Bev John

Fast screening for alcohol misuse

UNLABELLED The Fast Alcohol Screening Test (FAST) has been developed from the AUDIT questionnaire. AUDIT The Alcohol Use Disorders Identification Test: guidelines for use in primary health care. Geneva, Switzerland: World Health Organization for use in very busy medical settings. One feature of the FAST is its ease and speed of administration, especially since one question identifies over 50% of patients as either alcohol misusers or not. This study further explores the sensitivity and specificity of the FAST across ages, gender, and locations using the AUDIT as the gold standard. Two other quick tests are also compared with the AUDIT and the FAST, namely the Paddington Alcohol Test and the CAGE. All tests were quicker to administer than the AUDIT with the FAST taking just 12 s on average. All tests identified drinkers who would accept a health education booklet (over 70% of those identified) or 5 min of advice (over 40%). The FAST was consistently reliable when sensitivity and specificity were tested against AUDIT as the gold standard.

The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis

Summary Background Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations. Methods We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251. Findings Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohens d=1·11; p<0·0001), paranoia (−2·22, −2·98 to −1·45, Cohens d=0·19; p<0·0001), and hallucinations (−1·58, −1·98 to −1·18, Cohens d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported. Interpretation To our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision. Funding Wellcome Trust.

Eficacia de las políticas institucionales de prevención del consumo de alcohol en adolescentes: la opinión de expertos y adolescentes

OBJECTIVE The objective of this study is to obtain the views of a sample of adolescents and experts on adolescence, family, school, local policies and media, regarding the effectiveness of institutional policies to prevent adolescent alcohol use. SETTING Four educational centers in the province of Seville. Head office of the Alcohol and Society Foundation in Madrid. DESIGN Qualitative study using the method proposed by Grounded theory (Glaser and Strauss, 1967). METHODOLOGY Data were collected from 10 discussion groups guided by semistructured interviews. The data were analyzed using Atlas ti 5 software. PARTICIPANTS A total of 32 national experts and 40 adolescents of both sexes aged 15 to 20 years living in the province of Seville, selected by theoretical intentional sampling. RESULTS The experts believed that most of the evaluated preventive actions were effective, while adolescents disputed the preventive impact of most of them. Adolescents proposed actions focused on the reduction of supply of alcohol. Experts proposed a mixed model as the most effective strategy to prevent alcohol consumption in adolescents, combining supply and demand reduction policies, depending on specific short and long term objectives. CONCLUSIONS We have obtained, not only an overview of what is working (or not) from the view of adolescents and experts, but also the key points that should be taken into account for designing effective prevention policies.

The feasibility of alcohol interventions in accident and emergency departments

Doctors and nurses in three accident & emergency (A&E) departments were interviewed about the feasibility of screening for hazardous drinking as well as the provision of minimal or brief interventions. They were also asked about a more comprehensive approach to alcohol‐related problems that would involve liaising with other services. The feasibility of a comprehensive approach to excessive alcohol consumption is considered. Quantitative data revealed that computerised A&E records did not accurately portray the prevalence of alcohol‐related attendance.

Primary Progressive Orofacial Apraxia: A Ten-Year Long Follow-Up Case Report.

Orofacial apraxia (OA) as the main symptom in neurodegenerative disorders has not been yet reported. We present the case of a woman with a 22-month long history of isolated OA, studied with cerebrospinal fluid biomarkers and repeated clinical, neuropsychological, and morpho-functional evaluations. Baseline morpho-functional neuroimages revealed a left frontal operculum hypoperfusion with a widespread fronto-temporal involvement at follow-up. Cerebrospinal fluid concentrations of tau and amyloid-β were normal. The ten-year long clinical observation disclosed progressive OA worsening and the late onset of frontal functions impairment and extrapyramidal signs. The early and late stages of a neurodegenerative syndrome with OA as the main clinical feature were characterized.

Communication of diagnosis in amyotrophic lateral sclerosis: stratification of patients for the estimation of the individual needs

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by a progressive loss of the corticospinal tract, brainstem, and spinal neurons, leading to progressive muscle atrophy and weakness, and ultimately to death due to respiratory failure. The right to be informed is enshrined in the European Oviedo Convention (Council of Europe, 1997). The Awaji diagnostic criteria for ALS are generally used, identifying definite, probable, possible and suspected ALS (de Carvalho et al., 2008). Moreover, the pathway of a correct diagnostic assessment of ALS needs a complex algorithm of knowledge. There are no biochemical markers that allow a definitive diagnosis, and the clinical knowledge of the general practitioner in the early stages is critical in order to direct the patient to the neurologist.

Participants’ experiences of ketamine bladder syndrome: A qualitative study

The aim of this study is to explore recreational ketamine users’ experiences of ketamine bladder syndrome (KBS) and related health care provision issues. KBS is an emerging condition caused by chronic, recreational ketamine use, which can result in extensive, irreparable damage to the bladder and urinary tract. However, little is yet known about how patients are personally affected by the condition, their help seeking behaviour or experiences of related health care services. A qualitative study, informed by Heideggerian hermeneutics was undertaken. Twelve participants affected by KBS were purposively recruited into the study from an National Health Service (NHS) continence service and a drug support agency in South Wales, UK. Data were collected through recorded, semi‐structured interviews and analysed using a three‐step approach. Participants were predominantly younger, poly‐drug users and typically developed KBS following prolonged, habitual ketamine use. The effects of KBS were considerable and included incontinence, haematuria, profound abdominal pain and embarrassment and were exacerbated by delays in help seeking, disjointed medical care and on‐going ketamine use, which was integral to the self‐management of KBS pain. KBS has significant impact on those affected and can result in extensive, irreversible damage to the bladder and urinary tract. The condition, and its management, is further compounded by chronic poly‐drug use, chaotic lifestyles and a range of complex, related co‐morbidities, which require a collaborative, multi‐disciplinary approach. Andersons behavioural model of health services use provides an appropriate framework for better understanding help seeking/avoidance behaviour in this cohort, which can help inform clinical practice.

The Effectiveness of Brief Information and Self-Efficacy-Based Interventions in Influencing Snack Choices in Homeless Individuals

Background Homeless adults frequently experience poor nutrition. Research suggests raising self-efficacy and nutritional knowledge can increase healthy eating but that the choice of specific behavioral change techniques (BCTs) is also critical. This study investigated how BCTs, operationalized to increase nutrition knowledge and self-efficacy, might influence the choice of homeless adults when presented with a “healthy” and an “unhealthy” snack. Methods A total of 125 homeless adults were randomly allocated to watch 1 of 4 brief films: “control,” “[nutrition] information only,” “self-efficacy” (aimed at increasing self-efficacy and general healthy eating knowledge), and “enhanced self-efficacy” (as “self-efficacy,” but the presenter identified themselves as a homeless adult). Post-film, participants were invited to choose between a healthy and an unhealthy snack. Data were analyzed using ANOVA and chi square. Results Participants in the “enhanced self-efficacy” condition were significantly more likely to choose the healthy option compared to those in the control condition; for the “self-efficacy” condition, the difference was marginally significant. Perceived knowledge and self-efficacy were significantly associated and those with high self-efficacy were significantly more likely to choose a healthy snack regardless of condition. Conclusion Homeless adults are more likely to make healthy snack choices if their nutritional self-efficacy is increased through encouragement by a peer.

Models of health behaviour predict intention to use long-acting reversible contraception:

The aim of this study was to investigate women’s intention to use long-acting reversible contraception using two established models of health behaviour: the theory of planned behaviour and the health belief model. A questionnaire was completed by a convenience sample of 128 women attending a community sexual health clinic. The independent variables were constructs of theory of planned behaviour (attitude, subjective norm and perceived behavioural control) and health belief model (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, health motivation and cues to action). The dependent variable was intention to use long-acting reversible contraception. The theory of planned behaviour and the health belief model accounted for 75% of the variance in intention to use. Perceived behavioural control, perceived barriers and health motivation predict the use of long-acting reversible contraception. Public health information for women considering using long-acting reversible contraception should be based around addressing the perceived barriers and promoting long-acting reversible contraception as a reliable contraceptive method.

Identification and evaluation of neuropsychological tools used in the assessment of alcohol-related brain damage: A systematic review protocol

Abstract Neuropsychological assessment forms an essential part of the screening, diagnosis and general assessment of Alcohol-Related Brain Damage (ARBD). A number of studies have evaluated the applicability of various neuropsychological tests within the context of ARBD assessment, yet little attempt has been made to collate this evidence and discuss its clinical application. The aim of this protocol is to outline the methodology for a systematic review that aims to identify the neuropsychological tools being used to assess cognitive impairments in individuals with ARBD and evaluate their efficacy within this context. We will search a number of online databases and other sources to identify studies using a neuropsychological tool in the screening, diagnosis or neuropsychological assessment of individuals with ARBD. Primary outcome measures of interest will be construct validity, convergent validity, reliability (retest and inter-rater), sensitivity, specificity, positive predictive value and practical considerations. Results from the review will assist clinicians and researchers involved in the assessment and diagnosis of ARBD by providing a synthesis and critical analysis of the evidence base for each tool, allowing them to make efficient and well-informed test selections. Review findings could also be used to inform the development of guidelines for ARBD diagnosis and assessment.