Search

Blood group and secretor status were determined in 89 heavy drinkers receiving outpatient treatment at a district general hospital in north-west London, and compared with 89 age-, sex- and ethnic origin-matched controls drawn from a panel of 1700 patients from a contiguous general practice. There were no significant differences in the distribution of ABO types and secretor status in the two groups. Differences in salivary mucins were investigated by assaying levels of sialylated and non-sialylated Lewis antigens and blood group antigens ABH in both patients and controls. Although there were no differences in the mean antigen levels for H, A, B Le(a) and Le(b) antigens, using the monoclonal antibody 19.9 (to sialylated Lewis(a) antigen), higher levels were found for groups O and B/AB non-secretors and for group A secretors in alcoholics compared with controls. In addition, inappropriate Le(a) and 19.9 immuno-reactivities were detected in the saliva samples of a group O Le(a)-b- secretor alcoholic and a group A Le(a)-b- secretor alcoholic, respectively. It is suggested that these changes in glycosylation of salivary proteins relate to the increased parotid gland cell proliferation known to occur in chronic alcoholics.

A self-administered questionnaire, the Health Survey Questionnaire (HSQ) was distributed to patients registered with 47 group general practices. The HSQ assesses alcohol consumption using a quantity frequency scale and includes the four CAGE questions and a question on whether respondents think they have an alcohol problem. A random stratified sample of those patients who returned an HSQ (2666 men and 1537 women) were subsequently invited to attend their general practice for an interview with the practice nurse, where weekly alcohol consumption was estimated using both a quantity frequency scale and a systematic enquiry about alcohol consumption for the week immediately preceding the interview. The latter method was taken as the 'gold standard'. Excessive drinkers were defined as men whose weekly consumption by this method was not less than 35 units per week and women drinking at least 21 units per week. After weighing the results to take account of the sampling bias in favour of the excessive drinkers, 11.7% of men and 2.9% of women were excessive drinkers according to the estimate of alcohol consumption at interview. This compares with the 7.6% of men and 2.7% of women who were heavy drinkers by the HSQ quantity frequency scale. The two interview estimates were comparable but in general the HSQ tended to underestimate consumption compared with these estimates. The questionnaire was found to be most effective in screening for excessive drinkers if all the patients who indicated concern about their drinking (i.e. those who were with CAGE positive or had a self-assessed drinking problem), as well as all of those who were above the limits for the trial on the quantity frequency scale, were selected as being potentially excessive drinkers. In the weighted sample, 14.8% of men and 6.9% of women were in this group. Using these selection criteria and taking the interview as the standard for determining the excessive drinkers a sensitivity of 58.6% and specificity of 91.08% was obtained for men, with a positive predictive value of 46.1% and a negative predictive value of 94.3%. For women the test was more sensitive (69.7%) and more specific (95.0%) and had a better negative predictive value (99.1%) than for men. The positive predictive value for women at 29.6% was not as good as that obtained for men. This analysis shows that the HSQ is a fairly effective tool for detecting excessive drinkers in general practices with a small proportion of false positive results. It is both economical and acceptable to patients in a wide range of practice settings.