Programa de hipertensão e diabetes: um projeto de intervenção para a atenção à saúde do idoso

TCC(especialização) - Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Programa de Pós-graduação em Enfermagem. Linhas de Cuidado em Doenças Crônicas Não TransmissíveisObjetivo: capacitar as equipes de saúde da família sobre o Programa de HIPERDIA das Unidades de Saúde da Família do Município de São Lourenço da Mata – PE. Metodologia: Trata - se de um Projeto de Intervenção com ênfase educacional para as USF cadastradas como Ponto de Telessaúde, a fim de fortalecer as ações desenvolvidas para o público de Hipertensos e Diabéticos. As atividades educacionais serão desenvolvidas de forma direta – para os profissionais de saúde destas USF e de forma indireta – pelas atividades de educação em saúde realizadas pelos profissio nais para os usuários de saúde. A população Alvo serão todos os profissionais da Estratégia Saúde da Família, além dos usuários e seus familiares. Viabilidade: Para execução deste projeto o Núcleo de Telessáude apoiará com os recursos humanos e tecnológicos para promover os Seminários por Webconferência, enquanto a equipe da Secretaria Municipal de Saúde de São Lourenço da Mata fornecerá informações necessárias sobre o HIPERDIA. Resultados esperados: capacitar no mínimo 80% dos profissionais da Saúde da Família – pontos de telessaúde; a umentar em 60% as atividades de Educação em Saúde sobre hipertensão e diabetes; a umentar em 60% a taxa de adesão dos pacientes hipertensos e diabéticos às consultas de acompanhamento ao Programa do HIPERDIA; reduzir em 50% as intercorrências do grupo de pacientes hipertensos e diabéticos do Município de São Lourenço da Mata

Complicações dos portadores de lesões traumato- ortopédicas das vítimas de acidente motociclístico / Complications of traumate-orthopedic injury holders of motocyclistic accident victims

Introdução: O índice de lesões traumáticas incapacitantes decorrentes a acidentes motociclísticos vem aumentando continuamente, caracterizando-se assim um problema grave de saúde pública, pois seus efeitos implicam na elevada demanda de leitos hospitalares, incapacidade física temporária ou definitiva das vítimas e até mesmo o óbito. Objetivo: O presente estudo teve como objetivo avaliar as complicações dos portadores de lesões traumato-ortopédicas das vítimas de acidente motociclístico. Métodos: Foi realizada uma pesquisa de natureza exploratória e descritiva, através de abordagem quantitativa, no setor de ortopedia e traumatologia do Hospital Otávio de Freitas na cidade do Recife. Foi aprovado pelo Comitê de Ética e Pesquisa, e também houve a autorização da instituição pesquisada. Utilizou-se como instrumento de coleta de dados dois questionários estruturados com questões fechadas e abertas, onde foi captada uma amostra de 80 pacientes vítimas de acidente motociclístico. Resultados: Observou-se que a faixa etária prevalente das vítimas é de 18 a 30 anos, equivalente a 52,5%, sendo 95% do sexo masculino, o que corresponde a 76 entrevistados. A maioria possuía apenas o ensino fundamental II completo, o que representa 45%. Dos pesquisados, em relação ao tipo de colisão, prevalece aquelas envolvidas com carro, ônibus ou caminhão, o que corresponde a 50%. No que diz respeito às complicações pós-traumáticas, 95% das vítimas apresentaram dor apesar do uso de medicações prescritas para controle, 94% apresentaram incapacidade funcional e 78% desenvolveram lesões infectadas, o que contribui para complicações crônicas como osteomielite, aumentando o período de internação. Conclusão: Este estudo permitiu o conhecimento do perfil epidemiológico dos pacientes, bem como as complicações desenvolvidas após o acidente, interferindo na qualidade de vida dos mesmos. A identificação dessas particularidades proporciona ao enfermeiro planejar sua assistência possiblitando o planejamento do cuidado especializado a essas vítimas, e implementando ações que visem a diminuição das complicações com o objetivo de auxiliar na recuperação precoce dos pacientes.

FATORES QUE AFETAM A QUALIDADE DE VIDA DE CRIANÇAS E ADOLESCENTES PORTADORES DE DIABETES MELLITUS TIPO 1: UMA REVISÃO INTEGRATIVA

Diabetes Mellitus type 1 (DM1) is a metabolic, autoimmune disease defined by blood hyperglycemia considered an organ-specific pathology characterized by the attack of antibodies in an autoimmune process causing selective destruction of pancreatic cells. DM1 is one of the most common chronic diseases in childhood, corresponding to about 5% to 10% of diabetes cases. The present article aims to identify the factors that affect the daily life of patients with T1DM. This is an integrative literature review conducted in the following databases: Latin American and Caribbean Literature on Health Sciences (LILACS), National Library of Medicine of the United States of America (MEDLINE), and the Virtual Health Library (VHL). The search was conducted between 2010 and 2020, from the crossing of the following descriptors: "Type 1 Diabetes Mellitus", "Quality of Life", "Adolescent" and "Child". A total of 162 articles were found, and after applying the inclusion criteria, 15 were excluded for duplicity, 141 for not answering the guiding question, 02 excluded because it was an integrative review, and 05 were included in the final analysis. The articles evaluated showed that Quality of Life is a factor primarily affected by the lack of glycemic control that can cause serious consequences to the DM1 carrier, causing complications such as: Ketoacidosis that can lead to hospitalization, increasing the chances of death and chronic complications that can cause renal and visual impairment.INTRODUCCIÓN: La diabetes mellitus tipo 1 (DM1) es una enfermedad metabólica, autoinmune definida por hiperglucemia sanguínea, considerada una patología específica de órganos caracterizada por el ataque de anticuerpos en el proceso autoinmune causando la destrucción selectiva de los votos pancreáticos. La DM1 es una de las enfermedades crónicas más comunes en la infancia que corresponde a alrededor del 5% al 10% de los casos de diabetes. OBJETIVO: Identificar en los archivos científicos publicaciones sobre cómo la DM 1 puede interferir en diversos aspectos de la vida de los pacientes. METODOLOGÍA: Se trata de una revisión integradora de la literatura realizada en las bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Biblioteca Nacional de Medicina de los Estados Unidos de América (MEDLINE), Biblioteca Virtual Científica Electrónica en Línea (SCIELO) y Google Scholar para fortalecer los resultados. La investigación se realizó a partir del cruce de los siguientes descriptores: "Diabetes Mellitus tipo 1", "Calidad de Vida", "Adolescente" e "Infantil". RESULTADOS: Se identificaron 162 artículos tras la aplicación de los criterios de inclusión, 15 fueron excluidos por duplicidad, 141 por no responder a la pregunta guía, 02 excluidos por tratarse de una revisión integradora y para fortalecer los resultados con mayor robustez, se utilizó Google Scholar, identificando 02 artículos más que cumplieron con el objeto del estudio tras la exclusión del título, con 06 artículos como muestra final. CONCLUSIÓN: Los principales factores relacionados con la calidad de vida de los pacientes con DM1.Diabetes Mellitus tipo 1 (DM1) é uma doença metabólica, autoimune definida pela hiperglicemia sanguínea considerada uma patologia órgão-específica caracterizada pelo ataque de anticorpos em processo autoimune causando destruição seletiva das células pancreáticas. A DM1 é uma das doenças crônicas mais comuns na infância que corresponde acerca de 5% a 10% dos casos de diabetes. O presente artigo tem como objetivo identificar os fatores que afetam o cotidiano dos pacientes com DM1. Trata-se de uma revisão integrativa de literatura realizada nas bases de dados: Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Nacional de Medicina dos Estados Unidos da América (MEDLINE), e na Biblioteca Virtual em Saúde (BVS). A pesquisa foi realizada no período de 2010 a 2020, a partir do cruzamento dos seguintes descritores: “Diabetes Mellitus tipo 1”, “Qualidade de Vida”, “Adolescente” e “Infantil”. Foram encontrados 162 artigos, após a aplicação dos critérios de inclusão, 15 foram excluídos por duplicidade, 141 por não responder à pergunta norteadora, 02 excluídos por se tratar de revisão integrativa e 05 foram incluídas na análise final. Os artigos avaliados demonstram que a Qualidade de Vida é um fator primordialmente afetado com o descontrole glicêmico que pode ocasionar sérias consequências ao portador do DM1, causando complicações como: Cetoacidose que pode levar à hospitalização aumentando as chances de óbito e as complicações crônicas que podem causar comprometimento renal e visual

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Copyright (C) 2021 World Health Organization; licensee Elsevier

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Factors related to the association of social anxiety disorder and alcohol use among adolescents: a systematic review

Objective: To identify the risk factors related to the association between social anxiety disorder and alcohol use in adolescents. Source of data: The PICO research strategy was used to perform a systematic review in Medline, LILACS, Pubmed, IBECS and Cochrane Library databases. DeCS/MeSH: Phobic Disorders, Adolescent, Behavior, Ethanol, Risk Factors, and the Boolean operator “AND” were used. Inclusion criteria were: cross‐sectional, prospective/retrospective cohort, and case‐control studies, carried out in adolescents (10 to 19 years), original articles on social anxiety disorder and alcohol use published between 2010 and 2015. Studies that did not report the terms “anxiety disorder” and “alcohol use” in the title and abstract were excluded. Synthesis of data: 409 articles were retrieved; after the exclusion of 277 repeated articles, the following were eligible: 94 in MEDLINE, 68 in Pubmed, 12 in IBCS, and three in LILACS. Titles and abstracts were independently read by two examiners, which resulted in the selection of eight articles for the analysis. Risk factors associated to the two disorders were female gender, age, peer approval and affective problems for alcohol use, confrontation situations and/or compliance reasons, frequency of alcohol use, and secondary comorbidities, such as depression and generalized anxiety. Conclusions: It is necessary to assess the period of social anxiety disorders first symptom onset, as well as the risks for alcohol use in order to establish corrective intervention guidelines, especially for socially anxious students