Christiane Sybille Schmidt

The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews.

Aims: The aim of the study was to assess the cumulative evidence on the effectiveness of brief alcohol interventions in primary healthcare in order to highlight key knowledge gaps for further research. Methods: An overview of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare published between 2002 and 2012. Findings: Twenty-four systematic reviews met the eligibility criteria (covering a total of 56 randomized controlled trials reported across 80 papers). Across the included studies, it was consistently reported that brief intervention was effective for addressing hazardous and harmful drinking in primary healthcare, particularly in middle-aged, male drinkers. Evidence gaps included: brief intervention effectiveness in key groups (women, older and younger drinkers, minority ethnic groups, dependent/co-morbid drinkers and those living in transitional and developing countries); and the optimum brief intervention length and frequency to maintain longer-term effectiveness. Conclusion: This overview highlights the large volume of primarily positive evidence supporting brief alcohol intervention effects as well as some unanswered questions with regards to the effectiveness of brief alcohol intervention across different cultural settings and in specific population groups, and in respect of the optimum content of brief interventions that might benefit from further research.

Meta-analysis on the effectiveness of alcohol screening with brief interventions for patients in emergency care settings

BACKGROUND AND AIMS Despite ambiguous evidence for the effectiveness of alcohol screening with brief interventions (BI) in emergency departments (ED), ambition for their widespread implementation continues to grow. To clarify whether such an application of BI is justifiable, we conducted a systematic review and meta-analysis on studies testing the impact of BI on alcohol consumption. METHODS We included peer-reviewed, randomized controlled studies investigating the effects of BI on alcohol consumption in injured and/or intoxicated patients, published January 2002-September 2015. Changes from baseline in consumption quantity, intensity and number of heavy drinking episodes were assessed at 3-, 6- and 12-month follow-up, resulting in nine separate random-effects meta-analyses of standardized mean differences (SMD). Moderation effects of intervention mode, length, type of interventionist, intensity of control intervention and study quality were assessed using subgroup comparisons and meta-regression. RESULTS We considered 33 publications (28 separate studies) including 14 456 patients. Six of nine comparisons revealed small significant effects in favour of BI, with the highest SMD at 0.19 [95% confidence interval (CI) = 0.08-0.31]. No significant moderators could be identified, and statistical heterogeneity (I(2) ) was below 40%. CONCLUSIONS In a large meta-analysis of randomized controlled trials in emergency care settings, there was evidence for very small effects of brief interventions on alcohol consumption reductions. More intensive interventions showed no benefit over shorter approaches. Non-face-to-face interventions appear to be comparably effective, but this finding remains tentative due to the low number of non-face-to-face studies.

Alcohol screening and brief intervention in workplace settings and social services: a comparison of literature.

Background: The robust evidence base for the effectiveness of alcohol screening and brief interventions (ASBIs) in primary health care (PHC) suggests that a widespread expansion of ASBI in non-medical settings could be beneficial. Social service and criminal justice settings work frequently with persons with alcohol use disorders, and workplace settings can be an appropriate setting for the implementation of alcohol prevention programs, as a considerable part of their social interactions takes place in this context. Methods: Update of two systematic reviews on ASBI effectiveness in workplaces, social service, and criminal justice settings. Review to identify implementation barriers and facilitators and future research needs of ASBI in non-medical settings. Results: We found a limited number of randomized controlled trials in non-medical settings with an equivocal evidence of effectiveness of ASBI. In terms of barriers and facilitators to implementation, the heterogeneity of non-medical settings makes it challenging to draw overarching conclusions. In the workplace, employee concerns with regard to the consequences of self-disclosure appear to be key. For social services, the complexity of certain client needs suggest that a stepped and carefully tailored approach is likely to be required. Discussion: Compared to PHC, the reviewed settings are far more heterogeneous in terms of client groups, external conditions, and the focus on substance use disorders. Thus, future research should try to systematize these differences, and consider their implications for the deliverability, acceptance, and potential effectiveness of ASBI for different target groups, organizational frameworks, and professionals.

HYPOTHALAMIC mRNA-DIRECTED SYNTHESIS OF NEUROPOLYPEPTIDES: IMMUNOLOGICAL IDENTIFICATION OF PRECURSORS TO NEUROPHYSIN II/ARGININE VASOPRESSIN AND TO NEUROPHYSIN I/OXYTOCIN

Bovine hypothalamic mRNA was translated in wheat germ and reticulocyte lysate cell-free systems.Translation products were immunoprecipitated with specific antisera and analyzed by SDS-PAGE.

Structural barriers in the context of opiate substitution treatment in Germany - a survey among physicians in primary care

BackgroundOpiate substitution treatment (OST) is the most widely used treatment for opioid dependence in Germany with substantial long-term benefits for the patient and for society. Due to lessened restrictive admission criteria, the number of registered OST patients in Germany has increased continuously in the recent years, whereas the number of physicians providing OST has remained constant. Previous data already indicated a deteriorating situation in the availability or quality of OST delivered and that structural barriers impede physicians in actively providing OST. The present survey among a sample of primary care physicians in Germany aimed to identify and assess potential structural barriers for the provision of health care in the context of OST.MethodsAn anonymous written questionnaire was sent out to a sample of 2,332 physicians across Germany providing OST. Physicians contacted were identified through databases of the Federal State Chambers of Physicians and/or of the Federal Associations of Statutory Health Insurance Physicians. Data obtained were analysed descriptively.ResultsThe response rate was 25,5% and the majority of 596 physicians sampled viewed substantial problems in terms of the regulatory framework of OST care in the German context. Furthermore, financial remuneration, insufficient qualification, as well as inadequate interdisciplinary cooperation in the treatment of comorbidities of opiate substituted patients were regarded as problematic. The number of physicians providing OST in Germany is expected to substantially decrease in the near future.ConclusionDespite less restrictive admission criteria for OST in Germany, the legal regulation framework for OST is still a limiting factor through raising concerns on the provider and consumer side to be unable to adhere to the strict rules. To avoid future shortages in the provision of OST care on the system level in Germany, revisions to the legal framework seem to be necessary. In regards to adequate care for drug use-related infectious diseases and psychiatric comorbidities commonly found in opiate substituted patients, efforts are required to improve professional qualifications of physicians providing OST as well as respective interdisciplinary collaboration.

Viral hepatitis in alcohol-dependent inpatients: prevalence, risk factors, and treatment uptake.

Objectives:Most epidemiological literature on the prevalence of viral hepatitis in alcohol-dependent patients is based on older data. This study aimed to provide current estimates and an assessment of risk factors. We further investigated whether the initiation of antiviral hepatitis C virus (HCV) treatment is feasible after detoxification. Methods:We assessed serological markers for hepatitis B virus (HBV) and HCV infection and liver enzyme levels (alanine aminotransferase, aspartate aminotransferase, &ggr;-glutamyltransferase) in a sample of 463 inpatients in a tertiary care hospital, fulfilling International Classification of Diseases, Tenth Revision criteria for alcohol dependence. A subsample of 141 patients was interviewed on addiction history and risk factors for HCV acquisition. All patients with an indication for antiviral treatment were followed up. Results:Compared with that in the general population, we found an elevated anti-HCV prevalence in alcohol-dependent patients (5.2%; 95% confidence interval, 3.2%-7.2%), whereas anti-Hbc immunoglobulin G prevalence (8.3%; 95% confidence interval, 5.7%-10.8%) corresponded to normal rates. Liver enzyme levels significantly differed between patients with chronic, past/remitted, or no HCV infection. On an observational level, a history of injection drug use or nonprofessional tattooing emerged as potential risk factors. In 1 of 10 patients, antiviral therapy was initiated. This 1 patient achieved the end-of-treatment response after extended rapid virological response, despite continuous alcohol consumption. Conclusions:The elevated HCV infection rates in our sample and the higher levels of fibrosis biomarkers in those with positive polymerase chain reaction corroborate previous findings and emphasize the importance of HCV screening in this population, particularly if further risk factors like injection drug use are given. Factors influencing treatment reluctance and conditions that may enhance the feasibility of antiviral treatment in alcohol-dependent patients should be subject of further research.

Epidemiology of hepatitis C virus infection among people receiving opioid substitution therapy (ECHO): study protocol

BackgroundHepatitis C virus infection is highly prevalent among people who inject drugs. Opioid substitution therapy, the standard treatment for opioid dependence, provides an excellent opportunity for the treatment of hepatitis C virus infection due to the close and regular contact between patients and clinicians. However, there is little research on the impact of opioid substitution therapy on the prevalence of the hepatitis C virus at a national level. This paper describes the protocol for the Epidemiology of Hepatitis C Virus Infection among People Receiving Opioid Substitution Therapy (ECHO) study. The aim of this study is to estimate the national prevalence and incidence of hepatitis C virus infection among people receiving opioid substitution therapy in Germany and to describe factors associated with hepatitis C treatment uptake and seroconversion.Methods/DesignAn observational, longitudinal, multicentre study is being conducted between 2014 and 2016 in a representative sample of approximately 2500 people receiving opioid substitution therapy from about 100 clinicians providing opioid substitution therapy in Germany. Data will be collected during routine patient care and by means of patient and clinician questionnaires at baseline and 12-month follow-up. Stratified sampling will be performed to obtain a representative sample of clinicians providing opioid substitution therapy. The strata will be constructed based on the distribution of the total sample of clinicians providing opioid substitution therapy in Germany according to German Federal State and the number of patients per clinician.DiscussionOpioid substitution therapy may be an important strategy to prevent the spread of hepatitis C virus in opioid dependent populations, but its effectiveness may be diminished by our limited understanding of factors associated with treatment uptake and seroconversion. The present study will provide important information for developing strategies to address hepatitis C virus-related disease burden in people receiving opioid substitution therapy.Trial registrationClinicalTrials.gov: NCT02395198

Informations- und Beteiligungspräferenz sowie Patientenzufriedenheit bei Opiatsubstituierten. Ergebnisse einer deutschlandweiten repräsentativen Stichprobe von ambulanten Substitutionseinrichtungen

Einleitung: In verschiedenen Studien konnte gezeigt werden, dass viele Patienten ein groses Informationsbedurfnis haben und haufig der Wunsch besteht, an medizinischen Entscheidungsprozessen beteiligt zu werden. Bisher gibt es allerdings kaum Erkenntnisse daruber, welche Praferenzen in ambulanten Substitutionseinrichtungen betreute Opiatpatienten hinsichtlich Informationen uber bzw. Beteiligung an medizinischen Entscheidungsprozessen haben. Diese zu ermitteln erscheint relevant, da anzunehmen ist, dass eine systematische Berucksichtigung der Patientenpraferenzen bedeutsam fur die Frage ist, ob es zu einer (erfolgreichen) Therapieinitiierung kommt. Hierbei ist neben der Substitutionstherapie auch die Therapie von haufig vorkommenden Komorbiditaten innerhalb der Opiatklientel gemeint. Des Weiteren ist eine intakte und vertrauensvolle Beziehung zwischen Arzt und Patient ein entscheidender Faktor fur den Erfolg der arztlichen Masnahmen. Die Qualitat des Arzt-Patient-Verhaltnisses, insbesondere hinsichtlich der partizipativen Entscheidungsfindung, lasst sich valide uber die Messung der Patientenzufriedenheit abbilden, die sich in der Forschung als zentraler Indikator fur die Akzeptanz einer Behandlung erwiesen hat. Methoden: Das erwahnte Forschungsdefizit soll im Rahmen einer multizentrischen naturalistischen Beobachtungsstudie mit einer Dauer von 27 Monaten gezielt angegangen werden. Hierfur wurde eine fur Deutschland reprasentative Stichprobe ambulanter Substitutionspraxen generiert. Zur Datenerhebung werden schriftliche Patienten- und Arztefragebogen eingesetzt, auserdem wird auf Daten der Regelversorgung zuruckgegriffen. Die Fragebogen enthalten unter anderem Instrumente zur Erhebung des Gesundheitszustands (OTI, BSI, CGI), zur Messung der Informations- und Beteiligungspraferenz (API-Dm) sowie zur Patientenzufriedenheit (ZAPA). Die hier prasentierten Ergebnisse beruhen auf einer Stichprobe von ca. 1000 Substitutionspatienten aus ca. 40 Praxen. Ergebnisse: Da die Datenerhebung noch nicht komplett abgeschlossen ist, liegen derzeit noch keine Ergebnisse vor. Erste zentrale Ergebnisse der Studie werden auf dem Poster prasentiert. Diskussion: Im Rahmen der Studie werden erstmals reprasentativ fur Deutschland das Informations- und Beteiligungsbedurfnis sowie die Patientenzufriedenheit von substituierten Opiatabhangigen untersucht. Auf Grundlage der Ergebnisse konnen zukunftige Versorgungsempfehlungen hinsichtlich der partizipativen Entscheidungsfindung diskutiert werden.

Subjektive Belastung aufgrund von körperlichen Beschwerden bei Opiatsubstituierten

Einleitung: Die Aussagekraft aktueller Instrumente zur Messung somatischer Belastung bei opiatsubstituierten Patienten ist begrenzt: So ermoglicht die Gesundheitsskala des Opiate treatment Index (OTI) bislang nur eine Schatzung der 30-Tages-Pravalenz einzelner Symptome, ohne deren jeweilige subjektive Belastung mit zu erfassen. Letztere wird zwar im Addiction Severity Index erhoben, jedoch ohne einzelne Symptome gezielt abzufragen. Entsprechend liegt nur wenig Literatur dazu vor, welchen Stellenwert korperliche Erkrankungen (einschlieslich Infektionserkrankungen wie Hepatitis C) und der potenziell damit verbundene Leidensdruck bei substituierten Patienten tatsachlich einnehmen. In dieser Untersuchung werden die folgenden Fragestellungen bearbeitet: Methoden: Im Rahmen der ECHO-Studie (Epidemiologie der Hepatitis C Virusinfektion bei Opioidsubstituierten: Einflussfaktoren auf Therapieinitiierung und Serokonversion) werden an einer reprasentativen Stichprobe von 2500 Patienten aus rund 100 ambulanten Substitutionseinrichtungen patientenbezogene Daten aus der Regelversorgung erhoben sowie Arzt- und Patientenfragebogen vorgegeben. Die Gesundheitsskala des OTI (Checkliste mit 50 Symptomen) wurde im Rahmen dieses Forschungsvorhabens um eine 5-stufige Likert-Skala „Schweregrad der Belastung“ (von 1 =„gar nicht“ bis 5 =„sehr stark“) fur jedes vorhandene Symptom erganzt, sodass sich zusatzlich zum Summenscore auch ein „Belastungsscore“ ergibt. Diese erweiterte Version wird bei jedem zweiten der ersten 1000 eingeschlossenen Patienten vorgegeben, sodass sich eine Teilstichprobe von n = 500 Patienten mit Belastungsdaten ergibt. An dieser Teilstichprobe werden die Haufigkeiten einzelner Symptome, durchschnittliche Belastung und Varianz pro Symptom sowie Korrelationen von Summen- und Belastungsscores ermittelt. Ergebnisse: Zum Zeitpunkt der Beitragseinreichung ist die Rekrutierung der Patienten und Praxen der ECHO-Studie zu rund 50% abgeschlossen. Die fur diese Fragestellung notwendige Teilstichprobe von n = 500 Patienten liegt somit fast vollstandig vor. Neben einer Einordnung der Ergebnisse in den Kontext bestehender Literatur sowie der Diskussion moglicher Implikationen fur die Praxis werden auch Uberlegungen zur tatsachlichen Reprasentativitat der Stichprobe und moglichen geografischen Unterschieden diskutiert.