James G. Rankin

The Benefits of HIV Antibody Testing of Saliva in Field Research

Much of the data that has been collected as part of the evaluation of the City of Toronto’s prevention programme comes from the interviews undertaken with Injection Drug Users (IDUs) at various locations around the city1. From these, we are able to describe the self-reported sexual and injecting behaviours of our participants. However, our respondents may answer in a fashion which they consider is expected of them rather than according to their actual behaviour. Therefore, the success of prevention programmes which are attributed to results obtained from interview data solely may be questioned on this basis. In contrast, if one can demonstrate a change in HIV infection rates amongst those utilizing compared to those not utilizing the programme or service, then policy makers may be more inclined to accept the validity of the findings. Therefore, in tandem with the analysis of results from our interviews we wished to look at HIV antibody test results in those who attended our needle exchange programme compared to those who did not.

Beyond Ischemic Heart Disease: Are There other Health Benefits from Drinking Alcohol?:

Evidence is growing that alcohol consumption confers health benefits beyond protection from ischemic heart disease. We review this evidence with regard to cerebrovascular disease, peripheral vascular disease, diabetes, cholelithiasis (gallstones), cognitive functioning, and stress reduction and subjective psychosocial benefits. Other possible benefits are briefly considered. The weight of evidence suggests that low-level alcohol consumption offers some protection against ischemic stroke. The evidence that moderate alcohol consumption protects against diabetes and gallstones is also fairly strong. The possibility of other health benefits cannot be dismissed. For all the conditions considered, more research is indicated. The application of more appropriate statistical techniques, studies of patterns of drinking, and experimental approaches to delineating underlying mechanisms should enable firmer conclusions to be drawn. A better understanding of both the benefits and the risks of alcohol use for individuals and populations will facilitate the development of appropriate program and policy interventions to promote health.

Morbidity Patterns in Hazardous Drinkers: Relevance of Demographic, Sociologic, Drinking, and Drug Use Characteristics

A profile of the demographic, sociologic, drug use, and drinking characteristics of a large group of inpatient alcoholics has been constructed as background for discussion of the clinical significance of these factors as determinants of physical morbidity in hazardous drinkers. Factors specifically considered include sex, skid row status, social class, and abnormal use of drugs of dependence, the amount of alcohol consumed and duration of drinking, drinking pattern, and type of beverage. While heavy drinking is of primary importance, the physical disease profile found in hazardous drinkers is modified by certain host and environmental characteristics. The implications for treatment planning and preventive programs are considered.

Biological mechanisms at moderate levels of alcohol consumption that may affect coronary heart disease

The aims of the present article are to present a framework for understanding the ways in which various alcohol-related mechanisms might fit into current hypotheses of coronary artery disease (CAD) and to consider whether proposed alcohol-related mechanisms have a degree of validity conceptually, experimentally and epidemiologically. It does not attempt to review in detail the literature on either current concepts of CAD or alcohol-related mechanisms. which has been well reviewed elsewhere (Steinberg et al., 1989; Fuster et al., 1992a, b; Kreisberg and Segrest, 1993; Steinberg et al., 1991; Veenstra, 1992). In carrying out this task, it is important to

Reducing volunteer bias: using left-over specimens to estimate rates of HIV infection among inmates in Ontario, Canada.

ObjectiveTo estimate the prevalence of HIV-1 infection among adult and young offenders admitted to remand facilities in the province of Ontario, Canada, by using a design that reduces volunteer bias. MethodsA study using a modified anonymous HIV-surveillance design was conducted with urine specimens routinely collected from male and female entrants to all Ontario jails, detention and youth centres between February and August 1993. Information on sex, age, and history of injecting drug use was also collected. Urine was screened using a modified commercial HIV enzyme-linked immunosorbent assay kit and confirmed using a modified in-house Western blot assay. ResultsData were obtained on 10530 adult men, 1518 adult women, 1480 young male offenders, and 92 young female offenders. Urine specimens were available for 88% of new entrants. Of the entrants, 1 % (n = 163) refused to have their urine used for research. Refusals were not associated with history of injecting drug use. Overall rates of HIV-1 infection were 1 % for adult men, 1.2% for adult women, and 0% for young offenders. Both the rates of infection and prevalence of injecting drug use varied across facilities and geographic regions. Overall, 13% of adult men, 20% of adult women, 3% of young male offenders, and 2% of young female offenders reported a history of injecting drug use. Rates of infection were highest among self-reported injecting drug users. Rates of HIV were 3.6% for adult men and 4.2% for adult women who injected compared with 0.6 and 0.5%, respectively, for non-injecting drug users. ConclusionsThe use of unlinked left-over specimens is an important tool for measuring HIV-prevalence rates and should be encouraged. The results indicate that HIV rates are much higher among those entering prisons than in the general population. The pattern of HIV in Ontario prisons is similar to that reported in Europe and the United States. We are optimistic that these data will stimulate much needed efforts towards education and health promotion, and open the door to further research in Canadian prisons.

Relationship between hepatitis B surface antigen prevalence, per capita alcohol consumption and primary liver cancer death rate in 30 countries

The relationships between the prevalence of hepatitis B surface antigen (HBsAg), mean annual per capita alcohol consumption and primary liver cancer (PLC) death rates were explored in 30 countries. HBsAg prevalence was associated, significantly, with the logarithm of the primary liver cancer death rate (simple correlation coefficient = 0.44, p less than 0.05). This significant association increased following adjustment for a countrys mean annual per capita alcohol consumption (partial correlation coefficient = 0.53, p less than 0.01). A logarithmic linear relationship was also found between per capita alcohol consumption and the primary liver cancer death rate after adjustment for the countrys prevalence of HBsAg (partial correlation coefficient = 0.38, p less than 0.05). Results from both correlation and regression analyses showed that prevalence of HBsAg was more significantly associated with PLC death rates than was alcohol consumption. However, these two variables were independently related to the PLC death rate in a stepwise multiple regression model. We could not demonstrate an interaction between the two variables. These findings are consistent with the prevailing view that chronic hepatitis B infection is the major factor in the most common form of primary liver cell cancer, hepatocellular carcinoma. In addition, they support the notion that alcohol consumption contributes significantly and independently, although probably to a lesser extent than hepatitis B, to deaths from that disease.

Social class and morbidity in clinically treated alcoholics

The lifetime physical disease profiles of 122 lower and 724 middle class non-skid row alcoholics admitted to an inpatient treatment facility were compared to further clarify the significance of social class as a determinant of morbidity in alcoholics. The overall severity of physical disease and the frequency of all recorded lifetime illness diagnoses were greater in the lower than in the middle class. The former experienced more trauma, genitourinary disorders, venereal disease and malnutrition, as well as small excesses of respiratory and nervous system disorders. There were no class differences in the lifetime frequencies of liver and biliary tract, gastrointestinal, cardiovascular, endocrine and metabolic, integumentary, locomotor and haemopoietic disorders, or in the incidences of a number of disease entities including acute brain syndromes and chronic brain damage. The drinking patterns of the classes were similar, but the average duration of hazardous drinking was longer and the average current consumption was greater in the lower class. There were no class differences, however, in the average duration of hazardous drinking before the first occurrence of certain diseases. The referral sources of the classes were significantly different. Possible explanations for the differences between the findings of this and earlier studies are discussed.

From scrubland to vintage wine: Australia's response to substance-related problems in the last 40 years.

Over the last 40 years Australias response to substance-related problems compared with most western nations has been outstandingly good. Since the 1960s concerns about problems of substance use have expanded from a focus on alcohol to include tobacco and a wide range of other licit as well as illicit psychoactive substances. During this period there have been major advances in our knowledge and understanding of substance-related problems and effective methods of prevention, intervention and treatment. In parallel has been the development of a large number of non-government, government and professional organizations concerned with problems of substance use. These groups, individually and collectively, have contributed to the development of policies, plans, resources and programmes to prevent and minimize substance-related harm. Although significant progress in these endeavours took place between 1960 and 1986, there has been accelerated growth since and largely as a result of the establishment of the National Campaign Against Drug Abuse in 1986 and the ensuing National Drug Strategy and the Illicit Drug Strategy. However, much of this more recent success was possible because of the existence of the organizations, networks and infrastructures established in the earlier period and the Nations general health, social and educational programmes. These initiatives have been associated with reductions in alcohol and tobacco use and related problems and evidence of reductions in some problem areas associated with illicit drug use. Despite these gains, there have been areas of failure and missed opportunities. Finally, it is critical to ensure that past achievements and opportunities for continued successful initiatives are not undermined by identifiable impediments and risks that could imperil the philosophy, goals, infrastructure and programmes that form the basis for Australias success to date.

Responding to drug and alcohol problems in health professionals, with special reference to Ontario

Concern has been expressed about alcohol and drug problems among health professionals because of the possibility of professional impairment, although there has been no evidence of increased legal suits by patients against such individuals. Alcohol and drug problems among health professionals were recognized but usually ignored by health professional organizations, except for sporadic disciplinary action, until the mid-1970s. At that time, important initiatives took place, particularly in the USA. Approaches developed so far by health professional groups to help their members with alcohol and drug problems can be broadly categorized as either coercive/therapeutic/disciplinary or therapeutic. The former approach is exemplified by US programs for physicians, and the latter by the approach to that profession in Canada. It is suggested that the employee assistance model is an alternative approach that could be adopted by health professionals, and that this model could be expanded to a health promotion/prevention/assistance model. Although there has been significant progress in the development of programs in Ontario to help health professionals with alcohol and drug problems, this development is faltering because of lack of support from health professional organizations.

Australia, a consumptive society

Until the mid-20th century, consumption, as tuberculosis was then known, was a major cause of illness and death in Australia. Unfortunately, since then, other so-called consumptive diseases have emerged to supplant tuberculosis, namely, those related to the use of alcohol and tobacco, and overweight and obesity. Over the last 30 years, much progress has been made in reducing and eliminating the use of and exposure to tobacco. Per capita consumption of alcohol is at a 50-year low, having reached peak levels in the 1970s. Since the 1960s, Australians have become increasingly overweight and obese. The major objective of the liquor, food and associated industries is to optimise profits, that is, to sell as much food and alcohol as possible. The problem for Australians is that any growth in per capita consumption of alcohol and a continuation of current levels of food consumption carries ever-increasing health risks and burdens. The protection and promotion of the health of Australian citizens are major responsibilities of Commonwealth, State and Territory Governments. They have a responsibility to intervene to maintain a balance between actions that support commercial growth and development and the health and welfare of its citizens. In this context, they have largely failed. Solutions to this impasse are only possible if APSAD and other relevant organisations and individuals are active professionally and politically as leaders and advocates for evidence-based actions by both governments and commercial groups. [James G. Rankin. Australia, a consumptive society. Drug Alcohol Rev 2017;36:270-277].