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 29,987 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 1987, the Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA) developed a set of questions on alcohol-related problems in the general population. The aim of this article is to study the results of the questionnaire used as a screening instrument to detect problem drinking in the Swiss population, and to compare it with the CAGE test. The sample consisted of 953 people aged 20 or over. Among the drinkers (89% of the sample), 91 males (21.7%) and 34 females (8.7%) had a positive SIPA test and 53 males (12.7%) and 17 females (4.3%) a positive CAGE test. The SIPA test was more sensitive than the CAGE in detecting persons who drink regularly and quite heavily but without binge drinking. The item "Eye-opener" of the CAGE is too blunt for application to the Swiss general population and could with advantage be removed from the questionnaire. Females tend to deny alcohol problems much more than males. Binge drinking increases the risk of a positive test (SIPA: OR: 1.9; i.c. 95%: 1.2-3.0; CAGE: OR: 3.3; i.c. 95%: 1.8-6.0). In short, the SIPA test is more suitable in estimating the number of problem drinkers in the Swiss population than the CAGE, which was initially developed for the American medical population. Furthermore, the results suggest the necessity of using a different cut-off for each gender.
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PMID:[Screening for problem alcohol drinking in the Swiss population: comparison between an ISPA-developed instrument and the CAGE questionnaire. The Swiss Institute for the Prevention of Alcoholism]. 922 87

AUDs are increasingly recognized as common problems among older adults. The magnitude of this problem is likely to increase over ensuing decades as baby boomers reach retirement age with drinking habits that are significantly different from current cohorts of older adults. Barriers to detection are numerous and include nonspecificity of alcohol-related presentations, patient denial, and clinicians' unwillingness to recognize that patients can and do develop alcohol problems in later life. Despite the limitations of current screening and diagnostic instruments, the authors recommend use of the CAGE as a formal screening tool for older patients because of its brevity, demonstrated efficacy, and convenience. In patients who answer affirmatively to any CAGE question, diagnostic certainty can be increased by use of follow-up questions or referral to an alcohol treatment specialist. Referral of patients with established alcohol abuse or dependence is essential for definitive treatment, and successful outcomes can be expected and are gratifying once achieved. In patients with less severe AUDs, brief interventions with frequent follow-up are recommended. Age-specific screening and diagnostic instruments for older AUD patients, once fully developed and validated, will facilitate identification. Much less is known about other substance use disorders in older adults. Psychoactive drug use is not uncommon in this patient population and may result in adverse health outcomes. Treatment interventions proposed for AUDs are advocated for older adults found to have other substance use disorders as well and are likely to yield improved outcomes. Future investigations that better define the epidemiology, detection, and treatment of other substance use disorders in older populations are clearly warranted at this time.
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PMID:Geriatric substance use disorders. 922 65

A number of brief screening instruments to identify alcohol dependence exist, but the validity of these instruments across ethnic groups or regions of the country is not well established. The sensitivity and specificity of a number of standard screening instruments (CAGE, brief MAST, AUDIT, TWEAK, and RAPS), as well as other measures (History of Trauma Scale, breathalyzer reading, self-reported drinking before the event, and consuming five or more drinks at a sitting at least monthly) are compared against ICD-10 and DSM-IV criteria for alcohol dependence between probability samples of Black and White emergency room patients in Santa Clara County, CA (n = 716) and in Jackson, MS (n = 1330). Variability in the sensitivity of screening instruments among current drinkers was found to be greater between samples for both Blacks and Whites, than for Blacks compared with Whites within the same sample. The AUDIT, TWEAK, and RAPS seemed to perform well by gender and injury status for both Blacks and Whites in the two samples, and no significant differences were found in the performance of these instruments across sample sites. To evaluate the influence of regional differences in alcohol dependence on differences found in the performance of screening instruments, using logistic regression with the simultaneous entry of demographic variables (age, gender, ethnicity, injury status, and site) and drinking variables (breathalyzer reading, self-reported drinking before the event, and drinking five or more drinks at a sitting at least monthly) to predict alcohol dependence in a merged sample of these patients (Jackson vs. Santa Clara) site was not found to be significant. Data suggest that, whereas region of the country may not be important in predicting alcohol dependence in emergency room populations, regional differences in the performance of screening instruments for alcohol dependence may exist, even when ethnicity is taken into account. Given distinct regional differences in drinking patterns and problems in the U.S., further research on commonly used screening instruments is needed to determine those screeners most efficient for identifying problem drinking.
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PMID:Comparison of screening instruments for alcohol problems between black and white emergency room patients from two regions of the country. 939 9

The prevalence of problem drinking among medical and surgical in-patients in a general hospital was studied using the CAGE questionnaire. Almost a quarter (23.3%) of the in-patients had associated drinking problems which were more among medical than surgical in-patients. In a large majority of these patients, the associated problem drinking was not recognised by the treating medical professionals. Routine administration of instruments like CAGE which are brief and easy to use would contribute to the early detection and management of alcohol problems in the general hospital setting.
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PMID:Alcohol problems in a general hospital--a prevalence study. 952 84

In the US, about 11% to 20% of patients presenting to general medical clinics are diagnosed as suffering from alcohol abuse or dependence. Alcohol screening in primary care settings, whether in the US or Singapore, can utilise various strategies for the early detection of alcohol problems. This paper briefly reviews several self-reports and screening procedures to assist general practitioners in identifying problem drinkers. The use of CAGE questionnaire, MAST, and its variation, SAAST and the AUDIT, are discussed and evaluated. Likewise, useful biochemical markers of excessive alcohol consumption like the liver enzymes (AST, ALT, GGT), MCV, CDT are described. They can be combined with each other to improve validity or used in conjunction with self-report screening tests for more accurate detection of problem drinkers. In particular, use of the AUDIT for routine screening of alcohol problems in primary care settings is recommended. Selective administration to those with at least two drinks per setting can overcome time constraints. Alternatively, sequential screening utilising the TRAUMA questionnaire with frequency and quantity questions administered to higher frequency drinkers can circumvent concerns about direct questioning. Use of self-reports and when possible, biochemical screening for alcohol problems should be a standard part of primary care practice.
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PMID:What you need to know: detecting alcohol problems in general medical practice. 955 5

The prevalence of problem-drinking and alcohol dependence in Austria was assessed on the basis of two random samples of the general population drawn in 1995 (n=216) and in 1996 (n=531). Measurements were performed using the CAGE questionnaire (Mayfield et al. 1974). Both cut-off points (> or = 1, > or = 2) of the CAGE were used. Both samples showed a very similar prevalence of alcoholism. 2.2% (95% confidence interval 1.1-3.9%) of the Austrian adult population could be regarded as alcohol dependent (four positive CAGE answers). Using a cut-off > or = 2, 16-24% of the general population were rated as problem drinkers. The ratio of male to female problem drinking was found to be 3:1; this ratio increased to 4:1 for alcohol dependence. Subjects aged 18 to 59 years were found to be at greatest risk for problem drinking. Alcohol dependence showed an equal distribution among all age groups with a peak prevalence of 3.7% among 45 to 59-year-olds. Significant differences in test scores were found for gender in both samples, and for age in one sample; marital status had no impact on test scores. The findings reported in this study partly confirm the results of Austrian alcohol consumption surveys. Although our prevalence estimates rely on self-report and need to be validated by future epidemiological interview studies, the results indicate that alcoholism and problem drinking pose a major public health problem.
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PMID:[Incidence of alcoholism and problem drinking in Austria]. 965 88

The aim of this study is to deliver representative epidemiological data about the prevalence of alcohol abuse and dependence in general practices in an urban area. In 12 general practices at Luebeck, a Northern German city with 220,000 inhabitants, a total of 929 patients (aged between 14 and 75 years) were screened using the CAGE and the Short Michigan Alcoholism Screening Test. If one of these screening questionnaires or the General Practitioners' assessment of the patient indicated an alcohol problem, the patient underwent a standardized diagnostic interview using the alcohol section of the Schedules for Clinical Assessment in Neuropsychiatry. The prevalence rates according to ICD-10 or DSM-III-R were 3.5% for alcohol abuse and 7.2% for alcohol dependence, the sex ratio was 1:2.8 (female:male). These results are compared with previous findings, and general epidemiological implications of this study are discussed.
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PMID:Prevalence of alcohol dependence and abuse in general practice. 966 Mar 25

Screening instruments for problem drinking have been developed in clinical populations, and little is known of their performance in the general population. Sensitivity and specificity of the CAGE and the TWEAK for ICD-10 and/or DSM-IV criteria for alcohol dependence are compared among those sampled from the southern region in the 1995 National Alcohol Survey (n = 776), and from emergency room (ER) (n = 1327) and primary care clinic (n = 767) samples in Jackson, MS. Sensitivity of the CAGE was higher in both the ER (85%) and primary care (82%) samples than in the general population (75%), although differences were not significant, and this held for males and females alike. Sensitivity of the TWEAK was lower in the general population sample (83%) than in the ER sample (89%), but higher than in the primary care sample (75%). In the general population, sensitivity of both screeners was better (although not significantly so) among those making an ER or primary care visit during the last year than among those not doing so, with the largest difference found for the CAGE (85% vs. 65%, respectively). In a merged sample of the three sites, the interaction of site by screening instrument was not a significant predictor of alcohol dependence for either the CAGE or TWEAK. Data suggest that screening instruments may not perform as well in the general population as in some clinical populations, with more variation apparent across groups for some screeners than for others. Although further analysis is necessary to explore this issue further, attention should be given to selection of the best instrument for use in a given population.
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PMID:Performance of screening instruments for identifying alcohol dependence in the general population, compared with clinical populations. 980 19

The prevalence of adult cirrhosis in Western countries is estimated to be about 3-5 per cent. Hepatocellular carcinoma (HCC), the predominant type of primary liver cancer, is associated with cirrhosis in a majority of cases. The estimated annual incidence of cancer associated with cirrhosis is 1-11 per cent. All cirrhosis may be complicated by cancer, but the cancer risk is reported to be highest in cases of hepatitis B (HBV) or C (HCV) infection, or haemochromatosis. In two Swedish studies, comprising a total of 605 patients with HCC, cirrhosis was present in about 70 per cent. The most common causes of cirrhosis were alcohol abuse and chronic HCV infection, and there was not a single case of chronic HBV infection. Most patients presented with cancer but no history of cirrhosis. In HCC, prognosis is usually very poor, and the results of screening for HCC in cirrhosis patients have been disappointing. Thus, prevention of cirrhosis (e.g., by reducing alcohol consumption), treatment of chronic HCV infection and, in certain cases, vaccination against HBV, is an approach likely to have the greatest impact on the incidence of HCC.
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PMID:[Prevention of cirrhosis is the best measure against hepatocellular cancer]. 1002 24

The sensitivity and specificity of several screening instruments including the CAGE, brief MAST, AUDIT, TWEAK, RAPS, and Trauma Scale, were evaluated against both ICD-10 and DSM-IV criteria for alcohol dependence and for harmful drinking and abuse in a probability sample of 586 Hispanic emergency department patients. Screening instruments were not as sensitive for females as for males, for those in the low acculturation group, or for non-dependent drinkers. Acculturation was positively associated with the likelihood of being a current drinker and among current drinkers, was positively associated with alcohol dependence and with harmful drinking or alcohol abuse.
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PMID:Gender, injury status and acculturation differences in performance of screening instruments for alcohol problems among US Hispanic emergency department patients. 1008 40


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