Alcohol use disorders in French hospital patients

Alcohol use disorder and alcohol withdrawal syndrome in Vietnamese hospitalized patients

AIMS

To identify the extent to which patients admitted to a general hospital in Vietnam meet the criteria for risky alcohol drinking, alcohol use disorder (AUD), and alcohol withdrawal syndrome (AWS), describe problems and behavior of alcohol use such as types and quantity of alcohol drinking in a hospitalized population in Vietnam, and investigate the association among age, disease-related factors, and alcohol consumption with AWS.

METHODS

This study was conducted prospectively in 1340 patients admitted to a general hospital. All patients were screened for risky alcohol drinking. Risky alcohol drinkers were assessed by using the Alcohol Use Disorder Identification Test (AUDIT) to identify AUD patients. The diagnosis of AWS was based on criteria defined by Diagnostic and Statistical Manual of Mental Disorders, version 5. The AWS scale was used to quantitate AWS severity level.

RESULTS

Prevalence of risky alcohol drinkers, AUD patients, and AWS patients among hospitalized patients was 15.5%, 13.1%, and 7.3%, respectively. All of the AUD and AWS patients were male. The majority of risky alcohol drinkers, patients with AUD, and patients with AWS were 40-60-year-old men. Almost all patients (98.3%) drank homemade alcohol. Hospitalized patients were more likely to develop AWS if they had liver disease or past experience with AWS.

CONCLUSIONS

AUD and AWS are common in hospitalized patients. Formulating a protocol to identify and care for patients with alcohol-related disorders is urgent.

[Consumption of alcohol and tobacco remain high in hospital population]

BACKGROUND

Consumption of alcohol and tobacco are influenced by many factors that require regular epidemiological assessments. As such, the study of a hospital population seems all the more relevant it can help to better identify patients at risk and tailor addiction interventions.

OBJECTIVES

Determine the prevalence of risky alcohol use and tobacco use among hospitalized patients in order to propose to the scale of a General Hospital (CHG), algorithms of interventions with these patients. The secondary objective was the analysis socio-demographic determinants of these patients.

METHODS

A descriptive study on any given day was done. Regarding tobacco use, patients were classified as "smoking", "no smoking" and "ex smoker". Regarding alcohol consumption, test DETA and AUDIT Court were able to classify patients into "consumer risk", "user without risk" and "non user".

RESULTS

Hence, 20.5% of patients reported smoking and 23% of patients were classified as having a risky alcohol use.

CONCLUSION

Given the importance of prevalence, it appears necessary to improve activity-tracking consumption of tobacco and alcohol at the hospital. To this end, we propose decision algorithms to better differentiate what is a matter of allowing the patient service (tracking and consultants), which may fall to a strategy of specialized care.

[Feasibility of systematic screening for addictive behaviours of hospitalized patients]

BACKGROUND

The national policy against addiction led to the establishment of specialized units with liaison teams trained in addiction specifically to work with the in-patients. The aim of this study has been established within the context of the implementation of one of these addiction liaison units in a Parisian Hospital, the Georges Pompidou European Hospital (HEGP), that is namely to evaluate the feasibility of a systematic screening procedure concerning tobacco and alcohol dependence among inpatients in two of the hospital's specialization departments between December 6, 2001, and March 6, 2002.

METHODS

Self-administered questionnaires on addictive behaviours were distributed to each patient admitted to the vascular health department and to the hypertension department They included the Fagerström Test for Nicotine Dependence and the AUDIT for evaluating levels of alcohol abuse.

RESULTS

The response rate was 30.2% (110/364). Twenty-nine smokers were identified. Among them, 72.5% presented a low level of physical nicotine dependence. Nearly half of them (14/29) were not interested in participating in a smoking cessation intervention with the assistance of relevant hospital staff. Among eleven patients at risk of excessive alcohol abuse, only one accepted to be referred to a specialist.

CONCLUSION

This study highlights the difficulties of the systematic screening for addictive behaviours in hospitalized patients. Nevertheless, the obstacles faced in terms of the acceptability of the screening, but the patients as well as by the hospital staff, do not lean against the development of this trend or oppose this type of approach. New methods of individual screening for addictive behaviours should be explored.

Alcohol abuse and dependence in elderly emergency department patients

Although elderly people are particularly vulnerable to the adverse effects of alcohol, alcohol use disorders in late life have received relatively little attention in the literature. Our objectives were to assess the prevalence of alcohol use disorders (abuse and dependence), the medical profile and psychosocial characteristics in elderly people visiting emergency department (ED). A cohort of 2405 patients aged over 60 who came to the ED of a university hospital during a 3-month period was studied. Alcohol use disorder diagnosis (DSM-IV), medical profile and social characteristics were collected from retrospective review of patient files. The data derived from 128 patients (mean age, 69.8+/-6.8 years; 87% males) with alcohol use disorders and 128 non-alcoholic controls. The prevalence of current alcohol use disorder was 5.3%. The most common current alcohol-induced disorders were alcohol intoxication and alcohol-induced mood disorder. Social factors associated with alcohol use disorders were being homeless, living alone, being divorced and never married. Falls and delirium were frequent ED admission circumstances in elderly drinkers. Drinkers more commonly presented with gastrointestinal disorders. In conclusion, alcohol use disorders among older patients admitted in ED are common and occur more frequently among men. Falls and delirium are the main ED admission circumstances in elderly drinkers. Alcohol use disorders are also associated with gastrointestinal problems.

Questionnaires are better than laboratory tests to screen for current alcohol abuse or dependence in a male inpatient population

OBJECTIVE

To assess the diagnostic performance of the CAGE and AUDIT (Alcohol Use Disorder Identification Test) and its derivatives, and laboratory tests for screening alcohol abuse or dependence in a male medical hospital population.

DESIGN

A diagnostic cross-sectional prevalence study.

SETTING

Three general hospitals and one university hospital.

PATIENTS

All male patients older than 18 years admitted to the hospitals, during a period of 6 weeks, were consecutively included in the study (N = 233).

MEASUREMENTS

Calculation of diagnostic measurements with 95% CI and ROC curves for different scores of CAGE, AUDIT and derivatives, laboratory tests and % Carbohydrate Deficient Transferrin (CDT), using DSM-III-R as the reference standard, derived from the CIDI.

RESULTS

A current diagnosis of alcohol abuse or dependence was found in 29 medical male inpatients, representing 12.4% (95% CI: 8.6-17.5). Ten of these (4.2%) fulfilled criteria of alcohol abuse and 19 (8.2%) the criteria of alcohol dependence. Laboratory tests are useless as screening tools with sensitivities between 10% (%CDT) and 52% (GammaGT). Only the Fiveshot questionnaire seems to yield reasonable diagnostic parameters at the recommended cutpoint of > or = 2.5 with a sensitivity of 79.3% and a specificity of 87.7%.

CONCLUSIONS

With a prevalence of 12.4%, our results are similar with other published studies for alcohol abuse and dependence according DSM criteria. The AUDIT as well as the Fiveshot seems to have the best diagnostic properties in this male medical inpatient population, and regarding to brief interventions, these questionnaires can be used as screening instruments as well as opportunities to talk about alcohol problems with admitted patients.

Moderate alcohol consumption and adverse drug reactions among older adults

PURPOSE

To assess the effect of moderate alcohol consumption on Adverse Drug Reactions (ADRs) among older adults admitted to acute care hospitals and to examine the consistency of this effect across gender and age groups.

METHODS

We used the GIFA (Italian Group of Pharmacoepidemiology in the Elderly) database, which includes information on patients admitted to 81 medical centers in Italy. For this study we examined exclusively the ADRs detected at hospital admission that were classified as definite or probable based on the Naranjo algorithm.

RESULTS

Among 22,778 participants, 894 were found to have one or more ADRs (3.9%). Gastrointestinal complications (n = 210; 0.9% of the population) were the most frequent ADRs, followed by metabolic/endocrine (n = 156; 0.7%), dermatological/allergic (n = 102; 0.4%) and arrhythmic (n = 78; 0.3%) complications. Diuretics were the most frequent culprit drugs, followed by NSAIDs and digoxin. An ADR was recorded in 383/10,427 (3.7%) non-drinkers and in 511/12,351 (4.1%) moderate drinkers. After adjusting for potential confounders, moderate alcohol consumption was associated with a 24% increased risk of ADRs (OR 1.24; 95%CI: 1.08-1.43). This effect seemed more evident among women (OR 1.30; 95%CI: 1.09-1.55), than men (OR 1.14; 95%CI: 0.90-1.43), while it was similar across different age groups (< 65 years OR 1.28; 95%CI: 0.99-1.66; 65-79 years OR 1.22; 95%CI: 0.98-1.52; > or = 80 years OR 1.20; 95%CI: 0.93-1.56). Considering the most common ADRs, moderate alcohol users presented a significantly higher risk of drug-related headache (OR 3.89; 95%CI: 1.43-10.61) and metabolic/endocrine complications (OR 1.67; 95%CI: 1.19-2.33).

CONCLUSIONS

Moderate alcohol intake is associated with an increased risk of ADRs; this effect seems more evident among women than men, and it does not differ across age groups.