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Background: Observational studies have documented lower risks of coronary heart disease and diabetes among moderate alcohol consumers relative to abstainers, but only a randomized clinical trial can provide conclusive evidence for or against these associations. Aim: The purpose of this study was to describe the rationale and design of the Moderate Alcohol and Cardiovascular Health Trial, aimed to assess the cardiometabolic effects of one alcoholic drink daily over an average of six years among adults 50 years or older. Methods: This multicenter, parallel-arm randomized trial was designed to compare the effects of one standard serving (∼11–15 g) daily of a preferred alcoholic beverage to abstention. The trial aimed to enroll 7800 people at high risk of cardiovascular disease. The primary composite endpoint comprised time to the first occurrence of non-fatal myocardial infarction, non-fatal ischemic stroke, hospitalized angina, coronary/carotid revascularization, or total mortality. The trial was designed to provide >80% power to detect a 15% reduction in the risk of the primary outcome. Secondary outcomes included diabetes. Adverse effects of special interest included injuries, congestive heart failure, alcohol use disorders, and cancer. Results: We describe the design, governance, masking issues, and data handling. In three months of field center activity until termination by the funder, the trial randomized 32 participants, successfully screened another 70, and identified ∼400 additional interested individuals. Conclusions: We describe a feasible design for a long-term randomized trial of moderate alcohol consumption. Such a study will provide the highest level of evidence for the effects of moderate alcohol consumption on cardiovascular disease and diabetes, and will directly inform clinical and public health guidelines. Fil: Spiegelman, Donna. Harvard University. Harvard School of Public Health; Estados Unidos Fil: Lovato, Laura C.. Universidad de Barcelona; España Fil: Khudyakov, Polyna. Harvard University. Harvard School of Public Health; Estados Unidos. Universidad de Barcelona; España Fil: Wilkens, Trine L.. Universidad de Copenhagen; Dinamarca Fil: Adebamowo, Clement A.. University of Maryland; Estados Unidos Fil: Adebamowo, Sally N.. University of Maryland; Estados Unidos Fil: Appel, Lawrence J.. No especifíca; Fil: Beulens, Joline W.J.. No especifíca; Fil: Coughlin, Janelle W.. No especifíca; Fil: Dragsted, Lars Ove. Universidad de Copenhagen; Dinamarca Fil: Edenberg, Howard J. No especifíca; Fil: Eriksen, Jane N.. Universidad de Copenhagen; Dinamarca Fil: Estruch, Ramon. Universidad de Barcelona; España Fil: Grobbee, Diederick E.. No especifíca; Fil: Gulayin, Pablo Elías. No especifíca; Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Krystal, John H.. University of Yale. School of Medicine; Estados Unidos Fil: Lazo, Mariana. No especifíca; Fil: Murray, Margaret M.. University of Yale. School of Medicine; Estados Unidos Fil: Rimm, Eric B.. Harvard University. Harvard School of Public Health; Estados Unidos Fil: Schrieks, Ilse C.. Universidad de Barcelona; España Fil: Williamson, Jeff D.. No especifíca; Fil: Mukamal, Kenneth J.. Harvard Medical School; Estados Unidos

Objective: To compare the characteristics of mothers of children with Fetal Alcohol Spectrum Disorder (FASD) with mothers of typically developing control children. Methods: The study utilized a cross-sectional, observational design, using active case ascertainment. Biological mothers were interviewed using a standardized retrospective questionnaire to collect data on demographics, living environment, pregnancy history, nutrition, alcohol and other drug use prior to and following pregnancy recognition. Results: A total of 173 mothers were interviewed. Of these, 19 had a child who was diagnosed with FASD, five had a child who had received a deferred FASD diagnosis, and 37 had children who were selected into the control group as typically developing children. The remaining 112 mothers had children who did not meet diagnostic criteria for FASD. The mothers of children with FASD did not differ significantly from mothers of the control group children with respect to age, ethnicity, marital status, and employment status at the time of pregnancy. However, mothers of children with FASD had lower levels of education (p &lt, 0.01) and were more likely to have received financial support (p &lt, 0.05) at the time of pregnancy, to have smoked tobacco (p &lt, 0.001), and to have used marijuana or hashish (p &lt, 0.01) prior to pregnancy recognition, compared with mothers of control children. All mothers of children with FASD reported alcohol consumption prior to pregnancy recognition, however, only 10.5% reported alcohol consumption following pregnancy recognition. None of the mothers interviewed reported any drug use following pregnancy recognition. Conclusions: Population-based preventive interventions, including repeated screening, monitoring, and education regarding the effects of alcohol use, as well as other substances, before and during pregnancy, are needed to eliminate risk for FASD and other negative consequences on child and maternal health.

Adolescence is a time of dramatic changes in brain structure and function, and the adolescent brain is highly susceptible to being altered by experiences like substance use. However, there is much we have yet to learn about how these experiences influence brain development, how they promote or interfere with later health outcomes, or even what healthy brain development looks like. A large longitudinal study beginning in early adolescence could help us understand the normal variability in adolescent brain and cognitive development and tease apart the many factors that influence it. Recent advances in neuroimaging, informatics, and genetics technologies have made it feasible to conduct a study of sufficient size and scope to answer many outstanding questions. At the same time, several Institutes across the NIH recognized the value of collaborating in such a project because of its ability to address the role of biological, environmental, and behavioral factors like gender, pubertal hormones, sports participation, and social/economic disparities on brain development as well as their association with the emergence and progression of substance use and mental illness including suicide risk. Thus, the Adolescent Brain Cognitive Development study was created to answer the most pressing public health questions of our day. Keywords: Adolescent, Brain development, Neuroimaging, Longitudinal, Substance use, Mental health

Background Fetal alcohol spectrum disorder (FASD) is one of the most disabling potential outcomes of prenatal alcohol exposure. The population-based prevalence of FASD among the general population of Canada was unknown. The objective of this study was to determine the population-based prevalence of FASD among elementary school students, aged 7 to 9 years, in the Greater Toronto Area (GTA) in Ontario, Canada. Methods This screening study used a cross-sectional, observational design utilizing active case ascertainment, along with retrospective collection of prenatal alcohol exposure information. Data collection involved two phases. Phase I consisted of taking growth measurements, a dysmorphology examination, and obtaining a history of behavioral and/or learning problems. Phase II consisted of a neurodevelopmental assessment, maternal interview, and behavioral observations/ratings by parents/guardians. Final diagnostic screening conclusions were made by consensus by a team of experienced multidisciplinary experts during case conferences, using the 2005 Canadian guidelines for FASD diagnosis. The prevalence of FASD was estimated, taking into consideration the selection rate, which was used to account for students who dropped out or were lost to follow-up during each phase. Monte Carlo simulations were employed to derive the confidence interval (CI) for the point estimates. Results A total of 2555 students participated. A total of 21 cases of suspected FASD were identified. The prevalence of FASD was estimated to be 18.1 per 1000, or about 1.8%. Using a less conservative approach (sensitivity analysis), the prevalence of FASD was estimated to be 29.3 per 1000, or about 2.9%. Therefore, the population-based prevalence of FASD is likely to range between 2 and 3% among elementary school students in the GTA in Ontario, Canada. Conclusions This study provides the first population-based estimate of the prevalence of FASD in Canada. The estimate is approximately double or possibly even triple previous crude estimates. FASD prevalence exceeds that of other common birth defects such as Down’s syndrome, spina bifida, trisomy 18, as well as autism spectrum disorder in Canada. More effective prevention strategies targeting alcohol use during pregnancy, surveillance of FASD, and timely interventions and support to individuals with FASD and their families are urgently needed. Electronic supplementary material The online version of this article (10.1186/s12889-019-7213-3) contains supplementary material, which is available to authorized users.

Observational neuroimaging studies with children and adolescents may identify neurological anomalies and other clinically relevant findings. Planning for the management of this information involves ethical considerations that may influence informed consent, confidentiality, and communication with participants about assessment results. Biomedical ethics principles include respect for autonomy, beneficence, non-maleficence, and justice. Each project presents unique challenges. The Adolescent Brain and Cognitive Development study (ABCD) collaborators have systematically developed recommendations with written guidelines for identifying and responding to potential risks that adhere to biomedical ethics principles. To illustrate, we will review the ABCD approach to three areas: (1) hazardous substance use; (2) neurological anomalies; and (3) imminent potential for self-harm or harm to others. Each ABCD site is responsible for implementing procedures consistent with these guidelines in accordance with their Institutional Review Board approved protocols, state regulations, and local resources. To assure that each site has related plans and resources in place, site emergency procedures manuals have been developed, documented and reviewed for adherence to ABCD guidelines. This article will describe the principles and process used to develop these ABCD bioethics and medical oversight guidelines, the concerns and options considered, and the resulting approaches advised to sites. Keywords: Ethics, Adolescence, Magnetic resonance imaging, Clinical oversight, Substance use

Summary This paper discusses the development of the first Nurse-led triage clinic for back pain developed in the United Kingdom (UK). It identifies some of the health policies that support development of new ways to deliver services within the UK's National Health Service (NHS), and explores some of the drivers that enabled such changes. The importance of using evidenced-based practice in developments is noted with some of the benefits to patients, consumers and organisations outlined. The reality of this type of service and its contribution to enabling the organisation to deliver on targets that have been part of regular health care expectations, are noted. Importantly, the Spinal Assessment Clinic (SAC) was a local solution to a local problem. However, the commitment to develop the service underpinned by evidence has made it possible to share this example of best practice with others who have then been able to adapt this to their own ‘local needs'. Consequently this approach has become accepted practice within the NHS, the service has been recognised as important to South Tees Trust in delivering back pain services, and the author was awarded the Order of the British Empire (OBE) in 2002 for her work.

Drinking within recommended limits is highly prevalent in much of the world, and strong epidemiological associations exist between moderate alcohol consumption and risk of several major chronic diseases, including coronary heart disease, diabetes, and breast cancer. In many cases, plausible biological mediators for these associations have been identified in randomized trials, but gold-standard evidence that moderate drinking causes or prevents any chronic disease remains elusive and important concerns about available evidence have been raised. Although long-term randomized trials to test the observed associations have been termed impossible, clinical investigators have now successfully completed randomized trials of complex nutritional interventions in a variety of settings, along with trials of alcohol consumption itself of up to two years duration. The successful completion of these trials suggests that objections to the execution of a full-scale long-term clinical trial of moderate drinking on chronic disease are increasingly untenable. We present potential lessons learned for such a trial and discuss key features to maximize its feasibility and value.

Aims: Although National Alcohol Screening Day (NASD) became the USA's largest and most visible community-based intervention targeting risky drinking over the past decade, its utility in identifying individuals who are at risk for alcohol problems and in catalyzing behaviour change has not been tested in studies including untreated controls. The purpose of this study was to assess changes in alcohol use three months following NASD participation using a quasi-experimental pretest-posttest control group design. Methods: Participants (N = 713) were recruited from 5 NASD sites in Florida, Massachusetts, and New York, USA. Intervention subjects (N = 318) were recruited at the NASD event; control subjects (N = 395) were recruited at the same locations approximately 1 week after NASD. All participants completed brief surveys at the time of enrollment, and then again 3 months later. Results: Significant decreases in the typical number of drinks consumed per occasion were observed among at-risk drinkers in the intervention group relative to controls in the 3 months following NASD. At-risk NASD participants averaged approximately 5.6 fewer drinks per week than at-risk controls. Conclusions: Findings suggest that exposure to a brief screening program with provision of feedback can result in significant reductions in alcohol consumption among risky drinkers.

The review article summarizes the mission of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with focus on the NIAAA's current and future research version for alcoholic liver disease and alcoholic pancreatitis.

Objetivos. La atencion primaria proporciona la oportunidad de identificar y tratar a personas cuyo consumo de alcohol se encuentra por encima de los niveles permisibles. Con el fin de preparar a los medicos de atencion primaria de todo el mundo para prevenir y tratar los problemas relacionados con el alcohol, el Instituto Nacional sobre el Abuso de Alcohol y el Alcoholismo (National Institute on Alcohol Abuse and Alcoholism: NIAAA) de los Estados Unidos de America (EE. UU.) ha creado y probado un Programa Internacional de Educacion Medica sobre el Alcohol, destinado a aumentar las aptitudes clinicas, educativas e investigadoras del profesorado de las facultades de medicina que trabaja con los estudiantes universitarios, los residentes y los medicos de atencion primaria. Venezuela fue uno de los paises seleccionados para la puesta en marcha de esta iniciativa. Metodos. Durante 5 dias del mes de septiembre de 1999 se realizo en la Universidad del Zulia, Maracaibo, Venezuela, un curso de formacion del profesorado que consistio en 19 talleres. Los metodos de ensenanza fueron clases, representaciones demostrativas, presentaciones de casos, talleres de desarrollo de aptitudes y la creacion de un plan educativo por cada uno de los participantes. Resultados. En el proyecto participaron 33 profesores de nueve de las 10 escuelas de medicina en Venezuela: 18 mujeres y 15 hombres con un promedio de 44 anos, 9 de ellos con formacion en medicina de familia, 7 en psiquiatria, 6 en pediatria, 4 en obstetricia, 3 en medicina interna, y 4 en especialidades no especificadas. El 76% de los participantes completaron una entrevista 6 meses mas tarde. Este grupo refirio que su competencia en 14 areas clinicas habia aumentado de forma significativa y que habia emprendido con buenos resultados nuevas actividades curriculares en sus respectivas facultades de medicina y programas de residencia. Conclusiones. Este modelo demostro ser eficaz para incrementar la formacion de los medicos en la prevencion y el tratamiento de los problemas relacionados con el alcohol en Venezuela. La evaluacion del programa proporciono resultados similares a los obtenidos en otros paises en los que tambien se ha puesto en marcha.

Copepods are often said to require a mixed diet to maximize their survival and reproduction potential. Copepods may be forced to feed nonselectively in food limited environments, but this does not mean they require a diverse diet. In this study, we show that the right single food item, at the right stage, can be as good or better than a mixed diet for development, survival, diapause egg production and viability. Centropages hamatus was reared on unialgal or mixed diets of five dinoflagellates: Amphidinium carterae , Prorocentrum micans , Scrippsiella trochoidea , Lingulodinium polyedra , and Gymnodinium sanguineum , ranging in size from 11×16 μm to 44×57 μm. Four experiments of 12–30 days were conducted, each testing five diets against a mixed Control diet of the four larger dinoflagellates. Algal volumes were adjusted so diets would have the same initial carbon content or cell volume at a level known to be in excess of the amount required for growth. Eggs were collected on the final 2 days of the experiments, the survivors were counted and female prosome length was measured. Diapause egg viability was measured after the eggs completed a refractory period. Nauplii had high survival on unialgal P. micans and S. trochoidea diets, but the adult females did not produce eggs. Naupliar survival was low on a unialgal diet of G. sanguineum , but the adult females had the highest rate of egg production. An optimal diet fosters growth and survival at all stages and maximizes viable egg production, to ensure high recruitment to the next generation. This can be achieved with single food items appropriate for the developmental stage. Copepods fed just two dinoflagellates, P. micans to foster juvenile growth and G. sanguineum to support final maturation and fecundity, had higher total egg production than copepods reared on the mixed diet of four dinoflagellates.

The aim of this study was to evaluate the feasibility of producing, storing, and hatching copepod diapause eggs that could be used as a source of nauplii for rearing larval fish. The copepod Centropages hamatus was reared on a mixed diet of four dinoflagellates: Gymnodinium sanguineum, Lingulodinium polyedra, Prorocentrum micans, and Scrippsiella trochoidea, in 19-l carboys mounted on a plankton rotator in a walk-in environmental chamber, set at 15°C and a 12L–12D cycle. Eleven experiments were conducted. Following maturation to the adult stage, eggs were produced over a 16–33 day period. Total egg production was assessed in three of the experiments and ranged from 1.2 to 2.4 million eggs. Hatching success was generally >80% for eggs stored 4–17 months at 25°C. Diapause eggs shipped via overnight express remained viable and were used as a source of nauplii to feed larval fish.

Nursing has a central role in the prevention and treatment of alcohol use disorders in almost any practice setting. Alcohol consumption is the third leading actual cause of death in the United Stat...

The review article summarizes the mission of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with focus on the NIAAA's current and future research version for alcoholic liver disease and alcoholic pancreatitis.

Epidemiologic evidence indicates that substance use typically begins in adolescence, with alcohol, nicotine, and marijuana being the most commonly used substances. Large national surveys in the U.S. indicate that while overall rates of alcohol and tobacco use have been declining for several years, rates of marijuana use …

1. (1) The occurrence of goitre in West Pakistan was studied from October 1955, to February 1956, 8 years after partition from India in 1947. Attention was drawn to the Multan area where a recent epidemic of goitre had been reported in the press. 2. (2) The evidence showed a marked increase of goitre on the alluvial plain south of the Salt Range. Records were available to show that the incidence of goitre had varied considerably during the past 100 years, being related to the use of well-water. 3. (3) In the Multan district the water from numerous hand pumps recently installed was found to have a low iodine content (1.4 to 3.6 μg./1.).The incidence of goitre was directly correlated with a small amount of iodine in the drinking water. There appeared to be no correlation between the incidence of goitre and other salts in the water. This does not rule out the possibility that other constituents as yet unrecognized may be of importance.

THE association of congenital deafness or mutism with districts where endemic goitre and cretinism are prevalent is well known1–5. It is now generally accepted that endemic goitre and cretinism occur among inhabitants of areas where the iodine content of the water is low, provided no other rich source of iodine such as sea fish is utilized6. Russell Brain7 considered that many hereditary factors influence iodine utilization and that in congenital cases what is inherited is not goitre, cretinism or deaf-mutism as such, but rather some defect in iodine utilization. Hallpike8 has pointed out that congenital deafness does not necessarily involve a congenital anatomical defect, but may depend on an inherited predisposition to degeneration of certain tissues and be precipitated by biological factors, which are identifiable and subject to control.