[Does macrocytosis without anemia require more careful studies?].
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Anemia, Macrocytic↗
Biomedical subjects
K Seppä
Publications and source records attributed to K Seppä.
The efficiency of a questionnaire in detecting heavy drinkers.
The suitability of the nine-question Malmö modified Michigan Alcoholism Screening Test (Mm-MAST) was tested on 133 40-year-old men and 140 45-year-old men attending a voluntary population health screening in a typically week-end-drinking society. With a cut-off level of two 'yes' answers 29% of the middle-aged male population has been reported to give a positive result in this questionnaire. In our study alcoholics were excluded. The amount and type of alcohol consumed per week was asked. The subjects were divided into three groups: (1) social drinkers (0 or 1 'yes' answer), (2) suspect abusers (two 'yes' answers), and (3) abusers (three or more 'yes' answers or drinking at least 280 g absolute alcohol per week). Group 2 reported drinking more than group 1, but according to biological markers they belonged better to group 1 than group 3. With the originally recommended cut-off level of two 'yes' answers 50.8% of 40-year-old men and 36.5% of 45-year-old men in our study proved positive. With the three 'yes' answer criterion the corresponding percentages were 28.5 and 24.0. Forty- and 45-year-old men in group 2 gave many positive answers in the question concerning week-end drinking and avoidance of alcohol for a time, as did 40-year-old men in the question concerning bad conscience after drinking. Beer and spirits were the most popular beverage combination and week-end drinking was the commonest drinking habit. The number of positive answers correlated well with the announced amount of alcohol.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Effect of acetaldehyde on hemoglobin: HbA1ach as a potential marker of heavy drinking.
The appearance of a new acetaldehyde-induced hemoglobin fraction, HbA1ach, and the effect of alcohol consumption on it and on the ratio of HbA1ach and glycated hemoglobin, HbA1c, were studied in vivo by cation exchange liquid chromatography. The mean +/- SEM of blood HbA1ach level was 171 +/- 13.10(-3)% of total hemoglobin as measured in 34 male teetotallers. Blood HbA1ach levels of 127 social drinkers (182 +/- 6.10(-3)%) were compared with those of 72 heavy drinkers (213 +/- 8.10(-3)%, p less than 0.01), 79 alcoholics (209 +/- 6.10(-3)%, p less than 0.01) and 16 diabetics (419 +/- 28.10(-3)%, p less than 0.001). HbA1ach correlated positively with HbA1c (p less than 0.001) and negatively with HbAo (p less than 0.001). The ratio of HbA1ach/HbA1c was effective in detecting the alcohol-induced increase in the HbA1ach fraction because the ratio reduced the disturbing effect of glucose. The sensitivity of the HbA1ach/HbA1c ratio was 33% in the heavy drinker group as compared to 40% of gamma-glutamyltransferase and 24% of mean corpuscular volume. The HbA1ach fraction and the HbA1ach/HbA1c ratio seem to be valuable in detecting excessive alcohol consumption in its early phase.
Acetaldehyde↗
Blood count and hematologic morphology in nonanemic macrocytosis: differences between alcohol abuse and pernicious anemia.
In order to find out if blood count parameters could help to differentiate between the two most common causes for nonanemic macrocytosis, alcohol abuse and vitamin B12 deficiency, we studied 18 nonanemic pernicious anemia patients and 136 alcohol abusers without deficiency of folate and with an erythrocyte mean cell volume (MCV) value > or = 100 femtoliters. In addition to blood count reticulocytes, peripheral blood smear and marrow aspirates were examined. The combination of a low red cell count (< 4.0 x 10(12)/l) or a high red cell distribution width (E-CDW) value (> 15.0%) with a normal thrombocyte count and a normal thrombocyte mean cell volume (T-MCV) was found in 94.4% of the vitamin deficient patients but in only 14.6% of the abusers, in 25.0% of the folate deficient patients (n = 8), and in 26.9% of the patients without any cause for macrocytosis (n = 52). None of the peripheral blood smear or marrow findings exceeded this sensitivity, and the few highly specific findings had low sensitivities. Thus, the combination of the four blood count parameters proved to be, as compared to hematologic morphology, a good diagnostic tool in selecting patients for appropriate further diagnostic tests. All patients with macrocytosis should be asked about their alcohol consumption. Additionally, serum B12 vitamin should be measured at least when nonanemic macrocytosis is combined to a low red cell count or a high E-CDW and the thrombocyte count and T-MCV are normal.
Adult↗
Alcohol consumption profile by time in middle-aged men: a longitudinal study based on three different diagnostic instruments.
This longitudinal study aimed at comparing aggregate measures of heavy or problem drinking and their variations across time among the same subjects. We examined middle-aged men participating in a health survey over a 5-year interval. Of the 133 consecutive men in the whole age group interviewed as 40-year-olds in 1989, 114 were reached and re-interviewed in 1994. Alcohol consumption was measured by self-report, Malmo-modified Michigan Alcoholism Screening Test (Mm-MAST), and serum carbohydrate-deficient transferrin (CDT). Self-reported alcohol consumption decreased with years (142 vs 105 g/week, P = 0.01), as did CDT (16.9 vs 14.4 U/l, P = 0.02), but there was no change in the Mm-MAST results. There was no significant difference in the number of heavy drinkers (either Mm-MAST score > or = 3, or by self-reported alcohol consumption > or = 280 g/week, or by CDT > or = 20 U/l) at 40 and 45 years of age (37 and 47% respectively). At the individual level, alcohol consumption both increased and decreased with age. At 45 years of age 5/114 (4%) of the men reported that they had increased their alcohol consumption by more than 80 g/week and 25/114 (22%) said that they had reduced their drinking by the same amount. The remaining 84 (74%) reported drinking the same amount as 5 years earlier (+/- 80 g/week). This indicates that alcohol drinking habits are not stable in middle age. Most heavy drinkers in both age groups were detected by Mm-MAST and this proportion increased with age while the proportion of positive self-reports and CDTs decreased. Thus, the social consequences, measured here by the Mm-MAST, may be more readily experienced with years even at smaller consumption levels.
Adult↗
Persistence of substance use-related hospital utilization among psychiatric consultation patients.
Among 86 consecutive consultation-liaison (C-L) patients with current substance use-related hospital attendance, the case records revealed an average history of 5.9 years in male patients and 5.3 years in female patients of repeated substance use-related hospital visits. A history of at least 1 year was found in 60% (52/86) of patients. The history had started at the age of early 30s with attempted suicide as the most common principal diagnosis. By the age of 40, there had been several hospital visits for various health problems. However, 48% (41/86) of the patients had never received substance use treatment. It appeared that opportunities to intervene with substance use were frequently missed on hospital encounters, a finding also observed in earlier studies.
Adolescent↗
Opinions on alcohol-related issues among professionals in primary, occupational, and specialized health care.
The objective of this study was to analyse differences in health care personnel's knowledge, skills, and attitudes in relation to alcohol-related matters by a postal questionnaire between primary, occupational, and specialized health care. Heavy drinking was considered to be common among patients at all health care levels, and particularly in specialized health care. However, early recognition and treatment of heavy drinkers was considered more appropriate in primary and occupational health care, than in specialized health care. Alcohol consumption was found to be an easy subject to discuss at all health care levels. In addition, 90% (165/183) of the respondents thought that patients had a positive or neutral attitude towards questions on their alcohol consumption. Of the respondents, 32% (58/182) considered discussing alcohol-related matters unacceptable and 81% (121/149) believed that they could not influence patients' drinking using brief intervention; there was no significant difference between different settings. Additionally, motivational skills of doctors and nurses were found to be poor at all health care levels. Our study shows that, although discussing alcohol consumption is easy, better motivational skills and more positive attitudes are needed in primary, occupational, and specialized health care. Professionals need further education at all health care levels, but particularly in specialized health care.
Adult↗
Brief intervention for male heavy drinkers in routine general practice: a three-year randomized controlled study.
The aim of this research was to evaluate the effectiveness of long-term brief intervention in routine general practice. In five primary care out-patient clinics in a Finnish town, 296 male early-phase heavy drinkers consulting a general practitioner (GP) for various reasons were identified. Control group C (n = 88) was informed of the risks of drinking after the screening and were advised at the subsequent feedback about 2 weeks later to reduce their drinking. Groups A (n = 109) and B (n = 99) were offered in addition seven and three brief intervention sessions, respectively. All GPs took part, whether or not they indicated a special interest. The main outcome measures were differences between beginning and end-point at 3 years in self-reported alcohol consumption, mean corpuscular volume (MCV), and serum carbohydrate-deficient transferrin, aspartate aminotransferase, alanine aminotransferase and gamma-glutamyltransferase. There were no statistically significant differences between study groups A, B and C in mean changes in outcome measures. Within all the groups, MCV decreased. Depending on the outcome measure used and the study group analysed, clinically significant reduction of drinking was found in 25-53% of the subjects. In routine general practice, giving additional sessions of brief intervention may not be as effective as in special research conditions. Factors reducing the effectiveness of brief intervention programmes should be investigated, so that primary health care staff can be better supported in their efforts.
Adult↗
At which drinking level to advise a patient? General practitioners' views.
This study examined the views of 64 general practitioners (GPs) on how much a patient has to drink to be advised by them and compared the results to the recommended Finnish threshold values of heavy drinking. The levels stated by GPs were not too high to prevent early-phase intervention in heavy drinking; rather, they were so low that numerous moderate drinkers were also included. The mean (SD) level was 15.5 (6.5) drinks for male and 11.0 (4.6) drinks for female patients per week. These are about two-thirds of the Finnish threshold values of heavy drinking. Attempting to advise such high proportions of patients, including both heavy and moderate drinkers, might mean a discouraging burden for GPs. However, there may be a discrepancy between GPs' statements about when to advise and when they actually do so.
Adult↗