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1.	Forouzanfar, Mohammad H, et al. (författare) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013. 2015 Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 386:10010, s. 2287-2323 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.FUNDING: Bill & Melinda Gates Foundation.
2.	Rehm, Jürgen, et al. (författare) Prevalence of and potential influencing factors for alcohol dependence in Europe 2015 Ingår i: European Addiction Research. - : S. Karger AG. - 1022-6877 .- 1421-9891. ; 21:1, s. 6-18 Tidskriftsartikel (refereegranskat)abstract Alcohol use disorders (AUDs), and alcohol dependence (AD)in particular, are prevalent and associated with a large burdenof disability and mortality. The aim of this study wasto estimate prevalence of AD in the European Union (EU), Iceland, Norway, and Switzerland for the year 2010, and toinvestigate potential influencing factors. The 1-year prevalenceof AD in the EU was estimated at 3.4% among people18–64 years of age in Europe (women 1.7%, men 5.2%), resultingin close to 11 million affected people. Taking into accountall people of all ages, AD, abuse and harmful use resultedin an estimate of 23 million affected people. Prevalenceof AD varied widely between European countries, andwas significantly impacted by drinking cultures and socialnorms. Correlations with level of drinking and other drinking variables and with major known outcomes of heavy drinking,such as liver cirrhosis or injury, were moderate. Theseresults suggest a need to rethink the definition of AUDs.
3.	Stanaway, Jeffrey D., et al. (författare) Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017 2018 Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 392:10159, s. 1923-1994 Tidskriftsartikel (refereegranskat)abstract Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk- outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.
4.	Babor, Thomas, et al. (författare) Drug Policy and the Public Good 2018. - 2 Bok (refereegranskat)abstract Drug Policy and the Public Good presents the accumulated scientific knowledge of direct relevance to the development of drug policy on local, national, and international levels. The book explores both illicit drug use and non-medical use of prescription medications within a public health perspective. A conceptual basis for a rational drug policy is presented, along with new epidemiological data on the global dimensions of drug misuse, significant trends in drug epidemics, and the global burden of disease attributable to drug misuse. The markets for both illicit and legally prescribed psychoactive substances are described, showing that these two sources of drug supply are becoming increasingly connected in many countries. The core of the book is a critical review of the cumulative scientific evidence in five general areas of drug policy: primary prevention programmes in schools and other settings; treatment interventions and harm reduction approaches; attempts to control the supply of illicit drugs, including drug interdiction and law enforcement; decriminalization and penal approaches; and control of the legal market through prescription drug regimes. The final chapters discuss the trend toward legalization of some psychoactive substances in different parts of the world and describe the need for a new approach to drug policy that is evidence-based, realistic, and coordinated. The evidence reviewed in this book suggests that an integrated and balanced approach to evidence-informed drug policy is more likely to benefit the public good than are uncoordinated efforts to reduce drug supply and demand.
5.	Babor, Thomas F., et al. (författare) Alcohol : No Ordinary Commodity - a summary of the third edition 2022 Ingår i: Addiction. - : NLM (Medline). - 0965-2140 .- 1360-0443. ; 117:12, s. 3024-3036 Tidskriftsartikel (refereegranskat)abstract Background and Aims: This article summarizes the findings and conclusions of the third edition of Alcohol: No Ordinary Commodity. The latest revision of this book is part of a series of monographs designed to provide a critical review of the scientific evidence related to alcohol control policy from a public health perspective.Design: A narrative summary of the contents of the book according to five major issues.Findings: An extensive amount of epidemiological evidence shows that alcohol is a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. Trends in alcohol products and marketing are described, indicating that a large part of the global industry has been consolidated into a small number of transnational corporations that are expanding their operations in Asia, Africa and Latin America. The main part of the book is devoted to a review of strategies and interventions designed to prevent or minimize alcohol-related harm. Overall, the most effective strategies to protect public health are taxation that decreases affordability and restrictions on the physical availability of alcohol. A total ban on alcohol marketing is also an effective strategy to reduce consumption. In addition, drink-driving counter-measures, brief interventions with at-risk drinkers and treatment of drinkers with alcohol dependence are effective in preventing harm in high-risk contexts and groups of hazardous drinkers.Conclusion: Alcohol policy is often the product of competing interests, values and ideologies, with the evidence suggesting that the conflicting interests between profit and health mean that working in partnership with the alcohol industry is likely to lead to ineffective policy. Opportunities for implementation of evidence-based alcohol policies that better serve the public good are clearer than ever before as a result of accumulating knowledge on which strategies work best.
6.	Babor, Thomas F., et al. (författare) Alcohol : No Ordinary Commodity - A Summary of the Third Edition 2023 Ingår i: SUCHT. - 0939-5911 .- 1664-2856. ; 69:4, s. 147-162 Tidskriftsartikel (refereegranskat)abstract Background and Aims: This article summarizes the findings and conclusions of the third edition of Alcohol: No Ordinary Commodity. The latest revision of this book is part of a series of monographs designed to provide a critical review of the scientific evidence related to alcohol control policy from a public health perspective. Design: A narrative summary of the contents of the book according to five major issues. Findings: An extensive amount of epidemiological evidence shows that alcohol is a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. Trends in alcohol products and marketing are described, indicating that a large part of the global industry has been consolidated into a small number of transnational corporations that are expanding their operations in Asia, Africa and Latin America. The main part of the book is devoted to a review of strategies and interventions designed to prevent or minimize alcohol-related harm. Overall, the most effective strategies to protect public health are taxation that decreases affordability and restrictions on the physical availability of alcohol. A total ban on alcohol marketing is also an effective strategy to reduce consumption. In addition, drink-driving counter-measures, brief interventions with at-risk drinkers and treatment of drinkers with alcohol dependence are effective in preventing harm in high-risk contexts and groups of hazardous drinkers. Conclusion: Alcohol policy is often the product of competing interests, values and ideologies, with the evidence suggesting that the conflicting interests between profit and health mean that working in partnership with the alcohol industry is likely to lead to ineffective policy. Opportunities for implementation of evidence-based alcohol policies that better serve the public good are clearer than ever before as a result of accumulating knowledge on which strategies work best.
7.	Babor, Thomas F., et al. (författare) Drug Policy and the Public Good : a summary of the second edition 2019 Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 114:11, s. 1941-1950 Tidskriftsartikel (refereegranskat)abstract The second edition of Drug Policy and the Public Good presents up-to-date evidence relating to the development of drug policy at local, national and international levels. The book explores both illicit drug use and non-medical use of prescription medications from a public health perspective. The core of the book is a critical review of the scientific evidence in five areas of drug policy: (1) primary prevention programs in schools and other settings; (2) treatment interventions and harm reduction approaches; (3) attempts to control the supply of illicit drugs, including drug interdiction and law enforcement; (4) penal approaches, decriminalization and other alternatives; and (5) control of the legal market through prescription drug regimens. It also discusses the trend towards legalization of some psychoactive substances in some countries and the need for a new approach to drug policy that is evidence-based, realistic and coordinated. The accumulated evidence provides important information about effective and ineffective policies. Shifting the emphasis towards a public health approach should reduce the extent of illicit drug use, prevent the escalation of new epidemics and avoid the unintended consequences arising from the marginalization of drug users through severe criminal penalties.
8.	Carr, Sinclair, et al. (författare) Alcohol Consumption Levels and Health Care Utilization in Germany. Results from the GEDA 2014/2015-EHIS Study 2022 Ingår i: SUCHT. - : Hogrefe Publishing Group. - 0939-5911 .- 1664-2856. ; 68:3, s. 151-160 Tidskriftsartikel (refereegranskat)abstract Aims: Due to large inconsistencies in previous studies, it remains unclear how alcohol use is related to health care utilization. The aim of this study was to examine associations between alcohol drinking status with utilization of outpatient and inpatient health care services in Germany. Methodology: Survey data of the GEDA 2014/2015-EHIS study with n = 23,561 German adults were analyzed (response rate: 27 %). Respondents were categorized as lifetime abstainers, former drinkers, and non-weekly drinkers, as well as weekly low-risk drinkers and risky drinkers. Outpatient services included GP, specialist, and hospital visits; inpatient services included hospital overnight stays in the last 12 months. For both settings, binary logistic regression models were applied, adjusted for possible confounders. Results: For specialist visits, elevated odds were found among former drinkers (odds ratio (OR) = 1.93, 95 % confidence interval (95 % CI) = 1.50-2.49), non-weekly drinkers (OR = 1.24, 95 % CI = 1.05-1.47), weekly low-risk drinkers (OR = 1.39, 95 % CI = 1.17-1.67), and risky drinkers (OR = 1.28, 95 % CI = 1.04-1.57) compared to lifetime abstainers. In contrast, lower odds for inpatient service use were found among non-weekly drinkers (OR = 0.76, 95 % CI = 0.62-0.93), low-risk drinkers (OR = 0.66, 95 % CI = 0.53-0.81), and risky drinkers (OR = 0.65, 95 % CI = 0.51-0.84). No differences were observed for GP and outpatient hospital visits. Conclusions: While the increased odds of consulting a specialist are consistent with higher health care needs among former and current drinkers, the lower use of inpatient care among current drinkers is contrary to known health risks associated with alcohol consumption and evidence from hospitalized populations. The findings also highlight the need to differentiate between lifetime abstainers and former drinkers in their use of health services.
9.	Carvalho, Andre F., et al. (författare) Alcohol use disorders 2019 Ingår i: The Lancet. - : ELSEVIER SCIENCE INC. - 0140-6736 .- 1474-547X. ; 394:10200, s. 781-792 Forskningsöversikt (refereegranskat)abstract Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.
10.	Carvalho, Andre F., et al. (författare) Evidence-based umbrella review of 162 peripheral biomarkers for major mental disorders 2020 Ingår i: Translational Psychiatry. - : NATURE PUBLISHING GROUP. - 2158-3188. ; 10:1 Forskningsöversikt (refereegranskat)abstract The literature on non-genetic peripheral biomarkers for major mental disorders is broad, with conflicting results. An umbrella review of meta-analyses of non-genetic peripheral biomarkers for Alzheimers disease, autism spectrum disorder, bipolar disorder (BD), major depressive disorder, and schizophrenia, including first-episode psychosis. We included meta-analyses that compared alterations in peripheral biomarkers between participants with mental disorders to controls (i.e., between-group meta-analyses) and that assessed biomarkers after treatment (i.e., within-group meta-analyses). Evidence for association was hierarchically graded using a priori defined criteria against several biases. The Assessment of Multiple Systematic Reviews (AMSTAR) instrument was used to investigate study quality. 1161 references were screened. 110 met inclusion criteria, relating to 359 meta-analytic estimates and 733,316 measurements, on 162 different biomarkers. Only two estimates met a priori defined criteria for convincing evidence (elevated awakening cortisol levels in euthymic BD participants relative to controls and decreased pyridoxal levels in participants with schizophrenia relative to controls). Of 42 estimates which met criteria for highly suggestive evidence only five biomarker aberrations occurred in more than one disorder. Only 15 meta-analyses had a power >0.8 to detect a small effect size, and most (81.9%) meta-analyses had high heterogeneity. Although some associations met criteria for either convincing or highly suggestive evidence, overall the vast literature of peripheral biomarkers for major mental disorders is affected by bias and is underpowered. No convincing evidence supported the existence of a trans-diagnostic biomarker. Adequately powered and methodologically sound future large collaborative studies are warranted.
11.	Crépault, Jean-François, et al. (författare) Legalization as more effective control? Parallels between the end of alcohol prohibition (1927) and the legalization of cannabis (2018) in Ontario 2021 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 97 Tidskriftsartikel (refereegranskat)abstract Background: In the 1920s, eight of nine Canadian provinces legalized alcohol sales, ending prohibition in favor of government control. Much has been written about the rise and fall of Prohibition in North America, but there is little work examining these events in the light of current drug policy debates. This paper attempts to fill some of these gaps.Methods: The aims of this paper are primarily exploratory and descriptive. Following a literature review, it draws from secondary and some primary sources to explore the debate around ending alcohol prohibition (i.e. legalizing its distribution) in Ontario between 1920 and 1927. It then uses material drawn from a comprehensive search of the Canadian House of Commons debates on cannabis legalization between 2016 and 2018 to draw parallels with the debates around alcohol legalization in Ontario about 90 years earlier.Results: While alcohol and cannabis legalization occurred in very different social and political contexts, there are similarities in both the arguments in favor of ending prohibition (ineffectiveness at preventing consumption and collateral social harms) and post-legalization debates around regulation (most notably the optimal way to replace the illicit market).Conclusion: The Canadian cannabis legalization debates of the 2010s echo the alcohol legalization debates of the 1920s in remarkable and relevant ways. Ultimately the most striking parallel may be the extent to which the political leaders advocating for legalization emphasized that their policy was not liberalization, but more effective control.
12.	Fischer, Benedikt, et al. (författare) Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use : A comprehensive evidence and recommendations update 2022 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 99 Forskningsöversikt (refereegranskat)abstract Background: Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis.Methods: Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process.Results: A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible.Conclusions: Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.
13.	Frick, Ulrich, et al. (författare) Average volume of alcohol consumption, drinking patterns and related burden of mortality in young people in established market economies in Europe 2001 Ingår i: European Addiction Research. - : S. Karger AG. - 1022-6877 .- 1421-9891. ; 7:3, s. 148-151 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To determine the burden of mortality in young people (age 15-29) in established market economies in Europe in 1999, which is attributable to alcohol consumption. Two dimensions of alcohol consumption were considered: average volume of consumption, and patterns of drinking.METHODS:Mortality data were obtained from the WHO EIP data bank, average volume data from the WHO global databank on alcohol, pattern of drinking data from a questionnaire sent out to experts, from the published literature and from the WHO global databank. Methods are explained and discussed in detail in two other contributions to this volume.RESULTS:More than 8,000 deaths of people aged 15-29 in Europe in 1999 were attributable to alcohol. Young males show a higher proportion of alcohol-attributable deaths (12.8%) than females (8.3%). Both average volume and patterns of drinking contribute to alcohol-related death.CONCLUSIONS:Alcohol-related deaths constitute a considerable burden in young people in Europe.
14.	Frischknecht, Ulrich, et al. (författare) Screening auf problematischen Alkoholkonsum – Erhebung zur Umsetzung der S3-Leitlinienempfehlungen in der transdisziplinären Versorgung einer Modellregion : [Screening for Problematic Alcohol Consumption – A Survey on Guideline Implementation in Transdisciplinary Health Care of a Model Region] 2022 Ingår i: Das Gesundheitswesen. - : Georg Thieme Verlag KG. - 0941-3790 .- 1439-4421. ; 84:01, s. 43-51 Tidskriftsartikel (refereegranskat)abstract Aim Recording the frequency of screenings for problematic alcohol consumption by professionals involved in the health care of respective patients. The German S3-guideline screening, diagnosis and treatment of alcohol-related disorders recommends the use of questionnaire-based screenings for all patients in all settings.Methods Cross-sectional survey on screening frequency among general practitioners, gynecologists, psychiatrists, child- and adolescent therapists, psychotherapists, social workers and midwives. Logistic regression was used to explore how healthcare professionals' attributes were associated with the implementation of screenings.Results With response rates of about 20%, health care professionals reported using screening instruments for an average of 6.9% of all patients during the previous four weeks. Most of the time, custom-made questions were used instead of the recommended instruments (AUDIT, AUDIT-C). Higher screening rates were reported for patients with newly diagnosed hypertension (21.2%), alcohol-related disorders (43.3%) and mental disorders (39.3%). Knowledge of the guideline was associated with implementation of screenings (OR=4.67; 95% KI 1.94-11.25, p<0.001).Conclusions Comprehensive screening for problematic alcohol use with questionnaire-based instruments in accordance with guidelines is far from being routinely implemented in the studied health care settings. Measures to increase the knowledge of the guidelines are necessary in order to increase the frequency of alcohol screening in health care.
15.	Gmel, Gerhard, et al. (författare) Dimensions of alcohol-related social and health consequences in survey research 2000 Ingår i: Journal of Substance Abuse. - 0899-3289 .- 1873-6491. ; 12:1-2, s. 113-138 Tidskriftsartikel (refereegranskat)abstract Dimensions of alcohol-related social and health consequences are approached from two different perspectives. First, classical approaches with factor analytic techniques are used to empirically determine the dimensionality of item batteries intended to measure harm. Second, a closer look is taken at theoretically underlying dimensions of social and health consequences and their association with alcohol consumption. Using as empirical material data from the US national survey of males aged 21–59 (N3) conducted in 1969, the following specific questions are discussed: (1) What are the underlying dimensions of alcohol-related social and health consequences? (2) How should the relation between alcohol consumption and consequences best be assessed (in terms of epidemiological traditions or social constructivist traditions)? (3) How can we best incorporate the time perspective into modeling the relationship between alcohol consumption and consequences? A first attempt is made to develop practical guidelines for future research on handling these problems.
16.	Hanschmidt, Franz, et al. (författare) Barriers to Alcohol Screening Among Hypertensive Patients and the Role of Stigma : Lessons for the Implementation of Screening and Brief Interventions in European Primary Care Settings 2017 Ingår i: Alcohol and Alcoholism. - : Oxford University Press (OUP). - 0735-0414 .- 1464-3502. ; 52:2, s. 572-579 Tidskriftsartikel (refereegranskat)abstract Aims1. To quantify barriers to alcohol screening among hypertensive patients reported by primary healthcare professionals. 2. To examine whether education and screening frequency measures are associated with stigma-related barriers.MethodsA web survey was conducted among 3081 primary healthcare professionals from France, Germany, Italy, Spain and the UK. Participants were asked about perceived barriers to alcohol screening as free-text response. The replies were independently categorized by two raters. Stigma-related barriers were predicted by logistic regressions with education, knowledge on alcohol as risk factor and frequency of alcohol screening.ResultsIn France and Italy, almost half of the reported barriers were stigma-related, whereas time constraints were cited most commonly in Spain and the UK. In Germany, nearly half of respondents rated the importance of alcohol screening for hypertension as low. Perception that regular screening is inappropriate or associated with too much effort, beliefs that screening is unnecessary, and insufficient knowledge of screening tools were cited as further barriers. Professional education on alcohol use was consistently rated to be poorer than the equivalent education on hypertension, and only a minority of respondents perceived alcohol as important risk factor for hypertension. Stigma-related barriers could not be significantly predicted by education, knowledge or screening frequency in most models.ConclusionsOverall, regular alcohol screening among hypertensive patients seems to be widely accepted, but further education (Germany) and structural support (Spain, UK) could contribute to increase screening rates. In France and Italy, screening uptake could be improved by addressing stigma.Short SummaryAlcohol screening among hypertensive patients was largely accepted among general practitioners from five different European countries. Reported screening barriers varied between countries and included time constraints, stigma and underrated importance of alcohol. Results did not indicate a positive impact of education and screening frequency on perception of stigma as barrier to screening.
17.	Heilig, Markus, et al. (författare) Addiction as a brain disease revised : why it still matters, and the need for consilience 2021 Ingår i: Neuropsychopharmacology. - : Springer Nature. - 0893-133X .- 1740-634X. ; 46:10, s. 1715-1723 Forskningsöversikt (refereegranskat)abstract The view that substance addiction is a brain disease, although widely accepted in the neuroscience community, has become subject to acerbic criticism in recent years. These criticisms state that the brain disease view is deterministic, fails to account for heterogeneity in remission and recovery, places too much emphasis on a compulsive dimension of addiction, and that a specific neural signature of addiction has not been identified. We acknowledge that some of these criticisms have merit, but assert that the foundational premise that addiction has a neurobiological basis is fundamentally sound. We also emphasize that denying that addiction is a brain disease is a harmful standpoint since it contributes to reducing access to healthcare and treatment, the consequences of which are catastrophic. Here, we therefore address these criticisms, and in doing so provide a contemporary update of the brain disease view of addiction. We provide arguments to support this view, discuss why apparently spontaneous remission does not negate it, and how seemingly compulsive behaviors can co-exist with the sensitivity to alternative reinforcement in addiction. Most importantly, we argue that the brain is the biological substrate from which both addiction and the capacity for behavior change arise, arguing for an intensified neuroscientific study of recovery. More broadly, we propose that these disagreements reveal the need for multidisciplinary research that integrates neuroscientific, behavioral, clinical, and sociocultural perspectives.
18.	Kilian, Carolin, et al. (författare) A new perspective on European drinking cultures : a model-based approach to determine variations in drinking practices among 19 European countries 2021 Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 116:8, s. 2016-2025 Tidskriftsartikel (refereegranskat)abstract Background and aims In recent decades, alcohol drinking in the European Union has been characterized by increasing homogenization of levels of drinking coupled with an overall decrease. This study examined whether we can still distinguish distinct practices of drinking by addressing two research questions: (1) are drinking practices still characterized by the choice of a certain alcoholic beverage; and (2) how do drinking practices vary across countries?Design Cross-sectional study: latent-class analyses of drinking variables and fractional response regression analyses of individual characteristics for individual-level class endorsement probabilities, respectively.Setting Nineteen European countries and one autonomous community.Participants A total of 27 170 past-year drinkers aged 18-65 years in 2015.Measurements Data were collected through the Standardized European Alcohol Survey included frequency of past-year drinking, pure alcohol intake per drink day, occurrence of monthly risky single-occasion drinking and preferred beverage, together with socio-demographic data.Findings Three latent classes were identified: (1) light to moderate drinking without risky single-occasion drinking [prevalence: 68.0%, 95% confidence interval (CI) = 66.7-69.3], (2) infrequent heavy drinking (prevalence: 12.6%, 95% CI = 11.5-13.7) and (3) regular drinking with at least monthly risky single-occasion drinking (prevalence: 19.4%, 95% CI = 18.1-20.9). Drinking classes differed considerably in beverage preference, with women reporting a generally higher share of wine and men of beer drinking. Light to moderate drinking without risky single-occasion drinking was the predominant drinking practice in all locations except for Lithuania, where infrequent heavy drinking (class 2) was equally popular. Socio-demographic factors and individual alcohol harm experiences (rapid alcohol on-line screen) explained up to 20.5% of the variability in class endorsement.Conclusions Beverage preference appears to remain a decisive indicator for distinguishing Europeans' drinking practices. In most European countries, multiple drinking practices appear to be present.
19.	Kilian, Carolin, et al. (författare) Alcohol Policy in Germany : Missed Opportunities to Lower Alcohol's Health Burden 2023 Ingår i: SUCHT. - 0939-5911 .- 1664-2856. ; 69:4, s. 163-171 Tidskriftsartikel (refereegranskat)abstract Upon the release of the third edition of the book Alcohol: no ordinary commodity, the authors evaluated the implementation of cost-effective alcohol policies in Germany. Method: Current legal regulations and practices addressing four policy areas were reviewed: (1) pricing and taxation policies; (2) regulating physical availability; (3) restrictions of alcohol marketing; and (4) drink-driving countermeasures. Results: Compared to other European countries, excise duties on alcoholic beverages and particularly on beer and wine are low and barely lower alcohol affordability. With few exceptions, alcoholic beverages can be purchased at any time and various retail venues (e. g., grocery stores, petrol stations). Restrictions on alcohol marketing are limited to youth protection and the portrayal of 'abusive' alcohol use. The recommended countermeasures to prevent driving under the influence of alcohol have been largely implemented. Conclusion: Cost-effective alcohol policies are insufficiently implemented in Germany, despite their potential to substantially lower the alcohol-related health burden.
20.	Kilian, Carolin, et al. (författare) Why Is Per Capita Consumption Underestimated in Alcohol Surveys? Results from 39 Surveys in 23 European Countries 2020 Ingår i: Alcohol and Alcoholism. - : Oxford University Press (OUP). - 0735-0414 .- 1464-3502. ; 55:5, s. 554-563 Tidskriftsartikel (refereegranskat)abstract Aims: The aims of the article are (a) to estimate coverage rates (i.e. the proportion of ‘real consumption’ accounted for by a survey compared with more reliable aggregate consumption data) of the total, the recorded and the beverage-specific annual per capita consumption in 23 European countries, and (b) to investigate differences between regions, and other factors which might be associated with low coverage (prevalence of heavy episodic drinking [HED], survey methodology).Methods: Survey data were derived from the Standardised European Alcohol Survey and Harmonising Alcohol-related Measures in European Surveys (number of surveys: 39, years of survey: 2008–2015, adults aged 20–64 years). Coverage rates were calculated at the aggregated level by dividing consumption estimates derived from the surveys by alcohol per capita estimates from a recent global modelling study. Fractional response regression models were used to examine the relative importance of the predictors.Results: Large variation in coverage across European countries was observed (average total coverage: 36.5, 95% confidence interval [CI] [33.2; 39.8]), with lowest coverage found for spirits consumption (26.3, 95% CI [21.4; 31.3]). Regarding the second aim, the prevalence of HED was associated with wine- and spirits-specific coverage, explaining 10% in the respective variance. However, neither the consideration of regions nor survey methodology explained much of the variance in coverage estimates, regardless of the scenario.Conclusion: The results reiterate that alcohol survey data should not be used to compare or estimate aggregate consumption levels, which may be better reflected by statistics on recorded or total per capita consumption.
21.	Klionsky, Daniel J, et al. (författare) Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition). 2016 Ingår i: Autophagy. - : Informa UK Limited. - 1554-8635 .- 1554-8627. ; 12:1, s. 1-222 Tidskriftsartikel (refereegranskat)
22.	Kraus, Ludwig, et al. (författare) Inanspruchnahme gesundheitlicher Versorgung durch Alkoholabhängige [Health care utilization of perople with alcohol dependence] 2015 Ingår i: Suchttherapie. - : Georg Thieme Verlag KG. - 1439-9903 .- 1439-989X. ; 16:1, s. 18-26 Tidskriftsartikel (refereegranskat)abstract Aims: The study aims at estimating health care utilization of alcohol dependents. Estimates will be provided for the number of people with dependence in the general population, the number of people that have received the diagnosis "dependence" by a general practitioner, and number of people treated in addiction care. Methods: Estimates are based on the most recent data on health care utilization. The estimation methods are described in detail. Results: In Germany, the prevalence of alcohol dependence in the general population aged 18 years and above is estimated at 2.8 % or 1.86 million individuals in 2012. Approximately 649 000 individuals were diagnosed as, alcohol dependent" by a general practitioner indicating that about one third of the people with dependence (35.0%) were registered in the health care system (2009 data). In the same year approximately 297 000 individuals with alcohol dependence (16 %) were utilizing specialized addiction services (in-or outpatient treatment, general hospital). The rate of addicts in rehabilitation treatment was estimated at 1.8%. Conclusions: For reducing the burden of morbidity and mortality associated with alcohol dependence considerable improvements in health care utilization by addicts are required. Utilization may be increased by improving excess to early intervention, diversification of treatment offers and challenging the paradigm of abstinence-oriented treatment.
23.	Kraus, Ludwig, et al. (författare) Quantifying harms to others due to alcohol consumption in Germany : a register-based study 2019 Ingår i: BMC Medicine. - : Springer Science and Business Media LLC. - 1741-7015. ; 17 Tidskriftsartikel (refereegranskat)abstract Background: The consumption of alcohol increases the risk of drinkers harming others. The extent of alcohol's morbidity and mortality harms to others in Germany in 2014 was estimated for (1) fetal alcohol syndrome (FAS) or fetal alcohol spectrum disorders (FASD) among newborns, (2) road traffic fatalities, and (3) interpersonal violence-related deaths. Methods: The incidences of FAS and FASD were estimated by means of a meta-analytical approach, combining data on alcohol use during pregnancy and the risk relationship between alcohol consumption during pregnancy and FAS/FASD. In order to estimate alcohol-attributable road traffic fatalities and interpersonal violence due to the drinking of others, an attributable fraction methodology was applied to cause-of-death statistics for road traffic and interpersonal violence-related deaths. Results: For 2014, the incidences of FAS and FASD were estimated at 41 children per 10,000 live births (95% CI 24; 63) and 177 children per 10,000 live births (95% CI 135; 320), or 2930 (95% CI 1720; 4500) and 12,650 (95% CI 9650; 23,310) children, respectively. Furthermore, alcohol was estimated to be responsible for 1214 (95% CI 1141; 1287) third-party road traffic fatalities and 55 (95% CI 46; 64) deaths from interpersonal violence, representing 45.1% of all third-party road traffic fatalities and 14.9% of all interpersonal violence deaths. Conclusion: These study's estimates indicate there is a substantial degree of health harm to third parties caused by alcohol in Germany. While more research on harms to others caused by alcohol is needed to provide comprehensive estimates, the results indicate a need for effective prevention.
24.	Krone, Michael, et al. (författare) Interactive Exploration of Protein Cavities 2011 Ingår i: Computer graphics forum (Print). - : Blackhorse Publishing. - 0167-7055 .- 1467-8659. ; 30:3, s. 673-682 Tidskriftsartikel (refereegranskat)abstract We present a novel application for the interactive exploration of cavities within proteins in dynamic data sets. Inside a protein, cavities can often be found close to the active center. Therefore, when analyzing a molecular dynamics simulation trajectory it is of great interest to find these cavities and determine if such a cavity opens up to the environment, making the binding site accessible to the surrounding substrate. Our user-driven approach enables expert users to select a certain cavity and track its evolution over time. The user is supported by different visualizations of the extracted cavity to facilitate the analysis. The boundary of the protein and its cavities is obtained by means of volume ray casting, where the volume is computed in real-time for each frame, therefore allowing the examination of time-dependent data sets. A fast, partial segmentation of the volume is applied to obtain the selected cavity and trace it over time. Domain experts found our method useful when they applied it exemplarily on two trajectories of lipases from Rhizomucor miehei and Candida antarctica. In both data sets cavities near the active center were easily identified and tracked over time until they reached the surface and formed an open substrate channel.
25.	Lasserre, Aurelie M., et al. (författare) Socioeconomic status, alcohol use disorders, and depression : A population-based study 2022 Ingår i: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 301, s. 331-336 Tidskriftsartikel (refereegranskat)abstract Background: Depressive disorders (DD) and alcohol use disorders (AUD) frequently co-occur. They are key to understanding the current increases in "deaths of despair" among individuals with lower socioeconomic status (SES). The aim of this study was to assess the prospective bidirectional associations between AUD and DD, as well as the effect of SES on these two conditions. Methods: The National Epidemiologic Survey on Alcohol and Related Conditions is a cohort study representative of the US adult population, which began in 2001-2002, with follow-up interviews conducted 3 years later. SES was primarily operationalized as educational attainment. AUD, DD, and their levels of severity were defined according to the DSM-5 criteria. Results: The risk of developing an incident DD increased gradually with the recency and the severity of AUD at baseline, but the converse was not observed. Lower SES was an independent risk for incident AUD or DD. SES did not modify the prospective association between AUD and DD. Limitations: The absence of interaction between SES and moderate or severe AUD for the incident DD must be considered with caution due to the limited number of DD cases reported in these AUD categories. Conclusions: This result is consistent with a causal relationship between AUD and DD, and suggests that therapeutic interventions for AUD may also have beneficial effects to lower DD rates. The independent effects of a lower SES and AUD on DD may result in a vulnerable population cumulating disorders with heavy consequences on health and social well-being.
26.	Lim, Stephen S, et al. (författare) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. 2012 Ingår i: Lancet. - 1474-547X. ; 380:9859, s. 2224-60 Tidskriftsartikel (refereegranskat)abstract Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time.
27.	Manthey, Jakob, et al. (författare) Alcohol Use in Germany and Europe during the SARS-CoV-2 Pandemic 2020 Ingår i: SUCHT. - : Hogrefe Publishing Group. - 0939-5911 .- 1664-2856. ; 66:5, s. 247-258 Tidskriftsartikel (refereegranskat)abstract Aims: The aim of this study was to examine changes in alcohol consumption during the Sars-CoV-2 pandemic in Germany in comparison to changes in other European countries. Method: Analyses of sociodemographic and socio-economic data, as well as reports on alcohol use changes since the pandemic collected through a European online survey (N=40,064) in 21 countries. Weights based on gender, age and education were applied to account for sample bias. Results: Since the beginning of the pandemic, alcohol consumption has decreased on average. The decline is primarily due to a reduction in heavy episodic drinking occasions. As compared to other European countries, alcohol consumption in Germany has declined less sharply. This is mainly due to an increase in alcohol consumption among women as well as among people who report negative impacts on jobs and finances and among people with risky consumption patterns. Conclusion: In order to counter negative consequences of increased alcohol consumption in sub-groups during the pandemic, cutting the availability of alcohol through reasonable taxation and fostering alcohol screening activities in primary health care settings is needed.
28.	Manthey, Jakob, et al. (författare) Versorgung von Personen mit riskantem Alkoholkonsum und schwerer Alkoholkonsumstörung in Bremen : bedarfsgerecht und leitlinienkonform? 2020 Ingår i: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. - : Springer Science and Business Media LLC. - 1436-9990 .- 1437-1588. ; 63, s. 122-130 Tidskriftsartikel (refereegranskat)abstract Hintergrund: Riskanter Alkoholkonsum und schwere Alkoholkonsumstörungen sollten wegen gesundheitlichen Folgeschäden rechtzeitig erkannt werden. Die S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“ empfiehlt daher die routinemäßige Anwendung von Screeningverfahren, z. B. in Allgemeinarztpraxen. Wird ein riskanter Konsum festgestellt, soll eine Kurzintervention erfolgen. Bei schwerer Alkoholkonsumstörung ist eine Entzugsbehandlung angezeigt, bei Komplikationsrisiken in stationärer Form.Ziel der Arbeit: Schätzung des Anteils von Personen mit riskantem Konsum und schwerer Alkoholkonsumstörung in leitlinienkonformer Versorgung im Bundesland Bremen.Material und Methoden: Die Prävalenz riskanten Konsums (weibl.: ≥12 g/Tag; männl.: ≥24 g/Tag) und schwerer Alkoholkonsumstörungen (weibl.: ≥60 g/Tag; männl.: ≥90 g/Tag) wurde über den Pro-Kopf-Konsum von Reinalkohol geschätzt. Behandlungsraten wurden auf Grundlage von Umfragedaten (für riskanten Konsum) sowie mittels Sekundärdaten vollstationärer Krankenhausaufenthalte (für schwere Alkoholkonsumstörung) geschätzt. Die Schätzungen beziehen sich auf die Bevölkerung ab 15 Jahre im Bundesland Bremen im Jahr 2016.Ergebnisse: Nur 2,9 % aller Personen mit riskantem Alkoholkonsum wurden durch ihre Hausärzt*innen gescreent; die Hälfte davon (1,4 %) erhielt eine Kurzintervention. 7,1 % der Personen mit einer schweren Alkoholkonsumstörung wurden vollstationär behandelt. Stationäre Entzugsbehandlungen wurden bei 14,1 % der Personen mit einer schweren Alkoholkonsumstörung durchgeführt, bei denen ein stationärer Entzug erforderlich ist. Unterdurchschnittliche Behandlungsraten wurden bei 21- bis 39-Jährigen registriert.Diskussion: Riskanter Konsum und schwere Alkoholkonsumstörungen sind in Bremen unzureichend versorgt, insbesondere bei 21- bis 39-Jährigen.
29.	Olderbak, Sally, et al. (författare) Trends and projection in the proportion of (heavy) cannabis use in Germany from 1995 to 2021 2024 Ingår i: Addiction. - 0965-2140 .- 1360-0443. ; 119:2, s. 311-321 Tidskriftsartikel (refereegranskat)abstract Aims: To measure the current trends of cannabis use in Germany, measure trends in the proportion of heavy cannabis users and estimate future cannabis use rates.Design: Repeated waves of the Epidemiological Survey on Substance Abuse, a cross-sectional survey conducted between 1995 and 2021 with a two-stage participant selection strategy where respondents completed a survey on substance use delivered through the post, over the telephone or on-line.Setting: Germany.Participants/cases: German-speaking participants aged between 18 and 59 years living in Germany who self-reported on their cannabis use in the past 12 months (n = 78 678). With the application of a weighting scheme, the data are nationally representative.Measurements: Questions on the frequency of cannabis use in the past 12 months and self-reported changes in frequency of use due to the COVID-19 pandemic.Findings: The prevalence of past 12-month cannabis users increased from 4.4% [95% confidence interval (CI) = 3.7, 5.1] in 1995 to 10.0% (95% CI = 8.9, 11.3) in 2021. Modeling these trends revealed a significant increase that accelerated over the past decade. The proportion of heavy cannabis users [cannabis use (almost) daily or at least 200 times per year] among past-year users has remained steady from 1995 (11.4%, 95% CI = 7.7, 16.5) to 2018 (9.5%, 95% CI = 7.6, 11.9), but significantly increased to 15.7% (95% CI = 13.1, 18.8) in 2021 during the COVID-19 pandemic. Extrapolating from these models, the prevalence of 12-month cannabis users in 2024 is expected to range between 10.4 and 15.0%, while the proportion of heavy cannabis users is unclear.Conclusions: Trends from 1995 to 2021 suggest that the prevalence of past 12-month cannabis users in Germany will continue to increase, with expected rates between 10.4 and 15.0% for the German-speaking adult population, and that at least one in 10 cannabis users will continue to use cannabis heavily (almost daily or 200 + times in the past year).
30.	Paglia, Angela, et al. (författare) Culture-specific findings from the CAR study : Canada – Toronto 2001 Ingår i: Disability and culture. - Seattle : Hogrefe & Huber Publishers. - 088937239X ; , s. 85-93 Bokkapitel (övrigt vetenskapligt/konstnärligt)
31.	Rehm, Jürgen, et al. (författare) Acceptable risk? : Why does society accept a higher risk for alcohol than for other voluntary or involuntary risks? 2014 Ingår i: BMC Medicine. - : Springer Science and Business Media LLC. - 1741-7015. ; 12, s. 189- Tidskriftsartikel (refereegranskat)abstract Background: Societies tend to accept much higher risks for voluntary behaviours, those based on individualdecisions (for example, to smoke, to consume alcohol, or to ski), than for involuntary exposure such as exposure torisks in soil, drinking water or air. In high-income societies, an acceptable risk to those voluntarily engaging in a riskybehaviour seems to be about one death in 1,000 on a lifetime basis. However, drinking more than 20 g purealcohol per day over an adult lifetime exceeds a threshold of one in 100 deaths, based on a calculation from WorldHealth Organization data of the odds in six European countries of dying from alcohol-attributable causes at differentlevels of drinking.Discussion: The voluntary mortality risk of alcohol consumption exceeds the risks of other lifestyle risk factors. Inaddition, evidence shows that the involuntary risks resulting from customary alcohol consumption far exceed theacceptable threshold for other involuntary risks (such as those established by the World Health Organization ornational environmental agencies), and would be judged as not acceptable. Alcohol’s exceptional status reflectsvagaries of history, which have so far resulted in alcohol being exempted from key food legislation (no labelling ofingredients and nutritional information) and from international conventions governing all other psychoactivesubstances (both legal and illegal). This is along with special treatment of alcohol in the public health field, in partreflecting overestimation of its beneficial effect on ischaemic disease when consumed in moderation.Summary: A much higher mortality risk from alcohol than from other risk factors is currently accepted by highincome countries.
32.	Rehm, Jürgen, et al. (författare) Classifying alcohol control policies enacted between 2000 and 2020 in Poland and the Baltic countries to model potential impact 2023 Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 118:3, s. 449-458 Tidskriftsartikel (refereegranskat)abstract Aims: The study's aim is to identify and classify the most important alcohol control policies in the Baltic countries (Estonia, Latvia and Lithuania) and Poland between 2000 and 2020.Methods: Policy analysis of Baltic countries and Poland, predicting potential policy impact on alcohol consumption, all-cause mortality and alcohol-attributable hospitalizations was discussed.Results: All Baltic countries implemented stringent availability restrictions on off-premises trading hours and different degrees of taxation increases to reduce the affordability of alcoholic beverages, as well as various degrees of bans on alcohol marketing. In contrast, Poland implemented few excise taxation increases or availability restrictions and, in fact, reduced stipulations on prior marketing bans.Conclusions: This classification of alcohol control policies in the Baltic countries and Poland provides a basis for future modeling of the impact of implementing effective alcohol control policies (Baltic countries), as well as the effects of loosening such policies (Poland).
33.	Rehm, Jürgen, et al. (författare) Classifying Alcohol Control Policies with Respect to Expected Changes in Consumption and Alcohol-Attributable Harm : The Example of Lithuania, 2000-2019 2021 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:5 Tidskriftsartikel (refereegranskat)abstract Due to the high levels of alcohol use, alcohol-attributable mortality and burden of disease, and detrimental drinking patterns, Lithuania implemented a series of alcohol control policies within a relatively short period of time, between 2008 and 2019. Based on their expected impact on alcohol consumption and alcohol-attributable harm, as well as their target population, these policies have been classified using a set of objective criteria and expert opinion. The classification criteria included: positive vs. negative outcomes, mainly immediate vs. delayed outcomes, and general population vs. specific group outcomes. The judgement of the alcohol policy experts converged on the objective criteria, and, as a result, two tiers of intervention were identified: Tier 1—highly effective general population interventions with an anticipated immediate impact; Tier 2—other interventions aimed at the general population. In addition, interventions directed at specific populations were identified. This adaptable methodological approach to alcohol control policy classification is intended to provide guidance and support for the evaluation of alcohol policies elsewhere, to lay the foundation for the critical assessment of the policies to improve health and increase life expectancy, and to reduce crime and violence.
34.	Rehm, Jürgen, et al. (författare) Cultural specificity in alcohol use disorders 2022 Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 399:10327, s. e7-e8 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
35.	Rehm, Jürgen, et al. (författare) Do alcohol control policies have the predicted effects on consumption? An analysis of the Baltic countries and Poland 2000–2020 2022 Ingår i: Drug And Alcohol Dependence. - : Elsevier BV. - 0376-8716 .- 1879-0046. ; 241 Tidskriftsartikel (refereegranskat)abstract Background: Many population-based alcohol control policies are postulated to work via changes in adult alcohol per capita consumption (APC). However, since APC is usually assessed on a yearly basis, often there are not enough data to conduct interrupted time-series or other controlled analyses. The current dataset, with 21 years of observation from four countries (Estonia, Latvia, Lithuania, and Poland), had sufficient power to test for average effects and potential interactions of the World Health Organization’s (WHO) three “best buys” for alcohol control: taxation increases leading to a decrease in affordability; reduced availability (via a decrease in opening hours of at least 20 %); and advertising and marketing restrictions. We postulated that the former two would have immediate effects, while the latter would have mid- to long-term effects.Methods: Linear regression analysis.Results: Taxation increases and availability reductions in all countries were associated with an average reduction in APC of 0.83 litres (ℓ) of pure alcohol per year (95 % confidence interval: −1.21 ℓ, −0.41 ℓ) in the same year, with no significant differences between countries. Restrictions on advertising and/or marketing had no significant immediate associations with APC (average effect 0.04 ℓ per year; 95 % confidence interval: −0.65 ℓ, 0.73 ℓ). Several sensitivity analyses corroborated these main results.Conclusions: The WHO “best buy” alcohol control policies of taxation increases and availability restrictions worked as postulated in these four northeastern European Union countries.
36.	Rehm, Jürgen, et al. (författare) Impact of the WHO "best buys" for alcohol policy on consumption and health in the Baltic countries and Poland 2000-2020 2023 Ingår i: The Lancet Regional Health. - 2666-7762. ; 33 Tidskriftsartikel (refereegranskat)abstract Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time -series analyses suggest improved health, measured as reductions in all -cause and alcohol -attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol -attributable deaths. The natural experiment in this region of high -income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health.
37.	Rehm, Jürgen, et al. (författare) Reducing the Harmful Use of Alcohol : Have International Targets Been Met? 2021 Ingår i: European Journal of Risk Regulation. - : Cambridge University Press (CUP). - 1867-299X .- 2190-8249. ; 12:2, s. 530-541 Tidskriftsartikel (refereegranskat)abstract Alcohol use has been identified in major United Nations (UN) initiatives, such as the Sustainable Development Goals and the Non-Communicable Disease Action Plan, as a major contributor to the global burden of disease. As a result, levels of alcohol use serve as an official indicator of progress towards these UN-set goals. Given current trends, UN targets for reduced alcohol consumption are unlikely to be met. Moreover, in many countries, especially in low- and middle-income countries, the alcohol-attributable burden of disease continues to increase. Pressure will need to be exerted on national and international decision-makers to arrive at more powerful and normatively persuasive instruments, such as a treaty.
38.	Rehm, Jürgen, et al. (författare) Regulatory Policies for Alcohol, other Psychoactive Substances and Addictive Behaviours : The Role of Level of Use and Potency. A Systematic Review 2019 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 16:19 Forskningsöversikt (refereegranskat)abstract The object of this contribution based on a systematic review of the literature is to examine to what degree the level of use and potency play a role in regulatory policies for alcohol, other psychoactive substances and gambling, and whether there is an evidence base for this role. Level of use is usually defined around a behavioural pattern of the user (for example, cigarettes smoked per day, or average ethanol use in grams per day), while potency is defined as a property or characteristic of the substance. For all substances examined (alcohol, tobacco, opioids, cannabis) and gambling, both dimensions were taken into consideration in the formulation of most regulatory policies. However, the associations between both dimensions and regulatory policies were not systematic, and not always based on evidence. Future improvements are suggested.
39.	Rehm, Jürgen, et al. (författare) Steps towards constructing a global comparative risk analysis for alcohol consumption: : Determining Indicators and Empirical Weights for Patterns of Drinking, Deciding about Theoretical Minimum, and Dealing with Different Consequences 2001 Ingår i: European Addiction Research. - : S. Karger AG. - 1022-6877 .- 1421-9891. ; 7:3, s. 138-147 Tidskriftsartikel (refereegranskat)abstract In order to conduct a comparative risk analysis for alcohol within the Global Burden of Disease Study (GBD 2000), several questions had to be answered. (1) What are the appropriate dimensions for alcohol consumption and how can they be categorized? The average volume of alcohol and patterns of drinking were selected as dimensions. Both dimensions could be looked upon as continuous but were categorized for practical purposes. The average volume of drinking was categorized into the following categories: abstention; drinking 1 (>0–19.99 g pure alcohol daily for females, >0–39.99 g for males); drinking 2 (20–39.99 g for females, 40–59.99 g for males), and drinking 3 (≥40 g for females, ≥60 g for males). Patterns of drinking were categorized into four levels of detrimental impact based on an optimal scaling analysis of key informant ratings. (2) What is the theoretical minimum for both dimensions? A pattern of regular light drinking (at most 1 drink every day) was selected as theoretical minimum for established market economies for all people above age 45. For all other regions and age groups, the theoretical minimum was set to zero. Potential problems and uncertainties with this selection are discussed. (3) What are the health outcomes for alcohol and how do they relate to the dimensions? Overall, more than 60 disease conditions were identified as being related to alcohol consumption. Most chronic conditions seem to be related to volume only (exceptions are coronary heart disease and ischemic stroke), and most acute conditions seem to be related to volume and patterns. In addition, using methodology based on aggregate data, patterns were relevant for attributing harms for men but not women.
40.	Rehm, Jürgen, et al. (författare) The addiction concept revisited 2014 Ingår i: Reframing addiction. - : Alice Rap. - 9788469716472 ; , s. 103-117 Bokkapitel (refereegranskat)abstract Summary: In the past 50 years, there had been quite varied definitions and operationalizations of the term addiction, and up to today, there are different underlying concepts in the two major classification systems by the World Health Organization (ICD) and by the American Psychiatric Association (DSM). This chapter reviews current and past definitions and introduces a new concept “heavy use over time” which could replace current definitions. First, heavy use over time causes the changes in the brain we currently associate with substance use disorders. Second, heavy use over time is also very closely linked to all criteria used to define such disorders in medical classification systems. Third, heavy use over time is easy to operationalize and fourth, it has been shown to associate with mortality and morbidity outcomes of dependence or other substance use disorders better than current diagnostic criteria. Finally, defining substance use disorders as heavy use over time promises to better align treatment with standard medical treatments and could play a role in reducing stigma. To summarize, heavy use over time promises to reconceptualise addictions/substance use disorders in a parsimonious and consistent matter, in line with major scientific results.
41.	Rehm, Jürgen, et al. (författare) The comparative risk assessment for alcohol as part of the Global Burden of Disease 2010 Study : What changed from the last study? 2013 Ingår i: International Journal of Alcohol and Drug Research. - : Kettil Bruun Society for Social and Epidemiological Research on Alcohol. - 1925-7066. ; 2:1, s. 1-5 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Rehm, J., Borges, G., Gmel, G., Graham, K., Grant, B., Parry, C., Poznyak, V. & Room R. (2013). The comparative risk assessment for alcohol as part of the Global Burden of Disease 2010 study: What changed from the last study? International Journal of Alcohol and Drug Research, 2(1), 1-5. doi: 10.7895/ijadr.v2i1.132 (http://dx.doi.org/10.7895/ijadr.v2i1.132)In December 2012, the new results of the Comparative Risk Assessment (CRA) for alcohol within the Global Burden of Disease and Injury (GBD) Study 2010 were presented at a joint meeting of the GBD Group and the journal Lancet at the Royal Society in London (Lim et al., 2012). At first glance, there do not appear to be many changes to alcohol consumption as a risk factor for death and disability: it is identified as the third most important risk factor, as it was in the last CRA (World Health Organization, 2009). The burden of disease attributable to alcohol had increased, compared to the 2004 estimate (Rehm, Mathers et al., 2009), but this could be due to an increase in global population, or to variations in the methodologies behind the 2004 and 2010 estimates.
42.	Rehm, Jürgen, et al. (författare) The contribution of unrecorded alcohol to health harm 2017 Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 112:9, s. 1687-1688 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
43.	Rehm, Jürgen, et al. (författare) The cultural aspect : How to measure and interpret epidemiological data on alcohol-use disorders across cultures 2017 Ingår i: Nordic Studies on Alcohol and Drugs. - : SAGE Publications. - 1455-0725 .- 1458-6126. ; 34:4, s. 330-341 Tidskriftsartikel (refereegranskat)abstract Aims: To examine the cultural impact on the diagnosis of alcohol-use disorders using European countries as examples. Design: Narrative review. Results: There are strong cultural norms guiding heavy drinking occasions and loss of control. These norms not only indicate what drinking behaviour is acceptable, but also whether certain behaviours can be reported or not. As modern diagnostic systems are based on lists of mostly behavioural criteria, where alcohol-use disorders are defined by a positive answer on at least one, two or three of these criteria, culture will inevitably co-determine how many people will get a diagnosis. This explains the multifold differences in incidence and prevalence of alcohol-use disorders, even between countries where the average drinking levels are similar. Thus, the incidence and prevalence of alcohol-use disorders as assessed by surveys or rigorous application of standardised instruments must be judged as measuring social norms as well as the intended mental disorder. Conclusions: Current practice to measure alcohol-use disorders based on a list of culture-specific diagnostic criteria results in incomparability in the incidence, prevalence or disease burden between countries. For epidemiological purposes, a more grounded definition of diagnostic criteria seems necessary, which could probably be given by using heavy drinking over time.
44.	Rehm, Jürgen, et al. (författare) The relationship between different dimensions of alcohol use and the burden of disease—an update 2017 Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 112:6, s. 968-1001 Forskningsöversikt (refereegranskat)abstract Background and aims Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). Methods Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. Results In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. Conclusions Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.
45.	Rehm, Jürgen, et al. (författare) The role of alcohol in the management of hypertension in patients in European primary health care practices - a survey in the largest European Union countries 2016 Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 17 Tidskriftsartikel (refereegranskat)abstract Background: Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care. Methods: Internet based survey of 3081 primary care physicians, recruited via the mailing lists of associations for general practitioners (GPs) in France, Germany, Italy, Spain and the UK. Clinical practice, attitudes, knowledge, education and training were assessed. Logistic regression to predict screening, brief intervention and treatment for alcohol dependence in the management of hypertension were assessed. Results: Overall, about one third of the interviewed GPs reported sufficient screening in cases with HTN (34.0 %, 95 % confidence interval (CI):32.1-35.8 %). One out of five GPs screened and delivered brief interventions in HTN patients with hazardous consumption (22.2 %, 95 % CI: 20.6-23.8 %) and about one in 13 GPs provided treatment for HTN patients with alcohol dependence other than advice or brief intervention (7.8 %, 95 % CI: 6.8-8.9 %). Post-graduate training and belief in their effectiveness predicted interventions. There were marked differences between countries. Conclusions: While current interventions were overall low, marked differences between countries indicate that current practices could be improved. Education and post-graduate training seems to be key in improving clinical practice of including interventions for problematic alcohol consumption and alcohol dependence in primary health care.
46.	Rehm, Jürgen, et al. (författare) Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union 2017 Ingår i: BMC Medicine. - : Springer Science and Business Media LLC. - 1741-7015. ; 15 Tidskriftsartikel (refereegranskat)abstract BackgroundHazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.MethodsA consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statisticalmodelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.ResultsScreening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.ConclusionsThe implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.
47.	Rehm, Jürgen, et al. (författare) Using Direct and Indirect Estimates for Alcohol-Attributable Mortality : A Modelling Study Using the Example of Lithuania 2023 Ingår i: European Addiction Research. - : S. Karger AG. - 1022-6877 .- 1421-9891. ; 29:2, s. 119-126 Tidskriftsartikel (refereegranskat)abstract Introduction: Comparative risk assessments (CRAs) for alcohol use are based on indirect estimates of attributable harm, and usually combine country-specific exposure estimates and global risk relations derived from meta-analyses. CRAs for Eastern European countries, such as Lithuania, base their risk relations not on global risk relations, but on a large Russian cohort study. The availability of a direct estimate of alcohol-attributable mortality following the 2017 implementation of a large increase in alcohol excise taxes in Lithuania has allowed a comparison of these indirect estimates with a country-specific gold standard. Methods: A statistical modelling study compared direct (predictions based on a time-series methodology) and indirect (predictions based on an attributable-fraction methodology) estimates of alcohol-attributable mortality before and after a large increase in alcohol excise taxes in Lithuania. Specifically, Russia-specific versus global relative risks were compared against the gold standard of time-series based predictions. Results: Compared to direct estimates, indirect estimates markedly underestimated the reduction of alcohol-attributable mortality 12 months post intervention by at least 63%. While both of the indirect estimates differed markedly from the direct estimates, the Russia-specific estimates were closer to the direct estimates, primarily due to higher estimates for alcohol-attributable cardiovascular mortality. Discussion: As all indirect estimates were markedly lower than direct estimates, current overall relative risks and price elasticities should be re-evaluated. In particular, global estimates should be replaced by new regional estimates based on cohort studies.
48.	Reissner, Volker, et al. (författare) Burnout, Coping and Job Satisfaction in Service Staff Treating Opioid Addicts-from Athens to Zurich 2010 Ingår i: Stress and Health. - : Wiley. - 1532-3005 .- 1532-2998. ; 26:2, s. 149-159 Tidskriftsartikel (refereegranskat)abstract The Treatment-systems Research on European Addiction Treatment study (TREAT-project) is a longitudinal multicenter study on predominantly opioid-dependent patients and their health-care system in six European cities. As part of the examination of the drug services, this study evaluates level of burnout, coping strategies, perceived self-efficacy and job satisfaction among health-care workers treating opioid addicts. Employees were recruited from organizations in Athens, London, Padua, Stockholm, Zurich and Essen. The Maslach burnout inventory, Brief COPE, general self-efficacy questionnaire and a job satisfaction scale were filled in by about 383 drug service workers. One-third of the staff suffer from severe burnout. London and Stockholm colleagues are significantly more burdened than Zurich personnel where job satisfaction is highest. No cross-national differences could be detected concerning coping styles or level of perceived self-efficacy. Burnout is positively correlated to passive coping strategies and negatively linked to self-efficacy and job satisfaction. Males experience more depersonalization. Organizational features such as the entry-threshold level of the institution or out- vs. inpatient setting are relevant for coping strategies and job satisfaction. These and other findings are discussed in relation to preliminary data from the TREAT-project on characteristics of opioid addicted patients and other specific features of the drug treatment system.
49.	Room, Robin, et al. (författare) Cross-cultural views on stigma, valuation, parity, and societal values towards disability 2001 Ingår i: Disability and culture. - Seattle : Hogrefe & Huber Publishers. - 088937239X ; , s. 247-297 Bokkapitel (övrigt vetenskapligt/konstnärligt)
50.	Room, Robin, 1939-, et al. (författare) “Harm per litre” as a concept and a measure in studying determinants of relations between alcohol consumption and harm 2023 Ingår i: International journal of drug policy. - : Elsevier BV. - 0955-3959 .- 1873-4758. ; 115 Tidskriftsartikel (refereegranskat)abstract The term “harm per litre” has been increasingly used in alcohol research in recent years as a concept and a comparative measure of alcohol-attributable harm in comparisons between environments, circumstances, and patterns of drinking. This essay discusses the origins of the term in connection with analyses in terms of patterns as well as levels of drinking and with concerns about differential harms from drinking different beverage types. Also discussed is the term's current primary usage, in the context of epidemiological concerns about differentially severe harms for poorer persons who drink. It is noted that these same concerns have been discussed, particularly in Britain, using the phrase “alcohol harm paradox”.“Harm per litre” was initially most often used in comparisons between rates of alcohol-attributable harm by beverage type. After 2010, the expression was applied more broadly, particularly after its use in various World Health Organization-related discussions and documents. In addition, and especially from 2018 onwards when most of the papers using this term were published, it has been used in comparisons by socioeconomic status at the individual level, and by level of socioeconomic development at the country level. Almost all the findings indicate that people with lower socioeconomic status, and countries with lower average income, e.g., low income and lower-middle income countries, incur considerably higher harm per litre (with harm being expressed in disease burden and mortality) than upper middle-income and high-income countries.“Harm per litre” is a practicable and easy-to-understand concept to compare groups of individuals or countries, and to quantify health inequalities. The next important step will need to be elucidating a better causal understanding of the processes underlying these inequalities, with an emphasis on factors which can be most easily changed by interventions.

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