Valentino Patussi

Alcohol, cardiovascular disease and cancer.

We have read the excellent paper by Chiva-Blanch et al . (2013). The Authors affirm that moderate alcohol consumption (30 g/day for men and 15 g/day for women), expecially in the form of wine and beer, has cardioprotective effects through different mechanisms. Moreover, they report that three or more drinks per day may increase the risk of hypertention, stroke and breast cancer. Recently, the International Agency for Cancer Research (IARC—WHO: World Health Organization) (IARC, 2010, 2012) has demonstrated sufficient evidence in humans for the carcinogenicity of alcohol consumption. Alcohol consumption causes cancers of the oral cavity, pharynx, larynx, oesophagus, colorectum, liver (hepatocellular carcinoma) and female breast. Also, an association has been observed between alcohol consumption and cancer of the pancreas. There is sufficient evidence in humans for the carcinogenicity of acetaldehyde associated with the consumption of alcoholic beverages. Acetaldehyde associated with the consumption of alcoholic beverages causes cancer of the oesophagus and of the …

Establishing an Italian General Practitioner Brief Intervention Pilot Project for Problem Drinkers

This national pilot project commenced in 2004. It was promoted by the Istituto Superiore di Sanità and financed by the Italian Ministry of Health. The Italian Society of General Practitioners supported implementation of the study in general medical practitioner settings and coordination was undertaken by the Alcohol Centre of the University Hospital of Florence. The objectives of the study are to create a brief intervention package, suitable for use within the Italian primary health care system for screening and treating “hazardous drinkers”; to survey alcohol consumption in a sample of the population aged 18 or over, who the general practitioners assessed as suitable for brief intervention using the projects instruments; to conduct an experimental trial of brief intervention procedures, with “hazardous drinkers” randomly allocated to intervention or control conditions; to assess the effectiveness of brief intervention as a primary preventive measure. The early stage of this study concentrated on creating a strong research partnership to foster the involvement of general medical practitioners on a national scale. Subsequently, resources were devoted to the creation of the brief intervention package, including support material and the training of the general medical practitioners in its implementation.

[Alcohol, cardiovascular prevention and cancer].

It is well known that light to moderate drinking (10-25 g/day) has a protective effect on ischaemic heart disease. This effect seems independent of the type of alcoholic beverage. Recently, the International Agency for Research on Cancer (World Health Organization) stated that alcoholic beverages are carcinogenic for human (oral cavity, pharynx, larynx, oesophagus, colorectum, liver and breast). There is a dose-response relationship between alcohol and cancer in that the risk of cancer increases proportionally with alcohol consumption. Low doses of alcohol (10 g/day) are associated with an increased risk for oral cavity, pharynx, larynx, oesophagus and breast cancer. Therefore, a physically active lifestyle and a healthy diet are more effective in preventing ischaemic heart disease than a low level of alcohol consumption.

Role of brief intervention for prenatal alcohol consumption conducted by nonmedical professionals.

Methods From January 2008 to December 2011, 251 (mean age: 34+/-6) pregnant women with a T-ACE positive screen for risk of alcohol consumption while pregnant were evaluated in our regional alcohol center. The T-ACE asks four questions that give the assessment its name: Tolerance (how many drinks does it take to make you feel high?), Annoyed (have people ever annoyed you by criticizing your drinking?), Cut down (have you ever felt you ought to cut down on your drinking?), and Eye-opener (have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?). The tolerance question is given two points if the respondent reports needing more than two drinks; affirmative replies to the A, C, and E questions are each given one point. All the women agreed to receive structured brief advice and referral for a 15to 20-minute motivational interviewing session with an alcohol health worker. The brief intervention group was compared with 150 women not treated with brief intervention (mean age 35+/-4). We also evaluated the impact of the support partner’s participation in the treatment. The intervention was offered during the first trimester. Statistical analysis was conducted using the Fisher exact test. Results Brief intervention = abstinent 60.6% (151/251), consumption or reduction (C-R): 39.4% (100/251); no intervention = abstinent: 20% (30/150) p<0.001, C-R: 80% (120/150) p<0.001; Partner participation = abstinent 55.7% (140/251), C-R 44.3% (111/251) p<0.01.

Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol

The chronic use of alcohol can lead to the onset of an alcohol use disorder (AUD). About 50% of subjects with an AUD may develop alcohol withdrawal syndrome (AWS) when they reduce or discontinue their alcohol consumption and, in 3–5% of them, convulsions and delirium tremens (DTs), representing life-threatening complications, may occur. Unfortunately, few physicians are adequately trained in identifying and treating AWS. The Italian Society on Alcohol has, therefore, implemented a task force of specialists to draw up recommendations for the treatment of AWS with the following main results: (1) while mild AWS may not require treatment, moderate and severe AWS need to be pharmacologically treated; (2) out-patient treatment is appropriate in patients with mild or moderate AWS, while patients with severe AWS need to be treated as in-patients; (3) benzodiazepines, BDZs are the “gold standard” for the treatment of AWS and DTs; (4) alpha-2-agonists, beta-blockers, and neuroleptics may be used in association when BDZs do not completely resolve specific persisting symptoms of AWS; (5) in the case of a refractory form of DTs, the use of anaesthetic drugs (propofol and phenobarbital) in an intensive care unit is appropriate; (6) alternatively to BDZs, sodium oxybate, clomethiazole, and tiapride approved in some European Countries for the treatment of AWS may be employed for the treatment of moderate AWS; (7) anti-convulsants are not sufficient to suppress AWS, and they may be used only in association with BDZs for the treatment of refractory forms of convulsions in the course of AWS.

Epatite alcolica acuta

Chronic alcohol related liver disease is characterized by a cascade of events defined as follows: steatosis, steatohepatitis/steatofibrosi, cirrhosis and hepatocellular carcinoma. On one of these histologic patterns may overlap acute alcoholic hepatitis (AAE) (mild, moderate, severe). Severe AAE can cause a severe clinical picture: jaundice with a duration of less than three months, jaundice in the first decompensation event, serum bilirubin higher than 5 mg/dL, ratio AST/ALT >2:1, AST less than 500 IU/L ALT 32 and MELD >21) with absence of contraindications, it is possible to use steroids therapy. If a positive answers cannot be obtained, an early liver transplantation is proposed. This possibility, after a careful selection, now is promoted by several authors.

Identificazione Precoce Intervento Breve (IPIB): the training program of the National Institute of Health--Italian National Health Service (ISS) on early identification and brief intervention on alcohol for primary health care professionals in Italy

The Early Identification and Brief Intervention (EIBI) programme, implemented in Italy since the 1990s, is one of the most important outcomes to be achieved to reduce the level of risk linked to hazardous and harmful alcohol consumption. The NOA-CNESPS of the ISS played a pivotal role carrying out formal activities preparing a national strategy aimed at the implementation of a common standard of EIBI training now explicitly included in all national public health documents and carried out under the frame of different national/international programmes. Identificazione Precoce Intervento Breve (IPIB) is the national EIBI working team at the NOA-CNESPS, ISS. The team started its activities in April 2006, publishing the national strategy and organising conferences to announce, promote and disseminate the IPIB training programme. The ISS has been indicated by the National Committee on Alcohol (Consulta Nazionale Alcol) as the national provider of the training activities in tight connection with the SIA (Italian Society of Alcohology) and the Regions. IPIB training is not yet compulsory for the professionals of the National Health System, but an example of implementation at the Regional level has been the specific training experience of the Tuscany Region, a programme for all the Regions on IPIB in the workplace funded by the Centre for Control of Diseases (CCM) of the Italian Ministry of Health. The courses at the ISS, funded by the Ministry of Health and by the Presidency of the Council of Ministers, Department for Anti-drug Policies, follow a formal evaluation in terms of credits to be earned through the Continuous National Training Programme (ECM). The NOA-CNESPS, ISS, implemented 11 residential courses with the main objectives of enhancing professional skills, knowledge, attitudes and motivation of primary health care professionals when dealing with patients with HHAC. The outcome of the training courses will be presented.