Background Alcohol screening scores ≥5 on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) up to a year before surgery have been associated with postoperative complications, but ...the association with postoperative health care use is unknown. This study evaluated whether AUDIT-C scores in the year before surgery were associated with postoperative hospital length of stay, total ICU days, return to the operating room, and hospital readmission. Study Design This cohort study included male Veterans Affairs patients who completed the AUDIT-C on mailed surveys (October 2003 through September 2006) and were hospitalized for nonemergent noncardiac major operations in the following year. Postoperative health care use was evaluated across 4 AUDIT-C risk groups (scores 0, 1 to 4, 5 to 8, and 9 to 12) using linear or logistic regression models adjusted for sociodemographics, smoking status, surgical category, relative value unit, and time from AUDIT-C to surgery. Patients with AUDIT-C scores indicating low-risk drinking (scores 1 to 4) were the referent group. Results Adjusted analyses revealed that among eligible surgical patients (n = 5,171), those with the highest AUDIT-C scores (ie, 9 to 12) had longer postoperative hospital length of stay (5.8 95% CI, 5.0−6.7 vs 5.0 95% CI, 4.7−5.3 days), more ICU days (4.5 95% CI, 3.2−5.8 vs 2.8 95% CI, 2.6−3.1 days), and increased probability of return to the operating room (10% 95% CI, 6−13% vs 5% 95% CI, 4−6%) in the 30 days after surgery, but not increased hospital readmission within 30 days postdischarge, relative to the low-risk group. Conclusions AUDIT-C screening results could be used to identify patients at risk for increased postoperative health care use who might benefit from preoperative alcohol interventions.
Abstract Turner AP, Kivlahan DR, Haselkorn JK. Exercise and quality of life among people with multiple sclerosis: looking beyond physical functioning to mental health and participation in life. ...Objective To describe the prevalence of exercise in a national sample of veterans with multiple sclerosis (MS) and the association of exercise with quality of life, including physical health, mental health, and participation restriction. Design Cross-sectional cohort study linking computerized medical records to mailed survey data from 1999. Setting Veterans Health Administration. Participants Veterans with MS (N=2995; 86.5% men) who received services in the Veterans Health Administration and returned survey questionnaires. Interventions Not applicable. Main Outcome Measures Demographic information, Veteran RAND 36-Item Health Survey (VR-36), self-reported exercise frequency. Results Among all survey respondents with MS, only 28.6% (95% confidence interval, 26.9–30.2) endorsed any exercise. In adjusted logistic regression, exercise was associated with younger age, more education, living alone, lower levels of bodily pain, and higher body mass index. After adjusting for demographic variables and medical comorbidities, exercise was associated with better physical and mental health. People who exercised reported they had better social functioning and better role functioning (participation in life despite physical and emotional difficulties). Conclusions Exercise in veterans with MS is uncommon. In the context of chronic illness care, the identification of exercise patterns and promotion of physical activity may represent an important opportunity to improve mental health and quality of life among people with MS. Intervention should address factors associated with lower rates of exercise including age, education, and pain.
Background Patients who screen positive for alcohol misuse on the Alcohol Use Disorder Identification Test Consumption Questionnaire (AUDIT-C ≥5 points) have significantly increased postoperative ...complications. Severe alcohol misuse (AUDIT-C ≥9 points) is associated with increased postoperative health care use; however, little is known about the prevalence of alcohol misuse in demographic and clinical subgroups of surgical patients. Methods The prevalence of alcohol misuse was evaluated among 10,284 patients (9,771 men and 513 women) who underwent major noncardiac surgery in Veterans Affairs (VA) hospitals during the fiscal years 2004 to 2006 and completed the AUDIT-C. Sex-stratified analyses evaluated prevalence rates of alcohol misuse (AUDIT-C ≥5) and severe misuse (AUDIT-C ≥9) across demographic and clinical subgroups. Results Overall, 1,607 (16%) men and 24 (5%) women screened positive for alcohol misuse (AUDIT-C ≥5) in the year before operation, with 4% and 2% screening positive for severe misuse (AUDIT-C ≥9), respectively. Alcohol misuse was more common among men who were <60 years of age, divorced or separated, current smokers, or American Stoke Association class 1 or 2, and those with cirrhosis/hepatitis or substance use disorders. Among patients with alcohol misuse, 36% of men and 58% of women were American Society of Anesthesiologists class 1 or 2, and most did not have diagnoses that were commonly associated with alcohol misuse. Conclusion Alcohol misuse is relatively common in male surgical patients. Moreover, surgical patients undergoing operation who screen positive for alcohol misuse are often relatively healthy, without health problems that might alert providers to their alcohol misuse in the absence of screening.
Alcohol Misuse and Multiple Sclerosis Turner, Aaron P., PhD; Hawkins, Eric J., PhD; Haselkorn, Jodie K., MD, MPH ...
Archives of physical medicine and rehabilitation,
05/2009, Letnik:
90, Številka:
5
Journal Article
Recenzirano
Abstract Turner AP, Hawkins EJ, Haselkorn JK, Kivlahan DR. Alcohol misuse and multiple sclerosis. Objective To describe the prevalence of alcohol misuse and medical advice to reduce drinking in a ...national sample of veterans with multiple sclerosis (MS). Design Cross-sectional cohort study linking computerized medical record information to mailed survey data from 2004 through 2006. Setting Veterans Health Administration (VHA). Participants Two thousand six hundred fifty-five of 4929 veterans with MS who received services in VHA between 2004 and 2006 and also a survey questionnaire (53.9% response rate). Interventions Not applicable. Main Outcome Measures Demographic information, Short-Form 12-Item Health Survey Mental Component Summary and Physical Component Summary, Alcohol Use Disorders Identification Test Consumption questions, and questions assessing depressive symptoms and the receipt of alcohol-related advice from a medical professional. Results Among all survey respondents with MS, the prevalence of alcohol misuse for the sample was 13.9% (confidence interval CI, 12.5–15.2), with 11.9% (CI, 10.6–13.2) and 2.0% (CI, 1.4–2.5) of participants scoring in the mild/moderate and severe range of alcohol misuse, respectively. In contrast to community samples there was no difference in prevalence by sex. In multivariate logistic regression, age younger than 60 years (<50y; adjusted odds ratio AOR=1.66; CI, 1.17–2.37, and 50–59; AOR=1.64; CI, 1.19–2.27), employment (AOR=1.54; CI, 1.06–2.24) and better physical health (AOR=1.02; CI, 1.01–1.04) were associated with a higher likelihood of alcohol misuse. Among persons who screened positive for alcohol misuse, only 26.2% (CI, 21.5–30.9) reported they had received advice from a medical provider in the past year to decrease or abstain from drinking. Self-report of advice was more likely among those endorsing severe misuse (AOR=3.65; CI, 1.85–7.17) and less likely among those with better mental health (AOR=0.97; CI, 0.94–1.00). Conclusions Despite the numerous health and social consequences of alcohol misuse, routine screening and intervention for people with MS remain uncommon. Brief screening and advice to reduce or refrain from alcohol use can be accomplished in as little as 5 minutes and can be incorporated into the regular course of medical care.
Abstract Turner AP, Kivlahan DR, Kazis LE, Haselkorn JK. Smoking among veterans with multiple sclerosis: prevalence, correlates, quit attempts, and unmet need for services. Objective To describe the ...prevalence and correlates of smoking as well as quit attempts and unmet need for smoking cessation services in a national sample of veterans with multiple sclerosis (MS). Design Cross-sectional cohort study linking computerized medical record information to mailed survey data from 1999. Setting Veterans Health Administration (VHA). Participants Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires, as well as a 20% random subsample (n=569) who completed a more extensive assessment of smoking. Interventions Not applicable. Main Outcome Measures Items assessing smoking, quit attempts, and unmet need for smoking services. Results Among all survey respondents with MS, 28.5% (95% confidence interval CI, 26.9–30.2) endorsed current smoking. Of extended survey respondents, 54.5% (95% CI, 46.6–62.1) reported a quit attempt in the past year, and 59.0% (95% CI, 51.1–66.4) reported not getting needed services for smoking in the past year. In fully adjusted logistic regression, smoking was associated with younger age, lower levels of education, being unmarried, higher levels of physical pain, and poorer mental health. A quit attempt was associated with higher levels of education and greater pain intensity. Conclusions Smoking among veterans with MS is common, with rates similar to those for other veterans. There is substantial need for cessation services. Cessation interventions should address correlates of smoking including pain, poorer mental health, and social isolation.
