Alcohol Availability, Consumption, Injury, And Emergency Department Use Among Heavy Drinkers

This study examines whether proximity and density of alcohol outlets is associated with number of emergency department (ED) visits in a year, and whether any such relationship is mediated by alcohol consumption or alcohol-related injury. The population sample consists of ED patients identified as heavy drinkers during random screening. Weekly alcohol consumption, frequency of binge drinking, number of injuries sustained within two hours of alcohol consumption, and number of ED visits in the past year were obtained by an ED patient screening survey. ED visit data were obtained from electronic medical records (EMR). Alcohol license data from the Connecticut Department of Consumer Protection were separated by outlet type (off-premises, restaurant, bar) and geocoded along with home addresses of participants to measure density and proximity. Poisson and negative binomial regression models were used to individually examine the association between alcohol availability and consumption, injury, and ED visits, and then the association of consumption and injury with ED visits, controlling for age, sex, race/ethnicity, education, and insurance. The models showed a positive association of off-premises outlet density with self-reported ED visits (IRR 1.067, 95% CI: 1.005-1.132) and a negative association of distance to nearest restaurant with ED visits in EMR (IRR 0.505, 95% CI: 0.323-0.789). No associations were found between proximity or density and alcohol consumption for any outlet type. Alcohol-related injury was positively associated with distance to nearest off-premises outlet (IRR 1.764, 95% CI: 1.114-2.794). Results support the conclusion that there is an association between some types of alcohol outlets and ED visits, but the mechanisms behind this relationship are unclear. The lack of association between alcohol availability and consumption, and the increase in injuries associated with increased distance to off-premises outlets was unexpected, and might indicate that alcohol availability influences heavy drinkers differentially than the general population. These findings should be further investigated because current policy recommendations to decrease alcohol outlet density may have unintentional harmful effects on heavy drinkers

Artri King-induced Hypothalamic-pituitary-adrenal Axis Disruption: A Report of 3 Cases.

We present a case series of 3 patients who developed iatrogenic hypothalamic-pituitary-adrenal axis disruption while taking Artri King, an over-the-counter supplement marketed for joint pain that is reported to contain dexamethasone not listed on the supplements label. Patient 1, a 58-year-old woman, presented with persistent hyponatremia, weight gain, proximal muscle weakness, dorsocervical fat pad, and new, red striae on her breast and abdomen in the setting of Artri King use. Her dexamethasone level was elevated (Table 1), confirming the suspicion of dexamethasone content in this supplement. Patient 2, a 55-year old woman, had presented with cushingoid features and a low morning cortisol level (Table 1) in the setting of Artri King use. Patient 3, a 59-year-old man, presented with poorly controlled diabetes in the setting of Artri King use and an elevated serum dexamethasone level. Supplements containing hidden glucocorticoids can cause not only iatrogenic Cushing syndrome, but also adrenal suppression, providing a diagnostic challenge for providers

Hookworm infection among school age children in Kintampo north municipality, Ghana: nutritional risk factors and response to albendazole treatment.

Children (n = 812) 6-11 years of age attending 16 schools in the Kintampo North Municipality of Ghana were screened for participation in a study on hookworm infection, nutrition, and response to albendazole. The prevalence of Necator americanus hookworm infection (n = 286) was 39.1%, and significant predictors of infection included age, malaria parasitemia, lack of health care, school area, levels of antibodies against hookworm, and low consumption of animal foods. The cure rate after a single dose (400 mg) albendazole was 43%, and the mean fecal egg count reduction rate was 87.3%. Data for an in vitro egg hatch assay showed a trend toward reduced albendazole susceptibility in post-treatment hookworm isolates (P = 0.06). In summary, hookworm infection is prevalent among school age children in the Kintampo North Municipality and animal food intake inversely correlates with infection status. Modest cure rates and fecal egg count reduction rates reinforce the need for further investigation of potential benzimidazole resistance in Ghana