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Bakalářská práce na téma "Intoxikace etylalkoholem v urgentní medicíně" je rozdělena do dvou hlavních celků. Teoretická část se zabývá intoxikací etylalkoholem, jeho chemickými vlastnostmi a mechanismy působení na lidský organismus. Dále možnostmi léčby akutních a chronických patologických stavů vzniklých v souvislosti s konzumací alkoholu a rovněž psychickými a sociálními důsledky alkoholismu. Výzkumná část přináší výsledky dotazníkového šetření, které bylo zaměřeno na psychosociální aspekty výjezdů ZZS k osobám pod vlivem alkoholu. Respondenty tohoto výzkumu byli zdravotničtí pracovníci výjezdových stanovišť ZZS., Bachelor Thesis on the topic "Ethyl Alcohol Intoxication in Emergency Medicine" is divided in to two main parts. The theoretical part deals with intoxication by ethylalcohol (ethanol), its properties and its impact on the human body, furthermore with treatment options for acute and chronic pathological states associated with alcohol consumption, and mental and social consequences of alcoholism as well. The research part presents results of a questionnaire survey performed among paramedics (of the EMS dispatch centres) which was focused on psychosocial aspects of EMS dispatches to persons under the influence of alcohol., Katedra ošetřovatelství, Hodnocení vedoucího: výborně minus Hodnocení oponenta: velmi dobře Doplňující otázky k obhajobě: 1. V teoretickém přehledu nemocí jater mi chybí diagnóza, která se v anglické literatuře označuje zkratkou NAFLD. O jakou nemoc se jedná a jaký je její český ekvivalent? 2. Na straně 25 uvádíte, že standard tělěsné hmotnosti člověka je 70 kg. Dlouhodobě se tento standard skutečně používá, včetně dávkování léků na kg hmotnosti. Jako preventivní lékař a obezitolog se skromně domnívám, že tato čísla jsou překonána. Prosím o uvedení citačních pramenů, které potvrzují váš předpoklad 70 kg normy dospělého člověka. 3. Na straně 24 uvádíte, že standard pro stupnivost piva je 5% (40g/l). Jaký je rozdíl mezi stupnivostí piva s obsahem alkoholu v pivu? Jaký je rozdíl mezi pivem typu ležák a pivem výčepní pivo? Na čem záleží stupnivost piva? Vysvětlete pojem obsah nebo extrakt původní mladiny v pivu. Jaké je stupnivost piva Pilsner Urquell? Napovídám, že se nejedná o dvanáctistupňové pivo. Obhajoba bakalářské práce s prezentací výborná., Dokončená práce s úspěšnou obhajobou

BACKGROUND: Craving is implicated the maintenance of alcohol abuse and dependence as well as relapse during attempts at recovery. An early investigation by Boggio et al. (2008b) demonstrated that transcranial direct current stimulation (tDCS) applied over dorsolateral prefrontal cortex (DLPFC) was effective in reducing craving among individuals with alcohol dependence. The present study is the first to continue to explore the potential of tDCS to manipulate craving in the context of alcohol use and abuse. METHODS: 18 adult participants completed assessments of alcohol abuse severity, and of alcohol craving and mood before and after transcranial stimulation. Active and sham tDCS of DLPFC was utilized in two separate experimental sessions. The protocol was revised midway through the study to include potential induction of craving through the visual presentation of alcohol cues. RESULTS: Within the revised protocol, a comparison of pre- to post-stimulation difference scores for active versus sham stimulation produced a reduction in craving that approached significance (p = .06). A comparison of pre- to post-stimulation scores for active stimulation produced a significant reduction in craving (p = .03), whereas a comparison of pre- to post-stimulation scores for sham stimulation was nonsignificant(p = .42). A significant linear relationship existed between response to active stimulation and both alcohol abuse severity and retrospective accounts of alcohol craving. CONCLUSIONS: The findings showed that tDCS applied to the DLPFC may be effective in reducing alcohol craving among individuals with alcohol use disorders who experience frequent or intense cravings. The use of minimum cutoff scores on assessments of alcohol abuse severity and alcohol craving may aid in identifying individuals who would benefit from tDCS treatment. Additional research may demonstrate the utility of noninvasive brain stimulation in clinical alcohol abuse treatment settings.

BACKGROUND: Craving is implicated the maintenance of alcohol abuse and dependence as well as relapse during attempts at recovery. An early investigation by Boggio et al. (2008b) demonstrated that transcranial direct current stimulation (tDCS) applied over dorsolateral prefrontal cortex (DLPFC) was effective in reducing craving among individuals with alcohol dependence. The present study is the first to continue to explore the potential of tDCS to manipulate craving in the context of alcohol use and abuse. METHODS: 18 adult participants completed assessments of alcohol abuse severity, and of alcohol craving and mood before and after transcranial stimulation. Active and sham tDCS of DLPFC was utilized in two separate experimental sessions. The protocol was revised midway through the study to include potential induction of craving through the visual presentation of alcohol cues. RESULTS: Within the revised protocol, a comparison of pre- to post-stimulation difference scores for active versus sham stimulation produced a reduction in craving that approached significance (p = .06). A comparison of pre- to post-stimulation scores for active stimulation produced a significant reduction in craving (p = .03), whereas a comparison of pre- to post-stimulation scores for sham stimulation was nonsignificant(p = .42). A significant linear relationship existed between response to active stimulation and both alcohol abuse severity and retrospective accounts of alcohol craving. CONCLUSIONS: The findings showed that tDCS applied to the DLPFC may be effective in reducing alcohol craving among individuals with alcohol use disorders who experience frequent or intense cravings. The use of minimum cutoff scores on assessments of alcohol abuse severity and alcohol craving may aid in identifying individuals who would benefit from tDCS treatment. Additional research may demonstrate the utility of noninvasive brain stimulation in clinical alcohol abuse treatment settings.

The investigators of the COMBINE (Combining Medications and Behavioral Interventions for Alcoholism) Study aimed to determine whether naltrexone, a drug alleged to reduce cravings for alcohol, combined with a behavioral intervention (CBI) assumed to change stress and coping behaviors, improves drinking outcomes more than either alone. After 16 weeks, only naltrexone alone and CBI alone significantly increased percent days abstinent (PDA) in models controlling for baseline PDA and site of treatment administration. Unexpectedly, the naltrexone + CBI combination did not offer any advantage over either naltrexone alone or CBI alone. To understand moderating and mediating factors, and to help explain the Combination's lack of improvement over each monotherapy, controlled and natural direct effect analyses were performed using targeted maximum likelihood estimation (TMLE). TMLE offers several advantages over traditional direct effect analytic approaches such as double-robustness and allowance of treatment moderation by potential mediators. Cravings and stress were examined as theoretically informed mediators/moderators. Controlled direct effect results show that naltrexone, CBI, and the Combination all work best when cravings are high, while none work when cravings are low. Similarly, naltrexone and the Combination work better when stress is high. Natural direct/indirect effect results show that all three treatments' effects are at least partially mediated by cravings, and that craving reduction explains 47-63% of treatment effects. Furthermore, naltrexone appears to affect cravings earlier while CBI works later. Taken together, the set of results suggests the possibility of a threshold effect; if naltrexone reduces cravings early on and CBI is not effective when cravings are low, then the Combination's lack of improvement over either monotherapy should not be surprising.

The investigators of the COMBINE (Combining Medications and Behavioral Interventions for Alcoholism) Study aimed to determine whether naltrexone, a drug alleged to reduce cravings for alcohol, combined with a behavioral intervention (CBI) assumed to change stress and coping behaviors, improves drinking outcomes more than either alone. After 16 weeks, only naltrexone alone and CBI alone significantly increased percent days abstinent (PDA) in models controlling for baseline PDA and site of treatment administration. Unexpectedly, the naltrexone + CBI combination did not offer any advantage over either naltrexone alone or CBI alone. To understand moderating and mediating factors, and to help explain the Combination's lack of improvement over each monotherapy, controlled and natural direct effect analyses were performed using targeted maximum likelihood estimation (TMLE). TMLE offers several advantages over traditional direct effect analytic approaches such as double-robustness and allowance of treatment moderation by potential mediators. Cravings and stress were examined as theoretically informed mediators/moderators. Controlled direct effect results show that naltrexone, CBI, and the Combination all work best when cravings are high, while none work when cravings are low. Similarly, naltrexone and the Combination work better when stress is high. Natural direct/indirect effect results show that all three treatments' effects are at least partially mediated by cravings, and that craving reduction explains 47-63% of treatment effects. Furthermore, naltrexone appears to affect cravings earlier while CBI works later. Taken together, the set of results suggests the possibility of a threshold effect; if naltrexone reduces cravings early on and CBI is not effective when cravings are low, then the Combination's lack of improvement over either monotherapy should not be surprising.

Kristen manlighet - en modernitetens paradox?

The focus for this thesis is the alcoholic care in Sweden from the establishment of the first alcoholic institution in 1885 and the years right after the compulsory care act was passed in 1913. In the thesis the practical activity at the four first alcoholic institutions is examined, but also the ideas concerning alcoholic care that were formulated by the men that were the institutions initiators and responsible for the activities. The research has its starting point in and also confirms care as a sociocultural phenomenon and not merely a medical issue, and that there is an agreement in terms of meaning between the ideals expressed by the medicine as well as other societal interests. Both idea and actual practice have been examined in order to answer the question how the alcoholic care was shaped as a result of the medicalization of the drunkenness problem, but also the consequences of this alcoholic care. Especially the American and the British research position has proved that conceptions about will and morals have been significant to the shaping of a care ideology concerning the alcoholism and its treatment. A second question the research has intended to answer is if, an if then how, such conceptions affected the care ideology and the actual care in practice also in Sweden. One of the results of this thesis is that the early alcoholic care in Sweden ideologically claimed to represent and originate from medical principles and knowledge, even though the treatment methods proposed and practiced originated from the conception about alcoholism as a willpower illness. The purpose with the treatment was primarily to affect the will and moral and consequently the traditional medical science and pharmaceutics were given a subordinated position compared to the medical methods that proceeded from a holistic view on the human, as for example hypnosis and water therapy. The treatment was also individualized according to a relation between the doctor and each patient. The exam

The study concerns multivariate prediction of the short-term outcome of alcoholism in a coercive treatment setting in Sweden. One hundred and twenty-one patients (87 men, 34 women) with a mean age of 41 (range 26-63) years attended a 5-week programme. They were for the most part severely alcohol-dependent and socially unstable. Compulsorily committed patients (n=32) were less socially stable but did not differ from the voluntary patients (n=89) in the type of drugs abused or the severity of their dependence. Nine months (mean) after treatment, a follow-up was performed by mailing questionnaires to the patients and to the referring social workers. The improvement data in the questionnaires were checked with other data. Data on alcohol abuse were available for 116 (96%) of the patients. Fifty-five percent improved. Of these, 13% had remained entirely abstinent. Using multivariate logistic regression, participation in a self-help group and first-time admission were found to be significant factors for overall improvement, while having a family and more than primary education were significant for abstinence. Compulsory commitment to treatment was not related to the short-term drinking outcome. Undergoing voluntary treatment and having previous treatment experience were significant factors for participation in self-help groups.