive nicotine molecule. Varenicline is completely absorbed orally and not affected by food. Steady state. is reached within four days of administration. Three Phase III clinical trials of varenicline have been published. Two studies compared varenicline with bupropion in patients over age 18 years who smoked more than 10 cigarettes daily. When the data of the two trials were pooled, varenicline use was associated with significant improvements in the four-week carbon-monoxide-confirmed continuous quit rate (44.2% at weeks 9-12 compared with bupropion (29.7%) and placebo (17.7%) (p < 0.0001 for each comparison). The third trial found that continuous quit rates were also significantly higher in patients treated with varenicline versus placebo. Varenicline is generally well tolerated. Varenicline has been administered concurrently with warfarin, digoxin, transdermal nicotine, bupropion, cimetidine, and metformin without any clinically significant drug interactions. Conclusion. Varenicline, a newly approved agent for smoking cessation, offers a new option to patients who cannot tolerate the adverse effects associated with nicotine-replacement therapy and bupropion. It is also an alternative to consider in patients with contraindications to such therapies. Copyright 2007, American Society of Health-System Pharmacists.
A simple score for predicting alcohol relapse after liver transplantation: Results from 387 patients over 15 years.
De Gottardi A; Spahr L; Gelez P; Morard I; Mentha G; Guillaud O. Archives of Internal Medicine 167(11): 1183-1188, 2007. (31 refs.)
Background: Alcohol relapse can negatively influence the outcome after liver transplantation ( LT). The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT. Methods: A total of 387 consecutive patients ( 23.8% women) who underwent LT for alcoholic cirrhosis in Geneva, Switzerland, and Lyon, France, between 1989 and 2005 were evaluated. Mean +/- SD age was 51.3 +/- 7.5 years. Follow-up time was 61.2 +/- 47.5 months. Alcohol consumption relapse and potential factors associated with it were studied. Results: The relapse rate of harmful alcohol consumption after LT was 11.9%. In univariate analysis, alcohol relapse was significantly associated with age greater than 50 years ( P = .04), year of LT 1995 or earlier ( P < .05), duration of abstinence less than 6 months ( P = .02), presence of psychiatric comorbidities ( P < .001), presence of a life partner ( P < .05), and a high score on the High-Risk Alcoholism Relapse ( HRAR) scale ( P < .001). Multivariate logistic regression disclosed the following independent factors of relapse: duration of abstinence of less than 6 months ( odds ratio [ OR], 3.3; 95% confidence interval [ CI], 1.2-9.3) ( P = .02); presence of psychiatric comorbidities ( OR, 7.8; 95% CI, 3.1-20.0) ( P < .001); and HRAR score higher than 3 ( OR, 10.7; 95% CI, 3.8-30.0) ( P = .001). In patients with none of these factors, alcohol relapse was 5%, while the presence of 1, 2, or 3 factors was associated with relapse rates of 18%, 64%, and 100% of the patients, respectively. Conclusions: In a large cohort of patients undergoing LT for alcoholic cirrhosis, a duration of abstinence of less than 6 months before wait-listing for LT, the presence of psychiatric comorbidities, or an HRAR score higher than 3 was associated with relapse into harmful drinking. The presence of more than 1 factor dramatically increased this risk over 50%. In the pre-LT evaluation in this setting, these factors should be accurately determined. Copyright 2007, American Medical Association.
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