Alcoholism

Binge Drinking Boosts Mortality Risk in Older Adults

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Binge Drinking Boosts Mortality Risk in Older Adults.

They examined the association between episodic heavy drinking and total mortality among 446 regular moderate drinkers aged 55 to 65 years at baseline. Moderate drinking was defined as up to 1 standard drink per day for women and 2 for men.

Of the 446 adults, 74 engaged in episodic heavy drinking, defined as 4 or more drinks on 1 occasion for women and 5 for men.

During the course of 20 years, the death rate was higher in the moderate drinkers who binged (61%, 45 deaths) than in moderate drinkers who did not binge (37%, 137 deaths).

Although more men than women died during the 20-year period, the distribution of deaths across alcohol consumption groups was similar for women and men (P = .76).

In multiple logistic regression analyses, after adjusting for all covariates as well as overall alcohol consumption, moderate drinkers who engaged in episodic heavy drinking had more than 2 times higher odds of 20-year mortality in comparison with regular moderate drinkers (odds ratio, 2.13; 95% confidence interval, 1.14 – 3.97; P< .05).

And from the CDC –

CDC Online Newsroom – Press Release: January 10, 2012.

Binge drinking statistics from the CDC estimate more than 38 million US adults binge drink an average of 4 times a month and the most drinks they consume on average is 8. The report found that binge drinking is more common among households with incomes ≥$75,000, but the largest number of drinks consumed per occasion is highest among households with incomes of <$25,000

Pancreatitis May Confer Higher Risk for Cancer

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In an effort to quantify the relationship between acute pancreatitis and pancreatic cancer, Agarwal and colleagues reviewed inpatient and outpatient records for 495,504 patients who received care through the Veterans Health Administration from 2000 through 2007. The authors identified 5,720 patients who had one or more episodes of acute pancreatitis, 710 of whom subsequently had diagnoses of pancreatic cancer.

Median follow-up was 60 months for the entire cohort, 26 months for patients who developed pancreatic cancer, and 60 months for patients who did not develop pancreatic cancer.

The patient cohort was predominately male (89%). A third of the patients smoked, a fourth had a history of heavy alcohol use, and 3% had a history of gallstones.

The 710 patients included 86 who had one or more episodes of acute pancreatitis prior to cancer diagnosis. The authors found that 76 of the 86 patients had a least one episode of acute pancreatitis within 2 years of cancer diagnosis.

In 69 of the 76 cases, the preceding pancreatitis occurred within a year of pancreatic cancer diagnosis. In fewer than half of the cases (N=34), acute pancreatitis preceded pancreatic cancer diagnosis by 2 months or less.

via Pancreatitis May Confer Higher Risk for Cancer.

Heavy Drinking May Lead to Early Stroke

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Drinking three or more alcoholic beverages a day may raise the risk for spontaneous intracerebral hemorrhage at a much younger age than typical, researchers found.

These strokes occurred at an average age of 60 with such high alcohol consumption, 14 years earlier than seen without heavy drinking (P<0.0001), Charlotte Cordonnier, MD, PhD, of the University of Lille Nord de France in Lille, France, and colleagues,

Heavy drinking also predicted a near doubling in 2-year mortality risk after a deep intracerebral hemorrhage before age 60, the group reported in the Sept. 11 issue of Neurology.

via Heavy Drinking May Lead to Early Stroke.

Weight Loss Surgery May Boost Problem Drinking

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Almost 10% of patients undergoing bariatric surgery to combat obesity had symptoms of an alcohol use disorder 2 years after surgery, a large prospective cohort study showed.

The prevalence of alcohol use disorders increased from 7.6% before surgery to 9.6% 2 years after the procedure, as reported online in the Journal of the American Medical Association.

via Medical News: Weight Loss Surgery May Boost Problem Drinking – in Primary Care, Obesity from MedPage Today.

Have surgery, lose weight, become alcoholic!

Spider Angioma — NEJM Images in Clinical Medicine

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Compression of the central arteriole caused the entire lesion to blanch, and it quickly refilled once the compression was released  This pattern of blanching and refilling characterizes spider angiomas, which are suggestive of liver disease.

Spider Angioma — NEJM.

For the underwriter who always wondered what one of these things looks like.  For the geekiest underwriters, click on and take a look at the video.  And for the underwriter who thinks she should have a Medical Doctor, the following is from the NEJM Resident E-Bulletin of 02.23.12.

Clinical Pearls

  •   What is the differential diagnosis of a subacute confusional state in a patient with liver disease?

The differential diagnosis includes five major syndromes: hepatic encephalopathy, Wernicke’s encephalopathy, alcohol withdrawal, occult seizures, and infection. Hepatic encephalopathy refers to an alternation in cognitive function that is secondary to a metabolic process caused by liver failure. Wernicke’s encephalopathy refers to the triad of gait ataxia, ophthalmoplegia and confusion caused by thiamine deficiency, commonly seen in chronic alcoholics. Alcohol withdrawal, occult seizures, and underlying infection may also cause a subacute confusional state in a patient with chronic liver disease.

Binge Drinking in Adults United States 2010

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  • Binge drinking causes more than half of the 80,000 deaths and three quarters of the $223.5 billion in economic costs caused by excessive drinking.
  • Approximately one in six (38 million) U.S. adults binge drink, and do so approximately four times a month. On average, the largest number of drinks consumed by binge drinkers is eight drinks per occasion.
  • Prevalence and intensity of binge drinking was highest among persons aged 18–34 years, but the frequency of binge drinking was highest among binge drinkers aged ≥65 years. Binge drinkers with annual household incomes ≥$75,000 had the highest binge drinking prevalence, but binge drinkers with household incomes <$25,000 had the highest frequency and intensity of binge drinking.

via Medical News: Binge Drinking Common Among Adults, CDC Finds – in Public Health & Policy, Public Health from MedPage Today.

Vital Signs: Binge Drinking Prevalence, Frequency, and Intensity Among Adults — United States, 2010.

The first link takes you to the MedPage Today article.  The second link takes you to the source article which is also available in a downloadable PDF format.  This report is well worth sharing with your underwriting staff.

BBC News – Guns N’ Roses’ Duff McKagan’s ‘wake-up call’

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He began drinking heavily because he thought it would help to prevent his panic attacks – which he had suffered from since he was a teenager. At his worst, he says he was drinking “a gallon of vodka a day”, and then 10 bottles of wine a day “when I was trying to taper down”.

via BBC News – Hardtalk – Guns N’ Roses’ bassist Duff McKagan’s ‘wake-up call’.

For the next time someone asks you why entertainers are underwritten cautiously and carefully.