Four-year follow-up of an internet-based brief intervention for unhealthy alcohol use in young men.

To estimate the long-term efficacy of an internet-based brief intervention (IBI) in decreasing alcohol use among men on 1.) number of drinks/week and 2.) monthly or more binge drinking prevalence. In addition, overall changes in alcohol use were assessed. Participants in a cohort study were recruited in a two parallel-group randomized controlled trial of an IBI versus no-intervention control condition, showing a positive intervention effect at 6 months. As part of the regular cohort assessments, participants were re-assessed 47 months after the initial trial, offering an opportunity to determine long-term efficacy. Young Swiss men from the general population. Of 737 randomized trial participants with unhealthy alcohol use (>14 drinks/week or ≥ 6 drinks/occasion at least monthly, or Alcohol Use Disorders Identification Test (AUDIT) ≥ 8), 622 completed a cohort assessment at mean (SD) 47.4(2.6) months after their randomized trial baseline assessment. IBI: normative and personalized feedback on alcohol use, risk indicators, information about alcohol and health, and recommendations. assessment only. Self-reported number of drinks/week and monthly or more binge drinking prevalence. Comparisons at follow-up were adjusted for baseline drinking. Missing values were replaced with the last observation carried forward. There was no evidence of differences between the IBI and control group on either the number of drinks/week (IBI: 10.8[14.2]; control: 10.7[14.1], p=0.8) or monthly or more binge drinking prevalence (IBI: 65.1%; control: 63.5%, p=0.5). Although there was no evidence of overall change from baseline in number of drinks/week (9.8[7.9] at baseline, 10.8[14.1] at 47 months, p=0.051), there was evidence that monthly or more binge drinking prevalence had decreased over the follow-up time (84.9% at baseline, 64.3% at 47 months, p<.001). An internet-based brief intervention direct at unhealthy alcohol use among young men does not appear to reduce drinking over the long-term

Center, periphery: theory

info:eu-repo/semantics/publishedVersio

Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five country cluster randomized factorial trial

Aims: To test if training and support of primary health care providers (PHCP), financial reimbursement to PHCP for screening and brief advice, and option for PHCP to refer screen positive patients to an internet-based method of giving advice (eBI) increases PHCP’s delivery of screening and advice to heavy drinkers, compared to a control group of PHCPs. Design: Cluster randomized factorial trial with 12-week implementation measurement period. Setting: Primary health care units (PHCU) in different locations throughout Catalonia, England, Netherlands, Poland and Sweden. Participants: 120 PHCU, 24 in each of Catalonia, England, Netherlands, Poland and Sweden. Interventions PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR), and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI. Outcome measures Primary outcome measures is proportion of eligible patients screened during a 12-week implementation period. Secondary outcome measures are proportion of screen positive patients advised; and, proportion of consulting adult patients given an intervention (screening and advice to screen positives) during the same 12-week implementation period. Results During a 4-week baseline measurement period, 5.9 (95% CI 3.4 to 8.4)per 100 adult patients consulting per PHCU were screened for their alcohol consumption. Based on the factorial design, PHCU that received TS had a 1.48 (95% CI 1.13 to 1.95)relatively higher proportion of patients screened during the 12-week implementation period than PHCU that did not receive TS; PHCU that received FR had a 2.00 (95% CI 1.56 to 2.56) relatively higher proportion than no FR. The option of referral to eBI did not have a higher proportion. A combination of TS plus FR had a 2.34 (95% CI 1.77 to 3.10) relatively higher proportion of patients screened than no TS plus FR. A combination of TS plus FR plus eBI had a 1.68 (95% CI 1.11 to 2.53) relatively higher proportion of patients screened than no TS plus FR plus eBI. Conclusions Training and support of PHCP, and financial reimbursement to PHCP for screening and brief advice increase the proportion of adult patients screened for their alcohol consumption, at least in the short term

Catching Element Formation In The Act

Gamma-ray astronomy explores the most energetic photons in nature to address some of the most pressing puzzles in contemporary astrophysics. It encompasses a wide range of objects and phenomena: stars, supernovae, novae, neutron stars, stellar-mass black holes, nucleosynthesis, the interstellar medium, cosmic rays and relativistic-particle acceleration, and the evolution of galaxies. MeV gamma-rays provide a unique probe of nuclear processes in astronomy, directly measuring radioactive decay, nuclear de-excitation, and positron annihilation. The substantial information carried by gamma-ray photons allows us to see deeper into these objects, the bulk of the power is often emitted at gamma-ray energies, and radioactivity provides a natural physical clock that adds unique information. New science will be driven by time-domain population studies at gamma-ray energies. This science is enabled by next-generation gamma-ray instruments with one to two orders of magnitude better sensitivity, larger sky coverage, and faster cadence than all previous gamma-ray instruments. This transformative capability permits: (a) the accurate identification of the gamma-ray emitting objects and correlations with observations taken at other wavelengths and with other messengers; (b) construction of new gamma-ray maps of the Milky Way and other nearby galaxies where extended regions are distinguished from point sources; and (c) considerable serendipitous science of scarce events -- nearby neutron star mergers, for example. Advances in technology push the performance of new gamma-ray instruments to address a wide set of astrophysical questions.Comment: 14 pages including 3 figure

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation

Risks at Work: The Demand and Supply Sides of Government Redistribution

To understand how the welfare state adjusts to economic shocks it is important to explain both the genesis of popular preferences and the institutional incentives of governments to respond to these preferences. This paper attempts to do both, using a general theoretical framework and detailed data at both the individual and national levels. In a first step, we focus on how risk exposure and income are related to preferences for redistribution. To test our hypotheses, we extract detailed risk exposure measures from labor force surveys and marry them to cross-national survey data. In a second step, we turn our attention to the supply side of government redistribution. Institutions, we argue, mediate governments’ reactions to redistributional demands following economic shocks. Using time-series cross-country data, we demonstrate how national training systems, electoral institutions as well as government partisanship shape government responses.Um zu verstehen, wie Wohlfahrtsstaaten auf ökonomische Schocks reagieren, ist es wichtig, sowohl die Nachfrage- als auch die Angebotsseite von Umverteilung zu analysieren. Wie entstehen Umverteilungs-Präferenzen in der Bevölkerung? Welche institutionellen Anreize haben Regierungen, darauf zu reagieren? Das vorliegende Papier wendet einen generellen theoretischen Rahmen und umfangreiche Individual- und Aggregat-Daten an, um diesen Fragen nachzugehen. Dazu wird zuerst analysiert, wie Risiken im Arbeitsmarkt und das Einkommen Umverteilungs-Präferenzen von Individuen beeinflussen. Die abgeleiteten Hypothesen werden an neuen Datensätzen getestet. Diese kombinieren Informationen von Arbeitsmarkterhebungen und Umfrage-Daten für mehrere Länder und Jahre. In Sachen Angebotsseite wird argumentiert, dass unterschiedliche Regierungen auf ökonomische Schocks unterschiedlich reagieren, abhängig von Institutionen. Das Papier testet diese und andere Hypothesen auf der Aggregatsebene anhand von vergleichenden Zeitreihen. Es zeigt sich, dass die Art und Weise, wie Regierungen auf ökonomische Schocks reagieren, von Ausbildungs- und Wahlsystemen sowie der parteipolitischen Färbung der Regierung mitbestimmt werden

Serious adverse events reported in placebo randomised controlled trials of oral naltrexone: a systematic review and meta-analysis

Background Naltrexone is an opioid antagonist used in many different conditions, both licensed and unlicensed. It is used at widely varying doses from 3 - 250 mg. The aim of this review was to evaluate the safety of oral naltrexone by examining the risk of serious adverse events (SAEs) in randomised controlled trials (RCTs) of naltrexone compared to placebo. Methods A systematic search of Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, other databases and clinical trials registries was undertaken up to March 2018. Parallel placebo-controlled RCTs longer than 4 weeks published after 1/1/2001, of oral naltrexone at any dose were selected. Any condition and age group were included, excluding only studies for opioid or ex-opioid users, due to possible opioid/opioid antagonist interactions. The systematic review used the guidance of the Cochrane Handbook throughout. Numerical data was independently extracted by two people and cross-checked. Risk of bias was assessed with the Cochrane Risk of Bias Tool. Meta-analyses were performed using Stata 15 and R, using random and fixed effects models throughout. Results Eighty-nine RCTs with 11194 participants were found, studying alcohol use disorders, various psychiatric disorders, impulse control disorders, other addictions, obesity, Crohn’s disease, fibromyalgia and cancers. Twenty-six studies (4,960 participants) recorded SAEs occurring by arm of study. There was no evidence of increased risk of SAEs for naltrexone compared to placebo, relative risk (RR) 0.84 (95% CI: 0.66 to 1.06). Sensitivity analyses pooling risk differences supported this conclusion (RD = -0.01 (-0.02, 0.00)) and subgroup analyses showed that results were consistent across different doses and disease groups. The quality of evidence for this outcome was judged high using the GRADE criteria. Conclusions Naltrexone does not appear to increase the risk of SAEs over placebo. These findings confirm the safety of naltrexone when used in licensed indications and encourage investments to undertake efficacy studies in unlicensed indications

A Genetic Animal Model of Alcoholism for Screening Medications to Treat Addiction

The purpose of this review is to present up-to-date pharmacological, genetic, and behavioral findings from the alcohol-preferring P rat and summarize similar past work. Behaviorally, the focus will be on how the P rat meets criteria put forth for a valid animal model of alcoholism with a highlight on its use as an animal model of polysubstance abuse, including alcohol, nicotine, and psychostimulants. Pharmacologically and genetically, the focus will be on the neurotransmitter and neuropeptide systems that have received the most attention: cholinergic, dopaminergic, GABAergic, glutamatergic, serotonergic, noradrenergic, corticotrophin releasing hormone, opioid, and neuropeptide Y. Herein, we sought to place the P rat's behavioral and neurochemical phenotypes, and to some extent its genotype, in the context of the clinical literature. After reviewing the findings thus far, this chapter discusses future directions for expanding the use of this genetic animal model of alcoholism to identify molecular targets for treating drug addiction in general