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Indicative of alcoholism, not harmless drinking.

Emergency department patients with either a primary or secondary diagnosis of intoxication are far more likely to be alcoholics than moderate alcohol users, a study in France suggests. The assumption that their drinking is harmless or moderate may result in missed opportunities to intervene with offers of treatment for alcoholism.


Using biologic markers for blood alcohol level, carbohydrate-deficient transferrin (CDT) and [gamma]-glutamyltransferase (GGT), and the standard CAGE questionnaire, researchers evaluated ED patients admitted for acute alcohol intoxication. This screening for alcohol dependence took place over two nonconsecutive months.


Among 166 patients, the CDT level was higher than 60 mg/L in 109 (65.7%), indicating a positive test result. The GGT level was more than 65 IU/L in 69 (41.6%) patients, also indicating a positive test result. (The CDT level increases with the consumption of about 60 g of alcohol daily for at least three weeks. The GGT level increases with the consumption of 80 g to 200 g of alcohol daily for several weeks.) The CAGE questionnaire was positive in 137 patients (82.5%). All told, a problem with alcohol was suggested by at least one test result in 91% of patients.


While the health care system in France is very different from that in the United States, alcohol intoxication in any patient admitted to the ED should be considered a sign of possible alcohol abuse or dependency, requiring full examination and care, including medical treatment and substance abuse counseling.


Reynaud M, et al. Am J Psychiatry 2001;158(1):96-9.



Studies focus on miscarriage and heart disease.

Researchers in Scandinavia, where coffee consumption is extremely high, continue to investigate whether caffeine can be hazardous to one's health.


In a retrospective study published in the New England Journal of Medicine, high caffeine intake (of which coffee is considered the primary source) was associated with a greater risk of first-trimester spontaneous abortion in Swedish women. The risk was greatest among nonsmokers who ingested more than 500 mg of caffeine daily-this risk was twice that of women who ingested less than 100 mg.


In a study in Finland, in which more than 20,000 randomly selected men and women drank an average of more than five cups of coffee per day, no association was found between coffee drinking and the risk of nonfatal myocardial infarction or of death from coronary heart disease. High coffee consumption was associated with greater prevalence of smoking and higher serum cholesterol levels.


Cnattingius S, et al. N Engl J Med 2000;343(25):1839-45; Kleemola P, et al. Arch Intern Med 2000;160(22):3393-400.



Moderate, long-term weight loss reduces risk.

Long-term weight loss prevents people with "high-normal" blood pressure readings from progressing to clinical hypertension.


Overweight patients aged 30 to 54 with less than optimal blood pressure-diastolic blood pressure of 83 to 89 mmHg and systolic blood pressure no higher than 140 mmHg-were followed for three years while participating in an ongoing weight loss program involving diet, exercise, and both group and individual counseling.


Results were assessed every six months for three years. At the six-, 18-, and 36-month follow-ups, the participants in the intervention group had lower systolic and diastolic blood pressure levels than did those in a matched control group. Those who lost the most weight showed the greatest reductions in blood pressure, as did those who successfully maintained weight loss for the full three years. Patients who regained weight lost returned to near-baseline blood pressure levels. Weight loss participants were significantly less likely to develop hypertension than were members of the control group. Those who lost 10 pounds and kept them off for three years had a relative risk of hypertension of 0.35, compared with the control group.


Long-term weight loss can prevent the onset of hypertension, making both pharmacologic therapy, with its undesirable side effects, and continuing medical supervision unnecessary.


Stevens VJ, et al. Ann Intern Med 2001;134(1):1-11.



The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American Academy of Pediatrics have added pneumococcal conjugate vaccine, which became available in February 2000, to the childhood immunization schedule. They also have extended the recommendations for hepatitis A vaccination to include people through the age of 18 in certain geographic areas and in specific high-risk groups.


MMWR Morbid Mortal Wkly Rep 2001;50(1):7-10,19.