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ObjectivesTo evaluate associations between alcohol brief intervention (BI) in primary care and 12-month drinking outcomes and 18-month health outcomes among adults with hypertension and type 2 diabetes (T2D).DesignA population-based observational study using electronic health records data.SettingAn integrated healthcare system that implemented system-wide alcohol screening, BI and referral to treatment in adult primary care.ParticipantsAdult primary care patients with hypertension (N=72 979) or T2D (N=19 642) who screened positive for unhealthy alcohol use between 2014 and 2017.Main outcome measuresWe examined four drinking outcomes: changes in heavy drinking days/past 3 months, drinking days/week, drinks/drinking day and drinks/week from baseline to 12-month follow-up, based on results of alcohol screens conducted in routine care. Health outcome measures were changes in measured systolic and diastolic blood pressure (BP) and BP reduction ≥3 mm Hg at 18-month follow-up. For patients with T2D, we also examined change in glycohaemoglobin (HbA1c) level and ‘controlled HbA1c’ (HbA1c<8%) at 18-month follow-up.ResultsFor patients with hypertension, those who received BI had a modest but significant additional −0.06 reduction in drinks/drinking day (95% CI −0.11 to −0.01) and additional −0.30 reduction in drinks/week (95% CI −0.59 to −0.01) at 12 months, compared with those who did not. Patients with hypertension who received BI also had higher odds for having clinically meaningful reduction of diastolic BP at 18 months (OR 1.05, 95% CI 1.00 to 1.09). Among patients with T2D, no significant associations were found between BI and drinking or health outcomes examined.ConclusionsAlcohol BI holds promise for reducing drinking and helping to improve health outcomes among patients with hypertension who screened positive for unhealthy drinking. However, similar associations were not observed among patients with T2D. More research is needed to understand the heterogeneity across diverse subpopulations and to study BI’s long-term public health impact.

Background Unhealthy alcohol use is a public health problem with significant health, social and economic impacts. Alcohol screening and brief intervention (ASBI) in adult primary care is an evidence-based approach enabling early identification and intervention of unhealthy alcohol use. However, large-scale implementation and sustainment of ASBI in routine clinical practice remains a challenge, and little is known about its population-level impact. Using electronic health record (EHR) data in a large integrated healthcare system in Northern California that implemented systematic ASBI in adult primary care in mid-2013, this observational study examined: 1) trajectories of ASBI performance over 5 years post systematic implementation, and 2) their associations with both later ASBI performance and alcohol use outcomes. Methods Using the health plan’s EHR data, we calculated annual screening rates of adults with a primary care visit, and brief intervention (BI) rates among those with a positive screen (i.e., reporting alcohol consumption exceeding the age and sex specific daily and weekly low-risk National Institute on Alcohol Abuse and Alcoholism guidelines), for 57 medical facilities from years 2014 to 2021. We conducted latent class growth analysis using annual screening and BI rates to characterize trajectories of ASBI performance from years 2014–2018. Multivariable mixed-effects models were fit to examine the associations of ASBI performance trajectories with later ASBI performance and facility-level alcohol use outcomes. Results Three distinct screening performance trajectory groups (low-, middle- and high-performance) and four distinct BI performance trajectory groups (low-, improving-, middle- and high-performance) were identified. Facilities in the low-BI-performance group had panels of patients living in more deprived neighborhoods compared to the other 3 BI performance groups. After accounting for repeated measures and adjusting for time and patient panel characteristics, we found that screening and BI performance trajectories during 2014–2018 were significantly associated with screening and BI rates 2019–2021, respectively. We also observed a steeper decline in percentages reporting “exceeding daily drinking limits” and “having 5 + binge drinking days” over time among patients of facilities in the improving- and high-BI-performance groups. Conclusions Early success in ASBI performance is associated with long-term sustainability and may be associated with long-term population-level drinking outcomes.

Background: Nearly 80 million Americans suffer from hypertension, with approximately half of these patients lacking blood pressure control. Blacks are twice as likely to be diagnosed with hypertension. This places Blacks at a disproportionate risk for cardiovascular morbidity and mortality as compared to their white counterparts.Purpose: The purpose of this qualitative phenomenological study was to explore the lived experience of Black young adults with hypertension. The intention of this study was to give Black young adults an opportunity to voice their own truth as related to the phenomenon being explored.Philosophical Underpinnings: A hermeneutic phenomenological approach was used to guide this inquiry. The relativist ontology and subjectivist epistemology underpinned this study, which sought to understand the meaning of the participants’ experiences.Methods: Using the lens of qualitative paradigm and the hermeneutic phenomenological approach, data collection methods included purposive and snowballing sampling, semi-structured audio-recorded interviews, and participant transcription. Specifically, Max van Manen’s hermeneutic phenomenological approach was used to guide the process of data collection and analysis. Reflexive journaling was used to maintain credibility. The data were analyzed using Creswell’s six activities as an approach to data analysis.Results: Four major themes emerged from this inquiry’s findings. The themes were: our food is our culture, self-management, self-imposed stigma: we don’t talk our business, and journeying toward acceptance. These themes revealed the experience of Black young adults with hypertension.Conclusions: This study demonstrated that Black young adults with hypertension are aware of their disease and the potential implications of a lack of treatment adherence and lifestyle modifications, and they do work towards making the necessary changes that will improve outcomes. The theme of our food is our culture demonstrated that there are cultural nuances that greatly influence the dietary choices of Black young adults with hypertension. Although these participants were aware of the negative effect of some of their cultural foods, it was difficult to make the necessary adjustments to their diets. Many expressed the internal struggles with their decisions versus their health. All participants recognized self-management was key to meeting their blood pressure goals. Though each participant developed their self-management regime at different paces, they all recognized the importance of doing so. The theme of self-imposed stigma: we don’t talk our business was a significant part of the psychological and sociocultural dynamics that was disclosed in this inquiry. The participants had varying experiences with stigma, or a feeling of being judged. This unfortunately manifested in the participants largely not wanting to share their diagnosis and experiences with others. The final theme of journeying toward acceptance exemplified the process of the participants adjusting to their new reality in living with their diagnosis. Trying to be healthy, but it’s a struggle emerged as the essence of the phenomenon. This study’s findings add to the existing body of nursing knowledge and supports the need for further research that identifies strategies that support Black young adults with hypertension in achieving positive healthcare outcomes.

There is a need to increase the armamentarium of pharmacotherapies for alcohol use disorder (AUD). Recent research suggests that mineralocorticoid receptor (MR) antagonism via spironolactone may represent a novel pharmacological treatment for AUD. We conducted a pharmacoepidemiologic retrospective cohort study (June 1, 2014 to May 31, 2018) to examine whether spironolactone dispensation (≥90 continuous days), for any indication, is associated with changes in weekly alcohol use about 6 months later. We compared 523 spironolactone-treated adults and 2305 untreated adults, matched on high-dimensional propensity scores created from a set of predefined (sociodemographic and health characteristics, diagnoses, and service utilization) and empirical electronic health record-derived covariates. The sample was 57% female and 27% non-White with a mean age of 59.2 years (SD = 19.3). Treated patients reduced their weekly alcohol use by 3.50 drinks (95% CI = −4.22, −2.79), while untreated patients reduced by 2.74 drinks (95% CI = −3.22, −2.26), yielding a significant difference of 0.76 fewer drinks (95% CI = −1.43, −0.11). Among those who drank >7 drinks/week at baseline, treated patients, compared to untreated patients, reported a greater reduction in weekly alcohol use by 4.18 drinks (95% CI = −5.38, −2.97), while there was no significant difference among those who drank less. There was a significant dose-response relationship between spironolactone dosage and change in drinks/week. Pending additional evidence on its safety and efficacy in individuals with AUD, spironolactone (and MR blockade, at large) may hold promise as a pharmacotherapy for AUD.

Excessive alcohol consumption is associated with increased incidence of several medical conditions, but few nonveteran, population-based studies have assessed levels of alcohol use across medical conditions. To examine associations between medical conditions and alcohol consumption levels in a population-based sample of primary care patients using electronic health record data. This cross-sectional study used separate multinomial logistic regression models to estimate adjusted associations between 26 medical conditions and alcohol consumption levels in a sample of 2 720 231 adult primary care patients screened for unhealthy drinking between January 1, 2014, and December 31, 2017, then only among those reporting alcohol use. The study was conducted at Kaiser Permanente Northern California, a large, integrated health care delivery system that incorporated alcohol screening into its adult primary care workflow. Data were analyzed from June 29, 2018, to February 7, 2020. The main outcome was level of alcohol use, classified as no reported use, low-risk use, exceeding daily limits only, exceeding weekly limits only, or exceeding daily and weekly limits, per National Institute on Alcohol Abuse and Alcoholism guidelines. Other measures included sociodemographic, body mass index, smoking, inpatient and emergency department use, and a dichotomous indicator for the presence of 26 medical conditions in the year prior to the alcohol screening identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes. Among the 2 720 231 included patients, 1 439 361 (52.9%) were female, 1 308 659 (48.1%) were white, and 883 276 (32.5%) were aged 18 to 34 years. Patients with any of the conditions (except injury or poisoning) had lower odds of drinking at low-risk and unhealthy levels relative to no reported use compared with those without the condition. Among 861 427 patients reporting alcohol use, patients with diabetes (odds ratio [OR], 1.11; 95% CI, 1.08-1.15), hypertension (OR, 1.11; 95% CI, 1.09-1.13), chronic obstructive pulmonary disease (COPD; OR, 1.16; 95% CI, 1.10-1.22), or injury or poisoning (OR, 1.06; 95% CI, 1.04-1.07) had higher odds of exceeding daily limits only; those with atrial fibrillation (OR, 1.12; 95% CI, 1.06-1.18), cancer (OR, 1.06; 95% CI, 1.03-1.10), COPD (OR, 1.15; 95% CI, 1.09-1.20), or hypertension (OR, 1.37; 95% CI, 1.34-1.40) had higher odds of exceeding weekly limits only; and those with COPD (OR, 1.15; 95% CI, 1.07-1.23), chronic liver disease (OR, 1.42; 95% CI, 1.32-1.53), or hypertension (OR, 1.48; 95% CI, 1.44-1.52) had higher odds of exceeding both daily and weekly limits. Findings suggest that patients with certain medical conditions are more likely to have elevated levels of alcohol use. Health systems and clinicians may want to consider approaches to help targeted patient subgroups limit unhealthy alcohol use and reduce health risks.

Immediately following that lengthy debate, council took up the less mundane issue of rezoning at Maitland Avenue and Woodward Drive and, in so doing, rejected without discussion a written assertion that a community's rights...

Individually, our aldermen stood and expounded on the general virtues of welfare; the witless idea of having the proposed grant diverted to the welfare budget; the equally witless idea of closing down the National Arts Centre and redirecting the city's grant to the welfare budget; the facetious idea of converting to the welfare budget all the funds that are allocated to sports; and the equally facetious idea of converting to the welfare budget those monies which are allocated to the enlargement of aldermen's offices. Then, our aldermen introduced a few irrelevant issues of their own. They expounded on the amount of money that was being allocated to the sports group vis-a-vis the arts group; the justification of providing a grant to the Ottawa Dance Theatre just because the arts were worth supporting; the justification for providing a grant to the theatre because one had been given to the Great Canadian Theatre in 1985; and the justification for providing a grant because the Ottawa Dance Theatre hadn't received any city grants since 1981.

ABSTRACT Murine macrophages are activated by interferon-γ (IFN-γ) and/or Toll-like receptor (TLR) agonists such as bacterial endotoxin (lipopolysaccharide [LPS]) to express an inflammatory (M1) phenotype characterized by the expression of nitric oxide synthase-2 (iNOS) and inflammatory cytokines such as tumor necrosis factor-α (TNF-α) and interleukin (IL)-12. In contrast, Th2 cytokines IL-4 and IL-13 activate macrophages by inducing the expression of arginase-1 and the anti-inflammatory cytokine IL-10 in an IL-4 receptor-α (IL-4Rα)-dependent manner. Macrophages activated in this way are designated as “alternatively activated” (M2a) macrophages. We have shown previously that adenosine A 2A receptor (A 2A R) agonists act synergistically with TLR2, TLR4, TLR7, and TLR9 agonists to switch macrophages into an “M2-like” phenotype that we have termed “M2d.” Adenosine signaling suppresses the TLR-dependent expression of TNF-α, IL-12, IFN-γ, and several other inflammatory cytokines by macrophages and induces the expression of vascular endothelial growth factor (VEGF) and IL-10. We show here using mice lacking a functional IL-4Rα gene (IL-4Rα −/− mice) that this adenosine-mediated switch does not require IL-4Rα-dependent signaling. M2d macrophages express high levels of VEGF, IL-10, and iNOS, low levels of TNF-α and IL-12, and mildly elevated levels of arginase-1. In contrast, M2d macrophages do not express Ym1, Fizz1 (RELM-α), or CD206 at levels greater than those induced by LPS, and dectin-1 expression is suppressed. The use of these markers in vivo to identify “M2” macrophages thus provides an incomplete picture of macrophage functional status and should be viewed with caution.