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J B Saunders

Publications and source records attributed to J B Saunders.

At least 55 records · Page 3Linked to original sources
PubMed1993

Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II.

The Alcohol Use Disorders Identification Test (AUDIT) has been developed from a six-country WHO collaborative project as a screening instrument for hazardous and harmful alcohol consumption. It is a 10-item questionnaire which covers the domains of alcohol consumption, drinking behaviour, and alcohol-related problems. Questions were selected from a 150-item assessment schedule (which was administered to 1888 persons attending representative primary health care facilities) on the basis of their representativeness for these conceptual domains and their perceived usefulness for intervention. Responses to each question are scored from 0 to 4, giving a maximum possible score of 40. Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non-hazardous consumption had a score of less than 8. AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross-national study.

Alcoholism↗
PubMed1993

Factors associated with heroin users' AIDS risk-taking behaviours.

A survey was undertaken in Sydney in 1989 to identify factors associated with behaviour involving risk for human immunodeficiency virus infection. Self-report data on needle-sharing and sexual practices were collected from 91 heroin users entering a residential, drug-free detoxification unit. Data were analysed using polytomous and ordinal logistic regressions. Heroin-dependent subjects who also had a current alcohol problem were significantly more likely than others to report high risk needle-sharing behaviour. Subjects with more than one sexual partner in the last three months were significantly more likely to use condoms while those with a current benzodiazepine problem were significantly less likely to use condoms. Qualitative data suggest that high risk needle-sharing behaviour most often occurred around the time of relapse to injecting drug use and among homeless drug users occupying derelict buildings in inner-city suburbs.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Prediction of alcohol-related harm by laboratory test results.

We examined the value of laboratory markers of excessive alcohol (ethanol) intake as predictors of mortality, morbidity, and health-care utilization in a cohort of 330 patients attending an acute ambulatory care service. Among men, all four markers examined--gamma-glutamyltransferase (GGT) and aspartate aminotransferase (AST) activities, high-density lipoprotein cholesterol (HDL-C), and mean corpuscular volume (MCV)--were predictive of medical sequelae and health-care utilization over a 3-year period. In contrast, social problems were more closely related to the amount of alcohol consumption at initial assessment than to any biological marker. Serum GGT and AST activities and MCV were predictive of medical sequelae in women. The predictive value of GGT was an independent risk factor and did not merely reflect recent alcohol intake or the presence of chronic liver disease. We conclude that these readily available laboratory tests provide important prognostic information and should be an integral part of the assessment of persons with hazardous alcohol consumption.

Alcoholism↗
PubMed1992

Brief and early intervention: experience from studies of harmful drinking.

Brief and early interventions represent an innovative strategy for the prevention of harm from alcohol and other drugs. The pioneering study of early intervention, undertaken by Kristenson et al. (1983) as part of a preventive medicine programme, demonstrated the efficacy of this approach for problem drinking. Subsequent studies have confirmed these findings. Brief and early interventions have been shown to be effective in a wide range of health care settings, including hospital wards and outpatient clinics, general practice, private health screening facilities and community-based health screening programmes. What is required now is the ascertainment of the most effective settings for brief and early interventions and the incentives needed for incorporation into routine practice.

Alcohol Drinking↗
PubMed1992

Meaning of craving in research on addiction.

The meaning of the word craving varies as illustrated by Kozlowski and Wilkinson's reports of ambiguities in use amongst cigarette smokers. We extended this line of investigation to problem drinkers who sought a goal of controlled drinking versus abstinence, to professionals involved in the addictions area, and to university students. Significant differences in meaning were noted particularly among the problem drinkers (N = 256 between 17 and 60 years of age). Reasons for this are offered.

Adolescent↗
PubMed1991

Problem drinking in emergency department patients: the scope for early intervention.

OBJECTIVE: To determine the prevalence of previously undiagnosed problem drinking and thereby to assess the suitability of the emergency department for early intervention. DESIGN: Three hundred and fifty ambulatory care patients were assessed by means of a structured interview schedule, physical examination and blood tests. Alcohol intake and presence of alcohol-related problems were recorded, along with history of past advice on drinking and self-perception of an alcohol problem. SETTING: The ambulatory care section of the emergency department of Royal Prince Alfred Hospital, Sydney. PATIENTS: Three hundred and fifty subjects, aged between 18 and 55 years, were sequentially selected over an 18-month period. RESULTS: Forty-one per cent of subjects (95% confidence interval, 36%-46%), 50% of men and 26% of women, were classified as problem drinkers on the basis of hazardous or harmful levels of alcohol consumption, frequent drinking to intoxication, evidence of dependence, or experience of alcohol-related problems. Of these, 63% had not previously received advice on drinking from a health professional and only 28% perceived they had a problem. Of particular note was that 24% of men and 4% of women were drinking 12 or more drinks (120 g of alcohol or more) in a single session on a weekly or more frequent basis. CONCLUSIONS: Many of the problem drinkers attending the emergency department have not previously received advice about their drinking from a health professional. The emergency department therefore offers considerable potential as a site for early detection and intervention in patients with hazardous and harmful alcohol use and related disorders.

Adult↗
PubMed1991

Medical education in substance use disorders.

This paper outlines recent developments in drug and alcohol medical education, and highlights improved prospects for prevention and appropriate management of substance use disorders. The paper also presents a model of effective drug and alcohol medical education designed to induce both clinical competence and effective practice behaviour. Of particular note is the trend towards greater emphasis on skills development, especially clinical interaction skills. This emphasis is underpinned by an increasingly behavioural orientation, whereby concern is focused on fostering clinical competence in specific skills, e.g. identification, history taking and interventions. Practical examples of the application of such approaches are noted. In addition, relevance of concepts, such as self-efficacy and role legitimacy, to the area of drug and alcohol medical education is highlighted. Together with recent data on early intervention, and the widespread recognition and support for medical practitioners' involvement in drug and alcohol problems, future prospects are viewed as very encouraging.

Journal Article↗
PubMed1991

General practitioners' experiences of patients with drug and alcohol problems.

Convergent focus groups, a qualitative research methodology, were used to determine what general practitioners considered to be the main obstacles and disincentives to the effective management of persons with drug and alcohol problems. Seven groups were conducted, involving 44 general practitioners whose practices were based in representative parts of metropolitan Sydney and a rural area of New South Wales. The study revealed that most doctors are not as threatened, resistant or pessimistic about drug and alcohol intervention as much of the previous work in the area would suggest. However, they held different views according to the drug in question. General practitioners were more sympathetic to patients with alcohol problems but only some agreed that it was a legitimate area for medical involvement and one in which they were prepared to become involved. The prescribing and use of minor tranquillisers was widely tolerated and perceived to present few problems for individuals or the community. Opiate users, by contrast, were least favoured, with hostility expressed by most towards them. A provisional typology of general practitioners was developed with three distinct groupings ('interactive problem-solvers', 'traditionalist healers' and 'technologists'), according to the model of medical practice assumed. This scheme, whilst not definitive, provides a structure for targeting general practitioners for medical education and has implications for tailoring medical training programs at both the undergraduate and postgraduate levels. General issues relating to the development of typologies are discussed.

Adult↗
PubMed1990

Early identification of alcohol problems.

A high proportion of patients seen in clinical practice have an underlying alcohol problem. This is often difficult to detect, but failure to make the diagnosis may result in unnecessary investigations and inappropriate treatment. Furthermore, there is now good evidence of the effectiveness of brief intervention for problem drinking when it is still at an early stage. Several questionnaires and procedures based on clinical examination findings and laboratory tests are available to help in early diagnosis. They can be incorporated into the standard medical assessment and form the basis for screening programs for health risk factors.

Alcoholism↗
PubMed1989

Treatment of alcoholic liver disease.

With advances in our understanding of the pathophysiology of alcoholic liver disease, pharmacological treatments of some of the basic disease processes are now in sight. The most notable development has been the introduction of propylthiouracil for the treatment of alcoholic hepatitis. In a recent trial the mortality rate of patients treated with this drug was 62% lower than that of a control group. Its beneficial effects may stem not from its anti-thyroid properties but rather from other actions such as free radical scavenging. Corticosteroids now appear to have no place in the treatment of alcoholic liver disease. Anabolic steroids, however, show promise, though longer term trials are required before this can be confirmed. Colchicine, too, has been reported to improve survival in patients with established cirrhosis. More experience is required with this and other anti-inflammatory and anti-fibrogenic drugs. beta Adrenergic blocking drugs, such as propranolol, reduce portal venous pressure. In a trial among patients with alcoholic cirrhosis who had oesophageal varices, 39% of those receiving propranolol had not experienced a haemorrhage by 2 years compared with 74% in the control group. The mortality rates at this time were 28% and 49% respectively. Results of treatment once the first haemorrhage has occurred are less impressive. Treatment of the alcohol withdrawal syndrome in patients with liver disease is often problematic. The dose of any sedative should be reduced to 25-50% of the usual dose and sedatives should be avoided in patients who are encephalopathic. Once the patient has recovered from the acute illness, abstinence from alcohol remains the single most important factor that determines long term survival.

Alcoholism↗
PubMed1986

Chlorpropamide-alcohol flush reaction and isoenzyme profiles of alcohol dehydrogenase and aldehyde dehydrogenase.

To investigate the enzymatic basis of the chlorpropamide-alcohol flush reaction (CPAF) we compared the isoenzyme profiles of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) from liver biopsies, and of ALDH alone from erythrocytes and leucocytes, in CPAF-positive and CPAF-negative subjects. No differences were seen in ADH or ALDH phenotypes, or in the relative activities of the isoenzymes, between the two groups before chlorpropamide was given; in particular, no subjects showed the 'null' ALDH phenotype that is associated with the alcohol flush reaction in oriental subjects. There was a significant decrease in erythrocyte ALDH activity after 7 days' treatment with chlorpropamide in CPAF-positive individuals but no such difference was seen in CPAF-negative subjects. These results indicate that CPAF has a different enzymatic basis from the alcohol flush reaction of oriental subjects and suggest that in CPAF-positive subjects erythrocyte ALDH may be particularly susceptible to inhibition by chlorpropamide.

Alcohol Dehydrogenase↗
PubMed1986

Relation between alcohol intake, myocardial enzyme activity, and myocardial function in dilated cardiomyopathy. Evidence for the concept of alcohol induced heart muscle disease.

Detailed drinking histories were taken in 38 patients in whom dilated cardiomyopathy was diagnosed by cardiac catheterisation and left ventricular biopsy. On the basis of the drinking history twenty patients were classified as being in an abstinent or light drinking group and eighteen patients as being in a heavy drinking group (daily alcohol intake in excess of 80 g or cumulative lifetime intake exceeding 250 kg). Activities of myocardial creatine kinase, lactate dehydrogenase, alpha hydroxybutyric dehydrogenase, malic dehydrogenase, and aspartate amino-transferase were all higher in the heavy drinkers and myocardial enzyme activity correlated with cumulative lifetime alcohol intake, maximum daily intake, and recent daily intake. Activities of creatine kinase, alpha hydroxybutyric dehydrogenase, and malic dehydrogenase correlated with ejection fraction, irrespective of the alcohol intake of the patient. These findings were not altered by exclusion of patients with hypertension. The results indicate that among patients with dilated cardiomyopathy there is a group characterised by a high alcohol intake and raised myocardial tissue enzymes which supports the concept of alcoholic heart muscle disease as a distinct entity.

Adult↗
PubMed1985

Effects of ethanol administration on rat liver plasma membrane-bound enzymes.

Changes in the properties of rat liver plasma membranes were examined in studies designed to differentiate between direct and metabolic effects of acute and chronic ethanol ingestion. One hour after a single dose of ethanol (3 g/kg body weight) there were increases in Na+,K+-ATPase (32%) and 5'-nucleotidase (36%), and hepatic concentrations of ethanol and acetaldehyde were approximately 23 mM and 50 microM, respectively. Na+,K+-ATPase and 5'-nucleotidase activities in liver plasma membranes from control rats were not significantly changed by in vitro addition of 30 microM acetaldehyde or 50 mM ethanol. Increases in Na+,K+-ATPase (approximately 20%) and 5'-nucleotidase (approximately 30%) were also observed in liver plasma membranes isolated from rats 16 hr after feeding ethanol or sucrose supplements for 17 days. The intake of calories from dietary protein and lipid was decreased by about 25% in both the ethanol and sucrose-fed animals. Na+,K+-ATPase activities in liver plasma membranes isolated from control rats were inhibited (approximately 20%) by 100 mM ethanol in vitro, whereas no inhibition was observed using membrane preparations from rats fed ethanol or sucrose supplements. Our results show that changes in liver plasma membrane enzyme activities associated with a single dose of ethanol are not a direct effect correlated with blood, hepatic or plasma membrane concentrations of ethanol or acetaldehyde. Chronic ingestion of ethanol or sucrose supplements had similar effects on liver plasma membrane enzyme characteristics and parallel changes in nutrient intake may be a more feasible explanation of these results than any analogous direct effects of the two compounds.

5'-Nucleotidase↗