Archive for August, 2010

Women who drink beer more likely to develop psoriasis

Regular beer—but not light beer or other types of alcohol—appears to be associated with an increased risk of developing psoriasis, according to a report posted online that will be published in the Archives of Dermatology.

“Psoriasis is a common immune-mediated skin disease,” the authors write as background information in the article. “The association between alcohol consumption and increased risk of psoriasis onset and psoriasis worsening has long been suspected. For example, individuals with psoriasis drink more alcohol than individuals without psoriasis, and alcohol intake may exacerbate psoriasis severity.”

Alcohol and Psoriasis

For other diseases, type of alcoholic beverage has been shown to influence risk—for instance, beer confers a larger risk for gout than wine or spirits. To evaluate the association between different types of alcohol and psoriasis risk, Abrar A. Qureshi, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School, Boston, assessed data from 82,869 women who were age 27 to 44 years in 1991. The women, participants in the Nurses’ Health Study II, reported the amount and type of alcohol they consumed on biennial questionnaires. They also reported whether they had received a diagnosis of psoriasis.

Through 2005, 1,150 cases of psoriasis developed, 1,069 of which were used for analysis. Compared with women who did not drink alcohol, the risk of psoriasis was 72 percent greater among women who had an average of 2.3 drinks per week or more. When beverages were assessed by type, there was an association between non-light beer drinking and psoriasis, such that women who drank five or more beers per week had a risk for the condition that was 1.8 times higher. Light beer, red wine, white wine and liquor were not associated with psoriasis risk.

When only confirmed psoriasis cases—those in which women provided more details about their condition on a seven-item self-assessment—were considered, the risk for psoriasis was 2.3 times higher for women who drank five or more beers per week than women who did not drink beer.

Increased Risk of Psoriasis

“Non-light beer was the only alcoholic beverage that increased the risk for psoriasis, suggesting that certain non-alcoholic components of beer, which are not found in wine or liquor, may play an important role in new-onset psoriasis,” the authors write. “One of these components may be the starch source used in making beer. Beer is one of the few non-distilled alcoholic beverages that use a starch source for fermentation, which is commonly barley.” Barley and other starches contain gluten, to which some individuals with psoriasis show a sensitivity. Lower amounts of grain are used to make light beer as compared with non-light beer, potentially explaining why light beer was not associated with psoriasis risk, they note.

“Women with a high risk of psoriasis may consider avoiding higher intake of non-light beer,” the authors conclude. “We suggest conducting further investigations into the potential mechanisms of non-light beer inducing new-onset psoriasis.”

August 17th, 2010  in Alcohol No Comments »

ER pep talk with teens can reduce drinking, violence

A brief, motivational talk in the emergency room reduced by half the chances that teenagers would experience peer violence or problems due to drinking, according to a study published Aug. 4 in a theme issue of the Journal of the American Medical Association.

The special issue on violence and human rights includes the work of University of Michigan Health System researchers who immersed themselves at the Hurley Medical Center emergency department, in Flint, Mich., for three years.

Researchers offered help to 726 adolescents, ages 14-18, who reported they experienced aggression or had a drink of beer, wine or liquor at least two or three times in the past year.

Reduction in Aggression

A one-on-one talk with a therapist resulted in a 34 percent reduction in peer aggression. Teens who received only a brochure had a 16 percent drop in aggression over the next three months.

The study showed similar drops in alcohol misuse after teens heard prevention messages delivered by a therapist or while using a role-playing computer program.

“Violence and alcohol use are preventable behaviors and the emergency department can be a key location for reaching high-risk teenagers,” says senior author Rebecca Cunningham, M.D., an emergency room physician and director of the University of Michigan Injury Research Center.

Violence and injuries are the leading causes of deaths among adolescents in the United States and the incidents are often fueled by alcohol. The U-M study showed ED interventions can also reduce alcohol-related problems by as much as 32 percent for six months.

The talks with teens were more complex than a parent talking to a child about the dangers of drinking and how to avoid peer pressure.

“Therapists used motivational interviewing which is well-suited for adolescent development,” says study lead author Maureen Walton, M.P.H., Ph.D., research associate professor in the U-M Department of Psychiatry, Addiction Research Center. “It doesn’t preach or tell teens what to do, but allows adolescents to weigh the pros and cons of their choices in reference to their goals.”

The therapists’ talks with teens also included role play exercises and tools to cope with risky situations that involve drinking or violence and referrals to community services.

Motivational Interviewing

“Most of the adolescents had high aspirations – they wanted to go to college, be a good role model for their younger siblings. They didn’t want to make the mistakes they saw happening around them,” Walton explains. “We talked to them about the discrepancies between their behavior and what they wanted to do with their lives.”

Motivational Interviewing, with proper training, can be used effectively by healthcare providers as well those without a professional healthcare background. Study co-author Stephen T. Chermack, Ph.D, a clinical psychologist and addiction specialist at the U-M Health System and the VA Healthcare System in Ann Arbor, is a member of the Motivational Interviewing Network of Trainers (MINT).

Adolescents in the study reported to the emergency department at Hurley Medical Center between noon and 11 p.m., during the three-year period, September 2006 to September 2009.

All patients completed computerized screening questions regarding alcohol use and violence and were randomized into three groups: a control group receiving a brochure, or one of two groups receiving a 35-minute brief intervention delivered by a computer or a therapist in the emergency room.

Authors say the computer screening worked well with teenagers because of their comfort with using technology. The computer program included animated role playing such as how to handle drinking and driving and conflicts with peers.

High-Risk Youth in the ER

“The study tells us that technology can aid in assisting high-risk youth in busy clinical settings, as well as deliver important prevention messages,” says Cunningham who is also an associate professor of emergency medicine at the U-M Medical School and associate professor of health behavior & health education at the U-M School of Public Health. “Emergency staff are busy and not all hospitals have the resource of a social worker or therapist present at all times in the emergency department.”

The ED can be a prime location for reaching high-risk teenagers since many may skip school, consider themselves too old to go to a pediatrician, yet often do not have a primary care doctor.

“We see the consequences our patients face from violence,” says Cunningham who is part of the team of U-M physicians who work in the Flint emergency department.

“But in addition to treating the immediate wounds from violence, the emergency department can offer opportunities to help the teens we see prevent future problems with alcohol and violence.”

August 7th, 2010  in Alcohol No Comments »

Mexican Drug Crackdown Reduces Meth Usage

A study published in the scientific journal Addiction shows that the Mexican government’s recent efforts to control the manufacture of methamphetamine have caused a drop in methamphetamine treatment admissions in Mexico and in neighbouring Texas.

In 2005 Mexico began controlling its imports of pseudoephedrine (a precursor chemical used in the manufacture of methamphetamine), and in 2008 it became the first country in North America to ban all imports of pseudoephedrine as well as ephedrine, another important precursor chemical. Researchers estimate that the 2005 import controls caused a 12% drop in voluntary methamphetamine treatment admissions in Mexico, with similar reductions in Texas.

An even larger drop in voluntary admissions occurred following the 2007 closure of a commercial chemical company suspected of illicitly importing more than 60 tons of pseudoephedrine into Mexico. The head of the company fled Mexico but was eventually arrested in the United States. Methamphetamine treatment admissions in Mexico decreased by 56% following the closure of the company, with Texas showing similar results.

Signs of Meth Decline

All decreases in admissions appeared to be specific to methamphetamine, as researchers found no concurrent changes in cocaine, heroin, and alcohol treatment admissions during the same period. The study wound up shortly after the 2008 bans on precursor chemicals came into effect, so researchers weren’t able to examine fully the impact of those bans; however, the researchers noted that treatment admissions in Mexico showed signs of declining in the first few months following the bans.

Says lead researcher James Cunningham, a Fulbright Scholar at The University of Arizona: “These findings constitute the first evidence outside the United States that a country’s precursor chemical controls can have positive public health results both domestically and internationally.”

Brain can be taught to control cravings

Standard therapeutic techniques decrease cravings of cigarette smokers by regulating activity in two separate but related areas of the brain, a new study led by a Yale University researcher shows.

Smokers who are taught cognitive strategies, such as thinking about the long-term consequences of smoking, show increased activity in the prefrontal cortex, an area of the brain associated with cognitive control and rational thought. They also show decreased activity in areas of the striatum, an area of the brain associated with drug craving and reward-seeking behavior, according to the paper published online Aug. 2 in the Proceedings of the National Academy of Sciences.

“This shows that smokers can indeed control their cravings, they just need to be told how to do it,” said Hedy Kober, assistant professor of psychiatry at the Yale School of Medicine and lead author of the paper.

Cravings Trigger Relapse

Cravings are the triggers that often lead to relapse in a host of addictions, which carry a staggering economic and social cost. Cigarette smoking alone is responsible for over 400,000 deaths per year in the U.S. (more than all illicit drugs and alcohol combined). Some experts predict that substance abusers should show impairments in areas of the prefrontal cortex, which among other functions helps control emotion. But in smokers at least, this does not appear to be the case. This area of the brain showed increased activity—and smokers reported less intense cravings—when using cognitive strategies.

Cognitive behavioral therapy has been shown to be an effective tool in treating a variety of mental health disorders, including substance use disorders. The new study shows why this approach is effective, Kober said.

“We do not see any impairment in the prefrontal cortex, which suggests the brain is able, when prompted, to recruit control regions to reduce cravings,” Kober said.

August 3rd, 2010  in Substance Abuse, Tobacco No Comments »

Child abuse: malicious use of pharmaceuticals

Child abuse is a serious problem that affects nearly one million children a year in the United States alone. The American Academy of Pediatrics and the US Department of Health and Human Services classify child abuse into four categories including neglect, physical abuse, sexual abuse, and emotional abuse. None of these categories, however, clearly includes the abusive use of drugs on children. A study soon to be published in the Journal of Pediatrics investigates the malicious use of pharmaceuticals and attempts to shed light on this under-recognized problem.

Dr. Shan Yin from the University of Colorado and the Rocky Mountain Poison Drug Center at Denver Health reviewed cases of pharmaceutical abuse reported to the National Poison Data System between 2000 and 2008. Dr. Yin included reports of the malicious use of alcohol, painkillers, cough and cold medicines, sedatives and sleeping pills, and antipsychotic medicines.

Using Drugs to Subdue Children

Of the more than 1400 cases studied, nearly 14% resulted in moderate to major consequences, including death. Nearly one-half of the abused children were exposed to at least one sedative. An average of 160 cases, including two deaths, was reported each year. Motives and legal findings were unavailable for these particular cases; however, motives for the abusive use of drugs generally are varied, and can include punishment, amusement, or a wish for a break from childcare responsibilities.

This study illustrates the seriousness of the abusive use of drugs administered to children. According to Dr. Yin, “The malicious administration of pharmaceuticals should be considered an important form of child abuse.” He encourages pediatricians and emergency medical personnel to be on the watch for this form of maltreatment, and suggests the use of comprehensive drug screening during the evaluation of a child suspected to be the victim of abuse. Dr. Yin also cautions parents that the “non-therapeutic administration of pharmaceuticals to children can result in serious outcomes, including death.”