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Sinclair School of Nursing, University
of Missouri-Columbia, 65211, USA.
Alcohol abuse among aging adults is thought
to be one of the fastest growing health concerns in the
United States. To manage this problem, a stepped-care approach
is recommended. This approach consists of brief interventions
and, if necessary, a more extensive treatment program to
help individuals self-manage their drinking habits. Brief
interventions fall within the harm reduction philosophy
and normally consist of one to five short sessions. In contrast,
The Gerontology Alcohol Project (GAP) offers a more comprehensive
treatment protocol for individuals who require enhanced
self-management guidelines. Both treatment strategies are
supported by research conducted with older alcohol abusers.
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Center for Health Care Evaluation, Department
of Veterans Affairs and Stanford University, Palo Alto, California
94025, USA.
This study focused on the prospective associations
between older adults' health-related problems and their
late-life alcohol consumption and drinking problems. A sample
of 1,291 late-middle-aged community residents (55-65 years
old at baseline) participated in a survey of health and
alcohol consumption, and was followed one year, four years,
and 10 years later. Health-related problems increased and
alcohol consumption and drinking problems declined over
the 10-year interval. Medical conditions, physical symptoms,
medication use, and acute health events predicted a higher
likelihood of abstinence and less frequent and lower alcohol
consumption. However, overall health burden predicted more
subsequent drinking problems, even after controlling for
alcohol consumption and a history of heavy drinking and
increased drinking in response to stressors. Among older
adults, increased health problems predict reduced alcohol
consumption but more drinking problems. Older adults with
several health problems who consume more alcohol are at
elevated risk for drinking problems and should be targeted
for brief interventions to help them curtail their drinking.
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Centre of National Research on Disability
and Rehabilitation Medicine, Medical School, University of
Queensland, Herston, Queensland 4006, Australia.
With global trends in population aging,
many nations are developing and implementing healthy aging
policies to promote quality as well as years of healthy
life. To broaden the evidence base for such policy development,
a review of the literature was conducted to summarize the
existing evidence regarding the behavioral determinants
of healthy aging. Such research is needed so that the efficacy
of modes of intervention can be better understood. The outcome
of "healthy" or "successful" aging was
selected for this review since this nomenclature dominates
the literature describing a global measure of multidimensional
functioning at the positive end of the health continuum
in older age. Studies published between 1985 and 2003 that
reported statistical associations between baseline determinants
and healthy aging outcome were identified from a systematic
search of medical, psychological, sociological, and gerontological
databases. Eight studies satisfied the search criteria.
Modifiable risk factors among the behavioral determinants
included smoking status, physical activity level, body mass
index, diet, alcohol use, and health practices. On the basis
of these findings, effective healthy aging policies need
to enhance opportunities across the life span for modification
of lifestyle risk factors. Efforts to standardize concepts
and terminology will facilitate further research activity
in this important area.
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University of Washington, USA.
This study investigated the relationship
between alcohol consumption and cognitive performance in
two culturally diverse community-based populations. METHODS.
A cross-sectional analysis was used including Japanese Americans
(n = 1,836) and Caucasians (n = 2,581) aged 65 and older.
Cognitive performance was measured using the Cognitive Abilities
Screening Instrument (CASI) (0 to 100 point scale) and reaction
time. RESULTS. Multivariate analysis revealed significant
cultural and gender differences with cognitive performance.
Compared to abstainers, Caucasian drinkers scored higher
than Japanese American drinkers on the CASI (adjusted means
= 93.4 versus 91.6). In contrast, Japanese American drinkers
scored faster than Caucasian drinkers on choice reaction
time (adjusted means = 505 versus 579 milliseconds). DISCUSSION.
Results showed that current drinking was associated with
better cognition in both the Caucasian and Japanese American
groups. Longitudinal studies are needed to support the possible
protective effects of alcohol on cognition and explore whether
culture may modify this apparent benefit.
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Department of Psychiatry, Washington
University School of Medicine, St. Louis, MO 63110, USA.
BACKGROUND: Epidemiological studies of
traits such as alcohol dependence and depression have often
found lifetime rates in younger individuals exceeding those
found in older individuals. This suggests additional influences
of birth cohort or period effects so that individuals in
later-born cohorts have an increased lifetime risk. METHODS:
Data from the Collaborative Study on the Genetics of Alcoholism
were used to investigate secular trends for alcoholism and
related conditions and to examine risk predictors while
taking the cohort effect into account. We used data on 4099
interviewed parents and siblings of alcohol-dependent subjects
and 1054 members of control families. We used survival analysis
techniques and the Cox proportional hazards regression model
to estimate the relative risk for demographic covariates.
We used the relative sample to predict risk in the sibling
of the proband and family history information to determine
whether there was a bias when deceased individuals were
excluded from analysis. RESULTS: In the control sample,
we observed a 1.8% lifetime rate of DSM-III-R alcohol dependence
in women born before 1940, as contrasted to a 13% rate in
women born after 1960, and a 15% lifetime rate in men born
before 1940, contrasted with a 28% rate in men born after
1960. As expected, lifetime rates in relatives were increased
when compared with controls. Highly significant risk ratios
(RR) were observed for gender (RR, 2.3), cohort of birth
(RR, 1.5 over a decade), daily smoking (RR, 2.0), heavy
smoking (RR, 3.0), and comorbid diagnoses of antisocial
personality (RR, 2.2) and depression (RR, 1.6). Analysis
of the family history data indicated higher rates of alcohol
dependence in relatives who were deceased compared to those
who were living. CONCLUSIONS: Marked cohort differences
were observed and may reflect real changes over time, or
artifacts of memory recall, differential mortality, or public
awareness. The analysis of all relatives (living or deceased)
indicates that associated mortality may, in part, explain
the secular trends seen when analyses are restricted to
living, personally interviewed individuals.
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Psychoology Section, University of Teesside,
Middlesborough, United Kingdom.
BACKGROUND: Research has shown that
heavy alcohol use has a detrimental effect on retrospective
memory. Less is known about the effect of alcohol on everyday
memory. METHODS: This study examined self-ratings of two
aspects of memory performance: prospective memory (for example,
forgetting to pass on a message) and everyday memory (measured
by cognitive failures, such as telling someone a joke that
you have told them before). To ensure anonymity and expand
on the numbers of participants used in previous studies,
data were collected by using the Internet. Data from 763
participants remained after data screening. RESULTS: After
controlling for other drug and strategy use, there was clear
evidence that differential use of alcohol was associated
with impairments in the long-term aspect of prospective
memory and with an increased number of cognitive failures.
CONCLUSIONS: These results support and extend the findings
of previous research: our findings are consistent with the
idea that heavy use of alcohol does have a significant and
negative effect on everyday cognitive performance. Possible
causes of these impairments are discussed.
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Department of Psychiatry, University
of Connecticut School of Medicine, Farmington, 06030-2103,
USA.
BACKGROUND: This study examined gustatory
measures (intensity and hedonic values of salt and citric
acid solutions) that have been reported to differentiate
nonalcoholics who are at risk of alcoholism by virtue of
having an alcoholic father (PHP) from those with no such
paternal history (PHN). The study tested the hypothesis
that PHPs perceive salty and sour solutions to be more intense
and less pleasurable than do PHNs. METHODS: A total of 112
nonalcoholic subjects (44.7% male and 40.2% PHP) provided
intensity and pleasantness ratings for a series of salty
and sour solutions in varying concentrations. RESULTS: PHP
subjects rated salty solutions as more unpleasant than PHN
subjects. PHP subjects also showed higher mean sour intensity
ratings and less preference for sour solutions than PHN
subjects. CONCLUSIONS: This study replicates and extends
prior findings of salty and sour taste differences as a
function of paternal history of alcoholism. Further research
is needed to replicate these findings in other populations
and to examine their implications for the transmission of
alcoholism risk.
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University of Georgia, Athens, 30602-3013,
USA.
BACKGROUND: Research has demonstrated that
alcohol-related aggression is modulated by anger-based personality
traits. However, it is unclear how anger, as a concomitant
of aggression, is affected by an interaction among these
variables. The present study evaluated the effects of alcohol,
anger-based traits, and physical provocation on anger. METHODS:
Participants were 136 male social drinkers who completed
measures designed to assess trait anger and anger expression
styles and were assigned to an alcohol or no-alcohol control
beverage group. Participants engaged in a competitive reaction
time task in which electric shocks were received from a
fictitious opponent. Participants' experience of anger was
assessed unobtrusively via the Facial Action Coding System.
RESULTS: Intoxicated participants displayed more facial
expressions of anger than sober participants. Interactive
effects between anger expression styles and beverage group
also were detected in that, among intoxicated participants,
a positive relationship between facial expressions of anger
and the tendency to express anger outwardly was found after
high, but not low, provocation. This relationship was not
observed at either provocation level in the no-alcohol control
group. Similarly, whereas participants' tendency to control
anger resulted in fewer facial expressions of anger by intoxicated
participants, no such relationship was found among sober
participants. CONCLUSIONS: Findings suggest that alcohol
intoxication facilitates the experience of anger after provocation
and enhances the relationship between state anger and behavioral
tendencies to control anger expression.
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Department of Medicine, Hospital Clinic,
IDIBAPS, University of Barcelona, Spain.
BACKGROUND Chronic myopathy due to excessive
ethanol intake is one of the most frequent causes of acquired
skeletal myopathy in developed countries. Its pathogenesis
is multi-factorial, only partially clarified, and antioxidant
imbalance has been suggested to influence its development,
being a type II glucolytic, fast-twitch fiber subset more
sensitive to this effect. METHODS: We assessed superoxide
dismutase, glutathione peroxidase, and glutathione reductase
enzyme activities as well as the total antioxidant status
capacity in muscle samples obtained from 41 chronic alcoholic
males and 12 age-matched controls. Alcoholic skeletal myopathy
was defined according to standard histologic criteria. We
evaluated the influence of ethanol consumption, caloric
and protein nutritional status, and the presence of skeletal
myopathy with the tissue activities of these antioxidant
enzymes. RESULTS: Chronic alcoholics showed a 16% reduction
in glutathione peroxidase and a 13% increase of superoxide
dismutase in the skeletal muscle, compared with controls
(p < 0.05, both). Muscle antioxidant changes in chronic
alcoholics were not related to the presence of skeletal
myopathy, parameters of alcohol consumption, or conventional
nutritional parameters. CONCLUSIONS: Antioxidant muscle
enzyme activities are partially disturbed in chronic alcoholism,
although not related to the presence of myopathy, amount
of ethanol consumed, or the nutritional status of the patients.
Further studies should assess other aspects not included
in the present study such as muscle site-specific changes
in antioxidant status/oxidative damage, specific fiber-type
sensitivity to alcohol, and type and quantity of antioxidant
content of the diet or in the alcohol beverages.
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Psychiatry Department, Paril Brousse
Hospital, Cedex, France.
BACKGROUND: The aim of this study was to
better evaluate the role of alcohol drinking in fatalities
linked to road traffic accidents. METHODS: The data of accidents
were collected by a French official agency from police records,
including many variables, among which was a blood alcohol
test. They were analyzed in a descriptive way and toward
a logistic regression. This exhaustive database comprised
all of the 500,961 accidents with casualties that involved
less than three vehicles (28,506 fatal accidents) recorded
in France during a 52 month period (September 1995 to December
1999). The results of the alcohol tests were known in 78.7
of the drivers. RESULTS: The blood alcohol concentration
was over the legal limit (0.50 g/L in France) in 9.8% of
the accidents with casualties overall. Considering only
fatal accidents, the rate of positive alcohol test in drivers
was approximately 31.5%. This rate varied depending on the
period and the type of accident, raising up to 71.2% in
single-vehicle accidents (loss of control) at night during
the weekend. The percentage of positive alcohol tests also
dramatically increased following the number of fatalities
per accident (87.5% in single-vehicle accidents during weekend
nights involving three or more killed). The logistic regression
in single-vehicle accident shows that the higher odds ratios
concern the positive blood alcohol test (OR = 4.19), clearly
overwhelming the other precipitating factors of accidents
(age of driver, meteorological conditions, time of day,
and other factors). CONCLUSIONS: Drinking alcohol before
driving is a well known factor of accidents. We clearly
demonstrate here that it is the main factor leading to deaths
linked to road traffic accidents in France. The results
are strengthened, and some analyses are allowed, by the
exceptional features of our database. The authors emphasize
the need for prevention measures.
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Meander Medisch Centrum, afd. Interne
Geneeskunde, Postbus 1502, 3800 BM Amersfoort.
Epidemiological studies have shown a favourable
effect of moderate alcohol consumption with regard to atherosclerotic
disorders. In addition to alcohol, wine contains a large
number of other components including polyphenols. These
polyphenols mainly originate from the skins and seeds of
grapes and, because of differences in vinification, their
variety and concentration is higher in red wine than in
white wine. In vitro and ex vivo studies have shown that
some of these polyphenols are able to slow down LDL-cholesterol
oxidation, stimulate NO production, influence prostaglandin
synthesis and inhibit platelet aggregation. However, little
is known about their resorption, bioavailability and effectiveness
in vivo. Since data from intervention studies with wine
polyphenols are also lacking, no statement can yet be made
about any clinically relevant effect of these components,
in either red or white wine, in terms of cardiovascular
diseases.
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Department of Lipoproteins and Lipid
Mediators, INSERM U 563, Batiment C, Hopital Purpan, 31052
Toulouse-Cedex, France.
BACKGROUND: Alcohol consumption is associated
with high levels of high-density lipoproteins (HDLs). Moreover,
changes in the fatty acid patterns of red blood cell phospholipids
and plasma lipids have been observed in drinkers. The objectives
of this study were to characterize the composition of HDL
particles with respect to lipid molecular species in regular
wine drinkers and to assess the functional properties of
those HDLs as regards key steps of reverse cholesterol transport.
METHODS: Forty-six subjects were recruited in the frame
of a population study performed in Toulouse, southern France,
and a nutritional investigation, including daily alcohol
consumption, was performed. Subjects were sorted according
to their daily alcohol intake (0, < or =35, and >35
g/day), mostly as red wine. The plasma HDL fraction was
isolated, and neutral lipid molecular lipids and phospholipid
fatty acids were analyzed by gas liquid chromatography.
Efflux of cellular cholesterol and rates of cholesterol
esterification and cholesteryl ester transfers between lipoproteins
were assayed in a cell-plasma incubation system. RESULTS:
Wine drinking, at 47 g/day, was associated with an increase
in HDL cholesterol and apolipoprotein A-I, but not with
triglycerides. Isolated HDL displayed a 27% increase in
all cholesteryl ester molecular species. The particles were
also enriched in unsaturated phospholipids and, particularly,
in those containing arachidonic (+30%) and eicosapentaenoic
(+90%) acids. The plasma cholesterol esterification rate,
reflecting lecithin cholesterol acyl transferase activity
on HDL, was found to be higher (+27%) in drinkers than in
nondrinkers, whereas the rate of cellular cholesterol efflux
to plasma was identical. CONCLUSIONS: Regular wine consumption
is associated with high levels of polyunsaturated lipids
in HDL and with increases in the cholesterol esterification
rate.
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University of Connecticut School of Medicine,
Farmington, CT 06030-1110, USA.
Epidemiological studies suggest that the
consumption of wine, particularly of red wine, reduces the
incidence of mortality and morbidity from coronary heart
disease. This has given rise to what is now popularly termed
the "French paradox". The cardioprotective effect
has been attributed to antioxidants present in the polyphenol
fraction of red wine. Grapes contain a variety of antioxidants,
including resveratrol, catechin, epicatechin and proanthocyanidins.
Of these, resveratrol is present mainly in grape skin while
proanthocyanidin is present in the seeds. In this report,
we provide evidence that red wine extract as well as resveratrol
and proanthocyanidins are equally effective in reducing
myocardial ischemic reperfusion injury, which suggests that
these red wine polyphenolic antioxidants play a crucial
role in cardioprotection.
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Department of Psychology, University
of Colorado at Boulder, USA.
The body responds to stress through a hormone
system called the hypothalamic-pituitary-adrenal (HPA) axis.
Stimulation of this system results in the secretion of stress
hormones (i.e., glucocorticoids). Chronic excessive glucocorticoid
secretion can have adverse health effects, such as Cushing's
syndrome. Alcohol intoxication activates the HPA axis and
results in elevated glucocorticoid levels. Ironically, elevated
levels of these stress hormones may contribute to alcohol's
pleasurable effects. With chronic alcohol consumption, however,
tolerance may develop to alcohol's HPA axis-activating effects.
Chronic alcohol consumption, as well as chronic glucocorticoid
exposure, can result in premature and/or exaggerated aging.
Furthermore, the aging process affects a person's sensitivity
to alcohol and HPA axis function. Thus, a three-way interaction
exists among alcohol consumption, HPA axis activity, and
the aging process. The aging process may impair the HPA
axis' ability to adapt to chronic alcohol exposure. Furthermore,
HPA axis activation may contribute to the premature or exaggerated
aging associated with chronic alcohol consumption.
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Superior Institute for Health Sciences,
Lisbon, Portugal.
An extract from red-wine grape fermentation,
ANOX has been developed as a source of red-wine polyphenols,
which are thought to inhibit several of the pathogenic pathways
that lead to cardiovascular disease. New data indicate that
this extract has a significantly greater effect than either
red wine or red-wine powder on the inhibition of platelet
aggregation in vitro. Based on this data, about 300 - 500
mg of the extract is equivalent to the daily dose of red-wine
polyphenols that appears to protect against cardiovascular
disease. The possible synergistic effect of red-wine polyphenols
with vitamin C, their vasorelaxing activity and their possible
role in preventing over-crosslinking of connective tissues
(premature ageing) are considered. The extract contains
standardized amounts of the whole spectrum of polyphenolic
compounds found in red wine and may provide a valuable reference
substance in clinical investigations of the physiological
actions of plant polyphenols; its potential use in functional
nutrition and preventive medicine is also discussed.
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Department of Clinical Biochemistry,
Banting Institute, University of Toronto, Ontario, Canada.
Wine has been part of human culture for
6,000 years, serving dietary and socio-religious functions.
Its production takes place on every continent, and its chemical
composition is profoundly influenced by enological techniques,
the grape cultivar from which it originates, and climatic
factors. In addition to ethanol, which in moderate consumption
can reduce mortality from coronary heart disease by increasing
high-density lipoprotein cholesterol and inhibiting platelet
aggregation, wine (especially red wine) contains a range
of polyphenols that have desirable biological properties.
These include the phenolic acids (p-coumaric, cinnamic,
caffeic, gentisic, ferulic, and vanillic acids), trihydroxy
stilbenes (resveratrol and polydatin), and flavonoids (catechin,
epicatechin, and quercetin). They are synthesized by a common
pathway from phenylalanine involving polyketide condensation
reactions. Metabolic regulation is provided by competition
between resveratrol synthase and chalcone synthase for a
common precursor pool of acyl-CoA derivatives. Polymeric
aggregation gives rise, in turn to the viniferins (potent
antifungal agents) and procyanidins (strong antioxidants
that also inhibit platelet aggregation). The antioxidant
effects of red wine and of its major polyphenols have been
demonstrated in many experimental systems spanning the range
from in vitro studies (human low-density lipoprotein, liposomes,
macrophages, cultured cells) to investigations in healthy
human subjects. Several of these compounds (notably catechin,
quercetin, and resveratrol) promote nitric oxide production
by vascular endothelium; inhibit the synthesis of thromboxane
in platelets and leukotriene in neutrophils, modulate the
synthesis and secretion of lipoproteins in whole animals
and human cell lines, and arrest tumour growth as well as
inhibit carcinogenesis in different experimental models.
Target mechanisms to account for these effects include inhibition
of phospholipase A2 and cyclo-oxygenase, inhibition of phosphodiesterase
with increase in cyclic nucleotide concentrations, and inhibition
of several protein kinases involved in cell signalling.
Although their bioavailability remains to be fully established,
red wine provides a more favourable milieu than fruits and
vegetables, their other dietary source in humans.
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