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Clinical Toxicology (Philadelphia, Pa.) Jul 2017To review the evidence for "the Mellanby effect", that is, whether the response to a given blood alcohol concentration (BAC) is more marked when BAC is rising than at... (Review)
Review
OBJECTIVE
To review the evidence for "the Mellanby effect", that is, whether the response to a given blood alcohol concentration (BAC) is more marked when BAC is rising than at the same concentration when BAC is falling.
METHODS
We systematically searched the databases EMBASE, Medline, and Scopus up to and including December 2016 using text words "tolerance", "ascending", "descending" or "Mellanby" with Medline term "exp *alcohol/" or "exp *drinking behavior/" or equivalent. Articles were identified for further examination by title or abstract; full text articles were retained for analysis if they dealt with acute (within dose) alcohol tolerance in human subjects and provided quantitative data on both the ascending and descending parts of the BAC-time curve. Reference lists of identified works were scanned for other potentially relevant material. We extracted and analyzed data on the subjective and objective assessment of alcohol effects.
RESULTS
We identified and screened 386 unique articles, of which 127 full-text articles were assessed; one provided no qualitative results, 62 involved no human study, 25 did not consider acute tolerance within dose, and 13 failed to provide data on both ascending and descending BAC. We extracted data from the 26 remaining articles. The studies were highly heterogeneous. Most were small, examining a total of 770 subjects, of whom 564 received alcohol and were analyzed in groups of median size 10 (range 5-38), sometimes subdivided on the basis of drinking or family history. Subjects were often young white men. Doses of alcohol and rates of administration differed. Performance was assessed by at least 26 different methods, some of which measured many variables. We examined only results of studies which compared results for a given alcohol concentration (C) measured on the ascending limb (C) and the descending limb (C) of the BAC-time curve, whether in paired or parallel-group studies. When subjects were given alcohol in more than one session, we considered results from the first session only. Rating at C was better than at C for some measures, as expected if the Mellanby effect were operating. For example, subjects rated themselves less intoxicated on the descending limb than at the same concentration on the ascending limb in 12/13 trials including 229 subjects that gave statistically significant results. In 9 trials with a total of 139 subjects, mean difference could be calculated; weighted for study size, it was 29% [range 24-74%]. Willingness to drive was significantly greater in 4 of 6 studies including a total of 105 subjects; weighted mean difference increased by 207% [range 79-300%]. By contrast, measure of driving ability in three groups of a total of 200 trials in 57 subjects showed worse performance by a weighted mean of 96% [range 3-566%]. In three trials that tested inhibitory control (cued go or no-go response times), weighted mean performance was 30% [range 14-65%] worse on the descending limb.
CONCLUSIONS
The "Mellanby effect" has been demonstrated for subjective intoxication and willingness to drive, both of which are more affected at a stated ethanol concentration when BAC is rising than at the same concentration when BAC is falling. By contrast, objective measures of skills necessary for safe driving, such as response to inhibitory cues and skills measured on driving simulators, were generally worse on the descending part of the BAC-time curve for the same BAC.
Topics: Alcohol Drinking; Alcoholic Intoxication; Automobile Driving; Cues; Drug Tolerance; Ethanol; Humans; Inhibition, Psychological; Psychomotor Performance; Reaction Time
PubMed: 28277803
DOI: 10.1080/15563650.2017.1296576 -
Pharmacology, Biochemistry, and Behavior Jan 2018HIV sexual risk behavior is broadly associated with substance use. Yet critical questions remain regarding the potential causal link between substance use (e.g.,... (Review)
Review
HIV sexual risk behavior is broadly associated with substance use. Yet critical questions remain regarding the potential causal link between substance use (e.g., intoxication) and HIV sexual risk behavior. The present systematic review was designed to examine and synthesize the existing literature regarding the effects of substance administration on HIV sexual risk behavior. Randomized controlled experiments investigating substance administration and HIV sexual risk behavior (e.g., likelihood of condom use in a casual sex scenario) were included. Across five databases, 2750 titles/abstracts were examined and forty-three total peer reviewed published manuscripts qualified (few were multi-study manuscripts, and those details are outlined in the text). The majority of articles investigated the causal role of acute alcohol administration on HIV sexual risk behavior, although one article investigated the effects of acute THC administration, one the effects of acute cocaine administration, and two the effects of buspirone. The results of this review suggest a causal role in acute alcohol intoxication increasing HIV sexual risk decision-making. Although evidence is limited with other substances, cocaine administration also appears to increase sexual risk, while acute cannabis and buspirone maintenance may decrease sexual risk. In the case of alcohol intoxication, the pharmacological effects independently contribute to HIV sexual risk decision-making, and these effects are exacerbated by alcohol expectancies, increased arousal, and delay to condom availability. Comparisons across studies showed that cocaine led to greater self-reported sexual arousal than alcohol, potentially suggesting a different risk profile. HIV prevention measures should take these substance administration effects into account. Increasing the amount of freely and easily accessible condoms to the public may attenuate the influence of acute intoxication on HIV sexual risk decision-making.
Topics: Alcoholic Intoxication; Cocaine; Decision Making; Ethanol; HIV Infections; Humans; Risk-Taking; Unsafe Sex
PubMed: 28843425
DOI: 10.1016/j.pbb.2017.08.009 -
The Cochrane Database of Systematic... May 2011Alcohol misuse in young people is cause of concern for health services, policy makers, prevention workers, criminal justice system, youth workers, teachers, parents.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Alcohol misuse in young people is cause of concern for health services, policy makers, prevention workers, criminal justice system, youth workers, teachers, parents. This is one of three reviews examining the effectiveness of (1) school-based, (2) family-based, and (3) multi-component prevention programs.
OBJECTIVES
To review evidence on the effectiveness of universal school-based prevention programs in preventing alcohol misuse in school-aged children up to 18 years of age.
SEARCH STRATEGY
Relevant evidence (up to 2002) was selected from the previous Cochrane review. Later studies, to July 2010, were identified from MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Project CORK, and PsycINFO.
SELECTION CRITERIA
Randomized trials evaluating universal school-based prevention programs and reporting outcomes for alcohol use in students 18 years of age or younger were included. Two reviewers screened titles/abstracts and full text of identified records.
DATA COLLECTION AND ANALYSIS
Two reviewers extracted relevant data independently using an a priori defined extraction form. Risk of bias was assessed.
MAIN RESULTS
53 trials were included, most of which were cluster-randomised. The reporting quality of trials was poor, only 3.8% of them reporting adequate method of randomisation and program allocation concealment. Incomplete data was adequately addressed in 23% of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively.Six of the 11 trials evaluating alcohol-specific interventions showed some evidence of effectiveness compared to a standard curriculum. In 14 of the 39 trials evaluating generic interventions, the program interventions demonstrated significantly greater reductions in alcohol use either through a main or subgroup effect. Gender, baseline alcohol use, and ethnicity modified the effects of interventions. Results from the remaining 3 trials with interventions targeting cannabis, alcohol, and/or tobacco were inconsistent.
AUTHORS' CONCLUSIONS
This review identified studies that showed no effects of preventive interventions, as well as studies that demonstrated statistically significant effects. There was no easily discernible pattern in characteristics that would distinguish trials with positive results from those with no effects. Most commonly observed positive effects across programs were for drunkenness and binge drinking. Current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program, the Unplugged program, and the Good Behaviour Game. A stronger focus of future research on intervention program content and delivery context is warranted.
Topics: Adolescent; Alcohol Drinking; Alcoholic Intoxication; Central Nervous System Depressants; Child; Child, Preschool; Ethanol; Female; Humans; Male; Program Evaluation; Randomized Controlled Trials as Topic; School Health Services; Substance-Related Disorders
PubMed: 21563171
DOI: 10.1002/14651858.CD009113 -
European Geriatric Medicine Jun 2023Hypothermia is a serious condition in older adults. Knowledge of a priori chances of underlying diseases may affect initial management, hence prognosis. This systematic... (Review)
Review
PURPOSE
Hypothermia is a serious condition in older adults. Knowledge of a priori chances of underlying diseases may affect initial management, hence prognosis. This systematic review provided an overview of existing literature on the incidences of underlying causes of hypothermia in older patients at the emergency department.
METHODS
MEDLINE, The Cochrane Library, and Embase were searched up to February 1st, 2022. Inclusion criteria were age ≥ 65 years, emergency department setting, and body temperature < 36.0 degrees Celsius. Exclusion criteria were iatrogenic hypothermia, no underlying cause reported, and patient selection based on specific diseases. Title/abstract and full-text were screened and quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Data were presented using descriptive statistics and narrative analyses.
RESULTS
Forty-one reports were included, including 6 cohort studies and 35 case reports. The 6 studies involved 2173 hypothermic patients, whose age varied from a mean of 67 to a median of 79 years and temperature from a median of 30.8 to a mean of 33.7 degrees Celsius. One study reported about primary hypothermia (incidence of 44%). Acute medical illness was often reported as underlying cause of secondary hypothermia (49-51%). Reported incidences of infection and sepsis ranged from 10 to 32%, of trauma up to 14%, and of alcohol intoxication from 5 to 26%.
CONCLUSION
Limited studies have been published regarding this topic, and the overall quality of the evidence was graded as low. Causes that should not be missed include acute medical illness, trauma, alcohol intoxication, primary hypothermia, thyroid failure, and drug-induced hypothermia.
Topics: Humans; Aged; Hypothermia; Incidence; Alcoholic Intoxication; Emergency Service, Hospital; Hypothermia, Induced
PubMed: 37191873
DOI: 10.1007/s41999-023-00791-0 -
Journal of Studies on Alcohol and Drugs Mar 2016Previous meta-analyses of cohort studies indicate a J-shaped relationship between alcohol consumption and allcause mortality, with reduced risk for low-volume drinkers.... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Previous meta-analyses of cohort studies indicate a J-shaped relationship between alcohol consumption and allcause mortality, with reduced risk for low-volume drinkers. However, low-volume drinkers may appear healthy only because the "abstainers" with whom they are compared are biased toward ill health. The purpose of this study was to determine whether misclassifying former and occasional drinkers as abstainers and other potentially confounding study characteristics underlie observed positive health outcomes for lowvolume drinkers in prospective studies of all-cause mortality.
METHOD
A systematic review and meta-regression analysis of studies investigating alcohol use and mortality risk after controlling for quality-related study characteristics was conducted in a population of 3,998,626 individuals, among whom 367,103 deaths were recorded.
RESULTS
Without adjustment, meta-analysis of all 87 included studies replicated the classic J-shaped curve, with low-volume drinkers (1.3-24.9 g ethanol per day) having reduced mortality risk (RR = 0.86, 95% CI [0.83, 0.90]). Occasional drinkers (<1.3 g per day) had similar mortality risk (RR = 0.84, 95% CI [0.79, 0.89]), and former drinkers had elevated risk (RR = 1.22, 95% CI [1.14, 1.31]). After adjustment for abstainer biases and quality-related study characteristics, no significant reduction in mortality risk was observed for low-volume drinkers (RR = 0.97, 95% CI [0.88, 1.07]). Analyses of higher-quality bias-free studies also failed to find reduced mortality risk for low-volume alcohol drinkers. Risk estimates for occasional drinkers were similar to those for low- and medium-volume drinkers.
CONCLUSIONS
Estimates of mortality risk from alcohol are significantly altered by study design and characteristics. Meta-analyses adjusting for these factors find that low-volume alcohol consumption has no net mortality benefit compared with lifetime abstention or occasional drinking. These findings have implications for public policy, the formulation of low-risk drinking guidelines, and future research on alcohol and health.
Topics: Alcohol Abstinence; Alcohol Drinking; Alcoholic Intoxication; Alcoholism; Bias; Cause of Death; Female; Humans; Male; Mortality; Prospective Studies; Risk Factors
PubMed: 26997174
DOI: 10.15288/jsad.2016.77.185 -
International Journal of Environmental... Feb 2023Although varenicline has been used for alcohol dependence (AD) treatment, its efficacy for this condition remains controversial. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although varenicline has been used for alcohol dependence (AD) treatment, its efficacy for this condition remains controversial.
AIMS
This systematic review and meta-analysis of randomized controlled trials (RCTs) assesses the efficacy and safety of varenicline in patients with AD.
METHODS
PubMed, Cochrane Library, ScienceDirect, Web of Science, and ThaiLis were systematically searched. RCTs investigating the efficacy and safety of varenicline in patients with AD were included. Study selection, data extraction, and quality assessment were independently performed by two authors. The Jadad score and Cochrane risk of bias were used to assess the quality of the included studies. Heterogeneity was assessed using I and chi-squared tests.
RESULTS
Twenty-two high-quality RCTs on 1421 participants were included. Varenicline significantly reduced alcohol-related outcomes compared with placebo based on percentage of abstinent days (standardized mean difference [SMD] 4.20 days; 95% confidence interval [CI]: 0.21, 8.19; = 0.04), drinks per day (SMD -0.23 drinks; 95% CI: -0.43, -0.04; = 0.02), drinks per drinking day (SMD -0.24 drinks; 95% CI: -0.44, -0.05; = 0.01), craving assessed using the Penn alcohol craving scale (SMD -0.35; 95% CI: -0.59, -0.12; = 0.003), and craving assessed using the alcohol urge questionnaire (SMD -1.41; 95% CI: -2.12, -0.71; < 0.0001). However, there were no significant effects on abstinence rate, percentage of drinking days, percentage of heavy drinking days, alcohol intoxication, or drug compliance. Serious side effects were not observed in the varenicline or placebo groups.
CONCLUSION
Our results indicated that AD patients treated with varenicline showed improvement in percentage of very heavy drinking days, percentage of abstinent days, drinks per day, drinks per drinking day, and craving. However, well-designed RCTs with a large sample size and long duration on varenicline treatment in AD remain warranted to confirm our findings.
Topics: Humans; Alcoholic Intoxication; Alcoholism; Craving; Ethanol; Varenicline; Randomized Controlled Trials as Topic
PubMed: 36901103
DOI: 10.3390/ijerph20054091 -
The Cochrane Database of Systematic... Sep 2011Alcohol misuse is a cause of concern for health services, policy makers, prevention workers, the criminal justice system, youth workers, teachers and parents. (Review)
Review
BACKGROUND
Alcohol misuse is a cause of concern for health services, policy makers, prevention workers, the criminal justice system, youth workers, teachers and parents.
OBJECTIVES
1. To identify and summarize rigorous evaluations of psychosocial and educational interventions aimed at the primary prevention of alcohol misuse by young people. 2. To assess the effectiveness of primary prevention interventions over the longer-term (> 3 years).
SEARCH STRATEGY
Databases searched (no time limits): Project CORK, BIDS, PSYCLIT, ERIC, ASSIA, MEDLINE, FAMILY-RESOURCES-DATABASE, HEALTH-PERIODICALS-DATABASE, EMBASE, BIDS, Dissertation-Abstracts, SIGLE, DRUG-INFO, SOMED, Social-Work-Abstracts, National-Clearinghouse-on-Alcohol-and-Drug-Information, Mental-Health-Abstracts, DRUG-database, ETOH (all searched Feb-June 2002).
SELECTION CRITERIA
1. randomised controlled and non-randomised controlled and interrupted time series designs. 2. educational and psychosocial primary prevention interventions for young people up to 25 years old. 3. alcohol-specific or generic (drugs; lifestyle) interventions providing alcohol outcomes reported. 4. alcohol outcomes: alcohol use, age of alcohol initiation, drinking 5+ drinks on any one occasion, drunkeness, alcohol related violence, alcohol related crime, alcohol related risky behaviour.
DATA COLLECTION AND ANALYSIS
Stage 1: All papers screened by one reviewer against inclusion criteria. Stage 2: For those papers that passed Stage 1, key information was extracted from each paper by 2-3 reviewers.
MAIN RESULTS
20 of the 56 studies included showed evidence of ineffectiveness. No firm conclusions about the effectiveness of prevention interventions in the short- and medium-term were possible. Over the longer-term, the Strengthening Families Program (SFP) showed promise as an effective prevention intervention. The Number Needed to Treat (NNT) for the SFP over 4 years for three alcohol initiation behaviours (alcohol use, alcohol use without permission and first drunkeness) was 9 (for all three behaviours). One study also highlighted the potential value of culturally focused skills training over the longer-term (NNT=17 over three-and-a-half years for 4+ drinks in the last week).
AUTHORS' CONCLUSIONS
1. Research into important outcome variables needs to be undertaken. 2. Methodology of evaluations needs to be improved. 3. The Strengthening Families Programme needs to be evaluated on a larger scale and in different settings. 4. Culturally-focused interventions require further development and rigorous evaluation. 5. An international register of alcohol and drug misuse prevention interventions should be established and criteria agreed for rating prevention intervention in terms of safety, efficacy and effectiveness.
Topics: Adolescent; Adult; Alcohol Drinking; Alcoholic Intoxication; Child; Family; Humans
PubMed: 21901682
DOI: 10.1002/14651858.CD003024.pub2 -
Drug and Alcohol Dependence Jul 2010Alcohol consumption causes injury in a dose-response manner. The most common mode of sustaining an alcohol-attributable injury is from a single occasion of acute alcohol... (Review)
Review
Alcohol consumption causes injury in a dose-response manner. The most common mode of sustaining an alcohol-attributable injury is from a single occasion of acute alcohol consumption, but much of the injury literature employs usual consumption habits to assess risk instead. An analysis of the acute dose-response relationship between alcohol and injury is warranted to generate single occasion- and dose-specific relative risks. A systematic literature review and meta-analysis was conducted to fill this gap. Linear and best-fit first-order model were used to model the data. Usual tests of heterogeneity and publication bias were run. Separate meta-analyses were run for motor vehicle and non-motor vehicle injuries, as well as case-control and case-crossover studies. The risk of injury increases non-linearly with increasing alcohol consumption. For motor vehicle accidents, the odds ratio increases by 1.24 (95% CI: 1.18-1.31) per 10-g in pure alcohol increase to 52.0 (95% CI: 34.50-78.28) at 120 g. For non-motor vehicle injury, the OR increases by 1.30 (95% CI: 1.26-1.34) to an OR of 24.2 at 140 g (95% CI: 16.2-36.2). Case-crossover studies of non-MVA injury result in overall higher risks than case-control studies and the per-drink increase in odds of injury was highest for intentional injury, at 1.38 (95% CI: 1.22-1.55). Efforts to reduce drinking both on an individual level and a population level are important. No level of consumption is safe when driving and less than 2 drinks per occasion should be encouraged to reduce the risk of injury.
Topics: Accidents, Traffic; Alcohol Drinking; Alcoholic Intoxication; Case-Control Studies; Cross-Over Studies; Data Interpretation, Statistical; Dose-Response Relationship, Drug; Humans; Odds Ratio; Publication Bias; Research Design; Risk; Wounds and Injuries
PubMed: 20236774
DOI: 10.1016/j.drugalcdep.2010.02.011 -
BMC Public Health Feb 2016Alcohol is a leading cause of global suffering. Europe reports the uppermost volume of alcohol consumption in the world, with Ireland and the United Kingdom reporting... (Review)
Review
BACKGROUND
Alcohol is a leading cause of global suffering. Europe reports the uppermost volume of alcohol consumption in the world, with Ireland and the United Kingdom reporting the highest levels of binge drinking and drunkenness. Levels of consumption are elevated among university students. Thus, this literature review aims to summarise the current research on alcohol consumption among university students in the Republic of Ireland and the United Kingdom.
METHODS
MEDLINE, CINAHL, EMBASE and PsychInfo were systematically searched for literature from January 2002 until December 2014. Each database was searched using the following search pillars: alcohol, university student, Ireland or the United Kingdom and prevalence studies.
RESULTS
Two thousand one hundred twenty eight articles were retrieved from electronic database searching. These were title searched for relevance. 113 full texts were retrieved and assessed for eligibility. Of these, 29 articles were deemed to meet inclusion criteria for the review. Almost two thirds of students reported a hazardous alcohol consumption score on the AUDIT scale. Over 20% reported alcohol problems over their lifetime using CAGE while over 20% exceed sensible limits each week. Noteworthy is the narrowing of the gender gap throughout the past decade.
CONCLUSION
This is the first review to investigate consumption patterns of university students in Ireland and the United Kingdom. A range of sampling strategies and screening tools are employed in alcohol research which preclude comparability. The current review provides an overview of consumption patterns to guide policy development.
Topics: Alcohol Drinking in College; Alcoholic Intoxication; Alcoholism; Binge Drinking; Cross-Sectional Studies; Humans; Ireland; Substance-Related Disorders; United Kingdom
PubMed: 26895824
DOI: 10.1186/s12889-016-2843-1 -
Addictive Behaviors Nov 2015College students' 21st birthday celebrations often involve consumption of extreme amounts of alcohol as well as alcohol-related risks. This systematic review aims to... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
College students' 21st birthday celebrations often involve consumption of extreme amounts of alcohol as well as alcohol-related risks. This systematic review aims to determine whether birthday-focused, individually-targeted, no-contact (email or letter-based) brief alcohol interventions (BAIs) reduce college students' 21st birthday celebratory drinking.
METHODS
A systematic search identified 9 randomized evaluations with 10 interventions to reduce 21st birthday drinking. Quantity of alcohol consumed and estimated blood alcohol concentration (BAC) were measured. Random-effects meta-analysis was used to summarize the effects of the interventions.
RESULTS
There was no evidence that birthday-focused BAIs reduce quantities of alcohol consumed during birthday celebrations (g = 0.05, 95% CI [-0.03 to 0.13]). The interventions were associated with significant reductions in estimated BAC levels (g = 0.20, 95% CI [0.07 to 0.33]), but this effect was small in absolute terms. The quality of this body of evidence was very low, as evaluated using the GRADE approach. In particular, it was limited by substantial participant attrition post-randomization due to included studies' recruitment and randomization procedures.
CONCLUSIONS
There is no evidence that birthday-focused, individually-targeted BAIs reduce the quantity of alcohol consumed by students during 21st birthday celebrations, although these interventions may yield small beneficial effects on estimated BAC. Many methodological concerns were identified in included studies. This area of research would benefit from theory-based RCTs that are well-designed and executed. Future research should also investigate strategies other than birthday-focused, individually-targeted, brief interventions to curb 21st birthday celebratory drinking.
Topics: Alcohol Drinking in College; Alcoholic Intoxication; Anniversaries and Special Events; Correspondence as Topic; Electronic Mail; Female; Humans; Male; Social Environment; Students; Young Adult
PubMed: 26093502
DOI: 10.1016/j.addbeh.2015.06.001