Who receives treatment for alcohol use disorders in the European Union? A cross-sectional representative study in primary and specialized health care

Background Alcohol use disorders (AUDs) are highly prevalent in Europe, but only a minority of those affected receive treatment. It is therefore important to identify factors that predict treatment in order to reframe strategies aimed at improving treatment rates. Methods Representative cross-sectional study with patients aged 18\u201364 from primary health care (PC, six European countries, n = 8476, data collection 01/13\u201301/14) and from specialized health care (SC, eight European countries, n = 1762, data collection 01/13\u201303/14). For descriptive purposes, six groups were distinguished, based on type of DSM-IV AUD and treatment setting. Treatment status (yes/no) for any treatment (model 1), and for SC treatment (model 2) were main outcome measures in logistic regression models. Results AUDs were prevalent in PC (12-month prevalence: 11.8%, 95% confidence interval (CI): 11.2\u201312.5%), with 17.6% receiving current treatment (95%CI: 15.3\u201319.9%). There were clear differences between the six groups regarding key variables from all five predictor domains. Prediction of any treatment (model 1) or SC treatment (model 2) was successful with high overall accuracy (both models: 95%), sufficient sensitivity (model 1: 79%/model 2: 76%) and high specificity (both models: 98%). The most predictive single variables were daily drinking level, anxiety, severity of mental distress, and number of inpatient nights during the last 6 months. Conclusions Variables from four domains were highly predictive in identifying treatment for AUD, with SC treatment groups showing very high levels of social disintegration, drinking, comorbidity and functional losses. Earlier intervention and formal treatment for AUD in PC should be implemented to reduce these high levels of adverse outcomes

Individual empowerment in overweight and obese patients: a study protocol.

ABSTRACT Introduction: Obesity is a growing health problem in Europe and it causes many diseases. Many weightreducing methods are reported in medical literature, but none of them proved to be effective in maintaining the results achieved over time. Self-empowerment can be an important innovative method, but an effectiveness study is necessary. In order to standardise the procedures for a randomised controlled study, a pilot study will be run to observe, measure and evaluate the effects of a period of selfempowerment group treatment on overweight/obese patients. Methods: and analysis Non-controlled, experimental, pilot study. A selected group of patients with body mass index >25, with no severe psychiatric disorders, with no aesthetic or therapeutic motivation will be included in the study. A set of quantitative and qualitative measures will be utilised to evaluate the effects of a self-empowerment course in a 12 month time. Group therapy and medical examinations will also complete this observational phase. At the end of this pilot study, a set of appropriate measures and procedures to determine the effectiveness of individual empowerment will be identified and agreed among the different professional figures. Results will be recorded and analysed to start a randomised controlled trial to evaluate the effectiveness of the proposed methodology. Ethics and dissemination: This protocol was approved by the local Ethics Committee of Udine in March 2012. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations and public events involving the local administrations of the towns where the trial participants are resident. Trial Registration: http://www.clinicalstrials.gov identifier NCT0164470

Senso di coerenza e rischio cardiovascolare: Uno studio osservazionale | [Sense of coherence and cardiovascular risk: An observational study

3noThe aim of this study was to analyze possible existing correlations among the three dimensions of the sense of coherence (SOC), as a psychosocial risk factor, and some other cardiovascular risk factors in a group of primary care patients. Seventy-one persons at high cardiovascular risk were identified by their general practitioners and invited to answer the 13 questions included in the Antonovsky's SOC questionnaire. Psychosocial risk evaluation, performed with SOC analysis, may provide an important added value in the identification of behavioral changes and cardiovascular risk reduction.nonemixedStruzzo, Pierluigi; Costantini, Simone; Fornasin, AlessioStruzzo, Pierluigi; Costantini, Simone; Fornasin, Alessi

Alcohol Use Disorders in Primary Health Care: What Do We Know and Where Do We Go?

Aims: To analyze the current paradigm and clinical practice for dealing with alcohol use disorders (AUD) in primary health care. Methods: Analyses of guidelines and recommendations, reviews and meta-analyses. Results: Many recommendations or guidelines for interventions for peoplewith alcohol use problems in primary health care, from hazardous drinking to AUD, can be summarized in the SBIRT principle: screening for alcohol use and alcohol-related problems, brief interventions for hazardous and in some cases harmful drinking, referral to specialized treatment for people with AUD. However, while there is some evidence that these procedures are effective in reducing drinking levels, they are rarely applied in clinical practice in primary health care, and no interventions are initiated, even if the primary care physician had detected problems or AUD. Rather than asking primary health care physicians to conduct interventions which are not typical for medical doctors, we recommend treatment initiation for AUD at the primary health care level. AUD should be treated like hypertension, i.e. with regular checks for alcohol consumption, advice for behavioral interventions in case of consumption exceeding thresholds, and pharmaceutical assistance in case the behavioral interventions were not successful. Minimally, alcohol consumption should be screened for in all situations where there is a co-morbidity with alcohol being a potential cause (such as hypertension, insomnia, depression or anxiety disorders)

Time trends in smoking habits among Italian young adults.

Background: In most developed countries the prevalence of smoking habits is decreasing in men, while in women the prevalence seems to decline in Northern Europe but to increase in the Mediterranean area. The present research aims at assessing time trends in smoking habits in Italy. Methods: In the frame of the Italian Study on Asthma in Young Adults (ISAYA) a random sample of the Italian population aged 20-45 years was administered a mailed questionnaire in 9 Italian centers between 1998 and 2000. Cumulative response was 72.7% (18873/25969). Kaplan-Meier survival curves and tog-rank test were used to compare probability of remaining a life-time non-smoker across birth cohorts (1953-58, 1959-63, 1964-68, 1969-73, 1974-78). Probability to quit smoking was also evaluated among ever-smokers. Results: Probability to persist as a non-smoker significantly increased across subsequent generations in both sexes. At the age of 20 years this probability amounted to 41.7% (95% CI 39.4-44.0%) in men and 52.7% (50.4-54.9%) in women born between 1953 and 1958, and it increased to 57% (54.8-59.1%) in men and 68.7% (66.6-70.7%) in women born in 1969-73, but no further decline in smoking habits was observed in the next birth cohort (1974-78). Also the probability to quit smoking significantly increased from the 1953-58 birth cohort to the 1969-73 one. Conclusions: Smoking has declined among Italian young adults of both genders. Further efforts are necessary to promote active anti-smoking campaign, especially among adolescents, which are at higher risk of starting to smoke

Time trends in smoking habits among Italian young adults

BACKGROUND: In most developed countries the prevalence of smoking habits is decreasing in men, while in women the prevalence seems to decline in Northern Europe but to increase in the Mediterranean area. The present research aims at assessing time trends in smoking habits in Italy. METHODS: In the frame of the Italian Study on Asthma in Young Adults (ISAYA) a random sample of the Italian population aged 20-45 years was administered a mailed questionnaire in 9 Italian centers between 1998 and 2000. Cumulative response was 72.7% (18873/25969). Kaplan-Meier survival curves and log-rank test were used to compare probability of remaining a life-time non-smoker across birth cohorts (1953-58, 1959-63, 1964-68, 1969-73, 1974-78). Probability to quit smoking was also evaluated among ever-smokers. RESULTS: Probability to persist as a non-smoker significantly increased across subsequent generations in both sexes. At the age of 20 years this probability amounted to 41.7% (95% CI 39.4-44.0%) in men and 52.7% (50.4-54.9%) in women born between 1953 and 1958, and it increased to 57% (54.8-59.1%) in men and 68.7% (66.6-70.7%) in women born in 1969-73, but no further decline in smoking habits was observed in the next birth cohort (1974-78). Also the probability to quit smoking significantly increased from the 1953-58 birth cohort to the 1969-73 one. CONCLUSIONS: Smoking has declined among Italian young adults of both genders. Further efforts are necessary to promote active anti-smoking campaign, especially among adolescents, which are at higher risk of starting to smoke