Demonstration of a Posterior Atrial Input to the Atrioventricular Node During Sustained Anterograde Slow Pathway Conduction

AbstractObjectives. This study sought to demonstrate electrophysiologic evidence for the existence of different anatomic atrial input sites of fast and slow conduction pathways in patients with dual atrioventricular (AV) node physiology.Background. Although a separate posterior exit site exists for a retrograde slow AV node pathway, it remains unresolved whether a separate atrial input site into the AV node actually exists in patients with dual anterograde AV node pathway physiology.Methods. In 10 patients with dual AV node pathway physiology, atrial pacing at three chosen drive cycle lengths (DCL1, DCL2 and DCL3) was performed at an anterior site (A) just above the His bundle recording site and at a posterior atrial site (P) just below the coronary sinus ostium. DCL3 was chosen as the one cycle length that resulted in a long AH interval consistent with slow pathway conduction. The stimulus to His bundle conduction times (SH) at both sites (SHPand SHA, respectively) and their differences (ΔSH = SHP− SHA) at each of the three drive cycle lengths were analyzed.Results. The mean ± SD ΔSH values for DCL1 and DCL2 measured 9 ± 16 and 8 ± 18 ms, respectively, and the mean ΔSH value at DCL3 measured −34 ± 24 ms, which was significantly different from the mean ΔSH values at DCL1 and DCL2 (both p < 0.05).Conclusions. The significant change in the ΔSH (SHP− SHA) value during slow pathway conduction could be accounted for by a corresponding shift of anterograde input from an anterior to a posterior entry site to the AV node. These findings support the notion that a separate anterograde entry site of the slow pathway does exist in patients with dual AV node pathway physiology

Why Behavioral And Environmental Interventions Are Needed To Improve Health At Lower Cost

http://dx.doi.org/10.1377/hlthaff.2010.111

Impulsivity and drinking motives predict problem behaviours relating to alcohol use in University students

Aims: This study used a four-factor model of impulsivity to investigate inter-relationships between alcohol consumption, impulsivity, motives for drinking and the tendency to engage in alcohol-related problem behaviours. Methods: 400 University students aged 18-25 completed an online survey consisting of the following measures: Urgency, Premeditation, Perseverance and Sensation Seeking Scale (UPPS) to measure impulsivity; Student Alcohol Questionnaire to assess drinking quantity, frequency and rates of problem behaviours; Drinking Motives Questionnaire to assess motives for drinking. Results: The majority of the sample (94.5%) drank alcohol at least monthly. Path analysis revealed direct effects of urgency, sensation seeking and premeditation, as well as the quantity of alcohol consumed, on the tendency to engage in risky behaviours with negative consequences. The effect of urgency was mediated by drinking for coping motives and by a combined effect of drinking for social motives and consumption of wine or spirits. Conversely the effect of sensation seeking was mediated by the quantity of alcohol consumed, irrespective of drink type, and the effect of premeditation was mediated by the consumption of wine and spirits, in combination with enhancement motives. Conclusions: Sensation seeking, urgency and lack of premeditation are related to different motives for drinking and also demonstrate dissociable relationships with the consumption of specific types of alcohol (beer, wine and spirits) and the tendency to engage in risky behaviours associated with alcohol consumption. Screening for high levels of urgency and for severe drinking consequences may be useful predictors of alcohol-related problems in UK University students aged 18 to 25 years

Effects of beverage alcohol taxes and prices on drinking: a meta-analysis of 1003 estimates from 112 studies

Aims: We conducted a systematic review of studies examining relationships between measures of beverage alcohol tax or price levels and alcohol sales or self-reported drinking. A total of 112 studies of alcohol tax or price effects were found, containing 1003 estimates of the tax/price–consumption relationship. Design: Studies included analyses of alternative outcome measures, varying subgroups of the population, several statistical models, and using different units of analysis. Multiple estimates were coded from each study, along with numerous study characteristics. Using reported estimates, standard errors, t-ratios, sample sizes and other statistics, we calculated the partial correlation for the relationship between alcohol price or tax and sales or drinking measures for each major model or subgroup reported within each study. Random-effects models were used to combine studies for inverse variance weighted overall estimates of the magnitude and significance of the relationship between alcohol tax/price and drinking. Findings: Simple means of reported elasticities are -0.46 for beer, -0.69 for wine and -0.80 for spirits. Meta-analytical results document the highly significant relationships (P < 0.001) between alcohol tax or price measures and indices of sales or consumption of alcohol (aggregate-level r = -0.17 for beer, -0.30 for wine, -0.29 for spirits and -0.44 for total alcohol). Price/tax also affects heavy drinking significantly (mean reported elasticity = -0.28, individual-level r = -0.01, P < 0.01), but the magnitude of effect is smaller than effects on overall drinking. Conclusions: A large literature establishes that beverage alcohol prices and taxes are related inversely to drinking. Effects are large compared to other prevention policies and programs. Public policies that raise prices of alcohol are an effective means to reduce drinking

Ethnic Differences in Drinking Motives and Alcohol Use Among College Athletes

This study examined drinking motives, alcohol use, and alcohol-related problems among White collegiate athletes and collegiate athletes of color (N = 113). Results indicated no differences in drinking motives between the two groups. Although White athletes reported higher levels of alcohol use, athletes of color reported higher levels of alcohol-related problems. Athletes of color with high levels of coping and conformity motives reported the highest level of alcohol-related problems

Alcohol expectancies in childhood: Change with the onset of drinking and ability to predict adolescent drunkenness and binge drinking

Aims: Childhood expectancies about alcohol are present long before drinking begins. We examined the relationship between alcohol expectancies in childhood and onset of drinking, binge drinking, and drunkenness in adolescence and the influence of drinking onset on development of alcohol expectancies. Design: A prospective, longitudinal study of children assessed for alcohol expectancies and drinking at 4 time points between ages 6 and 17. Setting: Community study of families at high risk for alcoholism conducted in a 4-county area in the Midwest. Participants: The study involved 614 children; 460 were children of alcoholics and 70% were male. Measurements: Expectancies about effects of alcohol were measured using the Beverage Opinion Questionnaire and child’s drinking was measured using the Drinking and Drug History - Youth Form. Findings: Partial factor invariance was found for expectancy factors from age 6 to age 17. Survival analysis showed that social/relaxation expectancies in childhood predicted time to onset of binge drinking and first time drunk (Wald chi-square, 1 d.f. = 3.8, p < .05 and 5.1, p < .05, respectively). The reciprocal effect was also present; when adolescents began drinking, there was an increase in social/relaxation expectancy and a concomitant increase in slope of the expectancy change lasting throughout adolescence. Conclusions: A reciprocal relationship exists between childhood alcohol expectancies and involvement with alcohol. Higher expectancies for positive effects predict earlier onset of problem drinking. Onset of use, in turn, predicts an increase in rate of development of positive expectancies.NIH R37 AA07065 K01AA016591Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110697/1/Jester alcohol expectancies.pdfDescription of Jester alcohol expectancies.pdf : Main articl

Effectiveness of the Strengthening Families Programme 10–14 in Poland for the prevention of alcohol and drug misuse: protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Alcohol and other drug use and misuse is a significant problem amongst Polish youth. The SFP10-14 is a family-based prevention intervention that has positive results in US trials, but questions remain about the generalizability of these results to other countries and settings.</p> <p>Methods/Design</p> <p>A cluster randomized controlled trial in community settings across Poland. Communities will be randomized to a SFP10-14 trial arm or to a control arm. Recruitment and consent of families, and delivery of the SFP10-14, will be undertaken by community workers. The primary outcomes are alcohol and other drug use and misuse. Secondary (or intermediate) outcomes include parenting practices, parent–child relations, and child problem behaviour. Interview-based questionnaires will be administered at baseline, 12 and 24 months.</p> <p>Discussion</p> <p>The trial will provide information about the effectiveness of the SFP10-14 in Poland.</p> <p>Trial registration</p> <p>International Standard Randomised Controlled Trial Number: ISRCTN89673828</p

Is alcohol dependence best viewed as a chronic relapsing disorder?

This 'For Debate' paper starts by recognizing the growing trend towards considering alcohol dependence as a chronic relapsing disorder. We argue that the adoption of this model results from focusing on those in treatment for alcohol dependence rather than considering the larger number of people in the general population who meet criteria for alcohol dependence at some point in their lives. The majority of the general population who ever experience alcohol dependence do not behave as though they have a chronic relapsing disorder: they do not seek treatment, resolve their dependence themselves and do not relapse repeatedly. We suggest that caution is therefore needed in using the chronic relapsing disorder label. Our primary concerns are that this formulation privileges biological aspects of dependence to the detriment of psychological and social contributions, it inhibits much-needed developments in understanding alcohol dependence and leads to inefficient distributions of public health and clinical care resources for alcohol dependence. We invite debate on this issue

Commentary on White and Colleagues: Trends in Alcoholâ Related Emergency Department Visits in the United States: Results from the Nationwide Emergency Department Sample, 2006 to 2014 (ACER, 2018)

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142426/1/acer13593.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142426/2/acer13593_am.pd

The influence of socioeconomic environment on the effectiveness of alcohol prevention among European students: a cluster randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Although social environments may influence alcohol-related behaviours in youth, the relationship between neighbourhood socioeconomic context and effectiveness of school-based prevention against underage drinking has been insufficiently investigated. We study whether the social environment affects the impact of a new school-based prevention programme on alcohol use among European students.</p> <p>Methods</p> <p>During the school year 2004-2005, 7079 students 12-14 years of age from 143 schools in nine European centres participated in this cluster randomised controlled trial. Schools were randomly assigned to either control or a 12-session standardised curriculum based on the comprehensive social influence model. Randomisation was blocked within socioeconomic levels of the school environment. Alcohol use and alcohol-related problem behaviours were investigated through a self-completed anonymous questionnaire at baseline and 18 months thereafter. Data were analysed using multilevel models, separately by socioeconomic level.</p> <p>Results</p> <p>At baseline, adolescents in schools of low socioeconomic level were more likely to report problem drinking than other students. Participation in the programme was associated in this group with a decreased odds of reporting episodes of drunkenness (OR = 0.60, 95% CI = 0.44-0.83), intention to get drunk (OR = 0.60, 95% CI = 0.45-0.79), and marginally alcohol-related problem behaviours (OR = 0.70, 95% CI = 0.46-1.06). No significant programme's effects emerged for students in schools of medium or high socioeconomic level. Effects on frequency of alcohol consumption were also stronger among students in disadvantaged schools, although the estimates did not attain statistical significance in any subgroup.</p> <p>Conclusions</p> <p>It is plausible that comprehensive social influence programmes have a more favourable effect on problematic drinking among students in underprivileged social environments.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN18092805">ISRCTN18092805</a></p