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1.  High Rates of False-Positive Hepatitis C Antibody Tests Can Occur After Left Ventricular Assist Device Implantation 
REFERENCED PARAGRAPH
Hepatitis C virus (HCV) screening is routine before cardiac transplantation, and virus presence is an exclusion at most centers. Left ventricular assist devices (LVAD) are often used as bridge to transplantation and cause immune activation. We collected data on 32 consecutive patients undergoing LVAD between 1/2006–2/2008 at a single center. Of 23 patients potential bridge patients with HCV testing pre and post LVAD, 7 (30%) turned positive for HCV antibody but did not have true HCV infection on confirmatory testing. Cardiac transplant care providers should be aware of possible false positive HCV antibody tests in this setting.
doi:10.1097/MAT.0b013e3182a53d00
PMCID: PMC3815747  PMID: 24088900
Left ventricular assist device; hepatitis C antibody
2.  Efficacy and the Strength of Evidence of U.S. Alcohol Control Policies 
Background
Public policy can limit alcohol consumption and its associated harms, but no direct comparison of the relative efficacy of alcohol control policies exists for the U.S.
Purpose
To identify alcohol control policies and develop quantitative ratings of their efficacy and strength of evidence.
Methods
In 2010, a Delphi panel of ten U.S. alcohol policy experts identified and rated the efficacy of alcohol control policies for reducing binge drinking and alcohol-impaired driving among both the general population and youth, and the strength of evidence informing the efficacy of each policy. The policies were nominated based on scientific evidence and potential for public health impact. Analysis was conducted in 2010–2012.
Results
Panelists identified and rated 47 policies. Policies limiting price received the highest ratings, with alcohol taxes receiving the highest ratings for all four outcomes. Highly rated policies for reducing binge drinking and alcohol-impaired driving in the general population were also highly rated among youth, although several policies were rated more highly for youth compared with the general population. Policy efficacy ratings for the general population and youth were positively correlated for reducing both binge drinking (r = 0.50) and alcohol-impaired driving (r = 0.45). The correlation between efficacy ratings for reducing binge drinking and alcohol-impaired driving was strong for the general population (r = 0.88) and for youth (r = 0.85). Efficacy ratings were positively correlated with strength-of-evidence ratings.
Conclusions
Comparative policy ratings can help characterize the alcohol policy environment, inform policy discussions, and identify future research needs.
doi:10.1016/j.amepre.2013.03.008
PMCID: PMC3708657  PMID: 23790985
3.  Contribution of Excessive Alcohol Consumption to Deaths and Years of Potential Life Lost in the United States 
Introduction
Excessive alcohol consumption is a leading cause of premature mortality in the United States. The objectives of this study were to update national estimates of alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) in the United States, calculate age-adjusted rates of AAD and YPLL in states, assess the contribution of AAD and YPLL to total deaths and YPLL among working-age adults, and estimate the number of deaths and YPLL among those younger than 21 years.
Methods
We used the Centers for Disease Control and Prevention’s Alcohol-Related Disease Impact application for 2006–2010 to estimate total AAD and YPLL across 54 conditions for the United States, by sex and age. AAD and YPLL rates and the proportion of total deaths that were attributable to excessive alcohol consumption among working-age adults (20-64 y) were calculated for the United States and for individual states.
Results
From 2006 through 2010, an annual average of 87,798 (27.9/100,000 population) AAD and 2.5 million (831.6/100,000) YPLL occurred in the United States. Age-adjusted state AAD rates ranged from 51.2/100,000 in New Mexico to 19.1/100,000 in New Jersey. Among working-age adults, 9.8% of all deaths in the United States during this period were attributable to excessive drinking, and 69% of all AAD involved working-age adults.
Conclusions
Excessive drinking was responsible for 1 in 10 deaths among working-age adults in the United States. AAD rates vary across states, but excessive drinking remains a leading cause of premature mortality nationwide. Strategies recommended by the Community Preventive Services Task Force can help reduce excessive drinking and harms related to it.
doi:10.5888/pcd11.130293
PMCID: PMC4075492  PMID: 24967831
4.  Prevalence of Alcohol Dependence Among US Adult Drinkers, 2009–2011 
Introduction
Excessive alcohol consumption is responsible for 88,000 deaths annually and cost the United States $223.5 billion in 2006. It is often assumed that most excessive drinkers are alcohol dependent. However, few studies have examined the prevalence of alcohol dependence among excessive drinkers. The objective of this study was to update prior estimates of the prevalence of alcohol dependence among US adult drinkers.
Methods
Data were analyzed from the 138,100 adults who responded to the National Survey on Drug Use and Health in 2009, 2010, or 2011. Drinking patterns (ie, past-year drinking, excessive drinking, and binge drinking) were assessed by sociodemographic characteristics and alcohol dependence (assessed through self-reported survey responses and defined as meeting ≥3 of 7 criteria for dependence in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition).
Results
Excessive drinking, binge drinking, and alcohol dependence were most common among men and those aged 18 to 24. Binge drinking was most common among those with annual family incomes of $75,000 or more, whereas alcohol dependence was most common among those with annual family incomes of less than $25,000. The prevalence of alcohol dependence was 10.2% among excessive drinkers, 10.5% among binge drinkers, and 1.3% among non-binge drinkers. A positive relationship was found between alcohol dependence and binge drinking frequency.
Conclusion
Most excessive drinkers (90%) did not meet the criteria for alcohol dependence. A comprehensive approach to reducing excessive drinking that emphasizes evidence-based policy strategies and clinical preventive services could have an impact on reducing excessive drinking in addition to focusing on the implementation of addiction treatment services.
doi:10.5888/pcd11.140329
PMCID: PMC4241371  PMID: 25412029
5.  The Effectiveness of Tax Policy Interventions for Reducing Excessive Alcohol Consumption and Related Harms 
A systematic review of the literature to assess the effectiveness of alcohol tax policy interventions for reducing excessive alcohol consumption and related harms was conducted for the Guide to Community Preventive Services (Community Guide). Seventy-two papers or technical reports, which were published prior to July 2005, met specifıed quality criteria, and included evaluation outcomes relevant to public health (e.g., binge drinking, alcohol-related crash fatalities), were included in the fınal review. Nearly all studies, including those with different study designs, found that there was an inverse relationship between the tax or price of alcohol and indices of excessive drinking or alcohol-related health outcomes. Among studies restricted to underage populations, most found that increased taxes were also signifıcantly associated with reduced consumption and alcohol-related harms. According to Community Guide rules of evidence, these results constitute strong evidence that raising alcohol excise taxes is an effective strategy for reducing excessive alcohol consumption and related harms. The impact of a potential tax increase is expected to be proportional to its magnitude and to be modifıed by such factors as disposable income and the demand elasticity for alcohol among various population groups.
doi:10.1016/j.amepre.2009.11.005
PMCID: PMC3735171  PMID: 20117579
6.  Effectiveness of Policies Maintaining or Restricting Days of Alcohol Sales on Excessive Alcohol Consumption and Related Harms 
Local, state, and national laws and policies that limit the days of the week on which alcoholic beverages may be sold may be a means of reducing excessive alcohol consumption and related harms. The methods of the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness for preventing excessive alcohol consumption and related harms of laws and policies maintaining or reducing the days when alcoholic beverages may be sold. Outcomes assessed in 14 studies that met qualifying criteria were excessive alcohol consumption and alcohol-related harms, including motor vehicle injuries and deaths, violence-related and other injuries, and health conditions.
Qualifying studies assessed the effects of changes in days of sale in both on-premises settings (at which alcoholic beverages are consumed where purchased) and off-premises settings (at which alcoholic beverages may not be consumed where purchased). Eleven studies assessed the effects of adding days of sale, and three studies assessed the effects of imposing a ban on sales on a given weekend day. The evidence from these studies indicated that increasing days of sale leads to increases in excessive alcohol consumption and alcohol-related harms and that reducing the number of days that alcoholic beverages are sold generally decreases alcohol-related harms. Based on these findings, when the expansion of days of sale is being considered, laws and policies maintaining the number of days of the week that alcoholic beverages are sold at on- and off-premises outlets in local, state, and national jurisdictions are effective public health strategies for preventing excessive alcohol consumption and related harms.
doi:10.1016/j.amepre.2010.09.015
PMCID: PMC3712507  PMID: 21084079
7.  Effectiveness of Policies Restricting Hours of Alcohol Sales in Preventing Excessive Alcohol Consumption and Related Harms 
Local, state, and national policies that limit the hours that alcoholic beverages may be available for sale might be a means of reducing excessive alcohol consumption and related harms. The methods of the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of such policies. All of the studies included in this review assessed the effects of increasing hours of sale in on-premises settings (in which alcoholic beverages are consumed where purchased) in high-income nations. None of the studies was conducted in the U.S. The review team’s initial assessment of this evidence suggested that changes of less than 2 hours were unlikely to significantly affect excessive alcohol consumption and related harms; to explore this hypothesis, studies assessing the effects of changing hours of sale by less than 2 hours and by 2 or more hours were assessed separately.
There was sufficient evidence in ten qualifying studies to conclude that increasing hours of sale by 2 or more hours increases alcohol-related harms. Thus, disallowing extensions of hours of alcohol sales by 2 or more should be expected to prevent alcohol-related harms, while policies decreasing hours of sale by 2 hours or more at on-premises alcohol outlets may be an effective strategy for preventing alcohol-related harms. The evidence from six qualifying studies was insufficient to determine whether increasing hours of sale by less than 2 hours increases excessive alcohol consumption and related harms.
doi:10.1016/j.amepre.2010.09.016
PMCID: PMC3712516  PMID: 21084080
8.  Impact of a New Gender-Specific Definition for Binge Drinking on Prevalence Estimates for Women 
Background
Binge drinking accounts for more than half of the 79,000 deaths due to excessive drinking in the U.S. each year. In 2006, the Behavioral Risk Factor Surveillance System (BRFSS) lowered the threshold for defining binge drinking among women from ≥5 drinks to ≥4 drinks per occasion, in accordance with national recommendations.
Purpose
To assess changes in binge-drinking prevalence among women.
Methods
The relative and absolute change in binge drinking among U.S. adult women was assessed using pooled BRFSS data from the 2 years before (2004–2005) and after (2006–2007) the implementation of the new gender-specific definition. Analyses were conducted in 2008–2009.
Results
Binge-drinking prevalence among women increased 2.6 percentage points (from 7.3% in 2004–2005 to 9.9% in 2006–2007), a 35.6% relative increase. The percentage of women who reported consuming exactly 4 drinks in 2006 (3.6%) was similar to the increase in the prevalence of binge drinking among women that was observed from 2005 to 2006 (absolute change, 2.9 percentage points).
Conclusions
The new gender-specific definition of binge drinking significantly increased the identification of women drinking at dangerous levels. The change in prevalence among women was primarily due to the change in the definition and not to actual changes in drinking behavior. The new gender-specific definition of binge drinking can increase the usefulness of this measure for public health surveillance, and support the planning and implementation of effective prevention strategies (e.g., increasing alcohol excise taxes).
doi:10.1016/j.amepre.2010.12.008
PMCID: PMC3090660  PMID: 21406282
9.  Alcohol consumption and alcohol counselling behaviour among US medical students: cohort study 
Objective To determine which factors affect alcohol counselling practices among medical students.
Design Cohort study.
Setting Nationally representative medical schools (n=16) in the United States.
Participants Medical students who graduated in 2003.
Interventions Questionnaires were completed (response rate 83%) at the start of students’ first year (n=1846/2080), entrance to wards (typically during the third year of training) (n=1630/1982), and their final (fourth) year (n=1469/1901).
Main outcome measures Previously validated questions on alcohol consumption and counselling.
Results 78% (3777/4847) of medical students reported drinking in the past month, and a third (1668/ 4847) drank excessively; these proportions changed little over time. The proportion of those who believed alcohol counselling was highly relevant to care of patients was higher at entrance to wards (61%; 919/1516) than in final year students (46%; 606/1329). Although students intending to enter primary care were more likely to believe alcohol counselling was highly relevant, only 28% of final year students (391/1393) reported usually or always talking to their general medical patients about their alcohol consumption. Excessive drinkers were somewhat less likely than others to counsel patients or to think it relevant to do so. In multivariate models, extensive training in alcohol counselling doubled the frequency of reporting that alcohol counselling would be clinically relevant (odds ratio 2.3, 95% confidence interval 1.6 to 3.3) and of reporting doing counselling (2.2, 1.5 to 3.3).
Conclusions Excessive drinking and binge drinking among US medical students is common, though somewhat less prevalent than among comparably aged adults in the US general population. Few students usually discussed alcohol use with patients, but greater training and confidence about alcohol counselling predicted both practising and believing in the relevance of alcohol counselling. Medical schools should consider routinely training students to screen and counsel patients for alcohol misuse and consider discouraging excessive drinking.
doi:10.1136/bmj.a2155
PMCID: PMC2659955  PMID: 18996938
10.  Left Atrial Reverse Remodeling in Dogs with Moderate and Advanced Heart Failure Treated with A Passive Mechanical Containment Device: An Echocardiographic Study 
Journal of cardiac failure  2007;13(4):312-317.
Background
Assessment of global LV remodeling is important in evaluating the efficacy of pharmacologic and device therapies for the treatment of chronic heart failure (HF). The effects of pharmacologic or device therapies on global left atrial (LA) remodeling in HF, while also important, are not often examined. We showed that long-term therapy with the Acorn Cardiac Support Device (CSD), a passive mechanical ventricular containment device, prevents and/or reverses LV remodeling in dogs with HF. This study examined the effects of the CSD on global LA remodeling in dogs with moderate and advanced HF.
Methods and Results
Studies were performed in 24 dogs with coronary microembolization-induced HF. Of these, 12 had moderate HF (ejection fraction, EF 30% to 40%) and 12 advanced HF (EF ≤25%). In each group, the CSD was implanted in 6 dogs and the other 6 served as controls. Dogs were followed for 3 months in the moderate group and 6 months in the advanced HF group. LA maximal volume (LAVmax), LA volume at the onset of the p-wave (LAVp), LA minimal volume (LAVmin), LA active emptying volume (LAAEV) and LA active emptying fraction (LAAEF) were measured from 2-dimensional echocardiograms obtained prior to CSD implantation and at the end of the treatment period. Treatment effect (Δ) comparisons between CSD-treated dogs and controls showed that CSD therapy significantly decreased LA volumes (ΔLAVmax: 3.33 ± 0.70 vs. −2.87±1.31 ml, p=0.002; 7.77 ± 1.76 vs. −0.37 ± 0.87 ml, p=0.002) and improved LA function (ΔLAAEF: −6.00 ± 1.53 vs. 1.85 ± 1.32 %, p=0.003; −2.39 ± 1.10 vs. 3.13 ± 1.66 %, p=0.02) in the moderate HF and advanced HF groups respectively.
Conclusions
Progressive LA enlargement and LA functional deterioration occurs in untreated dogs with HF. Monotherapy with the CSD prevents LA enlargement and improves LA mechanical function in dogs with moderate and advanced HF indicating prevention and/or reversal of adverse LA remodeling.
doi:10.1016/j.cardfail.2007.01.006
PMCID: PMC1939806  PMID: 17517352
Atrium; Echocardiography; Heart failure; Heart-assist device
11.  Health Care Access Among U.S. Adults Who Drink Alcohol Excessively: Missed Opportunities for Prevention 
Preventing Chronic Disease  2006;3(2):A53.
Introduction
Excessive alcohol consumption kills approximately 75,000 people annually in the United States. Although alcohol screening among primary care patients is recommended by the U.S. Preventive Services Task Force, it is rarely performed. It is unclear whether low screening rates are due to limited access to health care, missed screening opportunities during patient visits, or both.
Methods
Data came from the 2002 Behavioral Risk Factor Surveillance System, a population-based telephone survey of noninstitutionalized U.S. adults. Current health insurance status and a history of a recent medical checkup (within 2 years) were assessed in relation to alcohol consumption status. Excessive drinkers included those who reported binge drinking (consuming five or more drinks on one or more occasions in the past month), heavy drinking (consuming more than 60 drinks in the past month for men or more than 30 for women), or both.
Results
The prevalence of excessive drinking among the general population (17%) was only slightly higher than the prevalence among those with current health insurance (15%) or a recent checkup (14%). Among excessive drinkers, 79% had current health insurance and 78% had a recent checkup. Although excessive drinkers were somewhat less likely to have health insurance or a recent checkup compared with nonexcessive drinkers and nondrinkers, these differences were less pronounced after stratifying by age. Excessive drinkers with the lowest rates of health insurance were young, Hispanic, less educated, and unemployed. However, most excessive drinkers who lacked insurance or a checkup were employed.
Conclusion
Most excessive drinkers were insured and had a recent medical checkup, suggesting that low screening rates among excessive drinkers are mostly due to missed screening opportunities rather than a lack of screening opportunities. Systems approaches to address these missed opportunities should be aggressively implemented.
PMCID: PMC1563973  PMID: 16539794
12.  Sex-Specific Outcomes in Patients Receiving Continuous-Flow Left Ventricular Devices as a Bridge to Transplantation or Destination Therapy 
Asaio Journal  2014;60(2):199-206.
Reports on sex-related outcomes in left ventricular assist device (LVAD) patients are conflicting. In addition, females have been underrepresented in most multicenter randomized controlled trials for mechanical circulatory support (MCS). The objective of our study was to analyze our experience implanting 130 continuous-flow LVADs and to determine the impact of sex on survival. We identified 130 patients who underwent implantation of a continuous-flow LVAD at our institution. Patients were stratified into two groups based on sex. Variables were compared using two-sided t-tests, χ2 tests, Cox proportional hazards models, and log-rank tests to determine whether there was a difference between the two groups and if sex was a significant independent predictor of outcome. Of the 130 patients, 35 were females and 95 were males. Female patients had worse pre-LVAD cardiac output and cardiac index and were more likely to be on MCS at the time of implantation. Male patients had worse renal function. Survival was analogous for both cohorts with 30 day, 6 month, 1 year, and 2 year survivals of 97%, 90.8%, 90.8%, and 84.3%, respectively, for female patients versus 94.7%, 87.9%, 78.4%, and 72.8%, respectively, for male patients. The incidence of other LVAD-related complications was also similar in both groups. Gender did not predict postoperative mortality on univariate analysis. Contrary to most published reports, female and male LVAD patients have similar postoperative and midterm survival, length of hospital stay, readmission rates, and postoperative complications. It appears that females have gained more benefit from newer generation devices compared to males.
doi:10.1097/MAT.0000000000000048
PMCID: PMC3942347  PMID: 24577371
left ventricular assist device; LVAD; sex; gender; female; male; outcomes

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