Dissertations / Theses on the topic 'Alcoholism – Diagnosis'

Alcohol use disorders are common and make a significant contribution to the burden of disease throughout the world. This is especially true among the younger age groups. Although these disorders are common, evidence suggests that those affected do not seek help for their disorders. In order to understand this, reviews of the treatment literature and the epidemiological data on prevalence and correlates of alcohol use disorders and treatment seeking are presented. These reviews confirm that effective treatments exist and that screening in primary care can be efficacious. The reviews also highlight deficits such as the need for more epidemiological evidence on the validity of DSM definitions of alcohol use disorders and for more Australian data on the prevalence and correlates of the disorders and related treatment seeking. This thesis sets out to address these deficits applying sophisticated statistical techniques to data from a large nationally representative Australian sample. A confirmatory factor analysis of the eleven criteria that specify alcohol dependence and abuse examined the validity of DSM-IV definitions of alcohol use disorders and the best solution was found to be a single factor, not two as currently defined. These findings question the bi-axial nature of alcohol use disorders that has underpinned their definition since the publication of DSM-III-R in 1987. Data from this national sample also confirm that, in line with research from other western countries, Australians have high levels of alcohol use disorders, especially amongst males and younger people. Also no association was found between alcohol dependence and treatment seeking, and young people were least likely to seek treatment. However, a relatively large proportion of young people who drink had been in contact with their GPs in the past year; demonstrating that there is ample opportunity for screening and referral for treatment for alcohol use disorders in this vulnerable group. This research has found that although alcohol disorders are not necessarily associated with disability, there are those who can benefit from treatment. It suggests that outcomes for such individuals may be improved by better specification of disorders as well as improved access to best treatments.

Since the anecdotal assumption is that GPs do not effectively diagnose and manage problem drinking amongst their patients, this study investigated the role of GPs in addressing problem drinking in Cape Town as well as the prevalence of problem drinking amongst their patients.

The purpose of the study was to evaluate the construct validity of the Substance Abuse Subtle Screening Inventory (SASSI) as a screening test for alcoholism. The study sample consisted of 238 participants. These included 50 alcoholics, 50 normals, 50 psychiatric outpatients, 50 co-dependent family members and 38 drug addicts, so classified by clinician diagnosis.All participants were administered the SASSI and also the Michigan Alcoholism Screening Test (MAST) and the MacAndrew Alcoholism-Screening Scale (AMAC). Correct classification rates for all three tests were determined using both a five-group criterion of classifying as an alcoholic, normal, psychiatric outpatient, co-dependent or drug addict, and a simpler two-group criterion of classifying as a substance abuser or non-abuser. Five null hypotheses were tested using Chi-square (alpha = .01) tests for equal proportions of classification accuracy. A sixth null hypothesis was tested using linear discriminant function analyses.Results Five-group criterion:1. The three tests differed in correctly classifying alcoholics, with the MAST statistically significantly superior to the AMAC and the SASSI.2. The three tests differed in correctly classifying normals, with the MAST and the AMAC statistically significantly superior to the SASSI.3. The three tests differed in correctly classifying psychiatric outpatients, with the AMAC statistically significantly superior to the SASSI.4. The three tests differed in correctly classifying drug addicts, with the AMAC and the SASSI statistically significantly superior to the MAST.5. The three tests did not differ to a statistically significant degree in classifying codependents.Two-group criterion (abuser/non-abuser):1. The three tests differed in correctly classifying alcoholics, with the MAST statitically significantly superior to the AMAC and the SASSI.2. The three tests differed in correctly classifying normals, with the SASSI statistically significantly superior to the AMAC and the MAST.3. The three tests differed in correctly classifying psychiatric outpatients, with the SASSI and the AMAC statistically significantly superior to the MAST.4. The three tests differed in correctly classifying drug addicts, with the MAST statistically significantly superior to the AMAC and the SASSI.5. The three tests differed in correctly classifying co-dependents, with the SASSI statistically significantly superior to the AMAC and the MAST.Employing the two-group criterion, all tests vastly improved their performance with the SASSI significantly superior to the MAST and the AMAC at author-recommended cutting scores. Increasing the cutting score for the MAST improved classification accuracy even further. Employing the linear discriminant function, the three tests differed significantly, with the MAST statistically significantly superior to all other scales.ConclusionsNone of the three scales performed adequately with the five-group criterion. The simpler two-group criterion produced an 87% classification accuracy rate for the SASSI with the study sample at author-recommended cutting scores, which was statistically significantly superior to the MAST and the AMAC. The highest classification accuracy rates of 90.3% and 91.2% respectively were produced by the MAST at elevated cutting scores of 10 and 12 in the two-group criterion. These parallelled linear discriminant function results for the MAST.
Department of Counseling Psychology and Guidance Services

FundaÃÃo de Amparo a CiÃncia e Tecnologia de Pernambuco
O estudo tem como objeto a revisÃo do diagnÃstico de enfermagem Processos familiares disfuncionais relacionados a abuso de Ãlcool. Estudo metodolÃgico, desenvolvido em trÃs etapas: anÃlise de conceito, anÃlise de conteÃdo por especialistas e anÃlise da acurÃcia de indicadores clÃnicos. Para a realizaÃÃo da anÃlise de conceito, utilizou-se como referÃncia o modelo de anÃlise de conceito proposto por Walker e Avant e os passos da revisÃo integrativa da literatura. Procedeu-se à busca na literatura em trÃs bases de dados: SCOPUS, PubMed e CINAHL, com os descritores alcoolismo e famÃlia disfuncional e suas sinonÃmias nas lÃnguas inglesa e espanhola. ApÃs a aplicaÃÃo dos critÃrios de inclusÃo e exclusÃo, restaram 11 estudos de um total de 113 que subsidiaram a anÃlise do conceito. A partir da revisÃo do conceito famÃlia disfuncional e sua correlaÃÃo com o diagnÃstico de enfermagem Processos familiares disfuncionais, foi possÃvel reduzir o quantitativo de 115 caracterÃsticas definidoras para 91, por meio da exclusÃo de 24 caracterÃsticas que apresentaram significado semelhante a outros indicadores ou por nÃo se aplicarem a alcoolistas adultos. TrÃs caracterÃsticas foram condensadas em uma e foram incorporadas duas novas caracterÃsticas definidoras: abuso fÃsico e abuso sexual. Foram utilizados artigos, livros e dicionÃrios para a construÃÃo das definiÃÃes conceituais e operacionais das 91 caracterÃsticas definidoras. A segunda etapa do estudo, anÃlise de conteÃdo por especialistas, consistiu no julgamento por 23 especialistas quanto à relevÃncia, clareza e precisÃo das definiÃÃes construÃdas na etapa anterior. Dois itens foram julgados como inadequados no critÃrio relevÃncia e, portanto, excluÃdos do estudo. Dezessete itens tiveram suas definiÃÃes julgadas como inadequadas nos critÃrios clareza e/ou precisÃo e foram reformuladas. Duas caracterÃsticas tiveram seu rÃtulo modificado segundo sugestÃes dos especialistas. Para esta etapa, considerou-se o nÃvel de concordÃncia de 85%. A partir das definiÃÃes operacionais das 89 caracterÃsticas definidoras julgadas como relevantes pelos especialistas, foi construÃdo o instrumento de coleta de dados aplicado com 110 alcoolistas internados em uma unidade de cuidados prolongados para tratamento de alcoolismo crÃnico. Para a delimitaÃÃo da amostra, foi realizado cÃlculo amostral e estabelecidos critÃrios de inclusÃo e exclusÃo. Os dados foram coletados por meio de entrevista e analisou-se a presenÃa ou ausÃncia de cada indicador clinico. Os dados foram submetidos à anÃlise de classe latente, que permitiu encontrar um conjunto de vinte e quatro caracterÃsticas que apresentaram bom ajuste para a correta identificaÃÃo do diagnÃstico Processos familiares disfuncionais. As caracterÃsticas definidoras Papeis familiares interrompidos, Problemas econÃmicos e Rituais familiares interrompidos apresentaram boa sensibilidade e especificidade. As caracterÃsticas definidoras Abuso sexual, DistÃrbio no desempenho escolar em crianÃas, ManipulaÃÃo, Falta de coesÃo e Baixa autoestima crÃnica apresentaram valor de especificidade significativo. As demais mostraram valor de sensibilidade significativo: Mentiras, AngÃstia, Ansiedade, ConfusÃo, Constrangimento, Perda, Raiva, ComunicaÃÃo contraditÃria, Dificuldade com relacionamentos Ãntimos, Imaturidade, Tristeza nÃo resolvida, DeterioraÃÃo nos relacionamentos familiares, DinÃmicas familiares perturbadas, Problemas conjugais, InseguranÃa e SolidÃo. A revisÃo do diagnÃstico Processos familiares disfuncionais relacionados a abuso de Ãlcool possibilitou uma reflexÃo crÃtica acerca das caracterÃsticas definidoras constantes na NANDA-I, com vistas ao seu refinamento. Espera-se que este estudo possa auxiliar o enfermeiro na sua prÃtica assistencial a identificar o referido diagnÃstico de modo mais acurado.
The study focuses the review of the nursing diagnosis Dysfunctional family processes related to alcohol abuse. Methodological study, developed in three stages: concept analysis, content analysis by experts and analysis of the accuracy of clinical indicators. For the realization concept analysis, was used as reference the concept analysis model proposed by Walker and Avant and steps of the integrative literature review. Proceeded the literature search in three databases: SCOPUS, PubMed and CINAHL, with descriptors alcoholism and dysfunctional family and their synonyms in English and Spanish. After applying the inclusion and exclusion criteria, 11 studies remained from a total of 113 that supported the concept analysis. From the review of the concept dysfunctional family and its correlation with the nursing diagnosis of Dysfunctional family processes, it was possible to reduce the quantitative defining characteristics from 115 to 91, by deleting the 24 characteristics that were similar to other indicators or meaning is not apply to adult alcoholics. Three characteristics were condensed into one and were incorporated two new defining characteristics: Physical abuse and Sexual abuse. Articles, books and dictionaries were used to build the conceptual and operational definitions of the 91 defining characteristics. The second stage of the study, content analysis by experts consisted at trial of 23 experts for relevance, clarity and accuracy of definitions constructed in the previous step. Two items were judged as inappropriate in relevance criteria and therefore excluded from the study. 17 items had their definitions judged as inadequate on the clarity and/or precision criteria and have been reformulated. Two had their labels modified second suggestions from experts. For this step, was considered the level of agreement of 85 %. From the operational definitions of the 89 defining characteristics judged as relevant by experts, was built the instrument of data collection applied with 110 alcoholics admitted to a unit for extended care treatment of chronic alcoholism. For the delimitation of the sample, sample size calculation was performed and established criteria for inclusion and exclusion. Data were collected through interviews and analyzed for the presence or absence of each clinical indicator. The data were subjected to latent class analysis, which allowed to find a set of twenty-four characteristics that showed good fit for the correct identification of diagnostic Dysfunctional family processes. The defining characteristics Disrupted family roles, Economic problems and Disrupted family rituals showed good sensitivity and specificity. The defining characteristics Sexual abuse, Disturbances in academic performance in children, Manipulation, Lack of cohesiveness and Chronic low self-esteem showed the mean value of specificity. The other showed the mean value of sensitivity: Lying, Distress, Anxiety, Confusion, Embarrassment, Loss, Anger, Contradictory communication, Difficulty with intimate relationships, Immaturity, Complicated grieving, Deterioration in family relationships, Disturbed family dynamics, Marital problems, Insecurity and Loneliness.. A review of the diagnosis Dysfunctional family processes related to alcohol abuse provided a critical analysis of the defining characteristics listed in the NANDA-I, with a view to its refinement. It is hoped that this study can help nurses in healthcare practice to identify the diagnosis more accurately.

The relationship between alcoholism and generalized anxiety disorder (GAD) has been discussed in two research areas: research on the prevalence of GAD in alcoholics, and the prevalence of alcoholism in individuals diagnosed with GAD. Studies indicate that between 6 to 26% of alcoholics have a current diagnosis of GAD, with a lifetime prevalence rate of up 51%. In the general population, 4% would currently receive a diagnosis of GAD, with a lifetime prevalence of 8%. This meta-analytic review of the empirical literature examines the relationship between GAD and alcoholism. The author used percentages to compare the results of various studies. The averaged results of these various studies suggested there is a 25% comorbidity rate of GAD and alcoholism. critical review of the studies examined in this review revealed substantial methodological errors. Based on a critical review of the research methodology in the studies cited, the author proposed further research.

L’analyse de l'arrimage de l'alcoolisme à la construction du sujet et la manière dont le diagnostic alcoolique peut produire des effets sur l’identité, nous a amené a élaborer trois hypothèses : l'étiquette 'alcoolique' peut avoir des effets dans le processus de production de la subjectivité; les effets subjectifs de la nomination sont liées aux usages que le nom« alcoolique » a dans de différents contextes historiques ; l'identification comme alcoolique est marquée par une recherche d’alliance du sujet à un réseau social plutôt que par le sentiment d'identité subjectif d'uniformité et de continuité de ce que désigne le diagnostic d'alcoolisme. La recherche de terrain dans des Centres d’addictologie et des Associations a abouti à la réalisation de cinq entretiens. L'identité alcoolique peut constituer des processus d'appartenance pour qui a une vie marquée par la migration; de résistance au productivisme, pour qui a dû travailler à l’armée et sur des chaînes de production; et une ouverture à l'amitié pour qui a souffert de ruptures affectives. Cependant cette identité peut cacher la singularité du sujet, lorsqu’elle sert comme explication close et clé à des conflits
The analysis of the connection made of alcoholism to the construction of the subject and how the alcoholic diagnosis might produce effects on the process of production of identity lead us to three hypotheses: the label "alcoholic" might impact the process of production of subjectivity; the subjective effects of a nomination are related to the uses the name “alcoholic” have in different historical contexts; The identification as an alcoholic is marked by a search for alliance of the subject with a social network a lot more than it is marked for the subjective feeling of identity to a uniformity and continuing of what is designated by the diagnosis of alcoholism. The field research in addictology centres and associations derived from five interviews. The alcoholic identity might constitute a process of belonging for those who have their lives transformed by migration; of resisting productivism, for those who have to be in the army and in big productive chains and it could also be an opening to new friendships for those who have been through relationship break-ups. However, this identity might hide the singularity of the subject, as when it is used as a conclusive key explanation to conflicts

Resumo: Visto que 80-95% dos estilistas são também tabagistas, é desejável que modelos experimentais de estudo dos efeitos deletérios do consumo crônico do álcool incluam grupos com a associação de etilismo e tabagismo, permitindo desta forma, mimetizar, de maneira mais precisa, os efeitos do abuso crônico do álcool em humanos. Objetivo: Investigar os efeitos da exposição crônica à fumaça do cigarro e ao álcool no estresse oxidativo, nas alterações morfo-funcionais e distúrbios imunohistoquímicos provocados por estas agressões no aparelho respiratório de ratos. Método: cento e vinte ratos machos Wistar foram divididos em oito subgrupos de quinze animais (controle, tabagista, alcoolista e alcoolista + tabagista) em dois tempos experimentais (180 e 260 dias). Os biomarcadores de estresse oxidativo (superóxido dismutase, concentração da proteína tiol, glutationa perodixase e substâncias reativas ao ácido tiobarbitúrico) foram pesquisados em hemáceas lavadas. As alterações morfo-funcionais pulmonares (presença de reação inflamatória e estimativa de enfisema) foram avaliadas através do estudo histológico em microscopia óptica e estudo do pulmão isolado (complacência e complacência específica). O estudo imunohistoquímico foi realizado através da pesquisa da expressão de survivina, proteína P53, antígeno nuclear de proliferação celular e do índice apoptótico, pela técnica de TUNEL, no parênquima pulmonar e na traquéia. Resultados: o peso corpóreo dos três grupos experimentais foi menor que o grupo controle, sendo os menores valores os dos grupos alcoolista + tabagista, sendo a estimativa de enfisema pulmonar também maior nestes animais. Os animais dos grupos tabagistas e tabagistas + alcoolista apresentaram: menor complacência, maior incidência de bronquiolite, maior expressão para a survivina nas traqueias e maior índice apoptótico... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Since 80-95% of alcoholic are also smokers, it is desirable that study's experimental models of deleterious effects of chronic alcohol consumption includes groups with association of alcohol and tobacco, thus allowing, mimic, more accurately, the effects of chronic alcohol abuse in humans. Objective: To investigate the effects of chronic exposure to cigarette smoke and alcohol on oxidative stress, on morpho-functional alterations and immunohistochemical disorders caused by these attacks to respiratory system of rats. Method: one hundred and twenty Wistar rats were divided into eight subgroups of fifteen animals (control, smoking, alcohol and alcohol + smoking) in two experimental times (180 and 260 days). Biomarkers of oxidative stress (superoxide dismutase, tiol protein concentration, glutathione perodixase and thiobarbituric acid reactive substances) were determined in washed red cells. The morpho-functional lung's alterations (presence of inflammatory reaction and estimate of emphysema) were evaluated by histological examination with optical microscopy and study of the isolated lung (compliance and specific compliance). The immunohistochemistry study was performed by investigating the expression of survivin, P53 protein, nuclear antigen of cell proliferation and apoptotic index by TUNEL technique, at pulmonary parenchyma and trachea. Results: The weight of the three experimental groups was lower than the control group, with the lowest values at the alcoholism + smoking groups, and the estimated pulmonary emphysema was higher also in these animals. The smokers and smokers+alcoholic groups's animals showed: lower compliance, higher incidence of bronchiolitis, larger survivin expression to trachea and higher bronchiolar apoptotic index. Animals exposed only to smoking showed elevated levels of thiobarbituric acid reactive substances and lower specific compliance. The three... (Complete abstract click electronic access below)
Orientador: Antonio José Maria Cataneo
Coorientador: Daniele Cristina Cataneo
Banca: Débora Damasceno
Banca: Maria Aparecida Custódio Domingues
Banca: Vera Luzia Capelozzi
Doutor

This study examined about 500 mock juror perceptions in a murder trial in which the defendant claims to have killed her abusive husband in self-defense. The defendants psychological diagnosis, the husbands alcohol abuse history, and documentation of domestic violence were varied across conditions. Results showed that medical evidence of domestic violence had a significant effect on guilt ratings and on perceptions of blame for the husbands death. History of alcohol use of the husband influenced mock jurors perceptions of the credibility of the defendant. Juror gender effects were also found on verdict ratings. In contrast, no main effect was found for the defendants diagnosis.

Using both qualitative and quantitative research designs, this study focused on the knowledge of Children Protective Services (CPS) social workers for identifying Alcohol and Other Drugs (AOD) risk factors in their clients, and the impact that these AOD issues have on the child welfare system in San Bernardino County, California.

Because of the prevalence of substance abuse in America and the association between this issue and common problems brought to the family therapist, it is important that family therapists be trained to diagnose and either treat or refer substance abusing clients and their families. This study gathered information from the Directors of Master's level family therapy programs accredited by AAMFT about the content and format of training that students in their programs receive preparing them to work with substance abusing families. Twenty of the 22 programs were represented by completed questionnaires. Five programs were reported as having a required substance abuse course; four, a popular elective. Three respondents reported plans to increase their coverage of the topic in their curricula.

The average of the responses for prevalence of substance abuse as a central issue in practicum cases was 30%. Although about 75% of the respondents believed that their graduates were ready to diagnose and refer these cases, only 25% believed that these same students were ready to treat substance abuse cases. Data showed that 40% of the respondents believed it advisable for AAMFT to require a separate course on substance abuse. Comments from those opposed to such a requirement noted the crowdedness of existing curricula, the importance of academic freedom, and the abundance of other topics to be covered.
Master of Science

Cerca de 50% dos pacientes portadores de transtorno afetivo bipolar (TAB) apresentam comorbidade com abuso ou dependência de álcool. A presença de alcoolismo nos pacientes com TAB está associada a manifestações clínicas mais graves e a uma pior resposta ao tratamento do transtorno de humor. Entretanto, as anormalidades neurobiológicas subjacentes à co-ocorrência de TAB e alcoolismo são desconhecidas. Neste estudo, nosso objetivo foi o de comparar o perfil neuroquímico do córtex pré-frontal dorsolateral esquerdo de pacientes portadores de TAB e diagnóstico prévio de alcoolismo ao de pacientes portadores de TAB não-alcoolistas e ao de indivíduos saudáveis, usando espectroscopia por ressonância magnética de hidrogênio. Para isso, obtivemos uma aquisição de espectroscopia de hidrogênio de voxel único e tempo de eco curto em campo magnético de 1,5 Tesla do córtex préfrontal dorsolateral esquerdo em 23 pacientes bipolares alcoolistas, 27 pacientes bipolares não-alcoolistas e 57 indivíduos saudáveis. Níveis absolutos de N-acetilaspartato (NAA), compostos de colina, creatina mais fosfocreatina, mio-inositol, glutamato mais glutamina (Glu+Gln), e glutamato foram determinados e comparados entre os três grupos. Pacientes bipolares alcoolistas apresentaram níveis menores de Glu+Gln (p = 0,06) e de glutamato (p = 0,03) do que pacientes bipolares nãoalcoolistas. Pacientes bipolares alcoolistas apresentaram níveis menores de NAA do que controles saudáveis (p = 0,06). Esses achados sugerem que anormalidades do sistema glutamatérgico, e, possivelmente, da integridade neuronal, estão presentes no córtex pré-frontal dorsolateral esquerdo de pacientes portadores de TAB em comorbidade com alcoolismo. Tais anormalidades podem caracterizar processos fisiopatológicos que seriam específicos da comorbidade entre TAB e alcoolismo.
About 50% of bipolar disorder (BD) patients present comorbidity with alcohol abuse or dependence. The presence of alcoholism in BD is associated with worse clínical manifestations and refractoriness to treatment of the mood disorder. Nevertheless, the neurochemical underpinnings that underlie the co-occurrence of bipolar disorder and alcoholism are unknown. In this study, we sought to compare the neurochemical profile of the left dorsolateral pre-frontal cortex of BD patients with a prior diagnosis of alcoholism to non-alcoholic BD patients and healthy controls (HC), using proton (1H) magnetic resonance spectroscopy. We obtained a short-TE, single-voxel 1H spectroscopy acquisition at 1.5 Tesla from the left dorsolateral pré-frontal córtex (DLFPC) of 23 alcoholic BD patients, 27 non-alcoholic BD patients and 57 HC. Absolute levels of N-acetyl-aspartate (NAA), choline-containing compounds, phosphocreatine plus creatine, myo-inositol, glutamato plus glutamina (Glu+Gln) and glutamato were determined and compared among the three groups. Alcoholic BD patients showed lower Glu+Gln (p = 0.06) and glutamate levels (p = 0.03) than non-alcoholic BD patients. Alcoholic BD patients tended to have lower NAA levels than HC (p = 0.06). These findings suggest that glutamatergic abnormalities, and possibly, neuronal integrity abnormalities, are present in the left DLPFC of BD patients with comorbid alcoholism. Such abnormalities may characterize pathophysiological processes that are specific for the comorbidity between BD and alcoholism.

This study explored: (1) The test-retest reliability of DSM III lifetime diagnoses in 69 active alcoholic subjects interviewed twice, before entering treatment and 4 weeks later with the computerized format of the DISSI (derived from the NIMH-Diagnostic Interview Schedule). (2) The stability of psychiatric diagnoses yielded by both interviews as influenced by subjects' age, gender, current level of psychological distress and current toxic status. Poor agreement (Kappa values below 0.5) was found for panic disorder (k = 0.337) and phobic disorder (k = 0.477) while generalized anxiety disorder and depression/dysthymia presented only fair agreement (k = 0.658 and k = 0.696 respectively). Current levels of psychological distress assessed by the Hopkins Symptom Checklist-58 (HSCL-58) was found to predict the risk of inconsistent reports. Contrary to expectations abstinence did not significantly influence the report of symptoms; neither did the age or gender of the respondents. Levels of self-perceived psychological distress may influence the recall of past symptom experiences among alcoholics and thus affect the reliability of lifetime reports in this population.

The purpose of this study was to investigate how women's perceptions of the helpfulness of services received at a substance abuse treatment clinic affected their compliance with the treatment program. The study surveyed thirty-two women who were receiving treatment from Inland Behavioral and Health Services. The study investigated the efficacy of these elements: parenting classes, health classes, substance abuse therapy groups, group therapy, drug screening, health clinics, Narcotics Anonymous meetings, Dual Diagnosis Anonymous meetings, Alcoholics Anonymous meetings, homeless support services, individual therapy, case managers, daycare, transportation.

Background: NAFLD is one of the most common causes of liver disease worldwide. It is a spectrum of disease characterized by macrovesicular steatosis of the liver that ranges from simple fatty liver (steatosis), to non-alcoholic steatohepatitis (NASH). NASH may eventually evolve to cirrhosis and end stage complication. Liver biopsy has long been considered the gold standard of reference to diagnose NAFLD but it is costly and invasive. Recently, non-invasive methods have been proposed. Aims and methods: The aim of this study was to investigate the accuracy of non-invasive methods including (Ultrasound, computed tomography scan, Xenon-133 scan, Hepatic steatosis index, Fibroscan, NAFLD fibrosis score, APRI index, and FIB-4 index) and their combination to diagnose steatosis and to diagnose significant liver fibrosis (>F2) and cirrhosis (F4) as compared to liver biopsy. We conducted a retrospective study of 114 NASH patients (79 males, mean age 49.6±10.6). All had adequate liver histology. Results: The distribution of fibrosis stage was as follows: F0-F1= 50%, F2=16.8%, F3=19.2%, F4=14%. The distribution of steatosis grade was as follows: grade 0-1=16%, grade2=53.3%, grade3=30.7%. The following tests correlated with fibrosis: APRI index (r=0.554), FIB-4(r=0.555), NAFLD fibrosis score (r=0.473), Fibroscan(r=0.586) and Hepatic Steatosis Index (HSI) (r=0.245). The FIB-4 and APRI index showed the best diagnostic accuracy for significant fibrosis as indicated by an Area Under the Curve (AUC) of 0.801 and 0.782, respectively. The FIB-4 showed the best AUC= 0.886 for cirrhosis. None of the following tests US, CT, HSI, and xenon-133 scan were considered correlated significantly. The best combination algorithm for the detection of cirrhosis was gender and FIB-4 with an AUC of 0.8937. Conclusion: this study demonstrates that non-invasive methods for liver fibrosis are accurate to diagnose >F2 and F4. Severe steatosis cannot be reliably diagnosed by non-invasive methods. Notably, a combination of FIB-4 and gender significantly improves the performance of the single method for cirrhosis. These methods may help reducing the number of liver biopsies stratifying NASH patients that should start a screening program for HCC and esophageal varices.
Contexte : La stéatose hépatique non alcoolique (SHNA) est l'une des causes les plus répandues des maladies du foie à l'échelle mondiale. Il s'agit d'un spectre de maladies qui se caractérise par une stéatose hépatique macrovésiculaire allant de la stéatose hépatique simple (stéatose) à la stéatohépatite non alcoolique (NASH). La NASH peut éventuellement évoluer vers une cirrhose et des complications en phase terminale. La biopsie du foie a longtemps été considérée comme la norme de référence par excellence pour le diagnostic de la SHNA, mais elle est coûteuse et invasive. Des méthodes non invasives ont récemment été proposées. Objectifs et méthodes : La présente étude avait pour objectif d'évaluer la précision de certaines méthodes non invasives (notamment les ultrasons [US], la tomographie par ordinateur [TO], la scintigraphie au xénon 133, l'indice de stéatose hépatique (ISH), la technique Fibroscan, le score de fibrose de SHNA, l'indice de ratio entre l'aspartate aminotransférase et les plaquettes [APRI] et l'indice FIB-4) et de l'utilisation combinée de ces méthodes pour le diagnostic de la stéatose et pour le diagnostic d'une fibrose hépatique significative (> F2) et de la cirrhose (F4), par comparaison à la biopsie du foie. Nous avons réalisé une étude rétrospective sur 114 patients atteints de NASH (79 patients de sexe masculin, âge moyen de 49,6 ans ± 10,6). Tous ces patients présentaient une histologie hépatique adéquate.Résultats : La répartition des stades de fibrose était la suivante : F0 F1 = 50 %, F2 = 16,8%, F3 = 19,2 %, F4 = 14 %. La répartition des stades de stéatose était la suivante : stade 0-1 = 16 %, stade 2 = 53,3 %, stade 3 = 30,7 %. Les tests suivants ont été mis en corrélation avec la fibrose : l'indice APRI (r = 0,554), l'indice FIB-4 (r = 0,555), le score de fibrose de SHNA (r = 0,473), la technique Fibroscan (r = 0,586) et l'indice de stéatose hépatique (r = 0,245). L'indice FIB-4 et l'indice APRI ont offert la meilleure précision diagnostique en ce qui concerne la fibrose significative, comme l'indiquent la surface sous la courbe (SSC) de 0,801 et la SSC de 0,782 respectivement. L'indice FIB-4 a présenté la meilleure SSC, soit 0,886, pour ce qui est de la cirrhose. Aucun des tests suivants, c'est à dire les tests aux US, la TO, l'ISH, et la scintigraphie au xénon 133, n'était considéré comme étant corrélé significativement. Le meilleur algorithme de combinaison pour le dépistage de la cirrhose était le sexe et l'indice FIB-4 avec une surface sous la courbe de 0,8937. Conclusion: cette étude démontre que les méthodes non invasives de diagnostic de la fibrose hépatique sont précises en ce qui concerne les stades > F2 et F4. La Stéatose sévère ne peut être diagnostiqué de façon fiable par des méthodes non invasives Notamment, une combinaison de l'indice FIB-4 et du sexe améliore considérablement le rendement de la méthode unique en ce qui a trait à la cirrhose. Ces méthodes pourraient aider à réduire le nombre de biopsies du foie visant à stratifier les patients atteints de NASH qui devraient entreprendre un programme de dépistage du carcinome hépatocellulaire (CHC) et des varices œsophagiennes.

Using autoethnography, performance praxis, and narrative theory, this thesis seeks to examine the discourses of the Recovery Industry in relationship to Adult Children of Alcoholics (ACoA). The Recovery Industry creates normalized identity scripts that may be problematic for some people who fall under this diagnosis/category. By using subversive performance praxis, the author hopes to rupture these dominant narratives in hope of creating new possibilities for identity narratives.

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O consumo abusivo de álcool interfere no metabolismo ósseo podendo causar a osteoporose, e o fluoreto de sódio tem sido usado para reduzir o risco de fratura na osteoporose. Não há relatos do efeito sinérgico dessas substâncias no tecido ósseo. A densitometria óssea é um método preciso para avaliação do conteúdo mineral ósseo. O objetivo deste estudo foi realizar a análise densitométrica óssea em fêmur de rato submetidos ao consumo de fluoreto e ao consumo crônico de álcool com e sem consumo prévio de fluoreto. Os 105 ratos foram divididos em 5 grupos conforme a dieta líquida: água (Controle C) e fluoreto (Grupo F) “ad libitum” por um período de 90 dias; água (Grupo CA) e fluoreto (Grupo FA) por 30 dias antes do consumo de aguardente de cana (40o GL) em concentrações crescentes de 30% e 60% durante 20 dias, e pura por 40 dias até eutanásia do animal; água por 60 dias e a seguir fluoreto por 30 dias (Grupo CF). Os animais foram sacrificados após 3, 10 e 28 dias de completada a dieta, os fêmures esquerdos foram dissecados e submetidos à análise densitométrica no sistema DXA. Os valores obtidos de conteúdo de massa óssea (CMO) e densidade mineral óssea (DMO) foram submetidos à análise de variância e teste de Tukey para comparação entre os grupos, sendo verificada diferença estatística entre os grupos no CMO e DMO. A ordem decrescente de DMO foi: F, CF, C, FA, CA, sendo observada diferença estatística entre os grupos F e CA. O grupo F apresentou os maiores valores de CMO e DMO, e os grupos FA e CA apresentaram menores médias de CMO e DMO comparados aos C, F e CF. Podemos concluir que o uso de NaF de maneira prolongada aumenta a densidade óssea e que o uso crônico de álcool diminui os valores de CMO e DMO, mesmo com o uso prévio de NaF, sendo encontrado valores intermediários após consumo das duas substâncias.
The abusive alcohol consumption intervenes with the bone metabolism being able to cause osteoporosis and the sodium fluorid has been used to reduce the risk of breaking in osteoporosis. There are not reports of the synergistic effect of such substances on bone tissue. The aim of this study was to analysis bone density in the rat femur submitted to the use of fluoride and the chronic consumption of alcohol with and without pre-fluoride. The 105 rats had been divided in 5 groups in agreement the liquid diet: water (Control C) and fluorid (Fluorid F) ad libitum for a period of 90 days; water (water and alcohol CA) and fluorid (fluorine and alcohol FA) per 30 days before the consumption of sugar cane brandy (40°GL) in increasing concentrations of 30% and 60% during 20 days, and pure for 40 days until euthanasia of the animal; water per 60 days and to follow fluorid per 30 days (fluorid 30 days CF). The animals were sacrificed after 3, 10 and 28 days of completion of the diet, the left femurs were dissected and submitted for analysis in the DXA standard system. The values obtained of bone mass content (BMC) and bone mineral density (BMD) were submitted to the analysis of variance and test Tukey for comparison between groups, and found statistical difference between the groups in the BMC and BMD. The order of decreasing BMD was: F, CF, C, FA, CA, and observed statistical difference between the groups F and CA. The group F presented the highest values of BMC and BMD, and the FA and CA groups had lower average BMC and BMD compared to C, F and CF. We can conclude that the use of NaF on a prolonged increases bone density and that the chronic use of alcohol lowers the values of BMC and BMD, even with the previous use of NaF, and intermediate values found after consumption of the both substances.

Thesis: S.M., Massachusetts Institute of Technology, Computation for Design and Optimization Program, 2017.
Cataloged from PDF version of thesis.
Includes bibliographical references (pages 57-61).
We propose and validate a non-invasive method to diagnose Non-Alcoholic Fatty Liver Disease (NAFLD). The proposed method is based on two fundamental concepts: 1) the speed of sound in a fatty liver is lower than that in a healthy liver and 2) the quality of an ultrasound image is maximized when the beamforming speed of sound used in image formation matches the speed in the medium under examination. The proposed method uses image brightness and sharpness as quantitative image-quality metrics to predict the true sound speed and capture the effects of fat infiltration, while accounting for the transmission through subcutaneous fat. Validation using nonlinear acoustic simulations indicated the proposed method's ability to predict the speed of sound within a medium under examination with little sensitivity to the transducer's frequency (errors less than 2%). Additionally, ex vivo testing on sheep liver, mice livers, and tissue-mimicking phantoms indicated the method's ability to predict the true speed of sound with errors less than 0.5% (despite the presence of subcutaneous fat) and its ability to quantify the relationship between fat content and speed of sound. Additionally, this work starts to create a framework which allows for the determination of the spatial distribution of the longitudinal speed of sound, thereby providing a promising method for diagnosing NAFLD over time.
by Alex Benjamin.
S.M.

Orientador: Leda Maria Pescinini Salzedas
Banca: Ana Maria Pires Soubhia
Banca: Ana Lucia Alvares Capelozza
Resumo: O consumo abusivo de álcool interfere no metabolismo ósseo podendo causar a osteoporose, e o fluoreto de sódio tem sido usado para reduzir o risco de fratura na osteoporose. Não há relatos do efeito sinérgico dessas substâncias no tecido ósseo. A densitometria óssea é um método preciso para avaliação do conteúdo mineral ósseo. O objetivo deste estudo foi realizar a análise densitométrica óssea em fêmur de rato submetidos ao consumo de fluoreto e ao consumo crônico de álcool com e sem consumo prévio de fluoreto. Os 105 ratos foram divididos em 5 grupos conforme a dieta líquida: água (Controle C) e fluoreto (Grupo F) "ad libitum" por um período de 90 dias; água (Grupo CA) e fluoreto (Grupo FA) por 30 dias antes do consumo de aguardente de cana (40o GL) em concentrações crescentes de 30% e 60% durante 20 dias, e pura por 40 dias até eutanásia do animal; água por 60 dias e a seguir fluoreto por 30 dias (Grupo CF). Os animais foram sacrificados após 3, 10 e 28 dias de completada a dieta, os fêmures esquerdos foram dissecados e submetidos à análise densitométrica no sistema DXA. Os valores obtidos de conteúdo de massa óssea (CMO) e densidade mineral óssea (DMO) foram submetidos à análise de variância e teste de Tukey para comparação entre os grupos, sendo verificada diferença estatística entre os grupos no CMO e DMO. A ordem decrescente de DMO foi: F, CF, C, FA, CA, sendo observada diferença estatística entre os grupos F e CA. O grupo F apresentou os maiores valores de CMO e DMO, e os grupos FA e CA apresentaram menores médias de CMO e DMO comparados aos C, F e CF. Podemos concluir que o uso de NaF de maneira prolongada aumenta a densidade óssea e que o uso crônico de álcool diminui os valores de CMO e DMO, mesmo com o uso prévio de NaF, sendo encontrado valores intermediários após consumo das duas substâncias.
Abstract: The abusive alcohol consumption intervenes with the bone metabolism being able to cause osteoporosis and the sodium fluorid has been used to reduce the risk of breaking in osteoporosis. There are not reports of the synergistic effect of such substances on bone tissue. The aim of this study was to analysis bone density in the rat femur submitted to the use of fluoride and the chronic consumption of alcohol with and without pre-fluoride. The 105 rats had been divided in 5 groups in agreement the liquid diet: water (Control C) and fluorid (Fluorid F) "ad libitum" for a period of 90 days; water (water and alcohol CA) and fluorid (fluorine and alcohol FA) per 30 days before the consumption of sugar cane brandy (40°GL) in increasing concentrations of 30% and 60% during 20 days, and pure for 40 days until euthanasia of the animal; water per 60 days and to follow fluorid per 30 days (fluorid 30 days CF). The animals were sacrificed after 3, 10 and 28 days of completion of the diet, the left femurs were dissected and submitted for analysis in the DXA standard system. The values obtained of bone mass content (BMC) and bone mineral density (BMD) were submitted to the analysis of variance and test Tukey for comparison between groups, and found statistical difference between the groups in the BMC and BMD. The order of decreasing BMD was: F, CF, C, FA, CA, and observed statistical difference between the groups F and CA. The group F presented the highest values of BMC and BMD, and the FA and CA groups had lower average BMC and BMD compared to C, F and CF. We can conclude that the use of NaF on a prolonged increases bone density and that the chronic use of alcohol lowers the values of BMC and BMD, even with the previous use of NaF, and intermediate values found after consumption of the both substances.
Mestre

Le FibroTest (Brevet APHP-Sorbonne Université) est un marqueur quantitatif de la sévérité de la fibrose, largement validé chez les sujets avec les quatre maladies chroniques les plus fréquentes: les hépatites chroniques C et B, la maladie alcoolique du foie et la stéatose non alcoolique du foie (NAFLD). Sa valeur pronostique pour la prédiction des décès liés au foie a également été validée dans ces maladies à l'exception de la NAFLD, probablement en raison de la progression plus lente de la fibrose, et du fait de la plus grande fréquence des décès d'origine extra-hépatique et la plus faible incidence des décès d'origine hépatique par rapport aux autres causes virales ou alcooliques. L'objectif principal de la thèse a été de démontrer que la valeur pronostique à long terme (10 ans) du FibroTest pour la mortalité liée au foie était équivalente à celle obtenue pour les patients avec hépatite chronique C, la population la mieux validée. Grâce à la précocité d'utilisation du Fibrotest utilisé dès 1997 dans la cohorte prospective de la Pitié-Salpêtrière (projet FibroFrance) il a été possible sur 20 ans de suivre suffisamment de patients à risque métabolique pour valider les performances pronostiques du FibroTest qui étaient au moins égales à celles obtenues chez les patients avec hépatites chroniques virales C et B et les maladies alcooliques du foie. La moitié de la mortalité des maladies du foie étant due au cancer du foie, le deuxième objectif a été de construire et de valider en interne deux nouveaux marqueurs précoces prédictifs de ce cancer, HR1 et HR2 (brevets APHP-Sorbonne Université), chez les sujets avec maladies chroniques du foie, sans ou avec cirrhose initiale. Ces tests combinent l'apolipoprotéine-A1, l'haptoglobine, deux protéines "hépato-protectrices", avec la gammaglutamyl transférase, un marqueur simple et sensible de cytotoxicité. HR1 ne comprend pas de marqueur spécifique de cancer et HR2 utilise l'alpha-foetoprotéine. Nos travaux ont démontré que l'apolipoprotéine-A1 et l'haptoglobine ont une valeur pronostique chez les sujets sans cirrhose avec hépatite médicamenteuse (DILI-ActiTest, brevet APHP-Sorbonne Université), et chez les sujets avec maladies chroniques du foie avec et surtout sans cirrhose, pour prédire précocement le risque de cancer du foie, qualités inconnues au début du projet FibroFrance. L'algorithme de surveillance combinant HR1 et HR2 permet chez les sujets de plus de 50 ans avec ou sans cirrhose de détecter un cancer pour 10 sujets dépistés, et donc autoriserait un dépistage coût-efficace. Pour le troisième objectif, l'amélioration des marqueurs de stéatose et de NASH, deux nouveaux tests quantitatifs ont été construits et validés, (brevets APHP-Sorbonne Université): le NashTest-2 pour le diagnostic de NASH et le SteatoTest-2 pour le diagnostic de stéatose. Pour prendre en charge ces patients à risque métabolique, les tests ont été construits pour reproduire le mieux possible le compte-rendu de biopsie du foie, c’est à dire estimant la présence et la gravité des trois lésions histologiques élémentaires : la stéatose, l'activité inflammatoire et la fibrose. C'est pour cette raison qu'un long travail méthodologique préalable a été mené pour utiliser au mieux les scores de référence maintenant uniformisé par les anatomopathologistes européens et américains. Les principales limites de ces travaux sont l'absence de larges validations externes chez les sujets à risque métabolique, pour reproduire les résultats observés sur nos cohortes, et ce d'autant plus qu'il existe un conflit d'intérêt. Pour les tests largement utilisés pour les hépatites virales et les maladies alcooliques du foie, et la première génération de tests pour les maladies métaboliques, les validations indépendantes avaient confirmé les performances initiales
The FibroTest (Patent APHP-Sorbonne University) has been validated as a biomarker for the diagnosis of the stages of fibrosis in non-alcoholic-fatty liver disease (NAFLD) with results similar to those in chronic hepatitis C, B and alcoholic liver disease (ALD), but it has not yet been confirmed for the prediction of liver-related death. This was mainly due to the lower incidence of liver related deaths, and the higher incidence of non-liver related deaths, as well as the slower progression of fibrosis to cirrhosis, in NAFLD in comparison with other liver diseases. The primary aim was to assess the long-term (10-year) prognostic value of FibroTest in NAFLD and in comparison with that observed in CHC, the most validated population. Due to the very early start of the FibroFrance project in 1997, FibroTest was prospectively assessed in the Pitié-Salpêtrière cohort allowing a 20 years follow-up with a sufficient number of liver-related deaths. As half of the liver-related deaths were due to primary liver cancer, the second aim was to construct and validate internally two new multi-analyte tests, HR1 and HR2 (APHP-Sorbonne University Patents) for the early prediction of cancer, in patients with chronic liver diseases, without and with cirrhosis. Those tests combined apolipoprotein- A1 and haptoglobin, two "hepato-protective" proteins, with gammaglutamyl transferase, a simple marker of cytotoxicity, without specific marker of liver cancer for HR1, and with alpha-fetoprotein for HR2. Our work demonstrated that apoliporotein-A1 and haptoglobin had a prognostic value in patients without cirrhosis and drug-induced liver injury (DILI-ActiTest, APHP-Sorbonne University patent), and in patients with chronic liver diseases with and mostly without cirrhosis, permitting to identify very early the patients at high risk of cancer. These advantages of these proteins were unknown when our project started in 1997. A surveillance algorithm combining HR1 and HR2 in patients older than 50-year permitted to detect one cancer every 10 patients screened. For the third aim, the improvement of blood test for the diagnosis of steatosis and NASH, two new quantitative tests have been constructed and internally validated (APHPSorbonne University Patents), SteatoTest-2 and Nash-Test-2. To manage patients with metabolic risk, these tests have been constructed to reproduce as well as possible the pathologist report of the biopsy, that is estimating the presence and the severity of the elementary histological features: steatosis, inflammatory activity and fibrosis. For this reason a long methodological analysis has been performed to better use as reference the scoring systems now uniformized and recommended by European and American pathologists. The main limitations of our works were the absence of large external validations in patients with metabolic risk, in order to reproduce our results, especially according to a conflict of interest. For the other blood tests widely used in chronic viral hepatitis and alcoholic liver disease, as well as the first generation used in NAFLD, the independent external validations has confirmed the initial performances

Shen, Jiayun.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 166-199).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstract also in Chinese.

In the 1980’s, a handful of authors distilled the anecdotal experiences of adult children of alcoholics (ACoAs) into a syndrome of dysfunctional characteristics that they proposed were shared by most ACoAs. The books they published were commercially successful and launched a popular movement and a self-help industry, which mental health clinicians would eventually need to either acknowledge or refute. In the ensuing years, the ACoA syndrome has become broadly accepted among laypersons, but efforts to validate this syndrome through empirical research have been inconclusive. To date, there is little evidence regarding the degree to which mental health clinicians have embraced the validity of an ACoA symptomology. In this study, mental health clinicians in a southeastern state were surveyed regarding both their endorsement of a distinct ACoA syndrome and the therapeutic utility of ACoA support groups. The results indicated a lack of support for either.

碩士
國立高雄應用科技大學
金融系金融資訊碩士在職專班
106
In the face of the changing global economic environment, the operating environment becomes more difficult, but the development prospects of an enterprise must continue to maintain the competitiveness of enterprises Only by strengthening the business system, and enhancing industrial competition, as well as immediately grasping the external environment and internal operations could we face any challenge, and then get the opportunity to sustainable development. Business management is to pursue profit maximization and sustainable management as the goal will have to do regular diagnosis of business ideas and practices. Through a comprehensive assessment, check, to find the key issues facing the enterprise, and then take appropriate countermeasures to seek to improve the corporate physique and operational efficiency, and to optimize its competitiveness, which will be an important issue of enterprise business. In recent years, the domestic Alcoholic beverage market with the proportion of the aging population continued to rise under the steady growth of market demand, domestic manufacturers focus on the importance of health care for consumers continue to improve. Spotted the relevant market opportunities, and actively goes into the Alcoholic beverage industry. In this study, we use S Company for the diagnosis case, for the Alcoholic beverage industry, the external industrial environment analysis and research, supplemented by the internal assessment of operational capacity of the diagnostic process. Our research based on S company as reference, and Financial/Management/Strategy Analysis proposed by Dr. Chu-yi You as model FMSA, extending into seven major management components: production, sales, human resources, research and development, finance, administration and information. Based on the cross analysis of corporation model evaluation mentioned above, the solution plan and definite strategies are proposed, and will provide to corporation manager as reference to improvise business performance and to help in each individual company. Keywords: Enterprise Diagnosis, Alcoholic beverage, FMSA

Tese no âmbito do Programa Interuniversitário de Doutoramento em Serviço Social da Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, em associação com a Faculdade de Ciências Humanas da Universidade Católica Portuguesa, apresentada à Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra.
O Alcoolismo é um dos maiores problemas de saúde pública, tanto a nível mundial como na sociedade portuguesa, quer pela sua prevalência e gravidade, quer pelo seu impacto social. A multidimensionalidade e carater sistémico do Alcoolismo, requerem a adoção de estratégias de avaliação e intervenção que permitam dar uma resposta mais eficaz a este relevante problema social. O Serviço Social, pela diversidade dos contextos organizacionais e problemáticas em que intervém, pode ter, a par de outras disciplinas profissionais, um papel relevante na sua abordagem, quer ao nível do despiste e diagnóstico, quer na motivação para tratamento, na reinserção social e na prevenção. Neste enquadramento, adotando uma abordagem qualitativa, a presente investigação consistiu na realização dum estudo descritivo e compreensivo das trajetórias de vida dos doentes alcoólicos e da atuação não só dos serviços de apoio e acompanhamento social, bem como do profissional de Serviço Social. Apresentando um quadro analítico do Alcoolismo, enquanto fenómeno e problema social, o estudo começa por discutir as questões ligadas à concetualização, passando a demonstrar o seu impacto no contexto português, refletindo finalmente sobre a intervenção e a eventual relevância do Serviço Social neste âmbito. Metodologicamente, tendo por base uma amostragem por conveniência, num primeiro eixo recorreu-se à realização de 62 entrevistas a doentes alcoólicos, acompanhados por Grupos de Auto-Ajuda, Comunidades Terapêuticas e/ou Centro de Acolhimento Temporário. Essas entrevistas tiveram em vista não só o reconhecimento dos problemas sociais mais associados ao consumo de álcool, como também o mapeamento dos contextos em que os doentes se movem. Para além destes objetivos pretendeu-se identificar as instituições a que os doentes mais recorrem ao longo da sua história de consumo e as situações em que as suspeitas e sinais de alcoolismo são mais evidenciadas. Os dados recolhidos foram analisados numa perspetiva biográfica, que permitiu a reconstituição das trajetórias do consumo e dos percursos institucionais e, em simultâneo, o reconhecimento de práticas efetivas (ou não) de despiste, referenciação e prevenção. Um segundo eixo teve por base a técnica da observação participante a um grupo de diversos representantes de distintos serviços sociais, reunidos num encontro de discussão da intervenção sobre os Problemas Ligados ao Álcool. A partir da modalidade observação-participação, pretendeu-se apreender as perceções, práticas e perspetivas dos assistentes sociais nesta problemática específica, na tentativa de identificar e compreender os fatores que influenciam a sua atuação. Os resultados desta investigação confirmam, por um lado, a relação sistémica e multidimensional entre Alcoolismo e fatores e problemas de ordem social. Por outro lado, identificaram-se diversas trajetórias dos doentes ao nível do consumo e da sua relação com os serviços, apontando para um prolongamento da história natural da doença e uma intervenção, diagnóstico, tratamento e reabilitação tardios. A realidade e o discurso profissional ilustram ainda as necessidades e dificuldades que condicionam a intervenção social neste contexto, nomeadamente ao nível de recursos humanos e físicos e de articulação institucional, bem como no que respeita ao reconhecimento da doença e das suas especificidades e complexidades. Por fim, o presente estudo aponta inequivocamente para o relevante papel dos grupos de auto-ajuda, enquanto estruturas de acompanhamento (in)formal dos doentes e suas famílias, a todos os níveis da intervenção, antes, durante e após o tratamento, da vertente preventiva à reinserção na comunidade, e ainda com uma ação fundamental no reforço para a manutenção da abstinência.
Alcoholism is one of the biggest public health problems worldwide and in portuguese society, both because of its prevalence and severity, and because of its social impact. The multidimensionality and systemic character of alcoholism require the adoption of assessment and intervention strategies that allow a more effective response to this relevant social problem. The Social Service, due to the diversity of the organizational and problematic contexts in which it intervene, may have, along with other professional disciplines, a relevant role in its approach, both in terms of screening and diagnosis, in motivating treatment, in social reintegration and in prevention. In this sense, starting from a qualitative research, was carried out a descriptive and comprehensive study of the life trajectories of alcoholic patients and the performances of not only the support and social monitoring services, as well as the Social Work professionals. Presenting an analytical framework of Alcoholism, as a phenomenon and social problem, the study begins by discussing the issues related to conceptualization, starting to demonstrate its impact in the portuguese context, finally reflecting on the intervention and the possible relevance of Social Work in this context. Methodologically, based on convenience sampling, in a first axis, 62 interviews were carried out with alcoholic patients, accompanied by Self-Help Groups, Therapeutic Communities and / or Temporary Reception Center. The goal of those interviews was not only to recognize the social problems most associated with alcohol consumption, but also to map the contexts in which the patients move. Beyond these aims, it pretend to identify the institutions they use the most throughout their history of consumption and the situations in which the suspicions and signs of alcoholism are most evident. The data collected were analysed from a biographical perspective, which allowed the reproduction of consumption trajectories and institutional paths and, simultaneously, the recognition of screening, referral and prevention, effective (or not), practices. A second axis was based on the participant observation technique to a group of diverse representatives of different social services, gathered in a meeting to discuss the intervention on Alcohol Related Problems. From the observation-participation modality, it was intended to seize the perceptions, practices and perspectives of social workers in this specific problem, to identify and understand the factors that influence their performance. The results of this investigation confirm, by one hand, the systemic and multidimensional relationship between alcoholism and social factors and problems. On the other hand, different trajectories of patients were identified in terms of consumption and their relationship with services, pointing to the extension of the natural history of the disease and late intervention, diagnosis, treatment and rehabilitation. The reality and the professional discourse also illustrate the needs and difficulties that confine social intervention in this context, namely in terms of human and physical resources and institutional link, as well in what concerns to the recognition of the disease and its specificities and complexities. Finally, the present study unequivocally points to the relevant role of self-help groups, as structures of (in) formal monitoring of patients and their families, at all levels of intervention, before, during and after treatment, since the preventive strand to the community reintegration, and also with a fundamental action in strengthening to the maintenance of abstinence.

OBJECTIVE. To identify clinical, socio-demographic, dietary and biological markers to be used in a non-invasive and cost-effective clinical tool for screening for non-alcoholic fatty liver disease (NAFLD) in obese adolescents. METHODS. We conducted a cross-sectional analysis using baseline data from 77 obese adolescents enrolled in a drug trial for the Glaser Pediatric Research Network, between October 2003 and August 2007. NAFLD was defined as the presence of fatty liver infiltration assessed by computed tomography. Receiver operation characteristic (ROC) analyses were performed to identify variables with the highest area under the curve (AUC) for NAFLD. Serum biomarkers were dichotomized using sensitivity analyses to identify the best cutoff point for NAFLD. Multiple logistic regression models were created to predict prevalent NAFLD. RESULTS. Serum triglycerides was identified as the best biomarker for NAFLD (AUC 0.790; pseudo R2 0.235). Additional adjustment for sex, age and Tanner stage improved the AUC to 0.846 and the pseudo R2 to 0.290. We then explored adding a simple biochemical marker for predicting NAFLD (HOMA-B, ALT or glutamate) and found that HOMA-B led to greater improvement in AUC, ALT to a greater improvement in sensitivity and glutamate to a greater improvement in the pseudo R2. Thus, all three factors individually improved overall model performance to some degree and inclusion of all three led to an AUC=0.907 and pseudo R2=0.433. Our second objective was to develop a more complex exploratory model starting with the inclusion of important clinical predictors (triglycerides, sex, age, Tanner stage, SBP, BMI, waist circumference); this yielded an AUC of 0.871 and pseudo R2 of 0.342. Further adjustment for HOMA-B, ALT and glutamate gave an AUC=0.913 and pseudo R2=0.497. CONCLUSION. Simple clinical and biochemical factors may be used to screen for prevalent NAFLD. Our simplest clinically relevant model using triglycerides, age, sex and Tanner stage provided a reasonable screening tool for NAFLD in obese adolescents. A second more complex model that warrants further testing includes triglycerides, sex, age, Tanner stage, SPB, BMI, waist circumference, HOMA-B, ALT and glutamate. In this study, this model was more accurate for detecting undiagnosed cases of NAFLD in this pediatric population.

Indiana University-Purdue University Indianapolis (IUPUI)
The ultimate goal of this study is to build a decision support system to aid the pathologists in diagnosing Non-Alcoholic Fatty Liver Disease (NAFLD) in both adults and children. The disease is caused by accumulation of excess fat in liver cells. It is prevalent in approximately 30% of the general population in United States, Europe and Asian countries. The growing prevalence of the disease is directly related to the obesity epidemic in developed countries. We built computational methods to detect and quantify the histological features of a liver biopsy which aid in staging and phenotyping NAFLD. Image processing and supervised machine learning techniques are predominantly used to develop a robust and reliable system. The contributions of this study include development of a rich web interface for acquiring annotated data from expert pathologists, identifying and quantifying macrosteatosis in rodent liver biopsies as well as lobular inflammation and portal inflammation in human liver biopsies. Our work on detection of macrosteatosis in mouse liver shows 94.2% precision and 95% sensitivity. The model developed for lobular inflammation detection performs with precision and sensitivity of 79.3% and 81.3% respectively. We also present the first study on portal inflammation identification with 82.1% precision and 88.3% sensitivity. The thesis also presents results obtained for correlation between model computed scores for each of these lesions and expert pathologists' grades.

Fetal Alcohol Syndrome (FAS) is a preventable cause of mental retardation and is the severest category within Fetal Alcohol Spectrum Disorder (FASD). As gestational alcohol exposure affects fetal cognitive functioning, children with FAS present with intellectual deficits. Unfortunately FASD prevalence rates are increasing amongst infants and school-going children. The main goal of this study was to compare the neurodevelopmental subscales of infants diagnosed with FAS, Partial FAS and non- FAS. Seventy-four infants with confirmed FAS, Partial FAS or Non- FAS diagnoses were assessed using the Griffiths Mental Developmental Scale. Development assessed at 7-12 and 17-29 months of age showed that, regardless of a FAS, PFAS or Non-FAS diagnosis, all infants performed weaker at their assessment at 17-29 months. The Subscales significantly affected included Personal-Social, Eye- Hand Coordination and Performance. The infants with FAS and PFAS displayed the most marked developmental delays. From this study it can be concluded that there are definite neurodevelopmental profiles for infant's diagnosed with FAS, PFAS and/or Non-FAS, highlighting the significant impact of prenatal alcohol exposure on various aspects of infant development.
Social work
M.Diac.

This thesis focuses on the effects of n-3 polyunsaturated fatty acids (n-3 PUFA) on development of non-alcoholic fatty liver disease (NAFLD) in experiment, on prevalence of this condition in patients with type 2 diabetes mellitus and metabolic syndrome and also on non-invasive diagnostics. The aim was to study the effect of n-3 PUFA on NAFLD development in an experimental model and based on analysis of a group of patients with type 2 diabetes and metabolic syndrome to assess the prevalence of this condition. Lastly we aimed to evaluate non-invasive diagnostic methods of liver fibrosis and NASH. We demonstrated beneficial effects of n-3 PUFA administration on NAFLD development in a C57/Bl6 mice high fat methionin-cholin defficient dietary model of NAFLD. n-3 PUFA administration led to biochemical improvement, decrease of lipid accumulation in the liver as well as improvement of histology. These effects are determined by complex modulation of lipid metabolism, mainly due to decrease in availability of fatty acids for triglyceride synthesis in the liver, changes of adipokine levels and amelioration of proinflammatory status in the liver. In a group of type 2 diabetics we found NAFLD prevalence of almost 80%, 14% of these patients had also signs of liver fibrosis or cirrhosis. Non-invasive methods...