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    "titulo" => "Comunicaciones orales : Estilos de vida: alcohol"
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    "textoCompleto" => "<p class="elsevierStylePara"> Jueves 2 de Octubre &#47; Thursday 2&#44; October<br></br> 18&#58;00&#58;00 a&#47;to 19&#58;30&#58;00</p><p class="elsevierStylePara"> Moderador&#47;Chairperson&#58;<br></br> Miguel Delgado</p><p class="elsevierStylePara"><span class="elsevierStyleBold">208 HEAVY DRINKING AND MORTALITY IN RUSSIA&#46; A STUDY USING SIBLINGS&#39; SURVIVAL</span></p><p class="elsevierStylePara"> Martin Bobak&#42;&#44; Michael Murphy&#42;&#42;&#44; Richard Rose&#42;&#42;&#42;&#44; Michael Marmot&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Dept&#46; of Epidemiology and Public Health&#44; University College London&#44; United Kingdom&#46; &#42;&#42;Dept&#46; of Social Policy&#44; London School of Economics&#44; United Kingdom&#46; &#42;&#42;&#42;Centre for the Study of Public Policy&#44; University of Strathclyde&#44; Glasgow&#44; United Kingdom&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> It has been proposed that heavy and&#47;or binge drinking is an important risk factor for total and cardiovascular mortality in Russia&#44; but there is little direct evidence on this important question&#46; We have modified the indirect demographic methodology and applied it to a convenience population cohort to investigate predictors of mortality in Russia&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> A national sample of the Russian population was interviewed in a cross-sectional survey&#46; The participants were asked about characteristics of their eldest siblings&#44; including drinking&#44; smoking&#44; their vital status and the year of birth and death &#40;if died&#41;&#46; The association between personal characteristics and mortality risk was estimated for the 682 male and 698 female siblings &#40;of whom 122 and 81&#44; respectively&#44; died&#41; with valid data&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> In both genders&#44; mortality was strongly associated with low education and smoking&#46; Childhood social circumstances were not associated with mortality&#46; After adjustment for education and smoking&#44; mortality was elevated in men and women who drank spirits at least once a month&#44; and in men who were binge drinking &#40;more than half a bottle of vodka per drinking session&#41; at least once a week &#40;adjusted RR 2&#46;45&#44; 95&#37; CI 1&#46;22-4&#46;94&#41; and in women who were bingeing at least once month &#40;RR 3&#46;94&#44; 95&#37; CI 1&#46;07-14&#46;5&#41;&#44; compared to non-bingeing subjects&#46; Similar association with drinking was found for cardiovascular deaths in men &#40;there were too few cardiovascular deaths in women&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Drinking spirits&#44; particularly in binges&#44; was associated with increased mortality from all-causes and from cardiovasscular diseases&#46; Mortality was also increased in smokers and in subjects with low education&#46; The indirect method appears to be a time- and cost-effective alternative for the study of mortality determinants in literate and numerate populations&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">209 ALCOHOL CONSUMPTION AND ADVERSE EFFECTS IN GENERAL SURGERY</span></p><p class="elsevierStylePara"> Miguel Delgado-Rodr&#237;guez&#42;&#44; Marcial Mariscal&#42;&#44; Antonio G&#243;mez-Ortega&#42;&#42;&#44; Gabriel Mart&#237;nez-Gallego&#42;&#42;&#44; Silvia Palma&#42;&#44; Mar&#237;a Sillero-Arenas&#42;&#42;&#42;&#44; Marcelino Medina-Cuadros&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Medicina Preventiva&#44; Univ&#46; de Ja&#233;n&#44; Ja&#233;n&#46; &#42;&#42;S&#46; de Cirug&#237;a General&#44; Hospital Ciudad de Ja&#233;n&#44; Ja&#233;n&#46; &#42;&#42;&#42;Servicio de Salud&#44; Delegaci&#243;n Provincial de Salud&#44; Ja&#233;n&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Alcohol consumption increases community-acquired infections and affects the immune system&#44; and in community studies increases mortality&#46; There are only small reports &#40;most with &#60; 200 patients&#41; with heavy drinkers analysing postoperative morbidity&#59; there is no previous report relating drinking to in-hospital mortality in general surgery&#46; The aim of this report was to analyse whether drinking&#44; stratifying its pattern of consumption&#44; increases the risk of nosocomial infection&#44; admission to intensive care unit &#40;ICU&#41; and in-hospital mortality&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> This was a prospective study on 1505 patients admitted consecutively to a Service of General Surgery in the period 1995-1997&#46; Alcohol consumption was assessed by a structured questionnaire&#44; considering routine &#40;daily&#41; drinking and weekend &#40;and holidays&#41; drinking&#46; Postoperative infection was classified using the Centers for Disease Control criteria&#46; Surveillance was extended to 30 days after hospital discharge&#44; to detect hospital infections clinically developed at home&#46; Relative risks and 95&#37; confidence intervals were estimated&#46; Confounding was controlled for by logistic regression analysis and the results were stratified by gender and drinking pattern&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Most women were light drinkers and no increased risk of postoperative infection was noted&#46; In men drinking was associated with a shorter duration of surgery&#44; lower ASA grade fewer comorbidities&#46; In men&#44; heavy alcohol consumption &#40;&#62; 108 g&#47;day&#41; increased the rate of all-site nosocomial infection &#40;adjusted odds ratio &#40;OR&#41; &#61; 2&#46;51&#44; 95&#37; confidence interval &#40;CI&#41; &#61; 1&#46;06-5&#46;96&#41; and the rate of in-hospital surgical site infection &#40;SSI&#41; &#40;adjusted OR &#61; 2&#46;16&#44; 95&#37; CI &#61; 0&#46;84-5&#46;58&#41;&#46; An intake of above 72 g&#47;day increased the rate of lower respiratory tract infection &#40;adjusted OR &#61; 5&#46;96&#44; 95&#37; CI &#61; 1&#46;41-25&#46;2&#41;&#46; Alcohol consumption was not related to the rate of SSI after hospital discharge&#46; When drinking was limited to weekends&#44; there was no relationship with nosocomial infection&#46; 29 &#40;1&#46;9&#37;&#41; patients died and 33 &#40;2&#46;1&#37;&#41; were admitted to the intensive care unit &#40;ICU&#41;&#46; After adjusting for age&#44; severity of underlying disease&#44; sex&#44; smoking&#44; and serum albumin&#44; male drinkers of 72&#43; g&#47;d had an increased risk of being admitted to ICU&#44; the effect being stronger for weekday drinking &#40;odds ratio&#44; OR &#61; 8&#46;48&#59; 95&#37; confidence interval&#44; CI &#61; 1&#46;68-42&#46;8&#41;&#46; A significant association was also seen between weekday drinking &#40;72&#43; g&#47;d&#41; and death in men &#40;OR &#61; 7&#46;19&#44; 95&#37; CI &#61; 1&#46;43-36&#46;1&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> Heavy alcohol consumption increased the risk of nosocomial infection&#44; admission to the ICU&#44; and mortality in men who underwent general surgical procedures&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">210 EMPIRICAL ASSESSMENT OF ALCOHOL MISCLASSIFICATION AND ITS CONSEQUENCES ON SEVERAL ASSOCIATIONS WITH ADVERSE OUTCOMES IN HOSPITALIZED PATIENTS</span></p><p class="elsevierStylePara"> Miguel Delgado-Rodr&#237;guez&#42;&#44; Marcial Mariscal&#42;&#44; Javier Llorca&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Med&#46; Preventiva&#44; Univ&#46; de Ja&#233;n&#44; Ja&#233;n&#46; &#42;&#42;Med&#46; Preventiva&#44; Univ&#46; de Cantabria&#44; Santander&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Deviations of the data collection protocol can introduce a misclassification bias&#46; The objective of this report is to analyze the consequences of alcohol drinking misclassification on the association with several adverse effects during hospitalization&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> This was a prospective study on 2989 patients admitted consecutively to a Service of General Surgery in two periods 1992-1994 and 1995-1997&#46; Alcohol consumption was assessed by a structured questionnaire&#44; considering routine &#40;daily&#41; drinking and weekend &#40;and holidays&#41; drinking&#46; In the first period&#44; interviewers introduced a general question &#40;&#34;do you drink&#63;&#34;&#41;&#44; not in the protocol&#44; to shorcut data collection&#46; In the second period&#44; this was corrected&#46; Postoperative infection was classified using the Centers for Disease Control criteria&#46; Surveillance was extended to 30 days after hospital discharge&#44; to detect hospital infections clinically developed at home&#46; Relative risks and 95&#37; confidence intervals were estimated&#46; Confounding was controlled for by logistic regression analysis and the results were stratified by gender and drinking pattern&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> In the first part of a prospective study on the hospital course of surgical patients an unusual low frequency of alcohol drinking was found&#46; An interview with data collectors revealed that they&#44; by their own&#44; have introduced a general introductory question &#34;Do you drink&#63;&#34; to shorten the questionnaire on alcohol&#46; In this study drinking was unrelated to any adverse effect during hospitalization&#46; In the second part&#44; done with the same methodology&#44; data collectors agreed to adhere the questionnaire on drinking&#44; in which alcohol drinking was asked beginning with most socially accepted drinking &#40;while eating and in weekends&#41; and ending with less undesirable behaviors &#40;out of meals&#44; early in the morning&#44; and in weekdays&#41;&#46; There were no major differences between the patients&#39; characteristics of the two parts of the study&#46; The frequency of alcohol drinking increased from 34&#46;5&#37; to 57&#46;5&#37;&#59; this increase was roughly similar according sex&#44; age&#44; severity of the underlying disease&#44; and other variables&#46; Alcohol drinking of 72&#43; g&#47;day in this second part increased the risk of nosocomial lower respiratory tract infection &#40;adjusted OR &#61; 5&#46;2&#44; 95&#37; confidence interval -CI-&#58; 1&#46;0-26&#46;3&#41;&#44; admission to intensive care unit &#40;adjusted OR &#61; 8&#46;8&#44; 95&#37; CI&#58; 1&#46;7-45&#46;1&#41;&#44; and in-hospital death &#40;adjusted OR &#61; 4&#46;6&#44; 95&#37; CI&#58; 1&#46;1-19&#46;6&#41;&#46; These associations are supported by scientific literature&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> A deviation from data collection protocol produced misclassification of alcohol drinking rendering non-significant relationships with known adverse effects of drinking&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">211 PATTERN OF ALCOHOL CONSUMPTION BEFORE PREGNANCY AND ALCOHOL CESSATION IN PREGNANCY</span></p><p class="elsevierStylePara"> Marcial Mariscal&#42;&#44; Javier Llorca&#42;&#42;&#44; Rosa Pardo-Crespo&#42;&#42;&#42;&#44; Mar&#237;a Antonio&#42;&#42;&#44; Miguel Garc&#237;a-Fuentes&#42;&#42;&#42;&#44; Miguel Delgado-Rodr&#237;guez&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Med&#46; Preventiva&#44; Univ&#46; de Ja&#233;n&#44; Ja&#233;n&#46; &#42;&#42;Med&#46; Preventiva&#44; Univ&#46; de Cantabria&#44; Santander&#46; &#42;&#42;&#42;Pediatr&#237;a&#44; Univ&#46; de Cantabria&#44; Santander&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Cantabria &#40;Spain&#41; has the highest prevalence of alcohol consumption in women in Spain &#40;European Union&#41;&#46; Reduction of drinking consumption in pregnant women has been reported in many countries&#44; although the change across the last decade has been small in several regions&#46; The assessment of the patterns of alcohol cessation can contribute to an improvement in the efficacy of prenatal care programs&#46; The determinants of alcohol cessation&#44; mainly the pattern of drinking&#44; in pregnant women in Cantabria have been assessed&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> Survey on a sixth random sample of women delivering for the period 1995-1999 &#40;n &#61; 1521&#41; in the reference hospital of the region&#46; Each month for the study period all the women delivering on five days&#44; randomly selected in advance &#40;using the random number generator of the program EpiInfo 6&#46;0&#41;&#44; were asked to participate&#46; Information was obtained from personal interview &#40;data on alcohol consumption&#41;&#44; clinical chart and prenatal care records&#46; Alcohol consumption was assessed by a structured questionnaire&#44; considering routine &#40;daily&#41; drinking and weekend &#40;and holidays&#41; drinking&#46; Relative risks &#40;RR&#41; and 95&#37; confidence intervals &#40;CI&#41; were estimated&#46; Multivariable analyses were carried out using logistic regression&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Nearly half &#40;49&#46;5&#37;&#41; women drank regularly before pregnancy and 22&#46;7&#37; during pregnancy&#46; The average alcohol consumption in drinkers before pregnancy was 9 g&#47;day&#44; and 6&#46;6 g&#47;day during pregnancy&#46; The sociodemographic variables favouring alcohol cessation during pregnancy were high education level and smoking cessation&#44; whereas high social class&#44; advanced maternal age and employment out home decreased the rate of alcohol cessation&#46; There was a significant inverse trend with the amount of alcohol consumed at weekdays &#40;p &#60; 0&#46;001&#41;&#44; not observed in those drinking only at weekends&#46; In this latter group&#44; the consumption of only spirits increased the rate of alcohol cessation &#40;adjusted RR &#61; 1&#46;33&#44; 95&#37; CI 1&#46;08-1&#46;50&#41;&#46; The consumption of wine &#40;either daily or at weekends&#41; decreased the rate of alcohol cessation in pregnancy&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> The pattern of drinking influenced the rate of alcohol cessation&#58; the heavier the alcohol consumption at weekdays the lower the rate of alcohol cessation&#46; Wine consumers were more reluctant to quit alcohol drinking&#44; whereas women drinking only spirits at weekends increased their rate of alcohol cessation&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">212 MOTOR VEHICLE INJURY CASES WITH POSITIVITY TO ALCOHOL IN HOSPITAL EMERGENCY DEPARTMENTS&#58; DIFFERENTIAL FEATURES</span></p><p class="elsevierStylePara"> Xavier Mart&#237;nez&#42;&#44; Antoni Plas&#232;ncia&#42;&#42;&#44; Alicia Rodr&#237;guez-Martos&#42;&#42;&#44; Helena Santamari&#241;a&#42;&#42;&#44; Josep Mart&#237;&#42;&#42;&#42;&#44; Merc&#232; Escayola&#42;&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Servei de Medicina Preventiva i Epidemiologia&#44; Hospital Vall d&#39;Hebron&#44; Barcelona&#46; &#42;&#42;Ag&#232;ncia de Salut P&#250;blica de Barcelona&#44; Barcelona&#46; &#42;&#42;&#42;Hospital de traumatolog&#237;a&#44; Hospital Vall d&#39;Hebron&#44; Barcelona&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> The importance of alcohol in motor vehicle crashes &#40;MVC&#41; is well documented in the scientific literature&#46; Nevertheless&#44; there is little information in Spain on the socio-demographic characteristics of MVC injury cases attending emergency departments and who appear to be positive to the presence of alcohol&#46; Besides&#44; in recent years&#44; there have been important changes regarding drinking patterns&#44; together with a lowering of the maximum blood alcohol levels &#40;BAL&#41; in drivers&#44; from 0&#46;8 to 0&#46;5 g&#47;l&#46; Screening for alcohol in emergency departments in association with secondary prevention activities &#40;such as brief interventions&#41; seems to be a promising intervention to decrease alcohol consumption among MVC injury cases and&#44; therefore&#44; the risk of subsequent road crashes&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Aim&#58;</span> The objective of the study was the identification of differential features depending on alcohol positivity in MVC injury cases attended to in the emergency department of a trauma centre in Barcelona&#44; Spain&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Subjects and methods&#58;</span> Cross-sectional study in the context of the IBAT study &#40;evaluation of effectiveness of a brief intervention in the reduction of alcohol intake&#41;&#46; Cases older than 18 years were included in the study if they had suffered a MVC within 6 hours before their arrival to the emergency department of Hospital de Traumatologia Vall d&#39;Hebr&#243;n&#44; between July 2001 and February 2002&#46; A saliva screening test was used to assess BAL&#44; although a urinary or a blood test were also used in a small proportion of cases&#46; Descriptive statistics as well as multivariate logistic regression models were fit to assess the relationship between selected independent variables and the presence of BAL&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The study sample included 431 patients&#44; with an average age of 30&#46;2 years in men and 34&#46;8 years in women&#46; Two thirds of the injured cases were drivers&#44; cars being the main vehicle involved in crashes &#40;51&#46;8&#37;&#41;&#46; Fifty-nine patients had a positive alcohol test &#40;13&#46;7&#37; of the sample&#41;&#46; A statistically significant and independent association was found between positive BAL and being a male &#40;OR&#58; 2&#46;38 &#91;95&#37; CI&#58; 1&#46;12-5&#46;05&#93;&#41;&#44; being admitted to the hospital &#40;OR&#58; 2&#46;59 &#91;95&#37; CI&#58; 1&#46;30-5&#46;14&#93;&#41; and suffering a MVC on a week-end &#40;OR&#58; 2&#46;98 &#91;95&#37; CI&#58; 1&#46;64-5&#46;41&#93;&#41; and night and early morning crashes &#40;OR&#58; 3&#46;48 &#91;IC 95&#37;&#58; 1&#46;67 - 7&#46;24&#93;&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> The study has identified four variables &#40;sex&#44; hospitalisation -as a proxy for severity-&#44; day and time of the MVC&#41; as factors associated with alcohol positivity in MVC crashes&#46; This information is useful to target subgroups of MVC injury cases with a greater likelihood of positive BAL&#44; in support of the implementation of more active and efficient screening and secondary prevention activities within acute care settings to help tackling MVC occurrence&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">213 ALCOHOL CONSUMPTION AND <span class="elsevierStyleItalic">HELICOBACTER PYLORI</span> INFECTION&#58; REVIEW AND META-ANALYSIS</span></p><p class="elsevierStylePara"> Nuno Lunet&#44; Ricardo Seromenho&#44; Henrique Barros</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Department of Hygiene and Epidemiology&#44; Porto Medical School&#44; Porto&#44; Portugal&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Animal and in vitro experimentation suggest that alcohol plays a role preventing or eliminating Helicobacter pylori infection&#46; However&#44; the assessment of the relation between alcohol consumption and the prevalence of H&#46; pylori infection yielded inconsistent findings that could be due to methodological flaws or represent accurate observations of a relation that varies among population groups&#46;</p><p class="elsevierStylePara"> We aimed to review epidemiological evidence on the association between the consumption of alcoholic beverages and H&#46; pylori infection&#44; to identify sources of heterogeneity across studies&#44; and to provide summary quantitative estimates of the association between alcohol intake and infection&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> We identified publications addressing the association between H&#46; pylori infection and the consumption of alcoholic beverages through Pubmed and cross reference search&#46; In the pooled analysis we used log odds ratios &#40;OR&#41; and corresponding variance concerning each level of alcohol consumption&#44; published or calculated from published data&#46; Pooled estimates of the effect of alcohol consumption on the risk of <span class="elsevierStyleItalic">H&#46; pylori</span> infection obtained in studies with three or more levels of alcohol exposure was based on meta-regression models and heterogeneity among studies was evaluated according to the methods described by Greenland and Longnecker&#46; Additionally to linear terms of alcohol consumption&#44; several functions were tested to model the relationship between alcohol intake and the risk of infection to appreciate possible J- or U-shaped curves&#46; Possible causes of heterogeneity were explored by stratifying analysis according to study characteristics&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> We analyzed data from 15 studies with at least three categories of alcohol consumption and including drinkers of more that two drinks&#47;day&#46; Pooled OR estimates for infection in consumers of one drink&#47;day compared with non-drinkers were 0&#46;98 &#40;95&#37; confidence interval &#40;CI&#41; 0&#46;95 - 1&#46;01&#41; in 4 studies using the urea breath test in samples with a prevalence of infection below 50&#37;&#46; In studies evaluating infection with other methods&#44; the OR was 1&#46;02 &#40;95&#37; CI 0&#46;98 - 1&#46;06&#41; when the prevalence of infection was above 50&#37; and 0&#46;84 &#40;95&#37; CI 0&#46;77 - 0&#46;91&#41; when H&#46; pylori prevalence was lower than 50&#37;&#46; In the former group of studies&#44; the association between alcohol consumption and infection was monotonic when adjustments were performed for smoking or socioeconomic status&#44; and U-shaped in two studies were no adjustments were made&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> Although the shape of the association can change with a finer adjustment for confounders&#44; our results suggest that the association between the consumption of alcoholic beverages and H&#46; pylori infection is population determined&#44; with an inverse association observed only when the prevalence of infection is low&#46;</p>"
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Comunicaciones orales : Estilos de vida: alcohol
Life styles: alcohol
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    "textoCompleto" => "<p class="elsevierStylePara"> Jueves 2 de Octubre &#47; Thursday 2&#44; October<br></br> 18&#58;00&#58;00 a&#47;to 19&#58;30&#58;00</p><p class="elsevierStylePara"> Moderador&#47;Chairperson&#58;<br></br> Miguel Delgado</p><p class="elsevierStylePara"><span class="elsevierStyleBold">208 HEAVY DRINKING AND MORTALITY IN RUSSIA&#46; A STUDY USING SIBLINGS&#39; SURVIVAL</span></p><p class="elsevierStylePara"> Martin Bobak&#42;&#44; Michael Murphy&#42;&#42;&#44; Richard Rose&#42;&#42;&#42;&#44; Michael Marmot&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Dept&#46; of Epidemiology and Public Health&#44; University College London&#44; United Kingdom&#46; &#42;&#42;Dept&#46; of Social Policy&#44; London School of Economics&#44; United Kingdom&#46; &#42;&#42;&#42;Centre for the Study of Public Policy&#44; University of Strathclyde&#44; Glasgow&#44; United Kingdom&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> It has been proposed that heavy and&#47;or binge drinking is an important risk factor for total and cardiovascular mortality in Russia&#44; but there is little direct evidence on this important question&#46; We have modified the indirect demographic methodology and applied it to a convenience population cohort to investigate predictors of mortality in Russia&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> A national sample of the Russian population was interviewed in a cross-sectional survey&#46; The participants were asked about characteristics of their eldest siblings&#44; including drinking&#44; smoking&#44; their vital status and the year of birth and death &#40;if died&#41;&#46; The association between personal characteristics and mortality risk was estimated for the 682 male and 698 female siblings &#40;of whom 122 and 81&#44; respectively&#44; died&#41; with valid data&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> In both genders&#44; mortality was strongly associated with low education and smoking&#46; Childhood social circumstances were not associated with mortality&#46; After adjustment for education and smoking&#44; mortality was elevated in men and women who drank spirits at least once a month&#44; and in men who were binge drinking &#40;more than half a bottle of vodka per drinking session&#41; at least once a week &#40;adjusted RR 2&#46;45&#44; 95&#37; CI 1&#46;22-4&#46;94&#41; and in women who were bingeing at least once month &#40;RR 3&#46;94&#44; 95&#37; CI 1&#46;07-14&#46;5&#41;&#44; compared to non-bingeing subjects&#46; Similar association with drinking was found for cardiovascular deaths in men &#40;there were too few cardiovascular deaths in women&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> Drinking spirits&#44; particularly in binges&#44; was associated with increased mortality from all-causes and from cardiovasscular diseases&#46; Mortality was also increased in smokers and in subjects with low education&#46; The indirect method appears to be a time- and cost-effective alternative for the study of mortality determinants in literate and numerate populations&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">209 ALCOHOL CONSUMPTION AND ADVERSE EFFECTS IN GENERAL SURGERY</span></p><p class="elsevierStylePara"> Miguel Delgado-Rodr&#237;guez&#42;&#44; Marcial Mariscal&#42;&#44; Antonio G&#243;mez-Ortega&#42;&#42;&#44; Gabriel Mart&#237;nez-Gallego&#42;&#42;&#44; Silvia Palma&#42;&#44; Mar&#237;a Sillero-Arenas&#42;&#42;&#42;&#44; Marcelino Medina-Cuadros&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Medicina Preventiva&#44; Univ&#46; de Ja&#233;n&#44; Ja&#233;n&#46; &#42;&#42;S&#46; de Cirug&#237;a General&#44; Hospital Ciudad de Ja&#233;n&#44; Ja&#233;n&#46; &#42;&#42;&#42;Servicio de Salud&#44; Delegaci&#243;n Provincial de Salud&#44; Ja&#233;n&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Alcohol consumption increases community-acquired infections and affects the immune system&#44; and in community studies increases mortality&#46; There are only small reports &#40;most with &#60; 200 patients&#41; with heavy drinkers analysing postoperative morbidity&#59; there is no previous report relating drinking to in-hospital mortality in general surgery&#46; The aim of this report was to analyse whether drinking&#44; stratifying its pattern of consumption&#44; increases the risk of nosocomial infection&#44; admission to intensive care unit &#40;ICU&#41; and in-hospital mortality&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> This was a prospective study on 1505 patients admitted consecutively to a Service of General Surgery in the period 1995-1997&#46; Alcohol consumption was assessed by a structured questionnaire&#44; considering routine &#40;daily&#41; drinking and weekend &#40;and holidays&#41; drinking&#46; Postoperative infection was classified using the Centers for Disease Control criteria&#46; Surveillance was extended to 30 days after hospital discharge&#44; to detect hospital infections clinically developed at home&#46; Relative risks and 95&#37; confidence intervals were estimated&#46; Confounding was controlled for by logistic regression analysis and the results were stratified by gender and drinking pattern&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Most women were light drinkers and no increased risk of postoperative infection was noted&#46; In men drinking was associated with a shorter duration of surgery&#44; lower ASA grade fewer comorbidities&#46; In men&#44; heavy alcohol consumption &#40;&#62; 108 g&#47;day&#41; increased the rate of all-site nosocomial infection &#40;adjusted odds ratio &#40;OR&#41; &#61; 2&#46;51&#44; 95&#37; confidence interval &#40;CI&#41; &#61; 1&#46;06-5&#46;96&#41; and the rate of in-hospital surgical site infection &#40;SSI&#41; &#40;adjusted OR &#61; 2&#46;16&#44; 95&#37; CI &#61; 0&#46;84-5&#46;58&#41;&#46; An intake of above 72 g&#47;day increased the rate of lower respiratory tract infection &#40;adjusted OR &#61; 5&#46;96&#44; 95&#37; CI &#61; 1&#46;41-25&#46;2&#41;&#46; Alcohol consumption was not related to the rate of SSI after hospital discharge&#46; When drinking was limited to weekends&#44; there was no relationship with nosocomial infection&#46; 29 &#40;1&#46;9&#37;&#41; patients died and 33 &#40;2&#46;1&#37;&#41; were admitted to the intensive care unit &#40;ICU&#41;&#46; After adjusting for age&#44; severity of underlying disease&#44; sex&#44; smoking&#44; and serum albumin&#44; male drinkers of 72&#43; g&#47;d had an increased risk of being admitted to ICU&#44; the effect being stronger for weekday drinking &#40;odds ratio&#44; OR &#61; 8&#46;48&#59; 95&#37; confidence interval&#44; CI &#61; 1&#46;68-42&#46;8&#41;&#46; A significant association was also seen between weekday drinking &#40;72&#43; g&#47;d&#41; and death in men &#40;OR &#61; 7&#46;19&#44; 95&#37; CI &#61; 1&#46;43-36&#46;1&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> Heavy alcohol consumption increased the risk of nosocomial infection&#44; admission to the ICU&#44; and mortality in men who underwent general surgical procedures&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">210 EMPIRICAL ASSESSMENT OF ALCOHOL MISCLASSIFICATION AND ITS CONSEQUENCES ON SEVERAL ASSOCIATIONS WITH ADVERSE OUTCOMES IN HOSPITALIZED PATIENTS</span></p><p class="elsevierStylePara"> Miguel Delgado-Rodr&#237;guez&#42;&#44; Marcial Mariscal&#42;&#44; Javier Llorca&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Med&#46; Preventiva&#44; Univ&#46; de Ja&#233;n&#44; Ja&#233;n&#46; &#42;&#42;Med&#46; Preventiva&#44; Univ&#46; de Cantabria&#44; Santander&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Deviations of the data collection protocol can introduce a misclassification bias&#46; The objective of this report is to analyze the consequences of alcohol drinking misclassification on the association with several adverse effects during hospitalization&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> This was a prospective study on 2989 patients admitted consecutively to a Service of General Surgery in two periods 1992-1994 and 1995-1997&#46; Alcohol consumption was assessed by a structured questionnaire&#44; considering routine &#40;daily&#41; drinking and weekend &#40;and holidays&#41; drinking&#46; In the first period&#44; interviewers introduced a general question &#40;&#34;do you drink&#63;&#34;&#41;&#44; not in the protocol&#44; to shorcut data collection&#46; In the second period&#44; this was corrected&#46; Postoperative infection was classified using the Centers for Disease Control criteria&#46; Surveillance was extended to 30 days after hospital discharge&#44; to detect hospital infections clinically developed at home&#46; Relative risks and 95&#37; confidence intervals were estimated&#46; Confounding was controlled for by logistic regression analysis and the results were stratified by gender and drinking pattern&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> In the first part of a prospective study on the hospital course of surgical patients an unusual low frequency of alcohol drinking was found&#46; An interview with data collectors revealed that they&#44; by their own&#44; have introduced a general introductory question &#34;Do you drink&#63;&#34; to shorten the questionnaire on alcohol&#46; In this study drinking was unrelated to any adverse effect during hospitalization&#46; In the second part&#44; done with the same methodology&#44; data collectors agreed to adhere the questionnaire on drinking&#44; in which alcohol drinking was asked beginning with most socially accepted drinking &#40;while eating and in weekends&#41; and ending with less undesirable behaviors &#40;out of meals&#44; early in the morning&#44; and in weekdays&#41;&#46; There were no major differences between the patients&#39; characteristics of the two parts of the study&#46; The frequency of alcohol drinking increased from 34&#46;5&#37; to 57&#46;5&#37;&#59; this increase was roughly similar according sex&#44; age&#44; severity of the underlying disease&#44; and other variables&#46; Alcohol drinking of 72&#43; g&#47;day in this second part increased the risk of nosocomial lower respiratory tract infection &#40;adjusted OR &#61; 5&#46;2&#44; 95&#37; confidence interval -CI-&#58; 1&#46;0-26&#46;3&#41;&#44; admission to intensive care unit &#40;adjusted OR &#61; 8&#46;8&#44; 95&#37; CI&#58; 1&#46;7-45&#46;1&#41;&#44; and in-hospital death &#40;adjusted OR &#61; 4&#46;6&#44; 95&#37; CI&#58; 1&#46;1-19&#46;6&#41;&#46; These associations are supported by scientific literature&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> A deviation from data collection protocol produced misclassification of alcohol drinking rendering non-significant relationships with known adverse effects of drinking&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">211 PATTERN OF ALCOHOL CONSUMPTION BEFORE PREGNANCY AND ALCOHOL CESSATION IN PREGNANCY</span></p><p class="elsevierStylePara"> Marcial Mariscal&#42;&#44; Javier Llorca&#42;&#42;&#44; Rosa Pardo-Crespo&#42;&#42;&#42;&#44; Mar&#237;a Antonio&#42;&#42;&#44; Miguel Garc&#237;a-Fuentes&#42;&#42;&#42;&#44; Miguel Delgado-Rodr&#237;guez&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Med&#46; Preventiva&#44; Univ&#46; de Ja&#233;n&#44; Ja&#233;n&#46; &#42;&#42;Med&#46; Preventiva&#44; Univ&#46; de Cantabria&#44; Santander&#46; &#42;&#42;&#42;Pediatr&#237;a&#44; Univ&#46; de Cantabria&#44; Santander&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> Cantabria &#40;Spain&#41; has the highest prevalence of alcohol consumption in women in Spain &#40;European Union&#41;&#46; Reduction of drinking consumption in pregnant women has been reported in many countries&#44; although the change across the last decade has been small in several regions&#46; The assessment of the patterns of alcohol cessation can contribute to an improvement in the efficacy of prenatal care programs&#46; The determinants of alcohol cessation&#44; mainly the pattern of drinking&#44; in pregnant women in Cantabria have been assessed&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> Survey on a sixth random sample of women delivering for the period 1995-1999 &#40;n &#61; 1521&#41; in the reference hospital of the region&#46; Each month for the study period all the women delivering on five days&#44; randomly selected in advance &#40;using the random number generator of the program EpiInfo 6&#46;0&#41;&#44; were asked to participate&#46; Information was obtained from personal interview &#40;data on alcohol consumption&#41;&#44; clinical chart and prenatal care records&#46; Alcohol consumption was assessed by a structured questionnaire&#44; considering routine &#40;daily&#41; drinking and weekend &#40;and holidays&#41; drinking&#46; Relative risks &#40;RR&#41; and 95&#37; confidence intervals &#40;CI&#41; were estimated&#46; Multivariable analyses were carried out using logistic regression&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> Nearly half &#40;49&#46;5&#37;&#41; women drank regularly before pregnancy and 22&#46;7&#37; during pregnancy&#46; The average alcohol consumption in drinkers before pregnancy was 9 g&#47;day&#44; and 6&#46;6 g&#47;day during pregnancy&#46; The sociodemographic variables favouring alcohol cessation during pregnancy were high education level and smoking cessation&#44; whereas high social class&#44; advanced maternal age and employment out home decreased the rate of alcohol cessation&#46; There was a significant inverse trend with the amount of alcohol consumed at weekdays &#40;p &#60; 0&#46;001&#41;&#44; not observed in those drinking only at weekends&#46; In this latter group&#44; the consumption of only spirits increased the rate of alcohol cessation &#40;adjusted RR &#61; 1&#46;33&#44; 95&#37; CI 1&#46;08-1&#46;50&#41;&#46; The consumption of wine &#40;either daily or at weekends&#41; decreased the rate of alcohol cessation in pregnancy&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> The pattern of drinking influenced the rate of alcohol cessation&#58; the heavier the alcohol consumption at weekdays the lower the rate of alcohol cessation&#46; Wine consumers were more reluctant to quit alcohol drinking&#44; whereas women drinking only spirits at weekends increased their rate of alcohol cessation&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">212 MOTOR VEHICLE INJURY CASES WITH POSITIVITY TO ALCOHOL IN HOSPITAL EMERGENCY DEPARTMENTS&#58; DIFFERENTIAL FEATURES</span></p><p class="elsevierStylePara"> Xavier Mart&#237;nez&#42;&#44; Antoni Plas&#232;ncia&#42;&#42;&#44; Alicia Rodr&#237;guez-Martos&#42;&#42;&#44; Helena Santamari&#241;a&#42;&#42;&#44; Josep Mart&#237;&#42;&#42;&#42;&#44; Merc&#232; Escayola&#42;&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Servei de Medicina Preventiva i Epidemiologia&#44; Hospital Vall d&#39;Hebron&#44; Barcelona&#46; &#42;&#42;Ag&#232;ncia de Salut P&#250;blica de Barcelona&#44; Barcelona&#46; &#42;&#42;&#42;Hospital de traumatolog&#237;a&#44; Hospital Vall d&#39;Hebron&#44; Barcelona&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Background&#58;</span> The importance of alcohol in motor vehicle crashes &#40;MVC&#41; is well documented in the scientific literature&#46; Nevertheless&#44; there is little information in Spain on the socio-demographic characteristics of MVC injury cases attending emergency departments and who appear to be positive to the presence of alcohol&#46; Besides&#44; in recent years&#44; there have been important changes regarding drinking patterns&#44; together with a lowering of the maximum blood alcohol levels &#40;BAL&#41; in drivers&#44; from 0&#46;8 to 0&#46;5 g&#47;l&#46; Screening for alcohol in emergency departments in association with secondary prevention activities &#40;such as brief interventions&#41; seems to be a promising intervention to decrease alcohol consumption among MVC injury cases and&#44; therefore&#44; the risk of subsequent road crashes&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Aim&#58;</span> The objective of the study was the identification of differential features depending on alcohol positivity in MVC injury cases attended to in the emergency department of a trauma centre in Barcelona&#44; Spain&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Subjects and methods&#58;</span> Cross-sectional study in the context of the IBAT study &#40;evaluation of effectiveness of a brief intervention in the reduction of alcohol intake&#41;&#46; Cases older than 18 years were included in the study if they had suffered a MVC within 6 hours before their arrival to the emergency department of Hospital de Traumatologia Vall d&#39;Hebr&#243;n&#44; between July 2001 and February 2002&#46; A saliva screening test was used to assess BAL&#44; although a urinary or a blood test were also used in a small proportion of cases&#46; Descriptive statistics as well as multivariate logistic regression models were fit to assess the relationship between selected independent variables and the presence of BAL&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The study sample included 431 patients&#44; with an average age of 30&#46;2 years in men and 34&#46;8 years in women&#46; Two thirds of the injured cases were drivers&#44; cars being the main vehicle involved in crashes &#40;51&#46;8&#37;&#41;&#46; Fifty-nine patients had a positive alcohol test &#40;13&#46;7&#37; of the sample&#41;&#46; A statistically significant and independent association was found between positive BAL and being a male &#40;OR&#58; 2&#46;38 &#91;95&#37; CI&#58; 1&#46;12-5&#46;05&#93;&#41;&#44; being admitted to the hospital &#40;OR&#58; 2&#46;59 &#91;95&#37; CI&#58; 1&#46;30-5&#46;14&#93;&#41; and suffering a MVC on a week-end &#40;OR&#58; 2&#46;98 &#91;95&#37; CI&#58; 1&#46;64-5&#46;41&#93;&#41; and night and early morning crashes &#40;OR&#58; 3&#46;48 &#91;IC 95&#37;&#58; 1&#46;67 - 7&#46;24&#93;&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions&#58;</span> The study has identified four variables &#40;sex&#44; hospitalisation -as a proxy for severity-&#44; day and time of the MVC&#41; as factors associated with alcohol positivity in MVC crashes&#46; This information is useful to target subgroups of MVC injury cases with a greater likelihood of positive BAL&#44; in support of the implementation of more active and efficient screening and secondary prevention activities within acute care settings to help tackling MVC occurrence&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">213 ALCOHOL CONSUMPTION AND <span class="elsevierStyleItalic">HELICOBACTER PYLORI</span> INFECTION&#58; REVIEW AND META-ANALYSIS</span></p><p class="elsevierStylePara"> Nuno Lunet&#44; Ricardo Seromenho&#44; Henrique Barros</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Department of Hygiene and Epidemiology&#44; Porto Medical School&#44; Porto&#44; Portugal&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Animal and in vitro experimentation suggest that alcohol plays a role preventing or eliminating Helicobacter pylori infection&#46; However&#44; the assessment of the relation between alcohol consumption and the prevalence of H&#46; pylori infection yielded inconsistent findings that could be due to methodological flaws or represent accurate observations of a relation that varies among population groups&#46;</p><p class="elsevierStylePara"> We aimed to review epidemiological evidence on the association between the consumption of alcoholic beverages and H&#46; pylori infection&#44; to identify sources of heterogeneity across studies&#44; and to provide summary quantitative estimates of the association between alcohol intake and infection&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods&#58;</span> We identified publications addressing the association between H&#46; pylori infection and the consumption of alcoholic beverages through Pubmed and cross reference search&#46; In the pooled analysis we used log odds ratios &#40;OR&#41; and corresponding variance concerning each level of alcohol consumption&#44; published or calculated from published data&#46; Pooled estimates of the effect of alcohol consumption on the risk of <span class="elsevierStyleItalic">H&#46; pylori</span> infection obtained in studies with three or more levels of alcohol exposure was based on meta-regression models and heterogeneity among studies was evaluated according to the methods described by Greenland and Longnecker&#46; Additionally to linear terms of alcohol consumption&#44; several functions were tested to model the relationship between alcohol intake and the risk of infection to appreciate possible J- or U-shaped curves&#46; Possible causes of heterogeneity were explored by stratifying analysis according to study characteristics&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> We analyzed data from 15 studies with at least three categories of alcohol consumption and including drinkers of more that two drinks&#47;day&#46; Pooled OR estimates for infection in consumers of one drink&#47;day compared with non-drinkers were 0&#46;98 &#40;95&#37; confidence interval &#40;CI&#41; 0&#46;95 - 1&#46;01&#41; in 4 studies using the urea breath test in samples with a prevalence of infection below 50&#37;&#46; In studies evaluating infection with other methods&#44; the OR was 1&#46;02 &#40;95&#37; CI 0&#46;98 - 1&#46;06&#41; when the prevalence of infection was above 50&#37; and 0&#46;84 &#40;95&#37; CI 0&#46;77 - 0&#46;91&#41; when H&#46; pylori prevalence was lower than 50&#37;&#46; In the former group of studies&#44; the association between alcohol consumption and infection was monotonic when adjustments were performed for smoking or socioeconomic status&#44; and U-shaped in two studies were no adjustments were made&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusion&#58;</span> Although the shape of the association can change with a finer adjustment for confounders&#44; our results suggest that the association between the consumption of alcoholic beverages and H&#46; pylori infection is population determined&#44; with an inverse association observed only when the prevalence of infection is low&#46;</p>"
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Información del artículo
ISSN: 02139111
Idioma original: Inglés
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