Prevenció dels problemes relacionats amb el consum d’alcohol a urgències

[cat] El consum d’alcohol i les seves conseqüències són un problema de salut pública de gran rellevància, que representa un dels principals factors de risc de morbimortalitat. A més a més, el consum de risc i el trastorn per ús d’alcohol sovint passen desapercebuts i una elevada proporció d’aquests pacients no reben tractament. Els programes SBIRT (screening, brief intevention and referral to treatment) són eines de salut pública desenvolupades principalment en el marc de l’atenció primària, que tenen com a objectiu la detecció de pacients amb un consum de risc d’alcohol de cara a poder administrar una intervenció breu per a disminuir el consum i derivar a tractament especialitzat aquells pacients que ho requereixen. Aquests programes han demostrat la seva eficàcia a atenció primària, disminuint la proporció de pacients amb un consum de risc d’alcohol i els problemes relacionats amb el consum. Amb l’objectiu d’estendre aquesta estratègia a altres dispositius sanitaris i arribar a aquells pacients amb un menor contacte amb els centres d’atenció primària, s’ha proposat el mateix model als serveis d’urgències. Els diferents estudis publicats han demostrat la seva eficàcia a curt termini, tanmateix, però la evidència a mig i llarg termini no ha estat clarament establerta. L’objectiu d’aquesta tesi és avaluar la taxa de detecció i registre del consum de risc d’alcohol a urgències i avaluar la viabilitat i eficàcia d’un programa SBIRT especialitzat, conduït per psiquiatres especialistes en conductes addictives. Els resultats posen de relleu que la taxa de detecció i registre del consum de risc d’alcohol és molt pobra i que cal implementar estratègies per a millorar la identificació d’aquest factor de risc. Per altra banda, el programa es va poder desenvolupar i adaptar al funcionament habitual del servei d’urgències. Així mateix, va demostrar ser eficaç especialment en la detecció i vinculació de pacients a tractament especialitzat, així com reduint la proporció de bevedors de risc a curt termini. Tanmateix, els resultats a mig llarg termini mostren com la eficàcia es va esvaint en el temps, motiu pel qual cal avaluar altres mecanismes per millorar la eficàcia a llarg termini.[eng] SBIRT programs (Screening, Brief Intervention and Referral to Treatment) have shown to be effective in identifying at-risk drinkers and reducing their alcohol consumption, particularly in Primary Health Care settings. Trying to expand these tools to other areas several trials have been performed in ED during the last years. Although short term results have consistently been positive, mid and long term findings have been mixed and therefore the evidence is far from conclusive. This thesis aims at assessing the proportion of at-risk drinkers attended in a emergency department of a tertiary hospital who are properly detected and registered as risky drinkers, as well as developing and assessing the effectiveness of a SBIRT program conducted by psychiatrists highly instructed in addictive disorders and motivational interviewing. The results show that the proportion of patients properly registered is very poor, and strategies to increase attention for alcohol related problems should be studied. Secondly, SBIRT programs are an effective tool for increasing the proportion of successful referrals to specific treatment and reducing alcohol use at short term. However, long term effects of brief interventions on alcohol use seem to decay over time

Effectiveness of a Specialized Brief Intervention for At-risk Drinkers in an Emergency Department: Short-term Results of a Randomized Controlled Trial

Bevedors de risc; Intervencions breus; Serveis d'urgències; ImplementacióBebedores de riesgo; Intervenciones breves; Servicios de urgencias; ImplementaciónRisk drinkers; Brief interventions; Emergency services; ImplementationBackground: Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs have been developed, evaluated, and shown to be effective, particularly in primary care and general practice. Nevertheless, effectiveness of SBIRT in emergency departments (EDs) has not been clearly established. Objective: We aimed to evaluate the feasibility and efficacy of an SBIRT program conducted by highly specialized professionals in the ED of a tertiary hospital. Methods: We conducted a randomized controlled trial to study the feasibility and efficacy of an SBIRT program conducted by alcohol specialists for at-risk drinkers presenting to the ED, measured with the three-item version of the Alcohol Use Disorder Identification Test (AUDIT-C). Patients were randomized to two groups, with the control group receiving two leaflets-one regarding alcohol use and the other giving information about the study protocol. The intervention group received the same leaflets as well as a brief motivational intervention on alcohol use and, where appropriate, a referral to specialized treatment. The primary outcomes were the proportion of at-risk alcohol use measured by AUDIT-C scale and the proportion of patients attending specialized treatment at 1.5 months. Results: Of 3,027 patients presenting to the ED, 2,044 (67%) were potentially eligible to participate, 247 (12%) screened positive for at-risk drinking, and 200 agreed to participate. Seventy-two percent of the participating sample were men, and the mean (±SD) age was 43 (±16.7) years. Follow-up rates were 76.5%. At 1.5 months, the intervention group showed greater reductions in alcohol consumption and fewer patients continuing with at-risk alcohol use (27.8% vs. 48.1%; p = 0.01). The SBIRT program also increased the probability of attending specialized treatment, compared to the control condition (23% vs. 9.8%, p = 0.0119) CONCLUSION: The SBIRT program in the ED was found to be feasible and effective in identifying at-risk drinkers, reducing at-risk alcohol use, and increasing treatment for alcohol problems.This work was supported by the Hospital Cl ınic (Grant“Premifide resid encia Emili Letang) and the CERCA Programme/Generalitat de Catalunya

Detección y registro del consumo de alcohol en urgencias

Fundamentos: El consumo excesivo de alcohol es uno de los factores de riesgo de morbimortalidad más im-portantes en nuestro entorno, por lo que en los últimos años se han desarrollado múltiples programas para la de-tección e intervención sobre los consumidores de riesgo en los centros de atención primaria y de Urgencias. El ob-jetivo de este estudio fue analizar la tasa de detección y registro del consumo excesivo de los pacientes atendidos en un servicio de Urgencias.Métodos: Se incluyeron todos los pacientes con un consumo de riesgo de alcohol, mayores de 18 años, aten-didos en un servicio de Urgencias del Hospital Clínic de Barcelona. Se realizó un análisis descriptivo de los datos, tras evaluar los informes de alta de los pacientes.Resultados: Se evaluaron 2.047 pacientes median-te la escala AUDIT, detectándose 247 consumidores de riesgo, de lo que 200 aceptaron participar. De estos, sola-mente se realizó una adecuada detección y registro en el 32,5%. En 122 historias clínicas no había ninguna refe-rencia sobre el consumo de alcohol, y en 13 la referencia era inexacta y no informaba sobre si la cantidad de alcohol consumida era excesiva.Conclusiones: El consumo de riesgo de alcohol se registra de manera adecuada en menos del 35% de los pa-cientes. Es necesario evaluar las barreras que están obsta-culizando la detección y registro para una mejor identifi-cación de estos pacientes

Tobacco cessation among smokers under substance use treatment for alcohol and/or cannabis: study protocol and pilot study

Background: Approximately 80% of people with a substance use disorder (SUD) are smokers. Starting SUD treatment offers the opportunity to also quit smoking. The ACT-ATAC project aims to identify the predictors associated with smoking cessation among persons treated for alcohol and/or cannabis use disorder in Barcelona. This manuscript reports its methodology and the experience of carrying it out during the COVID-19 pandemic. Methods: Mixed methods project with three substudies. Substudy 1 (S1) comprises heterogeneous discussion groups among clinicians. S2 has two prospective cohorts composed of smokers under treatment for alcohol and/or cannabis use disorder and the clinicians in charge of these patients. Participating smokers will be followed for 12 months and interviewed about their substance use and the tobacco cessation services received using the Spanish version of the users' Knowledge, Attitudes, and Services (S-KAS) scale. The clinicians will be asked about their self-reported practices in smoking cessation using the Knowledge, Attitudes, and Practices (S-KAP) scale. S3 comprises heterogeneous discussion groups with smokers. Data will be triangulated using qualitative and quantitative analyses. To facilitate the recruitment process, the researchers have introduced several strategies (design clear protocols, set monthly online meetings, extend the project, provide gift cards, etc.). Discussion: The results of S1 were used to develop the questionnaires. S2 required some adjustments due to the COVID-19 pandemic, particularly the follow-up interviews being conducted by phone instead of face-to-face, and the recruitment rhythm was lower than expected. Recruitment will last until reaching at least 200-250 users. The fieldwork could not have been possible without the collaboration of the ACT-ATAC team and the introduction of several strategies

Associations of hypomagnesemia in patients seeking a first treatment of alcohol use disorder

Introduction: Hypomagnesemia (hypoMg) has not yet been extensively studied in alcohol use disorder (AUD) . We hypothesize that chronic, excessive alcohol consumption favors oxidative stress and pro-inflammatory alterations that may be exacerbated by hypoMg. The objective of this study was to analyze the prevalence and associations of hypoMg in AUD.Patients and Methods: Cross-sectional study in patients admitted for a first treatment of AUD in six tertiary centers between 2013 and 2020. Socio-demographic, alcohol use characteristics, and blood parameters were ascertained at admission.Results: 753 patients (71% men) were eligible; age at admission was 48 years [IQR, 41-56 years]. Prevalence of hypoMg was 11.2%, higher than that observed for hypocalcemia (9.3%), hyponatremia (5.6%), and hypokalemia (2.8%). HypoMg was associated with older age, longer duration of AUD, anemia, higher erythrocyte sedimen-tation rate, gamma-glutamyl transpeptidase, glucose levels, advanced liver fibrosis (FIB-4 >= 3.25) and estimated glomerular filtration rate (eGFR) < 60 mL/min. In multivariate analysis, advanced liver fibrosis (OR, 8.91; 95% CI, 3.3-23.9) and eGFR < 60 mL (OR, 5.2; 95% CI, 1.0-26.2) were the only factors associated with hypoMg.Conclusions: Mg deficiency in AUD is associated with liver damage and glomerular dysfunction suggesting that both comorbidities should be assessed in the course of serum hypoMg

Evaluation of ceramic passive samplers using a mixed-mode strong cation-exchange sorbent to monitor polar contaminants in river water

Although most of the analytical methods developed for the monitoring of contaminants in environmental waters are based on discrete grab sampling, an alternative of increasing interest is the use of passive sampling. Methods based on passive sampling provide the sampling and pre-concentration of the analytes in-situ, which makes the sample treatment less time consuming and costly than using discrete grab sampling. In this study, ceramic passive samplers (CPSs) using mixed-mode strong cation-exchange sorbent (Oasis MCX) as retention phase were evaluated for the determination of a group of 21 therapeutic and illicit drugs and some of their metabolites in river water samples that were determined by liquid chromatography-tandem mass spectrometry. After assessing the stability of the analytes, the CPSs were calibrated for 9 days with bottled water and river water, obtaining, for the 19 stable compounds, sample rates (Rs) ranging between 0.180 and 1.767 mL/day and diffusion coefficients (De) between 2.02E-8 and 2.81E-7 cm2/s. Once calibrated, CPSs were deployed for the determination of contaminants in the Ebre River, with good reproducibility, and some of the analytes were determined, including amongst others, gabapentin at 76 ng/L, caffeine at 203 ng/L or diclofenac amine at 57 ng/L. The passive sampling method herein presented is simple and feasible and allows the time-integrated analysis of pharmaceuticals and drugs at trace levels in river water. This study opens the possibility of using other mixed-mode sorbents or other types of sorbents as retaining phase on CPSs for the determination of very polar contaminants in water.This research was funded by MICIN/AEI/10.13039/501100011033 under projects PID2020-114587GB-I00 and PID2019-105732GBC21 and the Severo Ochoa project Grant CEX2018–000794-S to IDAEA-CSIC as Centre of Excellence. The Consorci d'Aigües de Tarragona (CAT) is also acknowledged for their support during sampling. Jorge de Silva from INMA-CSIC is acknowledged for the fabrication of CPSs.Peer reviewe

Detección y registro del consumo de alcohol en urgencias

Background: Due to the high economic and morbimortality burden associated to alcohol use, in the last decades, public health services have developed several programs to detect and to intervene on at risk drinkers in primary care settings and emergency departments (ED). The aim of this study is to determine the proportion of detected and registered risky drinkers in an ED of Hospital Clínic de Barcelona. Methods: All patients over 18 years old, presenting to the ED and reporting risky drinking, were asked to participate. We did a descriptive analysis of the data after revising clinical records. Results: We detected 247 risky drinkers after assessing more than 2,047 patients with AUDIT-C scale. From these, 200 accepted to participate. Only 65 (32.5%) of these patients were properly detected and registered as risky drinkers, while the majority of them (122, 61%) had no record about their alcohol use in their clinical records. Conclusions: Risky drinkers are properly detected and registered in less than 35% of the patients. It is necessary to evaluate which barriers are restricting the implementation of screening programs to detect at risk drinkers.Fundamentos: El consumo excesivo de alcohol es uno de los factores de riesgo de morbimortalidad más importantes en nuestro entorno, por lo que en los últimos años se han desarrollado múltiples programas para la detección e intervención sobre los consumidores de riesgo en los centros de atención primaria y de Urgencias. El objetivo de este estudio fue analizar la tasa de detección y registro del consumo excesivo de los pacientes atendidos en un servicio de Urgencias. Métodos: Se incluyeron todos los pacientes con un consumo de riesgo de alcohol, mayores de 18 años, atendidos en un servicio de Urgencias del Hospital Clínic de Barcelona. Se realizó un análisis descriptivo de los datos, tras evaluar los informes de alta de los pacientes. Resultados: Se evaluaron 2.047 pacientes mediante la escala AUDIT, detectándose 247 consumidores de riesgo, de lo que 200 aceptaron participar. De estos, solamente se realizó una adecuada detección y registro en el 32,5%. En 122 historias clínicas no había ninguna referencia sobre el consumo de alcohol, y en 13 la referencia era inexacta y no informaba sobre si la cantidad de alcohol consumida era excesiva. Conclusiones: El consumo de riesgo de alcohol se registra de manera adecuada en menos del 35% de los pacientes. Es necesario evaluar las barreras que están obstaculizando la detección y registro para una mejor identificación de estos pacientes

Factors Affecting Quality of Life in Liver Transplant Candidates: An Observational Study

Health-related quality of life (HRQOL) before and after liver transplant (LT) is an important outcome in LT candidates as, in these patients, HRQOL is commonly impaired. However, evidence regarding factors that influence HRQOL in patients with end-stage liver disease is inconclusive. The aim of the present study was to identify factors associated with poor HRQOL. An observational study was conducted over LT candidates. The 36-item Short Form Health Survey (widely used to assess HRQOL) and the Hospital Anxiety and Depression Scale were administered to 211 patients during the pre-transplant assessment. Baseline demographic and clinical data were also collected. Multiple regression analysis was performed to investigate risk factors for poor HRQOL. Female sex (lower B = 7.99 95%C = 0.07–15.92, higher B = 18.09 95%CI = 7.56–28.62), encephalopathy (lower B = −9.45, 95%CI = −14.59–−4.31, higher B = −6.69, 95%CI = −13.13 to −0.25), higher MELD scores (lower B = −1.14, 95%CI = −1.67 to −0.61, higher B = −0.33, 95%CI = −0.65 to −0.12), anxiety (lower B = −3.04 95%C = −4.71 to −1.36, higher B = −1.93 95%CI = −3.39 to −0.47)and depression (lower B = −3.27 95%C = −4.46 to −2.08, higher B = −1.02 95%CI = −1.90 to −0.13) symptoms were associated to poorer HRQOL. Psychosocial interventions should be addressed to liver transplant candidates, especially to women, patients with anxiety, depression or episodes of encephalopathy, in order to prevent the impact that these conditions can have on HRQOL