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Neysluvenjur og misnotkun áfengis íslenskra kvenna yfir 55 ára aldri : samanburður klínískra einkenna við lifrarpróf og meðalfrumurými rauðra blóðkorna

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Authors
Helgi G. Garðarsson
Þórður Harðarson
Tómas Helgason
Issue Date
2007-12-01

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Use and abuse of alcohol among elderly women in Iceland. Comparison of clinical symptoms of abuse with liver function tests and mean corpuscular volume
Citation
Læknablaðið 1997, 83(1):818-23, 825-7
Abstract
Objective: This study was conducted to investigate the prevalence of alcohol abuse and dependency among elderly women in Iceland and to make an assessment of the sensitivity and specificity of liver function tests and mean corpuscular volume (MCV) in the diagnosis of alcohol abuse. Methods: The group was made of 280 women (age 55-74 years, mean age 61.9 years) from the Reykjavik Study. The diagnoses were based on a questionnaire (eight symptoms) which has been used in epidemiological studies of alcoholism in Iceland since 1974. To this questionnaire there were added five questions aiding to the diagnosis of the lifetime prevalence rate of abuse. The CAGE questionnaire is implicated in this scale of 13 symptoms. Results: Among 263 respondents (93.9%), there were 156 consumers (59.3%). Of the consumers 16% had at least one symptom indicating alcohol abuse. The diagnosis of abuse was made when three symptoms of eight occurred together. Abuse occured among 2.6% of consumers (1.5% of respondents). Symptom triad of dependency occurred among 1.3% of consumers (0.8% of respondents). Heavy drinking was equally frequent as dependency. Mean values of gamma glutamyl transferase (G-GT) and MCV increase with increasing number of symptoms of abuse. The sensitivity of G-GT and MCV is low (20%) but the specificity is high (94%) for both. Bilirubin and alkaline phosphatase do neither have a sensitivity nor specificity for the diagnosis of abuse. Conclusion: These findings indicate that these blood tests are not a reliable method for the screening of alcohol abuse among elderly women. A questionnaire searching for clinical symptoms of abuse is the best method for the diagnosis of abuse. Among elderly women, the symptom of guilty feelings connected to alcohol consumption, is the most sensitive indicator of abuse. But there are probably more women that experience guilty feelings than those which can be considered alcohol abusers.
Tilgangur: Að kanna neysluvenjur og misnotkun áfengis meðal eldri íslenskra kvenna og samtímis meta næmi og sértækni lifrarprófa og meðalfrumurýmis rauðra blóökorna til greiningar á áfengismisnotkun. Efniviður og aðferðir: Rannsóknarhópurinn samanstóð af 280 konum á aldrinum 55-74 ára (meðalaldur 61,9 ár) úr fimmta áfanga hóprannsóknar Hjartaverndar. Greining áfengismisnotkunar var byggð á átta einkenna skimprófi, sem reynsla hefur fengist af við áfengisrannsóknir hérlendis. Fimm spurningum, sem gefa vísbendingu um hvort misnotkun hafi einhvern tíma verið vandamál, var bætt við þetta skimpróf. Einkenni um áfengismisnotkun voru borin saman við meðaltöl lifrarprófa og meðalfrumurýmis rauðra blóðkorna (mean corpuscular volume, MCV). Niðurstöður: Af hópi 263 svarenda (93,9%) neyttu 59,3% áfengis. Eitt einkenni eða fleiri um misnotkun fannst hjá 16% áfengisneytenda (9,5% svarenda). Misnotendur áfengis, þeir sem hafa þrjú af átta einkennum samtimis, voru 2,6% áfengisneytenda (1,5% svarenda) og ávanabinding eða stórdrykkja fannst hjá nálega helmingi þess hóps. Stórdrykkja reyndist einungis vera meðal neytenda sterks áfengis. Meðaltöl gamma glutamyl transferasa (gamma glutamyl transferase, G-GT) og meðalfrumurýmis rauðra blóðkorna fara hækkandi með vaxandi fjölda misnotkunareinkenna. Næmi gamma glutamyl transferasa er lítið (20%) en sértæknin mikil (93,9%). Næmi meðalfrumurýmis rauðra blóðkorna er einnig lítið, bæöi þegar mörk eru dregin við 100 fl. (4%) og við 96 fl. (20%) en sértækni þess er hinsvegar mikil, eða 93,9% og 76%. Bilirubin og alkalískur fosfatasi (alkaline phosphatase, A1P) hafa hvorki næmi né sértækni til að greina misnotkun áfengis. Tilgáta: Rannsóknin sýnir að þessi blóðpróf eru ekki áreiðanleg til skimunar á áfengismisnotkun. Spurningar um neysluvenjur og afleiðingar þeirra eru besta leiðin til greiningar á áfengismisnotkun. Hjá eldri konum er sektarkennd eftir áfengisneyslu næmasta einkenni til að greina áfengismisnotkun en hún greinir ef til vill fleiri sem misnotendur en raunverulega geta talist til þess hóps.
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