Search

Objective: Studies of alcohol brief intervention for medical inpatients have mixed results. We explored potential moderators of the effectiveness of brief intervention for unhealthy alcohol use among medical inpatients. Method: This is a secondary analysis of a randomized controlled trial of brief motivational counseling among 341 urban-hospital medical inpatients (99 women) with unhealthy alcohol use. Self-reported main outcomes were receipt of alcohol treatment by 3 months in subjects with dependence and change in the mean number of drinks per day 3 and 12 months after enrollment in all subjects. Results: Among subjects with dependence, the effect of brief intervention on receipt of alcohol treatment differed significantly by gender and age (p = .02 for each interaction). In stratified analyses, brief intervention was associated with receipt of alcohol treatment in women (adjusted odds ratio [AOR] = 3.9, 95% confidence interval [CI]: 1.2-12.7), and younger (, PROFESSIONAL ORGANIZATIONS RECOMMEND screening and brief intervention for all adults with unhealthy alcohol use (i.e., the spectrum from drinking risky amounts through dependence; Institute of Medicine, 1990; U.S. Preventive Services [...]

We examined the association between substance abuse treatment services and emergency department (ED) utilization among participants in the HIV-Alcohol Longitudinal Cohort study of HIV-infected persons with a history of alcohol problems. A standardized questionnaire was administered to 350 subjects inquiring about demographics, substance use, use of substance abuse treatment services, and ED attendance. We operationally defined substance abuse treatment services as: stable, unstable, or none. The outcome, ED attendance, defined as presenting to an ED without subsequent hospitalization, occurred in 101 (28.8%) subjects in the past 6 months. Stable substance abuse treatment was significantly associated with lower odds of ED attendance (adjusted odds ratio; 95% CI): (0.5; 0.3-0.9). The relationship between substance abuse treatment and HIV-infected individuals' use of health care services merits additional attention. Substance abuse treatment may present an opportunity to impact health care utilization patterns of HIV-infected persons with a history of alcohol problems. Keywords: Health services; Utilization; Substance use; Alcohol use; HIV disease/AIDS; Substance abuse treatment centers; Emergency department

Aim: The Safe Passage Study, conducted by the Prenatal Alcohol in SIDS and Stillbirth Network, is investigating contributions of prenatal alcohol exposure to foetal and infant demise. This current report presents physiological data from full-term infants with no prenatal exposure to alcohol or maternal smoking.Methods: Data are from 666 infants from the Northern Plains (North and South Dakota) and South Africa. A standardised protocol assessed cardiorespiratory function during baseline and head-up tilts shortly after birth and at one month of age.Results: Analyses revealed significant increases in heart rate and decreases in BP from the newborn to one-month time period as well as diminished heart rate responses to head-up tilt in one-month-old infants.Conclusion: The Safe Passage Study was successful in characterising physiology in a large number of infants at sites known to have elevated risks for SIDS. Results demonstrate that even with low prenatal adverse exposures, there are significant changes in cardiorespiratory function as infants enter the window of increased risk for SIDS. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of an individualized multicomponent intervention to promote adherence to antiretroviral therapy (ART) in a cohort of HIV-infected individuals with a history of alcohol problems., Design: We conducted a randomized controlled trial to compare the usual medical follow-up with an adherence intervention., Setting: The principal enrolment site was Boston Medical Center, a private, not-for-profit, academic medical institution., Subjects: HIV-infected patients with a history of alcohol problems on ART. A total of 151 were enrolled and 141 (93%) were assessed at follow-up., Intervention: A nurse, trained in motivational interviewing, completed the following over 3 months in four encounters: addressed alcohol problems; provided a watch with a programmable timer to facilitate pill taking; enhanced perception of treatment efficacy; and delivered individually tailored assistance to facilitate medication use., Main Outcome Measures: Prior 30-day adherence > or =95%, prior 3-day adherence of 100%, CD4 cell count, HIV RNA and alcohol consumption, each at both short- and long-term follow-up., Results: At follow-up, no significant differences in medication adherence, CD4 cell count, HIV RNA or alcohol consumption were found (all P values >0.25)., Conclusions: A multicomponent intervention to enhance adherence among HIV-infected individuals with a history of alcohol problems was not associated with changes in medication adherence, alcohol consumption or markers of HIV disease progression. The failure to change adherence in a group at high risk for poor adherence, despite utilizing an intensive individual-focused patient intervention, supports the idea of addressing medication adherence with supervised medication delivery or markedly simplified dosing regimens.