Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.     

Psychological factors including sense of coherence and some lifestyles are related to general health questionnaire-12 (GHQ-12) in elderly workers in Japan

Objectives  The number of elderly workers has also been increasing and poor psychological well-being in elderly workers has been reported. The aim of this study is to elucidate the factors that are related to poor psychological well-being in elderly workers. Methods  We administered General Health Questionnaire-12 (GHQ-12) as an indicator of psychological well-being to 330 male elderly workers in the age range of 50–69, and analyzed different psychological factors, namely sense of coherence (SOC), and physical and lifestyle variables such as blood pressure, serum total cholesterol, smoking frequency, alcohol intake, exercise frequency, and body mass index (BMI) that are related to GHQ-12. Results  When the cut-off point of GHQ-12 was 2/3, 97 workers who showed high GHQ-12 score were classified as one group having poor psychological well-being. A statistically significantly lower SOC score, higher stress score, lower frequency of exercise, higher smoking score and higher BMI, but not longer working hours or higher shift work score in the workers with higher GHQ-12 scores were observed than in the workers with normal GHQ-12 scores. Multiple logistic regression analysis showed that the low SCO score, low frequency of exercise, high smoking frequency and high BMI significantly contributed to the high GHQ-12 score. Conclusions  A low SOC score in elderly workers is assumed to be directly related to poor psychological well-being, or via the development of lifestyle problems such as lack of exercise, obesity, and smoking in elderly workers. This assumption must be confirmed by conducting future intervention studies on lifestyle.     

Psychological impact of the 2003 severe acute respiratory syndrome outbreak on health care workers in a medium size regional general hospital in Singapore

AIMS: To describe the psychological impact of severe acute respiratory syndrome (SARS) on health care workers in a regional general hospital 2 months post-outbreak. METHOD: Doctors and nurses were encouraged to participate. The survey consisted of self-report measures: demographics, the General Health Questionnaire (GHQ) 28 and Impact of Events Scale (IES). A questionnaire enquiring about changes in life's priorities due to SARS and circumstances that helped with coping was used. Participation was strictly voluntary and responses anonymous. RESULTS: In total 177 out of 661 (27%) participants [40 out of 113 (35%) doctors and 137 out of 544 (25%) nurses] had a GHQ 28 score >or=5. Doctors [P = 0.026, odds ratio (OR) = 1.6 and 95% confidence interval (CI) = 1.1-2.5] and single health care workers were at higher risk (P = 0.048, OR = 1.4 and 95% CI = 1.02-2.0) compared to nurses and those who were married. Approximately 20% of the participants had IES scores >or=30, indicating the presence of post-traumatic stress disorder (PTSD). Four areas were classified as more important using factor analysis: health and relationship with the family, relationship with friends/colleagues, work and spiritual. The areas for coping strategies were clear directives/precautionary measures, ability to give feedback to/obtain support from management, support from supervisors/colleagues, support from the family, ability to talk to someone and religious convictions. Support from supervisors/colleagues was a significant negative predictor for psychiatric symptoms and PTSD. Work and clear communication of directives/precautionary measures also helped reduce psychiatric symptoms. CONCLUSIONS: Many health care workers were emotionally affected and traumatized during the SARS outbreak. Hence, it is important for health care institutions to provide psychosocial support and intervention for their health care workers.     

Are perceived stress, depressive symptoms and religiosity associated with alcohol consumption? A survey of freshmen university students across five European countries

ABSTRACT: BACKGROUND: The aim of this study was to investigate the association of perceived stress, depressive symptoms and religiosity with frequent alcohol consumption and problem drinking among freshmen university students from five European countries. METHODS: 2529 university freshmen (mean age 20.37, 64.9% females) from Germany (n=654), Poland (n=561), Bulgaria (n=688), the UK (n=311) and Slovakia (n=315) completed a questionnaire containing the modified Beck Depression Inventory for measuring depressive symptoms, the Cohen's perceived stress scale for measuring perceived stress, the CAGE-questionnaire for measuring problem drinking and questions concerning frequency of alcohol use and the personal importance of religious faith. RESULTS: Neither perceived stress nor depressive symptoms were associated with a high frequency of drinking (several times per week), but were associated with problem drinking. Religiosity (personal importance of faith) was associated with a lower risk for both alcohol-related variables among females. There were also country differences in the relationship between perceived stress and problem drinking. CONCLUSION: The association between perceived stress and depressive symptoms on the one side and problem drinking on the other demonstrates the importance of intervention programs to improve the coping with stress.     

Racial discrimination, ethnicity and work stress

BACKGROUND: Previous research has suggested higher work stress among minority ethnic workers. AIMS: To determine levels of work stress in three ethnic groups, consider the contribution of racial discrimination to the groups' profiles of occupational and demographic associations with stress, and assess the association between work stress and well-being. METHODS: A household quota sample design was used, and 204 black African-Caribbean, 206 Bangladeshi and 216 white (UK born) working people took part in structured interviews. RESULTS: More black African-Caribbean respondents reported high work stress than either Bangladeshi or white respondents. Reported racial discrimination among black African-Caribbean female respondents was strongly associated with perceived work stress. Among the black African-Caribbean respondents, women who reported experiencing racial discrimination at work had higher levels of psychological distress. CONCLUSIONS: Perceived work stress may be underpinned by exposure to racial discrimination at work among black African-Caribbean women, and this may affect their psychological well-being.     

Joint use of clinical parameters,biological markers and CAGE questionnaire for the identification of heavy drinkers in a large population-based sample

AIMS: Alcohol consumption in France is one of the highest in the world. Factors associated with excessive alcohol drinking are numerous. However, taken separately, none of the existing clinical or biological markers of excessive alcohol intake enables an adequate identification of heavy drinkers. The aim of this cross-sectional survey was to identify socio-demographic, clinical and biological factors associated with excessive alcohol drinking, to develop a model and to assess its reliability, thus enabling the detection of heavy drinkers. METHODS: Subjects were 1619 men and 1559 women, aged 35-64 years, living in three French areas (Lille, Strasbourg and Toulouse) and randomly selected from polling lists. Socio-demographic status, lifestyle, reported alcohol intake and answers to the CAGE questionnaire (alcohol dependence) were obtained by questionnaire. A blood sample was taken for quantification of biological parameters. Men who drank 60 g of ethanol a day (g/day) or above and women who drank 30 g/day or above were classified as heavy drinkers. The reference class (RC) gathered non-drinkers and moderate drinkers together. The sample was divided into two sub-samples: the first was used to estimate the parameters of a logistic regression model (heavy drinkers vs others), and the second to assess the accuracy of this model for the identification of heavy drinkers, using receiver operating characteristic (ROC) curves. A specific analysis was performed for each gender. RESULTS: Fourteen per cent of men and 40.8% of women were non-drinkers. Nine per cent of women and 14.4% of men were heavy drinkers. Wine was the most consumed alcoholic beverage. In the univariate analyses, differences were observed between the two groups of alcohol consumers for most of the socio-demographic, clinical and biological variables considered. In the multivariate analyses, low educational level, smoking, apoprotein B, high density lipoprotein cholesterol, mean corpuscular volume (MCV), gamma-glutamyl-transferase (GGT) and the CAGE score for men, and living area, age, MCV, GGT and the CAGE score for women remained independently and significantly associated with heavy drinking. In the validation sub-sample, these models combining different types of markers enabled a good discrimination between heavy drinkers and the RC, with an area under the ROC curve of 82% for men and of 79% for women. CONCLUSIONS: In this study, socio-demographic, clinical and biological factors and the CAGE score were independently related to excessive alcohol drinking and their joint utilization in a screening model enabled a good recognition of heavy drinkers.     

Efficiency of psychological debriefing in preventing post-traumatic stress disorders

BACKGROUND: Traumatic events are frequently followed by an acute stress reaction that may develop into a post-traumatic stress disorder. An intervention called psychological debriefing has been proposed to prevent these disorders. Although this method is widely used at present, its preventive effect is controversial. This article consist in a review of the studies which evaluated psychological debriefing efficiency in the prevention of post-traumatic stress disorder and associated disorders in adults. METHOD: We carried out a bibliographical search on MEDLINE (1966-2001), PASCAL (1987-2001), EMBASE (1988-2001), FRANCIS (1984-2001) and SCIENCEDIRECT (1967-2001). The key words were posttraumatic stress disorder, debriefing, treatment, psychological follow up, and prevention. We selected the studies with the following criteria: adults, one psychological debriefing session in the Month following the event, inclusion of a control group, more than 20 persons per group and evaluation of psychological disorders with standardized instruments more than one Month after the trauma. RESULTS: Twenty nine studies were identified and 8 selected. Four studies did not show any intervention effect, 3 suggested a negative intervention effect, and 1 suggested a positive effect on anxiety, depressive symptoms and alcohol dependence. CONCLUSION: Psychological debriefing implies re-exposure through memory processes to the trauma, which can interfere with the natural course of adjustment and recovery. Several Authors have suggested that psychological debriefing may delay the diagnosis and thus the early treatment of post-traumatic stress disorder. Psychological debriefing may not be appropriate to all victims of every type of incident or trauma. We discuss the intervention and its design. This review did not show evidence for psychological debriefing efficiency, as a unique session, in the prevention of posttraumatic reactions. The design and the objectives may be re-examined. Further evaluations following rigorous methods are warranted.     

Association between lifestyle and white blood cell count: a study of Japanese male office workers

METHODS: We assessed the association of lifestyle factors with white blood cell (WBC) count in 3681 Japanese male office workers aged 35-59 years. RESULTS: The WBC count differed significantly across lifestyle factors (overall obesity, alcohol consumption, cigarette smoking, eating breakfast, nutritional balance, physical exercise and hours of work). From multiple linear regression analyses, overall obesity, alcohol intake, cigarette smoking, nutritional balance and hours of work remained as statistically significant factors associated with WBC count. The WBC count increment showed a positive dose-response relationship with poor lifestyle factors regarding overall obesity, cigarette smoking and nutritional balance. On the other hand, the WBC count increment showed a negative dose-response relationship with alcohol intake and hours of work. CONCLUSION: These data indicate that lifestyle factors may exert an important effect on WBC count.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

Pre-deployment stress briefing: does it have an effect?

BACKGROUND: The role of giving information about stress and stress reactions to people about to be exposed to hazardous situations remains unclear. Such information might improve coping and hence resilience. Alternatively, it might increase the expectancy of experiencing adverse psychological consequences following exposure to a hazard. AIM: To determine the effect of a pre-operational stress briefing on health and occupational indices among Naval and Marine personnel who were subsequently deployed to the 2003 Iraq War. METHOD: Controlled, non-randomized, parallel group study. Mental health outcomes post-deployment were compared between those who received a pre-operational stress briefing and those who did not receive such a briefing. RESULTS: Stress briefing attendees were slightly younger, more likely to be marines and to have been exposed to traumatic events than non-attendees. There were no significant differences between the two groups for the health outcomes of common mental health disorders, post-traumatic stress disorder or alcohol misuse. Attendees reported higher morale/cohesion but these differences disappeared following adjustment for demographic and military factors. No differences between the two groups were apparent for experiencing problems during or post-deployment or for marital satisfaction. CONCLUSIONS: We found no evidence that a pre-deployment stress briefing reduced subsequent medium-term psychological distress. On the other hand, we found no evidence of harm either. While only a randomized trial can give genuinely unbiased results, at present stress debriefing must be regarded as an unproven intervention, and it remains a matter of judgement as to whether or not it is indicated.     

Psychological and occupational predictive factors for back pain among employees of a university hospital in southern Spain

OBJECTIVES: To identify the individual and occupational factors that are predictors for low back pain among the employees of a university hospital in southern Spain. METHODS: A transverse study was conducted in which the population used was the hospital employees who volunteered to participate. The information was obtained by using a questionnaire, which included demographic and anthropometric variables, habits, characteristics of the work done, and of any pain experienced. The mental health condition of subjects was measured using the GHQ-28, using a score of > or = 6 as the cut-off point. To study the variables associated with pain, crude odds ratios (ORs) were calculated (+/- 95% CI) and adjusted according to a logistic regression model. RESULTS: One thousand one hundred and four subjects participated in the study but only 890 of these completed the questionnaire in full (rate of response, 35.7% of total employees). The population studied was notable for the high proportion of women, for subjects > 41 years of age, and subjects who undertook little or no physical exercise. In addition, according to the GHQ-28 test, 29.9% of the total were 'probable psychiatric cases'. The crude ORs were high in all the occupational categories in comparison with the doctors, with the exception of the maintenance, cleaning, and catering group. They were also higher among women, among subjects with poor mental health, and among women with one or more children. The adjusted ORs showed that having a GHQ-28 score of > or = 6, and belonging to the auxiliary technician category, were independent risk factors for suffering low back pain. Being older than 41 years and in temporary employment were protective variables. CONCLUSIONS: The presence of probable mental illness is the variable most strongly associated with the presence of low back pain in the population studied. Its diagnostic confirmation and appropriate treatment could contribute to reducing the prevalence of vertebral pains in this occupational group.     

Alcohol intake in a healthy elderly population.

The relationship between amount of alcohol consumption and social, psychological, and cognitive status was examined in 270 healthy, independently living men and women over age 65. Forty-eight per cent of the sample recorded some alcohol intake during a three-day diet record, with 8 per cent drinking 30 or more grams of alcohol daily. Alcohol intake was positively associated with male gender, income, and amount of education and negatively associated with age. Alcohol intake was not associated with any changes in social or psychological status, but was positively associated with several measurements of cognitive status. These correlations were weak, however, and tended to disappear after controlling for income, education, gender, and age. Past alcohol intake was not associated with any indicators of present social, psychological, or cognitive functioning.     

Lifestyle and the development of hypertension: a 3-year follow-up study of middle-aged Japanese male office workers.

The association of lifestyle factors with the development of hypertension (blood pressure > or = 140/90 mmHg) over a 3-year follow-up period was studied in 949 hypertension-free Japanese male office workers aged 35 to 54 years. From the Cox proportional hazards model, age, alcohol intake, body mass index (BMI) and hours of work were independent factors associated with the development of hypertension. Adjusted hazard ratios for 5-year increases in age, daily consumption of alcohol, 5-kg/m2 increases in BMI and working 10 hours per day or more were 1.18 [95% confidence interval (CI) = 1.02-1.35]; 1.53 (CI = 1.14-2.05); 1.79 (CI = 1.38-2.33) and 0.58 (CI = 0.41-0.82), respectively. In the analysis using logistic regression, BMI was independently related to working 10 hours per day or more, controlling for other lifestyle factors. Adjusted odds ratio for 5-kg/m2 increase in BMI was 0.66 (CI = 0.49-0.88). These results suggest that the influences of long working hours on blood pressure are likely to be indirectly mediated through less overall obesity.     

Childhood cognitive ability and adult mental health in the British 1946 birth cohort

We examined whether childhood cognitive ability was associated with two mental health outcomes at age 53 years: the 28 item General Health Questionnaire (GHQ-28) as a measure of internalising symptoms of anxiety and depression, and the CAGE screen for potential alcohol abuse as an externalising disorder. A total of 1875 participants were included from the Medical Research Council National Survey of Health and Development, also known as the British 1946 birth cohort. The results indicated that higher childhood cognitive ability was associated with reporting fewer symptoms of anxiety and depression GHQ-28 scores in women, and increased risk of potential alcohol abuse in both men and women. Results were adjusted for educational attainment, early socioeconomic status (SES) and adverse circumstances, and adult SES, adverse circumstances, and negative health behaviours. After adjusting for childhood cognitive ability, greater educational attainment was associated with reporting greater symptoms of anxiety and depression on the GHQ-28. Although undoubtedly interrelated, our evidence on the diverging effects of childhood cognitive ability and educational attainment on anxiety and depression in mid-adulthood highlights the need for the two to be considered independently. While higher childhood cognitive ability is associated with fewer internalising symptoms of anxiety and depression in women, it places both men and women at higher risk for potential alcohol abuse. Further research is needed to examine possible psychosocial mechanisms that may be associated with both higher childhood cognitive ability and greater risk for alcohol abuse. In addition, the underlying mechanisms responsible for the gender-specific link between childhood cognitive ability and the risk of experiencing internalising disorders in mid-adulthood warrants further consideration.     

A longitudinal study of the influence of shift work on serum uric acid levels in workers at a telecommunications company

BACKGROUND: Hyperuricemia is a lifestyle-related disease. Although there have been many previous reports about the association of serum uric acid (UA) levels with lifestyle, including eating habits and alcohol intake, there has been no report of a longitudinal study of the relationship between serum UA levels and shift work. AIMS: To clarify the influence of shift work on serum UA levels in Japanese workers. METHODS: This was a 4-year cohort study of 15 871 workers at a telecommunications company. Pooled logistic regression analyses by sex were performed, with job schedule type, age, body mass index (BMI), lifestyle and the results of blood chemistries as covariates. RESULTS: In males, shift work, part-time work, BMI, consumption of alcohol (less than twice per week, two to five times per week or more than five times per week) and little preference for vegetables were positively associated with the development of increased serum UA (>or=8 mg/dl in males, >or=6 mg/dl in females). In females, age, BMI and a history of smoking were positively associated with the development of increased serum UA. CONCLUSION: This study revealed that shift work is independently related to increased serum UA in males.     

Post-trauma support in the workplace: the current status and practice of critical incident stress management (CISM) and psychological debriefing (PD) within organizations in the UK

Employers' duties of care under both common and statute law include the need to take reasonable care of the health and safety of the workforce. This includes both the moral and legal duties to consider the psychological needs of personnel following exposure to traumatic events related to the workplace. While this has been recognized within many high-risk occupations such the police, fire and rescue services and the military, there is also evidence that post-trauma support in the workplace is increasingly commonly provided not only among health and social services agencies, but within many private sector organizations. Over the past decade, however, there has been considerable controversy over the provision of early psychological support to personnel in the form of critical incident stress management (CISM) processes. In particular, one aspect of CISM, the use of psychological debriefing (PD) has come under scrutiny and criticism as two studies indicated that PD was ineffective and had the potential to do harm. Inevitably, this has provoked much uncertainty and confusion among some organizations as what should be the most appropriate support. It has also led to misconceptions and misunderstandings as to the aims and purpose of PD, together with inaccuracies of terminology, for example describing PD as 'counselling'. Despite the controversy, both CISM and PD continue to be provided on a widespread basis, often utilizing a framework of voluntary peer group support. This paper intends to (i) present a review of the current status of CISM practices, including the use of PD within various organizations in the UK and (ii) provide a clear framework and understanding of the main issues and to clarify conceptual misunderstandings. The history, principles and background of the use of post-trauma support in the workplace, charting trends over the past two decades, previous research, problems with the evidence base and current thinking and practice in the field are reviewed. The relevance and implications of the National Institute for Clinical Excellence Guidelines on the Assessment and Management of Post Traumatic Stress Disorder, which make recommendations for early interventions for post-traumatic stress disorder are discussed. Reference is made to the use of CISM and PD within both statutory and voluntary organizations in an international context.     

Stress symptomatology among Vietnam veterans. Analysis of the Veterans Administration Survey of Veterans. II

In 1979, the US Veterans Administration conducted a health survey of 11,230 veterans. The present analysis of these data focuses on the association between Vietnam service and combat experience with eight post-traumatic stress disorder symptoms among the 1,787 Vietnam era veterans who entered military service between 1965 and 1975. The advantages of this study are that it includes a large random sample selected from the total US population, had a high interview response rate (93%), and collected data prior to the recent public controversy surrounding the issue of the health effects of possible exposure of Vietnam veterans to Agent Orange. After adjustment for the potential confounding effects of military service and demographic factors, the level of combat exposure was significantly associated with all eight symptoms of post-traumatic stress disorder in a dose response pattern. For seven of the eight symptoms, a twofold increase in the factor-adjusted prevalence odds ratio was observed when non-Vietnam service veterans were compared with Vietnam veterans who experienced the most intense combat experience. Being younger, less well educated, or nonwhite at the time of military service are factors which independently further increased the probability of stress symptoms.     

Alcohol consumption in the new millennium – weighing up the risks and benefits for our health

• 1 Introduction
• 2 An introduction to alcohol and alcoholic beverages
  • 2.1 How is alcohol produced
  • 2.2 The production of alcoholic beverages
  • 2.3 Calculation of alcohol content in beverages
  • 2.4 Other measures of alcohol
• 3 Guidelines for sensible drinking
  • 3.1 UK guidelines
  • 3.2 Guidelines for sensible drinking around the world
• 4 Alcohol consumption
  • 4.1 Current alcohol intakes in the UK
  • 4.2 Recent trends in alcohol intake in the UK
  • 4.3 Trends around the world
• 5 Absorption and metabolism of alcohol
  • 5.1 Absorption of alcohol
  • 5.2 Alcohol metabolism
• 6 Alcohol and nutrition
  • 6.1 Nutrient composition of alcoholic beverages
  • 6.2 The effect of alcohol on energy intake
  • 6.3 Nutritional implications of chronic excessive alcohol consumption
  • 6.4 Other components of alcoholic beverages
• 7 The burden of disease and mortality related to alcohol
• 8 Alcohol and disease risk
  • 8.1 Methodological problems of studies assessing associations between alcohol consumption and disease risk
  • 8.2 Alcohol and bodyweight
  • 8.3 Alcohol and coronary heart disease
  • 8.4 Alcohol and blood pressure
  • 8.5 Alcohol and stroke
  • 8.6 Alcohol and type 2 diabetes
  • 8.7 Alcohol and cancer
• 9 Alcohol and other conditions
  • 9.1 Adverse reactions to alcohol for some susceptible individuals
  • 9.2 Alcohol and peptic ulcers
  • 9.3 Alcohol during pregnancy
  • 9.4 Alcohol, bone mineral density and fracture risk
  • 9.5 Alcohol and renal dysfunction
• 10 Alcohol and social issues
  • 10.1 Short‐term psychological and psychomotor effects of alcohol intake
  • 10.2 Crime and public disorder as a result of drinking alcohol
  • 10.3 Alcohol‐related harms and other public health issues
  • 10.4 The economics of alcohol consumption
  • 10.5 Population‐based initiatives underway to reduce the incidence of binge drinking
• 11 Conclusions

Summary Alcohol is produced via the anaerobic fermentation of sugars by yeast and involves glucose molecules (C₆H₁₂O₆) being broken down to yield ethanol (C₂H₅OH), carbon dioxide (CO₂) and energy. The amount of alcohol contained in different alcoholic beverages varies considerably and is referred to as the ‘strength’ of the drink, which is expressed as the percentage of alcohol by volume (ABV). A standard unit of alcohol in the UK equates to 8 g or 10 ml of pure alcohol. Guidelines for sensible drinking set by the UK government are 3–4 units (24–32 g) a day or less for men, and 2–3 units (16–24 g) a day or less for women. Specific recommendations have been set for those planning pregnancy and pregnant women, who should drink no more than 1–2 units of alcohol once or twice a week and should avoid heavy drinking sessions. Guidelines for sensible drinking are similar in other countries. When taking into account the standard drink unit used to define guidelines, the most commonly recommended limit is 24 g/day for men and 20 g/day for women. Older people are more likely to drink in line with the sensible drinking guidelines, as they tend to consume alcohol over a period of time, as opposed to consuming large quantities on one or two days of the week, a practice that is more popular among younger people. Consuming double the sensible drinking guidelines in one day is classified as binge drinking (an alternative definition is drinking until intoxicated). It has become recognised that binge drinking is a common phenomenon in the UK, particularly among younger people. Other factors, such as income, ethnicity and region of residence, are also recognised to be predictive of the quantity of alcohol consumed; for example, higher‐income households are more likely to consume large quantities of alcohol and consume alcohol more frequently. The quantity of alcohol consumed is an important factor in determining how it affects health and well‐being. In terms of nutritional health, chronic excessive alcohol intake is well recognised to affect an individual’s nutrient status, because it reduces food intake and/or may interfere with the digestion, absorption, metabolism and utilisation of some nutrients. However, when consumed in moderation, alcohol is unlikely to interfere with the metabolism of nutrients or be associated with impaired vitamin function or depletion to an extent that may harm health, provided that dietary intakes are adequate. Alcoholic beverages contain alcohol, carbohydrate and only small amounts of some vitamins, trace elements and minerals. They are therefore unlikely to contribute significantly to micronutrient intake. Any association that exists between moderate alcohol consumption and the absorption and metabolism of nutrients from the diet is dependant on a number of factors, including: the nutrient in question; habitual intake of the nutrient and the nutritional status of the individual; and the quantity of alcohol consumed over a period of time. Overall, little information exists about the implications of binge drinking on nutrient status; but it may alter food intake, and excessive alcohol consumption can cause disturbances to the digestive system. While infrequent binge drinking is unlikely to have any long‐term nutritional implications (although it may affect nutrient status in the short‐term), regular binge drinking may have a more negative impact. Although alcoholic beverages tend to have few nutrients, they can be a significant source of energy, as alcohol provides 7 kcal per gram. Studies indicate that alcoholic beverages are usually additive to an individual’s normal energy intake and individuals are unlikely to compensate for energy from them during the day. The aperitif effect of alcohol may also encourage an increase in energy intake. It is therefore not surprising that alcohol intake has been associated with weight gain and an increase in body mass index (BMI) (with the exception of chronic excessive drinkers). However, there are a number of methodological problems that need to be considered when comparing the findings of studies investigating the association between alcohol intake and disease risk, including: potential misreporting of total intake; the use of an appropriate control group; and the need for comparable measurement units. Consumption of alcoholic beverages has also been associated with increasing the risk of ill‐health associated with pre‐existing conditions. For example, it may contribute to ulcer development or aggravate symptoms of existing ulcers. There is evidence that moderate alcohol consumption during pregnancy may affect the development of the fetus’s central nervous system, and may result in low birthweight. However, there is currently no consensus as to whether alcohol should be completely avoided during pregnancy. However, it is well recognised that excess alcohol consumption during pregnancy can put the fetus at risk of fetal alcohol syndrome. Quantity of alcohol consumed is particularly important when considering the association between alcohol and chronic diseases; for example, there is now strong evidence that light to moderate (1–3 drinks per day) consumption decreases the risk of a coronary heart disease (CHD) episode compared with abstainers (with particular benefits in men aged over 55 years and post‐menopausal women). However, heavy drinking is associated with an increased risk of CHD. Further information is required to determine the association between drinking patterns and heart health. However, there is a consensus of opinion that it is the alcohol per se that influences heart health, rather than a particular type of alcoholic beverage; and other factors that affect an individual’s choice of drink may be important in distorting the findings from studies that show otherwise. As with risk of CHD, light to moderate alcohol consumption is associated with a decreased risk (of 30–40%) of type 2 diabetes, when compared with teetotallers. Heavy drinking may be associated with an increased risk, resulting in a ‘J’ or ‘U’ shaped relationship between alcohol consumption and the incidence of type 2 diabetes. A ‘J’ shaped relationship has also been reported between alcohol consumption and blood pressure. It is widely accepted that heavy alcohol intake is a risk factor for high blood pressure, and evidence indicates that moderate intakes may exert a short‐term lowering effect, while abstainers/teetotallers are reported to have a higher blood pressure. The type of stroke is important when considering the association between stroke and alcohol, as any alcohol consumption is associated with an increased risk of haemorrhagic stroke, but low intakes (i.e. one drink per day) may have a protective effect on ischaemic stroke. Heavy drinking is associated with an increased risk of both types of stroke. Alcohol intake has also been associated with an increased risk of cancers at a number of sites. However, a consensus for a likely causal association has only been identified between alcohol and cancers of the upper‐aero digestive tract and liver. The mechanisms to explain the positive associations between alcohol and breast cancer, and alcohol and colorectal cancer, have yet to be identified. It is unclear whether some types of alcoholic beverage are more strongly associated with increased risk of cancer than others. Mechanisms identified to date suggest that it is the alcohol per se that exerts damage and, therefore, quantity of alcohol consumed is the most important variable. Studies looking at the relationship between alcohol and mortality suggest that 10–80 g (approximately 1–8 drinks) of alcohol each week is optimal to reap the health benefits, but increased risk is noted at higher intakes (thus indicating a ‘U’ shaped relationship between alcohol intake and mortality). Gender and age are important factors when considering the association between alcohol and mortality. For example, for younger people, the benefits of alcohol may be outweighed by the increased risk of other diseases (e.g. alcohol‐related cancers, liver cirrhosis) and increased risk of violence and accidents. Aggressive behaviour, increased risk taking and decreased responsiveness to social expectations, which may lead to personal ‘harm’, including accidents and violence, are usually the result of alcohol intoxication (i.e. through binge drinking). Excess alcohol consumption may also result in a ‘hangover’, which disrupts normal life through symptoms of fatigue and increased anxiety, and has economic consequences in the workplace through poor performance or absenteeism. The extent to which a hangover can affect an individual’s performance, including psychomotor, recognition and managerial skills, is still being debated. Binge drinking is also associated with an increased risk of sexually transmitted diseases and unplanned pregnancies. Although the cost of binge drinking in terms of long‐term health has yet to be established, the significant economic cost is well recognised. A number of population‐based initiatives are underway to try and change the ‘drinking culture’, and thus reduce the incidence of binge drinking. Initiatives include: advertising campaigns; changes to alcohol advertising regulations; and changes to pub licensing regulations.     

Patterns of drinking in Thai men

Alcohol problems have increased considerably in Thailand in recent years, in common with many other countries in South East Asia. Little is known about the patterns or contexts of alcohol consumption in these countries, and so efforts to develop preventative strategies have been hampered. To identify current patterns related to alcohol consumption, we recruited 91 alcohol-dependent subjects, 77 hazardous or harmful drinkers, and 144 abstainers or light drinkers. A structured interview incorporating the World Health Organization 'tri-level' method to determine the amount and frequency of drinking, and the Alcohol Use Disorders and Associated Disabilities to diagnose alcohol dependence and harmful drinking was used. Median alcohol intake was 75 and 49 g/drinking day in the alcohol-dependent and harmful or hazardous groups respectively. The former group drank on average 25 days/month, whereas the harmful or hazardous drinkers drank 10 days/month. Drinking alone was more common in the alcohol-dependent group (67%), whereas harmful or hazardous drinkers typically drank with friends (58%), and infrequent drinkers drank only at social functions (61%). Only 28% of alcohol-dependent subjects perceived themselves as dependent on alcohol. The alcohol-dependent subjects and hazardous or harmful drinkers were more likely to currently smoke cigarettes and have a history of marijuana use than were non-drinkers, infrequent or light drinkers. Antisocial personality disorder was more commonly associated with alcohol dependence. In conclusion, alcohol dependence was characterized by continual drinking, whereas hazardous or harmful consumption was associated with an intermittent pattern. Other forms of substance use and personality disorder were associated with alcohol dependence. Clearer understanding of these factors would be of great benefit in planning an intervention programme for excessive drinking in Thailand.