Hospital Admissions for Alcohol Use Disorders Before, During, and After Pregnancy: A Study Based on Linked Population Data in New South Wales, Australia

Alcohol use disorders (AUD) during pregnancy can have profound lifelong effects on the baby, including fetal alcohol spectrum disorders (FASD). Hospital admission for AUD during pregnancy provides an opportunity for intervention. Characterization of women along the AUD spectrum during pregnancy aids the development of prevention strategies, policy, and clinical management guidelines aimed at this population. This study describes the hospital admission levels for AUD between the sixth month before pregnancy and the first year after birth and explores risk factors associated with the hospital admissions.

 

This study was based on linked population data between 2002 and 2005 using the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC), Australia. The study subjects included primiparous mothers who were admitted to hospital in the period from the sixth month before pregnancy to 1 year after birth with at least 1 of the following diagnoses (ICD-10-AM): mental and behavioral disorders due to the use of alcohol (MBDA) (F10.0–10.9); toxic effects of alcohol (T51.0–51.9); maternal care for suspected damage to fetus from alcohol (O35.4); or alcohol rehabilitation (Z50.2).

 

A total of 175 new mothers had 287 hospital admissions with the principal or stay AUD diagnoses during the study period in NSW. Of the 287 admissions, 181 admissions (63.07%) were reported for an alcohol-related disorder as the principal diagnosis. The hospital admission rate for AUD was 1.76/1,000 person-years (PY) (95% CI: 1.45 to 2.07) during the 6 months prepregnancy. The rate decreased to 0.49/1,000 PY (95% CI: 0.36 to 0.63) during pregnancy and to 0.82/1,000 PY (95% CI: 0.67 to 0.97) in the first year after birth. Women who smoked during pregnancy, lived in a remote area and were younger than 25 years, were more likely to be admitted to hospital with AUD diagnoses. Women in the middle disadvantaged quintile and born in other countries were less likely to be admitted to hospital with AUD diagnoses.

 

Hospital admission for AUD decreased significantly in pregnancy and the first year postpartum compared to the prepregnancy period.


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Ideas para desarrollar un Sistema de Referencia para el uso nocivo del alcohol

PRESENTACIÓN 1

SBIRT es un modelo de salud pública integral para detectar, prevenir, intervenir y referir a tratamiento a personas con problemas por el uso de sustancias. Se presentan los componentes y metas de este modelo, así como los escenarios de su aplicación.

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PRESENTACIÓN 2

Manuales, programas, centros universitarios, proyectos de investigación, cursos online, media, instituciones, bibliografía...

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PRESENTACIÓN 3

Con base en la Encuesta Nacional de Adicciones 2011 se exponen las necesidades de atención de los diferentes grupos poblacionales (edad y sexo) de acuerdo al tipo de uso del alcohol o problemas por el uso nocivo del alcohol.

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PRESENTACIÓN 4

En México, sólo un proporción pequeña de la población dependiente al alcohol asiste a tratamiento. Se propone brindar ayuda a dicha población desde los contextos que frecuentan debido al consumo y a sus consecuencias. Se señalan focos de oportunidad.

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PRESENTACIÓN 5

En México pocos alcohólicos reciben ayuda. Una parte de ellos utilizan servicios hospitalarios para atender las consecuencias. La carga de enfermedad por el uso nocivo del alcohol presenta una oportunidad para atender la dependencia en los hospitales.

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PRESENTACIÓN 6

Diversas enfermedades asociadas al alcohol son atendidas en los hospitales. Este contexto ofrece la oportunidad para brindar intervenciones adecuadas a las condiciones/necesidades para reducir el uso nocivo del alcohol.

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Selected Papers of William L. White

http://www.williamwhitepapers.com/

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Alcohol Policy Changes and Trends in Adolescent Drinking in Finland from 1981 to 2011

To test if changes in national alcohol policy have had an impact on alcohol use among 12- to 18-year-old adolescents in Finland over a 30-year period. 


Frequencies of drinking any amounts of alcohol and drinking alcohol until really drunk from bi-annual repeated cross-sectional surveys from 1981 to 2011 were examined against a national alcohol policy review using nationally representative samples of 12-, 14-, 16- and 18-year-old adolescents (n = 99,724) in Finland. 

Twelve-year-olds' alcohol drinking remained rare throughout the period. Drinking among 18-year-olds generally increased throughout the period. Significant increases until the late 1990s and decreases thereafter were observed in 14- and 16-year-olds' drinking patterns. A sharp increase was predicted between 2003 and 2005 as a result of EU-related processes, but instead decrease was observed among 14–16-year-olds. The tests of hypothesized decrease from 2005 to 2011 due to tightening alcohol policy including several tax raises produced mixed results. 


Alcohol policy changes between 1981 and 2011 seem not to have had noticeable influence on alcohol drinking or drunkenness among the under-aged in Finland. Conspicuous increases seen in population total consumption in association with EU-related developments have not materialized among adolescents.

Abstract

Volume 74, 2013 > Issue 4: July 2013

Integration and Sustainability of Alcohol Screening, Brief Intervention, and Pharmacotherapy in Primary Care Settings

Steven M. Ornstein, Peter M. Miller, Andrea M. Wessell, Ruth G. Jenkins, Lynne S. Nemeth, Paul J. Nietert

http://www.jsad.com/jsad/article/Integration_and_Sustainability_of_Alcohol_Screening_Brief_Intervention_an/4836.html

Objective: At-risk drinking and alcohol use disorders are common in primary care and may adversely affect the treatment of patients with diabetes and/or hypertension. The purpose of this article is to report the impact of dissemination of a practice-based quality improvement approach (Practice Partner Research Network-Translating Research into Practice [PPRNet-TRIP]) on alcohol screening, brief intervention for at-risk drinking and alcohol use disorders, and medications for alcohol use disorders in primary care practices. Method: Nineteen primary care practices from 15 states representing 26,005 patients with diabetes and/or hypertension participated in a group-randomized trial (early intervention vs. delayed intervention). The 12-month intervention consisted of practice site visits for academic detailing and participatory planning and network meetings for "best practice" dissemination. Results: At the end of Phase 1, eligible patients in early-intervention practices were significantly more likely than patients in delayed-intervention practices to have been screened (odds ratio [OR] = 3.30, 95% CI [1.15, 9.50]) and more likely to have been provided a brief intervention (OR = 6.58, 95% CI [1.69, 25.7]. At the end of Phase 2, patients in delayed-intervention practices were more likely than at the end of Phase 1 to have been screened (OR = 5.18, 95% CI [4.65, 5.76]) and provided a brief intervention (OR = 1.80, 95% CI [1.31, 2.47]). Early-intervention practices maintained their screening and brief intervention performance during Phase 2. Medication for alcohol use disorders was prescribed infrequently. Conclusions: PPRNet-TRIP is effective in improving and maintaining improvement in alcohol screening and brief intervention for patients with diabetes and/or hypertension in primary care settings. (J. Stud. Alcohol Drugs, 74, 598–604, 2013)

No más "Abuso" o "Dependencia" en el vocabulario del DSM-5

DSM-5: Comparison and Implications for Addiction Professionals Webinar.

Tuesday, July 2, 2013 
12pm - 1:30pm EST (11 CST/10 MST/9 PST) 

https://www3.gotomeeting.com/register/812933286

The proposed DSM‐5 will eliminate the words “abuse” and “dependence” from the diagnostic lexicon and replace them with a dimensional perspective consisting of three diagnoses: mild, moderate, or severe for each substance group  (leve, moderado, severo/grave). 

The proposed changes will also delete legal problems related to use and replace it with the construct of craving/compulsion to use. All 11 of the new criteria will be on a continuum. 

- Those with positive findings on two or three of the 11 will receive a diagnosis of “mild” substance use disorder, 

- Those positive for three or four will receive a “moderate” diagnosis, and 

- Those with six or more positive findings will receive a diagnosis of “severe” substance use disorder. 



This free webinar will examine the similarities and differences under the proposed DSM‐5 for alcohol, cannabis and cocaine diagnoses. We will utilize diagnostic information on a sample of more than 7,000 adults and 1,000 adolescents from structured interviews that capture elements of both diagnostic formulations. For no diagnosis or dependence, the new diagnoses will place most individuals into the "no diagnosis" and "severe" group, respectively. However, for those with a current diagnosis of abuse, substantial changes in diagnoses will be outlined. Results also indicate that all criteria are not equal in indicating a more severe condition. Clinical and policy implications will be discussed. Not to be missed! 

NAADAC (http://www.naadac.org/)

Effectiveness of brief alcohol interventions in primary care populations

1. Eileen F.S. Kaner^1,*, 
2. Heather O Dickinson², 
3. Fiona R Beyer³, 
4. Fiona Campbell⁴, 
5. Carla Schlesinger⁵, 
6. Nick Heather⁶, 
7. John B Saunders⁷, 
8. Bernard Burnand⁸, 
9. Elizabeth D Pienaa

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004148.pub3/abstract

Background

Many trials reported that brief interventions are effective in reducing excessive drinking. However, some trials have been criticised for being clinically unrepresentative and unable to inform clinical practice.

Objectives

To assess the effectiveness of brief intervention, delivered in general practice or based primary care, to reduce alcohol consumption. To assess whether outcomes differ between trials in research settings and those in routine clinical settings.

Search methods

We searched the Cochrane Drug and Alcohol Group specialised register (February 2006), MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006), CINAHL (1982 to February 2006), PsycINFO (1840 to February 2006), Science Citation Index (1970 to February 2006), Social Science Citation Index (1970 to February 2006), Alcohol and Alcohol Problems Science Database (1972 to 2003), reference lists of articles.

Selection criteria

Randomised controlled trials, patients presenting to primary care not specifically for alcohol treatment; brief intervention of up to four sessions.

Data collection and analysis

Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, sub-group, sensitivity analyses, and meta-regression were conducted.

Main results

Meta-analysis of 22 RCTs (enrolling 7,619 participants) showed that participants receiving brief intervention had lower alcohol consumption than the control group after follow-up of one year or longer (mean difference: -38 grams/week, 95% CI: -54 to -23), although there was substantial heterogeneity between trials (I2 = 57%). Sub-group analysis (8 studies, 2,307 participants) confirmed the benefit of brief intervention in men (mean difference: -57 grams/week, 95% CI: -89 to -25, I2 = 56%), but not in women (mean difference: -10 grams/week, 95% CI: -48 to 29, I2 = 45%). Meta-regression showed little evidence of a greater reduction in alcohol consumption with longer treatment exposure or among trials which were less clinically representative. Extended intervention was associated with a non-significantly greater reduction in alcohol consumption than brief intervention (mean difference = -28, 95%CI: -62 to 6 grams/week, I2 = 0%)

Authors' conclusions

Overall, brief interventions lowered alcohol consumption. When data were available by gender, the effect was clear in men at one year of follow up, but not in women. Longer duration of counselling probably has little additional effect. The lack of evidence of any difference in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care. Future trials should focus on women and on delineating the most effective components of interventions.

Necesidades de atención por consumo de alcohol y el modelo SBIRT: integración y retos.

Análisis de necesidades de atención de la población con niveles diferentes de consumo de alcohol (ENA'11). Ejercicio de integración de necesidades en población adulta y el modelo SBIRT. Retos para su integración: ¿dónde? ¿quién? ¿red de referencia?

Haz click en la imagen para ir a la presentación o en el link de abajo.

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Archivo SBIRT.

Archivo SBIRT
Manuales, programas, centros universitarios, proyectos de investigación, cursos online, media, instituciones, bibliografía... una miscelánea SBIRT!

Haz click en la imagen o en el link de abajo.

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El Hospital: un contexto para implementar el Modelo SBIRT.

Diversas enfermedades asociadas al alcohol son atendidas en los hospitales. Este contexto ofrece la oportunidad para brindar intervenciones adecuadas a las condiciones/necesidades para reducir el uso nocivo del alcohol.

Haz click en la imagen o en el link de abajo.

http://prezi.com/c30_htez5hap/