Influence from friends to drink more or drink less: a cross-national comparison.

Drinking habits are socially patterned and social networks influence individuals' drinking behaviors. Previous studies have focused primarily upon the influence from family members to drink less. Those studies that have focused upon peer influence have been largely confined to social norms among adolescent and college-age drinkers. By contrast, based in adult populations, this article examines exhortations from friends not only to reduce alcohol consumption but also to increase it. Survey data in 15 countries that participate in the Gender, Alcohol and Culture: An International Study project (GENACIS) were used to test whether there were country and gender differences concerning the influence to drink less or to drink more by friends and examine if this was affected by the drinking behavior. The findings revealed that those influenced to drink less had more heavy episodic drinking (HED) occasions than those who did not report such influence. By contrast, influence to drink more, originating mainly from same-sex friends, may be more the result of social situations that encourage all drinkers, regardless of their frequency of HED occasions. At the country level, influence to drink less for both sexes decreased with the proportion of drinkers in a country. Similarly, influence to drink less for both sexes also decreased in countries where gender roles were more egalitarian. Thus, in countries where alcohol use is more widespread and fewer differences are observed between male and female gender role expectations, fewer people were influenced to drink less. These findings have implications for social and behavioral strategies designed to reduce alcohol-related harm across a wide range of cultures.

Incidence and risk factors for chronic elevation of alanine aminotransferase levels in HIV-infected persons without hepatitis b or c virus co-infection.

BACKGROUND: Chronic liver disease in human immunodeficiency virus (HIV)-infected patients is mostly caused by hepatitis virus co-infection. Other reasons for chronic alanine aminotransferase (ALT) elevation are more difficult to diagnose. METHODS: We studied the incidence of and risk factors for chronic elevation of ALT levels (greater than the upper limit of normal at 2 consecutive semi-annual visits) in participants of the Swiss HIV Cohort Study without hepatitis B virus (HBV) or hepatitis C virus (HCV) infection who were seen during the period 2002-2008. Poisson regression analysis was used. RESULTS: A total of 2365 participants were followed up for 9972 person-years (median age, 38 years; male sex, 66%; median CD4+ cell count, 426/microL; receipt of antiretroviral therapy [ART], 56%). A total of 385 participants (16%) developed chronic elevated ALT levels, with an incidence of 3.9 cases per 100 person-years (95% confidence interval [CI], 3.5-4.3 cases per 100 person-years). In multivariable analysis, chronic elevated ALT levels were associated with HIV RNA level >100,000 copies/mL (incidence rate ratio [IRR], 2.23; 95% CI, 1.45-3.43), increased body mass index (BMI, defined as weight in kilograms divided by the square of height in meters) (BMI of 25-29.9 was associated with an IRR of 1.56 [95% CI, 1.24-1.96]; a BMI 30 was associated with an IRR of 1.70 [95% CI, 1.16-2.51]), severe alcohol use (1.83 [1.19-2.80]), exposure to stavudine (IRR per year exposure, 1.12 [95% CI, 1.07-1.17]) and zidovudine (IRR per years of exposure, 1.04 [95% CI, 1.00-1.08]). Associations with cumulative exposure to combination ART, nucleoside reverse-transcriptase inhibitors, and unboosted protease inhibitors did not remain statistically significant after adjustment for exposure to stavudine. Black ethnicity was inversely correlated (IRR, 0.52 [95% CI, 0.33-0.82]). Treatment outcome and mortality did not differ between groups with and groups without elevated ALT levels. CONCLUSIONS: Among patients without hepatitis virus co-infection, the incidence of chronic elevated ALT levels was 3.9 cases per 100 person-years, which was associated with high HIV RNA levels, increased BMI, severe alcohol use, and prolonged stavudine and zidovudine exposure. Long-term follow-up is needed to assess whether chronic elevation of ALT levels will result in increased morbidity or mortality.

Soins intégrés: comment accompagner un changement de culture [Integrated care: how to support a culture change?].

The primary care center at Lausanne University Hospital trains residents to new models of integrated care. The future GPs discover new forms of collaboration with nurses, pharmacists or social workers. The collaboration model includes seeing patients together or delegating care to other providers, with the aim of improving the efficiency of a patient-centered care approach. The article includes examples of integrated care in consultation for travelers, victims of violence, pharmacist medication adherence counseling, medicosocial team work for alcohol use disorders and nurse practitioners' primary care for asylum seekers.

Protective behavioral strategies and future drinking behaviors: Effect of drinking intentions.

Alcohol use is common among United States and Swedish high school students and is related to negative consequences. Whereas drinking intentions are associated with future drinking behaviors, the use of protective behavioral strategies (PBS) is associated with decreased alcohol-related harm among young adults. The interactive effect of PBS and drinking intentions in predicting alcohol outcomes has not been examined. Further, because most PBS studies have been conducted among U.S. college students, PBS research among other populations is needed. The aims of this study were to evaluate longitudinally (a) the relationships between drinking intentions, PBS and alcohol outcomes, and (b) the moderating roles of drinking intentions and country in these relationships among United States and Swedish high school drinkers. Data were collected at baseline, 6- and 12-month follow-ups on 901 Swedish and 288 U.S. high school drinkers. Drinking intentions were associated with more alcohol use and consequences, and use of certain PBS was related to fewer alcohol-related consequences over time. Additionally, the negative prospective relationship between use of PBS and alcohol use, but not alcohol-related consequences, was moderated by intentions, such that the relationship was stronger among participants endorsing high drinking intentions. Country did not moderate these relationships. These results provide initial support for the generalizability of PBS college research to United States and Swedish high school students and suggest that interventions targeting the use of PBS may be most effective among high school drinkers endorsing high drinking intentions. (PsycINFO Database Record

The Strengths and Difficulties Questionnaire (SDQ-Fin) among Finnish children and adolescents

Objective: The psychometric properties of The Strengths and Difficulties Questionnaire (SDQ-Fin), a Finnish version of a brief screening instrument were studied. Emotional and behavioural problems of 7- to 15-year-olds measured by the SDQ were reported, as well as the occurrence of self-reported eating disturbance symptoms and alcohol use among adolescents. Methods and samples: The cross-sectional school survey included 25 items of the SDQ-Fin, items about eating disturbance, alchol use and child psychiatric help-seeking. The study consists of three community samples: 1. The SDQ-Fin parent (n = 703) and teacher (n = 376) versions of 7 – 12 –year-olds, and self-report versions (n = 528) of 11 – 16 years-olds were obtained, and 2. the parent (n = 81) and self-report versions of 15-16 –year olds (n = 129) were obtained in Laitila and Pyhäranta. 3. The self-report versions of 13 – 16 – year-olds (n = 1458) in Salo and Rovaniemi were obtained. Results: The psychometric properties of the SDQ-Fin were for the most part comparable with the other European SDQ research results. The internal consistency (Cronbach’s alpha = 0.71 in all informants’ reports) and inter-rater reliability (between the pairs of reports r = 0.38 - 0.44) were adequate. The concurrent validity (r = 0.75 between the SDQ and the CBCL total scores; r = 0.71 between the SDQ and the YSR total scores) was sufficient. Factor analysis of the SDQ self-report generally confirmed the postulated structure for girls and boys, except for the conduct problems scale of boys, which was fused with emotional symptoms and with hyperactivity. The response rates, means and cut-off points of the SDQ self-report scores were similar to those found, e.g. in Norway and in Britain. A high level of psychological problems, especially emotional and conduct problems and hyperactivity-inattention, were associated with high level of eating disturbance symptoms and alcohol use. Conclusion: The results showed that the psychometric properties of the SDQ-Fin are adequate and provide additional confirmation of the usefulness of the SDQ-Fin for, e.g. screening, epidemiological research and clinical purposes.

Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism.

Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism. Azorin JM, Bowden CL, Garay RP, Perugi G, Vieta E, Young AH. Source Department of Psychiatry, CHU Sainte Marguerite, Marseilles, France. Abstract About half of all bipolar patients have an alcohol abuse problem at some point of their lifetime. However, only one randomized, controlled trial of pharmacotherapy (valproate) in this patient population was published as of 2006. Therefore, we reviewed clinical trials in this indication of the last four years (using mood stabilizers, atypical antipsychotics, and other drugs). Priority was given to randomized trials, comparing drugs with placebo or active comparator. Published studies were found through systematic database search (PubMed, Scirus, EMBASE, Cochrane Library, Science Direct). In these last four years, the only randomized, clinically relevant study in bipolar patients with comorbid alcoholism is that of Brown and colleagues (2008) showing that quetiapine therapy decreased depressive symptoms in the early weeks of use, without modifying alcohol use. Several other open-label trials have been generally positive and support the efficacy and tolerability of agents from different classes in this patient population. Valproate efficacy to reduce excessive alcohol consumption in bipolar patients was confirmed and new controlled studies revealed its therapeutic benefit to prevent relapse in newly abstinent alcoholics and to improve alcohol hallucinosis. Topiramate deserves to be investigated in bipolar patients with comorbid alcoholism since this compound effectively improves physical health and quality of life of alcohol-dependent individuals. In conclusion, randomized, controlled research is still needed to provide guidelines for possible use of valproate and other agents in patients with a dual diagnosis of bipolar disorder and substance abuse or dependence.

Ohjauksen ja neuvonnan vaikutukset sepelvaltimoiden ohitusleikkauspotilaiden terveyskäyttäytymiseen, terveyteen ja toimintakykyyn

Effects of counseling and guidance on health behavior, health, and functional abilities of coronary artery bypass (cab) patients Hospital periods of heart patients are brief and full of activity today, and for that reason, the meaning of counseling and guidance becomes emphasized. The present intervention study started based on observations of staff members at the heart organization. According to these observations, there were gaps in counseling and guidance intended for coronary artery bypass (CAB) patients. The purpose of the present intervention study was to describe and evaluate the program on counseling and guidance organized for patients who were referred to CAB operations. More specifically, the study was to assess its short-term (3-month), intermediate (6-month), and long-term (12-month) effects on health behavior, health, and functional abilities of CAB patients of any age on one hand and elderly on the other, as well as on their mortality. The data consisted of those individuals having coronary heart disease (CHD) and living in Uusimaa (n = 365) who went through their first CAB operation at the Helsinki University Hospital between May 7th, 1998 and December 31st, 2001. Based on the need of urgency, they were divided into two groups: 1) surgery with regular referral procedure (non-acute) or 2) surgery in the acute phase of CHD. Randomization into an intervention and a control group was separately carried out within these two groups. A subgroup was formed by including those 65 years or older who were operated on with regular referral procedure. Data on health behavior, health, and functional abilities were gathered with survey questionnaires. Times and causes of death were examined January 1st, 1998 through December 31st, 2004. Intervention included counseling and guidance in small groups. The intervention of the non-acutely operated patients was implemented prior to and following surgery, whereas the intervention of the acutely operated patients was implemented after surgery alone. The control group received regular health care services. Counseling and guidance contributed in positive terms to the frequency of alcohol use among non-acutely operated men and to the frequencies of exercise and functional ability among women. The intervention was also capable of having an effect on the exercise frequencies of elderly and acutely operated men. The present intervention did not have an effect on the body mass index, whereas it had barely a slight effect on the health status of the CAB patients. The findings of the intervention and generalizations resulting from them must be viewed critically because the data analysis utilized a multi-testing situation, many variables, and several subgroups. The study did not involve intention to treat analysis. Additionally, a loss of patients was great especially among the elderly and acutely operated patients.

A Portuguese version of the Christo Inventory for Substance-Misuse Services: a simple outcome evaluation tool

The Christo Inventory for Substance-Misuse Services (CISS) is a single page outcome evaluation tool completed by drug alcohol service workers either on the basis of direct client interviews or of personal experience of their client supplemented by existing assessment notes. It was developed to assist substance misuse services to empirically demonstrate the effectiveness of their treatments to their respective funding bodies. Its 0 to 20 unidimensional scale consists of 10 items reflecting clients' problems with social functioning, general health, sexual/injecting risk behavior, psychological functioning, occupation, criminal involvement, drug/alcohol use, ongoing support, compliance, and working relationships. Good reliability and validity has already been demonstrated for the CISS [Christo et al., Drug and Alcohol Dependence 2000; 59: 189-197] but the original was written in English and a Portuguese version is presented here. The present review explores its applicability to a Brazilian setting, summarizes its characteristics and uses, and describes the process of translation to Portuguese. A pilot study conducted in a substance misuse service for adolescents indicated it is likely to be suitable for use among a Brazilian population. The simplicity, flexibility and brevity of the CISS make it a useful tool allowing comparison of clients within and between many different service settings.

Preliminary data on the prevalence of psychiatric disorders in Brazilian male and female juvenile delinquents

The aim of the present investigation was to study the prevalence of psychiatric disorders in a sample of delinquent adolescents of both genders and to compare the prevalence between genders. A total of 116 adolescents (99 males and 17 females) aged 12 to 19 on parole in the State of Rio de Janeiro were interviewed using the screening interview based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime (KSADS-PL). Data were collected between May 2002 and January 2003. Of 373 male and 58 female adolescents present in May 2002 in the largest institution that gives assistance to adolescents on parole in the city of Rio de Janeiro, 119 subjects were assessed (three of them refused to participate). Their average age was 16.5 years with no difference between genders. The screening interview was positive for psychopathology for most of the sample, with the frequencies of the suggested more prevalent psychiatric disorders being 54% for attention-deficit/hyperactivity disorder, 77% for conduct disorder, 41% for oppositional defiant disorder, 57% for anxiety disorder 57, 60% for depressive disorder 60, 63% for illicit drug abuse, and 58% for regular alcohol use. Internalizing disorders (depressive disorders, anxiety disorders and phobias) were more prevalent in the female subsample. There was no significant difference in the prevalence of illicit drug abuse between genders. There were more male than female adolescents on parole and failure to comply with the sentence was significantly more frequent in females. The high prevalence of psychopathology suggested by this study indicates the need for psychiatric treatment as part of the prevention of juvenile delinquency or as part of the sentence. However, treatment had never been available for 93% of the sample in this study.

High incidence of adverse reactions to initial antiretroviral therapy in Brazil

A concurrent prospective study was conducted from 2001 to 2003 to assess factors associated with adverse reactions among individuals initiating antiretroviral therapy at two public referral HIV/AIDS centers in Belo Horizonte, MG, Brazil. Adverse reactions were obtained from medical charts reviewed up to 12 months after the first antiretroviral prescription. Cox proportional hazard model was used to perform univariate and multivariate analyses. Relative hazards (RH) were estimated with 95% confidence intervals (CI). Among 397 charts reviewed, 377 (95.0%) had precise information on adverse reactions and initial antiretroviral treatment. Most patients received triple combination regimens including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors. At least one adverse reaction was recorded on 34.5% (N = 130) of the medical charts (0.17 adverse reactions/100 person-day), while nausea (14.5%) and vomiting (13.1%) were the most common ones. Variables independently associated with adverse reactions were: regimens with nevirapine (RH = 1.78; 95% CI = 1.07-2.96), indinavir or indinavir/ritonavir combinations (RH = 2.05; 95% CI = 1.15-3.64), female patients (RH = 1.93; 95% CI = 1.31-2.83), 5 or more outpatient visits (RH = 1.94; 95% CI = 1.25-3.01), non-adherence to antiretroviral therapy (RH = 2.38; 95% CI = 1.62-3.51), and a CD4+ count of 200 to 500 cells/mm³ (RH = 2.66; 95% CI = 1.19-5.90). An independent and negative association was also found for alcohol use (RH = 0.55; 95% CI = 0.33-0.90). Adverse reactions were substantial among participants initiating antiretroviral therapy. Specially elaborated protocols in HIV/AIDS referral centers may improve the diagnosis, management and prevention of adverse reactions, thus contributing to improving adherence to antiretroviral therapy among HIV-infected patients.

A comprehensive examination of adolescent gambling

The purposes of this study were: a) to examine the prevalence and consequences associated with adolescent gambling, b) to examine the factors which influence adolescent gambling,. c) to detennine what factors discriminate among four groups of gamblers (no-risk/non-gamblers, low-risk gamblers, at-risk gamblers, and high-risk/problematic gamblers), and d) to examine the relation of gambling to nine other risk behaviours (i.e., alcohol use, smoking, marijuana use, hard drug use, sexual activity, minor delinquency, major delinquency, direct aggression, and indirect aggression). Adolescents (N = 3,767) from 25 secondary schools completed a twohour survey that assessed involvement in risk be~aviours as well as potential predictors from a wide range of contexts (school, neighbourhood, family, peer, and intrapersonal). The majority of adolescents reported gambling, although the frequency of gambling participation was low. The strongest predictors/discriminators of gambling involvement were gender, unstructured activities, structured activities, and risk attitudes/perceptions. In addition, the examination of the co-occurrence of gambling with other risk behaviours revealed that for high-risk/problem gamblers, the top three most frequent co-occurring high-risk behaviours were direct aggression, minor delinquency and alcohol. This study was the first to examine the continuum of gambling involvement (i.e., non-gambling to high risk/problematic gambling) using a comprehensive set ofpotential predictors with a large sample of secondary school students. The findings of this study support past research and theories (e.g., Theory of Triadic Influence) which suggest the importance ofproximal variables in predicting risk behaviors. The next step, however, will be to examine the direct and indirect 1 effects of the ultimate (e.g., temperament), distal (e.g., parental relationship), and proximal variables (e.g., risk attitudes/perceptions) on gambling involvement in a longitudinal study.

Students' knowledge about tobacco one year after receiving the PAL smoking prevention program

A review of literature revealed that the control of cigarette smoking could do more to improve health than any other single action in the field of preventive medicine. In Ontario, since 1989, both Public Health Units and Boards ofEducations have been mandated to provide educational studies related to tobacco use prevention. Even given this fact, there has been an increase in smoking behaviQurs at an earlier age and in females in particular. Smoking prevention progralns must use the most effective means to assist students to obtain the knowledge and skills required to remain or becom'e nonsmokers. In the Niagara Region, PAL smoking prevention programs are offered in some, but not all, schools. As a form of program evaluation, this research sought to determine if students who had PAL could answer correctly a greater number of smoking-related questions than students who did not have this program. Findings reported that students who had PAL in Grade 6 were able to correctly answer more knowledge-based questions (at a statistically significant level), could provide ways to refuse cigarettes at a greater rate, and were able to provide more reasons for remaining nonsmokers. Students who had smoking prevention programming re,ported smoking behavio'urs at a lower rate than those who did not receive this type of program.

The influence of familial smoking behaviours on adolescent smoking behaviours

The ability to identify adolescents who are at risk for becoming smokers may prove useful in developing effective smoking prevention programs. The purpose of this stUdy was to assess the importance of familial smoking behaviours on adolescent smoking patterns. The results were based on responses to The Grade 7 Lincoln County Smoking Survey designed by Chudzik and Partington (1994), and are a part of the "Peer Assisted Learning Program· (PAL) presented by the Niagara Regional Health Services Department, with the cooperation of a local Board of Education (Region of Niagara). The results indicate that 12% of the total group of 450 Grade 7 student respondents were current smokers at the time the data were collected (13% males and 11% females), while more than 37% of individuals indicated that they had tried smoking previously. Of the individuals who were classified as smokers, 11% reported that they smoked because their parents smoked, but only 6% reported that they smoked because their siblings smoked. More concerning, however, is the finding that 4% of smokers reported that they felt pressured to smoke by their relatives. In a society that is becoming increasingly concerned about health, it is also alarming to observe that only 50% of the respondents within this sample reported that there were no smokers (parents/siblings) in their homes. The results also indicate that 33% percent of respondents had grandparents who continued to smoke, and 53% of respondents indentified other relatives who continued to smoke.

Self-reported health status and lifestyle behaviours of the residents of the Town of Fort Erie, Ontario, as related to the Canadian Community Health Survey

The purpose of this cross sectional survey design was to examine self-reported health status and lifestyle behaviours of the residents of the Town of Fort Erie, Ontario, as related to the Canadian Community Health Survey. Using a mail-out survey, entitled the Fort Erie Survey of Health (FESH), a probability cluster sampling technique was used to measure self-reported health status (present health, health conditions, health challenges, functional health limitations) and lifestyle behaviour (smoking, alcohol use, drug use, physical activity, fruit and vegetable consumption, body weight, and gaming). Each variable was described and analyzed in relation to socio-economic variables, age and gender. The findings from this study were compared to the Canadian Community Health Survey 2000/2001. Overall, 640 surveys were completed. The majority of Fort Erie residents rated their present health as good and were satisfied with their overall health and quality of life. The main chronic conditions reported were arthritis, back pain and heart disease. Other main health problems reported were vision, sleeping and chronic pain. Overall, 14.6% smoke; 58.8% engaged in physical activity either occasionally or never as opposed to regularly engaging in physical activity; 52.1% did not eat the required daily fruits and vegetables; and 40.0% were in the overweight category. Persons who practiced one healthy lifestyle behaviour were more likely to practice other healthy promoting behaviours. Therefore, health promotion programs are best designed to address multiple risk factors simultaneously. The ffiSH was generally consistent with the Canadian Community Health Survey in the overall findings. A small number of inconsistencies were identified that require further exploration to determine if they are unique to this community.

The impact of tobacco control policies on university students' smoking in Ontario

Objective. Despite steady declines in the prevalence of tobacco use among Canadians, young adult tobacco use has remained stubbornly high over the past two decades (CTUMS, 2005a). Currently in Ontario, young adults have the highest proportion of smokers of all age cohorts at 26%. A growing body of evidence shows that smoking restrictions and other tobacco control policies can reduce tobacco use and consumption among adults and deter initiation among youth; whether young adult university students' smoking participation is influenced by community smoking restrictions, campus tobacco control policies or both remains an empirical question. The purpose of this study is to examine the relationship among current smoking status of students on university campuses across Ontario and various tobacco control policies, 3including clean air bylaws of students' home towns, clean air by-laws of the community where the university is situated, and campus policies. Methods. Two data sets were used. The 200512006 Tobacco Use in a Representative Sample of Post-Secondary Students data set provides information about the tobacco use of 10,600 students from 23 universities and colleges across Ontario. Data screening for this study reduced the sample to 5,114 17-to-24 year old undergraduate students from nine universities. The second data set is researcher-generated and includes information about strength and duration of, and students' exposure to home town, local and campus tobacco control policies. Municipal by-laws (of students' home towns and university towns) were categorized as weak, moderate or strong based on criteria set out in the Ontario Municipal By-law Report; campus policies were categorized in a roughly parallel fashion. Durations of municipal and campus policies were calculated; and length of students' exposure to the policies was estimated (all in months). Multinomial logistic regression analyses were used to examine the relationship between students' current smoking status (daily, less-than-daily, never-smokers) and the following policy measures: strength of, duration of, and students' exposure to campus policy; strength of, duration of, and students' exposure to the by-law in the university town; and, strength of, duration of, and students' exposure to the by-law in the home town they grew up in. Sociodemographic variables were controlled for. Results. Among the Ontario university students surveyed, 7.0% currently use tobacco daily and 15.4% use tobacco less-than-daily. The proportions of students experiencing strong tobacco control policies in their home town, the community in which their university is located and at their current university were 33.9%,64.1 %, and 31.3% respectively. However, 13.7% of students attended a university that had a weak campus policy. Multinomial logistic regressions suggested current smoking status was associated with university town by-law strength, home town by-law strength and the strength of the campus tobacco control policy. In the fmal model, after controlling for sociodemographic factors, a strong by-law in the university town and a strong by-law in students' home town were associated with reduced odds of being both a less-than-daily (OR = 0.64, 95%CI: 0.48-0.86; OR = 0.80, 95%CI: 0.66-0.95) and daily smoker (OR = 0.59, 95%CI: 0.39-0.89; OR = 0.76, 95%CI: 0.58-0.99), while a weak campus tobacco control policy was associated with higher odds of being a daily smoker (OR = 2.08, 95%CI: 1.31-3.30) (but unrelated to less-than-daily smoking). Longer exposure to the municipal by-law (OR = 0.93; 95%CI: 0.90-0.96) was also related to smoking status. Conclusions. Students' smoking prevalence was associated with the strength of the restrictions in university, and with campus-specific tobacco control policies. Lessthan- daily smoking was not as strongly associated with policy measures as daily smoking was. University campuses may wish to adopt more progressive campus policies and support clean air restrictions in the broader community. More research is needed to determine the direction of influence between tobacco control policies and students' smoking.