(154) Letter. There are other causes for a high gamma-glutamyl-transpeptidase, but in 209 healthy adult males 7.7% had a raised level attributable to alcohol and a like number with no other evidence of alcohol problems.
(157) Problem drinkers in England and Wales = 4% of population and in Scotland 10%.
(158) Alcohol related sickness and absenteeism cost industry £641 million/year.
(159) Accidents and poor performance related to alcohol may cost £.5 billion / year. "Identifying those with chronic alcohol problems must be an important part of a company's response to reducing alcohol related accidents."
(160) At least a fifth of all accidents at work are alcohol related.
(161) A combination of gamma-glutamyl-transpeptidase and mean corpuscular volume detects almost 100% of chronic alcoholics. If a careful medical history is taken then false positives can be avoided. A liver enzyme pattern of isolated or predominant increased Gamma-glutamyl-transpeptidase is found in about 80% of heavy drinkers.
(162) The chief difficulty in specifying the relation between blood tests and alcohol consumption is obtaining valid data on consumption. Self reports have been thought in many studies to be less than valid with a tendency to under reporting.
A high gamma-glutamyl-transpeptidase in a man who does not present as a heavy drinker may be a reason to question him or a relative more closely about alcohol intake.
(163) Screening tests for alcoholism.
Michigan Alcoholism Screening Test (MAST)
25 items at interview 98% accurate.
Short version 13 items self administered not so good.
CAGE A sensitive 4 question screening test
Ewing JA and Rouse BA
The CAGE questions
1) Have you ever felt that you should CUT down on your drinking?
2) Have people ANNOYED you by critisising your drinking?
3) Have you ever felt GUILTY about drinking?
4) Have you ever had a drink first thing in the morning to steady your nerves - an EYEOPENER?
(166) Two views expressed:- The The United States - measure cholesterol at least once during early adult life. The Canadian - cholesterol is not a sensitive measure of risk.
(167) 108 volunteers. Fingerstick consistently higher by about 3.6%.
(168) "Accurate results may meet WHO/CDC criterion of a maximum bias of < 5%". "As in all clinical chemical testing regular quality control is necessary".
(169) Comparison of Reflotron with standard laboratory method. The results did not differ significantly. Provided the operator is trained appropriately, the Reflotron system gives rapid, accurate and reproducible results.
(170) Search of the Boots data base for evidence of effect of Prothiaden on gamma-glutamyl-transpeptidase. Inconclusive.
|Claude Bernard was an oustanding 19th century physiologist. Select this picture if you wish to learn more about him.|
(179) Shaper explains coronary heart disease risk factors easily and lucidly.
(180) Heavy drinkers and abstainers have an increased risk of death from coronary heart disease compared with moderate drinkers. These findings are consistent over such populations as Japanese physicians, British civil servants, Puerto Ricans to name a few. (Surely the U shape should be J or hockey stick? - GC)
(181) 51,529 male health professionals followed up for 2 years. Those who reduced alcohol consumption through illness excluded. Results suggest moderate intake reduces the risk. However remember that alcohol is estimated to cause 28,00 excess deaths per year in England and Wales at as cost of treatment of related disease £67,000,000 in 1986.
(182) Use of a booklet in the management of anxiety. Appears to be helpful with a couple of weeks.
(183) Considers some cultural origins of public scepticism to health education messages and argues for a more balanced presentation of current knowledge concerning the causes of disease and the probability that individuals will benefit by changing their behaviour.
(184) Public perceptions of health risks are the outcome of a process termed "lay epidemiology". Heredity, adverse social circumstances are seen by public to be risk factors but not discussed by HE.
(185) The effect of lifestyle intervention in coronary heart disease prevention inconclusive.
(188) Most people well aware of current opinion regarding risk factors for coronary heart disease. Why then does the population not act upon this knowledge with more conviction?
(189) Public delight when experts are seen to have "got it wrong" as reactions to this report that low cholesterols are related to cancer has shown.
(190) Whole milk may actually be protective against coronary heart disease.
(191) Comparison of two Reflotrons and laboratory measurements of cholesterol for monitoring progress in an intensive dietary intervention clinic for hypertensives. "The Reflotron method is not useful for monitoring long term responses to drugs and diet in hyperlipidaemic patients".
(192) Average reduction in cholesterol by diet 2% only.
Poor efficiency of recommended diets.
More effect if effort directed towards smoking, obesity & raised blood pressure.
(193) 80% population never had a cholesterol test.
91% unaware of the desirable level
< half tested knew their number
< 10% know that family history or raised blood pressure are risk factors
(194) "We must have looked at gamma-glutamyl-transpeptidase levels in well over a thousand patients and have never seen any elevation which is not attributable to alcohol."
(195) 73% of teenagers came for a check when invited. 14% were regular smokers. These tended to have raised blood pressure, less exercise, body mass index up, drank more and slept less well. 60% agreed to give up.
(196) 562 people with familial hypercholesterolaemia followed up over ten years. Huge increase in mortality, particularly in those 20-39yrs old. 75% would be detected by selective cholesterol screening, but it would need screening of 80% of population (selective?? GMC).
(197) In countries such as the United Kingdom and the United States where coronary heart disease is common minority of population have cholesterol < 5. Therefore difficult to determine directly threshold below which a strong relationship between coronary heart disease & cholesterol exists. In Shanghai chol is 3.8 - 4.7 & coronary heart disease comparatively minor causes of death. Even at this low range there is a positive independent relation. with no apparent threshold.
(198*) Letter. Screening - Primary health care teams should, make up their own minds as to how much they can do. Help from other professionals always welcome; their advice on whom to screen is both irrelevant and unhelpful.
(199*) The results support the hypothesis that light and moderate alcohol consumption reduces the risk of coronary heart disease. This protective effect in this population (New Zealand) was not due to the misclassification of former drinkers with a high risk of coronary heart disease as non-drinkers.
(200) Cut fats intake in the United States from 37 to 30% 42,000 deaths per year deferred - an increase in life expectancy of 3-4 months mostly benefiting the over 65s. More achieved from persuading citizens not to smoke or to drive more safely.
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