The changing landscape of cancer in the USA — opportunities for advancing prevention and treatment

Nature Reviews Clinical Oncology, Journal Year: 2020, Volume and Issue: 17(10), P. 631 - 649

Published: May 28, 2020

Language: Английский

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Alcohol use disorder in community management of chronic liver diseases

Hepatology, Journal Year: 2022, Volume and Issue: 77(3), P. 1006 - 1021

Published: April 18, 2022

Rising rates of alcohol use disorder (AUD) combined with increases in alcohol‐related liver disease (ALD) and other have resulted the need to develop management strategies at all levels patient care. For those pre‐existing disease, whether ALD or others, attention treatment abstinence becomes critical avoiding worsening liver‐related consequences. Modalities help patients reduce stop include screening/brief intervention/referral treatment, various therapeutic modalities including cognitive behavioral therapy, motivational enhancement therapy 12‐step facilitation, relapse prevention medications. Harm reduction approaches versus total may be considered, but for existing ALD, particularly advanced (cirrhosis acute alcoholic hepatitis), from is recommendation, given clear data that ongoing worsens mortality morbidity. certain populations, cessation even more critically important. hepatitis C NAFLD, accelerates negative outcomes. In women, damage results worsened mortality. Efforts integrate AUD care are urgently needed can occur several levels, establishment multidisciplinary clinics fully integrated co‐management as an important goal.

Language: Английский

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Evaluating risk for alcohol use disorder: Polygenic risk scores and family history

Alcoholism Clinical and Experimental Research, Journal Year: 2022, Volume and Issue: 46(3), P. 374 - 383

Published: March 1, 2022

Abstract Background Early identification of individuals at high risk for alcohol use disorder (AUD) coupled with prompt interventions could reduce the incidence AUD. In this study, we investigated whether Polygenic Risk Scores (PRS) can be used to evaluate AUD and severity (as measured by number DSM‐5 diagnostic criteria met) compared their performance a measure family history Methods We studied European ancestry from Collaborative Study on Genetics Alcoholism (COGA). were available 7203 individuals, whom 3451 met DSM‐IV dependence or 1616 alcohol‐exposed controls aged ≥21 years no drug dependence. Further, 4842 had positive first‐degree (FH+), 2722 an unknown (FH?), 336 negative (FH−). PRS derived meta‐analysis genome‐wide association study Million Veteran Program scores problem subscale Alcohol Use Disorders Identification Test in UK Biobank. mixed models test between severity. Results cases higher than increasing as increased ( p ‐values ≤ 1.85E −05 ) full COGA sample, FH+ subsample, FH? subsample. Individuals top decile odds ratios (OR) developing 1.96 (95% CI: 1.54 2.51, ‐value = 7.57E −08 1.86 1.35 2.56, 1.32E −04 sample respectively. These values are comparable previously reported ORs (1.91 2.38) estimated national surveys. also significantly associated criterion count subsample ≤6.7E −11 ). remained after accounting ≤6.8E −10 Conclusions Both severity, indicating that these measures assess distinct aspects liability traits.

Language: Английский

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Medications for treating alcohol use disorder: A narrative review

Alcohol Clinical and Experimental Research, Journal Year: 2023, Volume and Issue: 47(7), P. 1224 - 1237

Published: May 25, 2023

Chronic heavy alcohol use impacts all major neurotransmitter systems and is associated with multiple medical, psychiatric, social problems. Available evidence-based medications to treat disorder (AUD) are underutilized in clinical practice. These promote abstinence or reduce consumption, though there questions regarding their optimal dosage, length of treatment, utility combination one another. Pharmacogenetic approaches, which a patient's genetic make-up inform medication selection, have garnered great interest but yet yield results robust enough incorporate them routine care. This narrative review summarizes the evidence both for approved by Food Drug Administration (disulfiram, oral naltrexone, acamprosate, extended-release naltrexone) those commonly used off-label (e.g., gabapentin, baclofen, topiramate) AUD treatment. We discuss these drugs' mechanisms action, use, pharmacogenetic findings, treatment recommendations. conclude that most consistent supporting pharmacotherapy opioid antagonists, naltrexone nalmefene (which not United States), topiramate. demonstrate small moderate effects reducing frequency drinking and/or drinking. Lastly, we make suggestions research needed refine expand current literature on effective AUD.

Language: Английский

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Medications for the Treatment of Alcohol Dependence—Current State of Knowledge and Future Perspectives from a Public Health Perspective

International Journal of Environmental Research and Public Health, Journal Year: 2023, Volume and Issue: 20(3), P. 1870 - 1870

Published: Jan. 19, 2023

No single effective therapy for alcohol abuse has been found, despite it being a serious sociological and economic problem hundreds of years. It seems difficult to find drug as panacea the due complexity pathophysiology dependence. The purpose this narrative review is existing potentially future pharmaceuticals treatment dependence in most affordable way possible. Psychotherapy mainstay alcoholism, while few drugs approved by legislators are available augmentation treatment, such acamprosate, disulfiram, naltrexone, FDA, nalmefene EMA. There recent reports literature on possibility using baclofen, topiramate, varenicline, gabapentin Moreover, results clinical trials psychoactive substances psilocybin MDMA appear be breakthrough modern abuse. Despite initial optimism, lot scientific effort still needed before new pharmacological methods supporting syndrome will widely available.

Language: Английский

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Evolutionary perspectives on substance and behavioural addictions: Distinct and shared pathways to understanding, prediction and prevention

Neuroscience & Biobehavioral Reviews, Journal Year: 2024, Volume and Issue: 159, P. 105603 - 105603

Published: Feb. 24, 2024

Addiction poses significant social, health, and criminal issues. Its moderate heritability early-life impact, affecting reproductive success, an evolutionary paradox: why are humans predisposed to addictive behaviours? This paper reviews biological psychological mechanisms of substance behavioural addictions, exploring explanations for the origin function relevant systems. Ancestrally, addiction-related systems promoted fitness through reward-seeking, possibly self-medication. Today, psychoactive substances disrupt these systems, leading individuals neglect essential life goals immediate satisfaction. Behavioural addictions (e.g. video games, social media) often emulate ancestrally beneficial behaviours, making them appealing yet irrelevant contemporary success. Evolutionary insights have implications how addiction is criminalised stigmatised, propose novel avenues interventions, anticipate new sources from emerging technologies such as AI. The potential glucagon-like peptide 1 (GLP-1) agonists targeting obesity suggest satiation system may be a natural counter overactivation reward system.

Language: Английский

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Reduction in Nonabstinent WHO Drinking Risk Levels and Change in Risk for Liver Disease and Positive AUDIT‐C Scores: Prospective 3‐Year Follow‐Up Results in the U.S. General Population

Alcoholism Clinical and Experimental Research, Journal Year: 2018, Volume and Issue: 42(11), P. 2256 - 2265

Published: Sept. 11, 2018

Abstinence is often the treatment aim for alcohol use disorders (AUD), but this may deter individuals who prefer drinking reduction goals from entering treatment, and be an overly restrictive end point in clinical trials. Nonabstinent reductions that predict improvement how feel or function useful trial outcomes, example, 4-category World Health Organization (WHO) risk levels. To investigate relevance of these reductions, we examined their relationship with 2 outcomes interest to medical providers: liver disease, positive scores on screening measure.Current drinkers a U.S. national survey (n = 21,925) were interviewed 2001 2002 (Wave 1) re-interviewed 3 years later 2). WHO levels, Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) assessed at both waves. Adjusted odds ratios (aORs) used indicate association change levels Wave disease AUDIT-C scores.Wave 1 very-high-risk reduced 1, 2, had significantly lower (aORs 0.34, 0.23, 0.17) 0.27, 0.09, 0.03). high-risk 0.61, 0.25). Adjusting dependence scoring variations did not affect results.In highest-risk drinkers, predicted likelihood scores. Results add findings are meaningful indicator function, could serve as nonabstinent points also connect commonly questions, which more familiar healthcare providers.

Language: Английский

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Exposure to alcohol and overall survival in head and neck cancer: A regional cohort study

Head & Neck, Journal Year: 2022, Volume and Issue: 44(10), P. 2109 - 2117

Published: June 17, 2022

Abstract Background There is a paucity of knowledge regarding the association alcohol use with overall survival (OS) patients head and neck squamous cell carcinoma (HNSCC). Methods All 1033 treated for new HNSCC in Southwest Finland regional referral center Turku University Hospital 2005–2015. Cox regression analysis was used. Tumor TNM classification, age at baseline tobacco smoking status were assessed as potential confounders. Results A history severe harmful major somatic complications (HR: 1.41; 95%CI: 1.06–1.87; p = 0.017) well current least 10 units per week 1.44, 1.16–1.78; 0.001) associated OS. Conclusions Alcohol consumption 10–20 units/week, often regarded moderate use, found to increase risk mortality independent other prognostic variables. Systematic screening level evaluation brief intervention strategies highly recommended.

Language: Английский

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Psychosocial and medication interventions to stop or reduce alcohol consumption during pregnancy

Cochrane library, Journal Year: 2024, Volume and Issue: 2024(4)

Published: April 29, 2024

Language: Английский

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A physiologically-based digital twin for alcohol consumption—predicting real-life drinking responses and long-term plasma PEth

npj Digital Medicine, Journal Year: 2024, Volume and Issue: 7(1)

Published: May 3, 2024

Abstract Alcohol consumption is associated with a wide variety of preventable health complications and major risk factor for all-cause mortality in the age group 15-47 years. To reduce dangerous drinking behavior, eHealth applications have shown promise. A particularly interesting potential lies combination apps mathematical models. However, existing models do not consider real-life situations, such as combined intake meals beverages, connect to clinical markers, phosphatidylethanol (PEth). Herein, we present model which can simulate situations long-term markers. The new accurately describe both estimation data according χ 2 -test (187.0 < T χ2 = 226.4) independent validation (70.8 93.5). also be personalized using anthropometric from specific individual thus used physiologically-based digital twin. This twin able short-term alcohol dynamics PEth levels blood, biomarker consumption. Here illustrate how connecting markers allows way determine patient measured levels. An additional use case could include evaluation patient-reported AUDIT forms Finally, integrated into an application, help guide users or clinicians drinking.

Language: Английский

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