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The frequency of smoking and problem drinking among general hospital inpatients in Brazil - using the AUDIT and Fagerström questionnaires

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INTRODUCTION

Data fro m the USA indicate that o nly 15% o f alco -ho lics seek specialized treatment fo r alco -ho lism. Ho w-ever, 70% o f the appro ximately 11 millio n alco ho lics in that co untry have been treated in general medicine ser-vices within the last 6 mo nths.1 Mo st o f these visits are

fo r general medical assessments and no t fo r mental health pro blems. Studies calculate that the eco no mic co sts o f alco ho l and drug abuse and mental illness are estimated at US$ 273.3 billio n. The estimates include US$ 85.8 billio n fo r alco ho l abuse, US$ 58.3 billio n fo r drug abuse and US$ 129.3 billio n fo r mental illness.2

Over the last two decades several studies have been undertaken in Brazil that sho w a relatively high prevalence o f alco ho l misuse amo ng inpatients in gen-eral ho spitals. One o f the pio neer studies in this field was that o f Masur et al,3 who fo und that 55% o f male

inpatients o n a general medical ward co nsumed mo re than half a liter o f “cachaça” (a distilled spirit made fro m sugar cane) per day. Since then o ther autho rs, fro m dif-ferent regio ns o f the co untry, have fo und a prevalence o f alco ho l abuse o r dependence o f between 9% and 32% amo ng general ho spital inpatients.4-7 Much o f this

varia-tio n in repo rted prevalence is due to metho do lo gical dif-ferences between the studies, in particular the defini-tio n o f alco ho l dependence o r abuse. Levels o f co nsump-tio n are, by and large, co nsiderably higher than tho se fo und in the general po pulatio n. Fo r example, in the Bra-zilian Multicentric Psychiatric Mo rbidity Survey, co n-ducted in three majo r urban areas in Brazil and using DSM-III diagno stic criteria, the prevalence o f alco ho l

dependence was 15%.8

Original Article

REVISTA PAULISTA DE MEDICIN A

The fre que ncy of smoking and proble m drinking

among ge ne ral hospital inpatie nts in Brazil

-using the AUDIT and Fage rström que stionnaire s

Alcohol and Drug Research Unit, Department of Psychiatry,

Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil

a b s t r a c t

CON TEXT: Altho ugh the CAG E questio nnaire is o ne o f the mo st widely used alco ho l screening instruments, it has been criticized fo r no t identifying peo ple who are drinking heavily o r who have alco ho l related pro blems but do no t as yet sho w sympto ms o f alco ho l de-pendence. The AUDIT (Alco ho l Use Diso rder Identificatio n Test) ques-tio nnaire was develo ped by W HO as a screening instrument spe-cifically desig ned to identify pro blem drinkers, as well as tho se who were already dependent o n alco ho l.

OBJECTIVE: The aim o f this study was to use the AUDIT and Fagerströ m questio nnaires in a g eneral ho spital inpatient po pulatio n to measure the frequency o f pro blem drinking and nico tine dependence, and to see if levels varied between medical speciality.

DESIGN : Retro spective cro ss-sectio nal study.

SETTIN G: Federally funded public teaching ho spital.

SAM PLE: 2 7 5 inpatients fro m bo th g enders.

M AIN M EASUREM EN TS: So cio demo g raphic data, AUDIT (Alco ho l Use Diso rders Identificatio n Test) and Fag erströ m Test fo r N ico -tine Dependence.

RESULTS: W e interviewed 2 7 5 inpatients, 4 9 % o f who m were men and 5 1 % wo men. Thirty-fo ur patients were identified as “ cases” by the Audit questio nnaire; 2 2 % o f the male patients and 3 % o f the females. Just o ver 2 1 % o f inpatients were current smo kers. The g as-tro entero lo g y (2 6 %) and g eneral medicine (1 6 %) inpatient units had the larg est number o f individual cases.

CON CLUSION S: O nly by kno wing the prevalence o f alco ho l abuse/ dependence and nico tine dependence in a g eneral ho spital can we evaluate the need fo r a specialized liaiso n service to identify and treat these patients.

KEY W ORDS: AUDIT. Fag erströ m. Screening . Liaiso n psychiatry. In-patients.

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Research fro m o ther co untries largely suppo rts the finding that inpatients are mo re likely to have pro blems with alco ho l.9-11 The impo rtance o f identifying these

pa-tients lies in the po ssibility o f pro viding so me fo rm o f interventio n aimed at reducing alco ho l co nsumptio n and thereby reducing the risk that the patient will subse-quently develo p co mplicatio ns o f alco ho l misuse.

Just ho w and by who m these patients sho uld be identified is o pen to debate. Sho rt screening instruments have the advantage that they do no t take lo ng to fill in and can be used with very little training by almo st any health care pro fessio nal.12 The CAGE questio nnaire is

o ne o f the mo st widely used alco ho l screening instru-ments and has a high sensitivity and specificity fo r iden-tifying patients with alco ho l dependence. Ho wever, it has been criticized fo r no t identifying peo ple who are drink-ing heavily o r who have alco ho l-related pro blems but do no t as yet sho w sympto ms o f alco ho l dependence. In-deed it is these very patients who may benefit mo st fro m early therapeutic interventio ns. The AUDIT (Alco ho l Use Diso rder Identificatio n Test) questio nnaire was devel-o ped by WHO13 as a screening instrument specifically

designed to identify pro blem drinkers, as well as tho se who were already dependent o n alco ho l. It has a repo rted sensitivity o f 92% and a specificity o f 93%.14 Skipsey, et

al.15 fo und an excellent level o f internal co nsistency in

the identificatio n o f “hard” drinkers and alco ho l dependence. When co mpared with the MAST (Michigan Alco -ho lism Screening Test), the AUDIT was co nsidered su-perio r, as the MAST failed to identify recent pro blems bro ught o n by heavy alco ho l co nsumptio n. The AUDIT has been fo und to be a very pro mising instrument fo r the identificatio n o f alco ho l abuse and dependence amo ng patients in diverse medical settings.16-18

It is estimated that 30% o f men and 35% wo man are current smo kers and abo ut 3 millio n peo ple die each year due to co nsequences o f cigarette smo king. Acco rd-ing to the Wo rld Health Organizatio n, if this prevalence is maintained, by the year 2020 ten millio n peo ple will be dying per year fro m smo king-related diseases.19

Nico tine dependence represents a serio us pub-lic health pro blem. Data sho w that 19% o f deaths in the USA are smo king–related.20 In Brazil there is a lack o f

data co ncerning the prevalence o f smo king, especially amo ng po pulatio ns in co ntact with health care services. The Fagerströ m To lerance Questio nnaire (FTQ) is a sho rt self-repo rted measure o f nico tine dependence.21

The FTQ has been criticized because o f psycho metric deficiencies, such as having a multifacto rial structure, a lo w le ve l o f re liab ility and po o r ite m se le ctio n.22

Heatherto n et al23 revised the questio nnaire to pro duce

what they call the Fagerströ m Test fo r Nico tine

Depen-dence (FTND), which has an internal co nsistency o f 0.61 and who se sco res are clo sely related to bio chemical in-dices o f heavy smo king. Saxo n, et al.24 fo und that when

smo kers were assessed with bo th instruments, the mean sco res o n the FTND were higher than tho se o f the FTQ.

The aim o f this study was to use the AUDIT and Fagerströ m questio nnaires in a general ho spital inpa-tient po pulatio n to measure the frequency o f pro blem drinking and nico tine dependence, and to see if levels varied between medical speciality.

METHODS

Design

This study is a retro spective cro ss sectio nal study, which the data was co llected o ver two days in via a struc-tured interview with all inpatients at that time.

Setting

The study was undertaken at the Ho spital São Paulo / Esco la Paulista de Medicina, a federally funded public teaching ho spital.

Participants

Patients were interviewed over two consecutive days in July 1995. The ho spital has 512 beds, o f which 394 were included in the study, with the remainder being excluded because they fo rmed part o f inpatient units that treated o nly children and teenagers belo w the age o f 16. The in-patient units included were: psychiatry, general medicine, intensive care unit, o rtho pedics, gastro entero lo gy, cardi-o lcardi-o gy, urcardi-o lcardi-o gy, cardi-o phthalmcardi-o lcardi-o gy, neurcardi-o lcardi-o gy, cardi-o bstetrics and gyneco lo gy, infectio us diseases and parasito lo gy unit, re-nal unit, hemato lo gy, endo crino lo gy, surgical units and pulmo nary diseases unit. Thirty patients were excluded because they were under the age o f 16, a further 7 refused to participate and 82 were physically o r psycho lo gically unable to co nsent, primarily because they were unco n-scio us, co nfused o r dro wsy. This gave a final sample o f 275 patients. Interviews were perfo rmed at the patient’s bedside and invo lved a team o f 9 interviewers who had been trained in the use o f the questio nnaire.

Instruments

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by J. D. (a Po rtuguese-speaking English psychiatrist). All items o f the AUDIT refer to the last 12 mo nths. The final sco re ranges 0 to 40, with a sco re o ver 8 indicating that the perso n pro bably has an alco ho l pro blem. In addi-tio n, further quesaddi-tio ns were asked abo ut alco ho l pro b-lems preceding the last 12 mo nths and previo us treat-ment experiences. The third part o f the questio nnaire co nsisted o f a Po rtuguese versio n o f the Fagerströ m Test fo r Nico tine Dependence - FTND. This instrument co n-sist o f 6 questio ns co ncerning the respo ndent’s current smo king behavio r, with sco res ranging fro m 0 to 10, and with sco res classified into mild, mo derate and severe de-pendence. The final part o f the instrument co ncerned current and past cigarette smo king.

Statistical Methods

Data were entered into the SPSS pro gram and analyzed using descriptive statistics.

RESULTS

Fo rty-nine percent o f the sample were male and the average age was 42 (SD 17, range: 16 to 85). The demo graphic characteristics o f the patients are sho wn in Table 1.

Of the 275 patients interviewed, 34 (12.4%; 95% CI: 8.5 to 16.3%) were diagno sed as having an alco ho l use diso rder by the AUDIT questio nnaire. Amo ng men the prevalence was 22% (n = 30) and wo man 3% (n = 4). The gastro entero lo gy and general medical inpatient units had the largest number o f individual cases: gastro enter-o lenter-o gy 11 (26%) and general medicine 5 (16%). Several wards had no cases at all: o rtho pedics, hemato lo gy, en-do crino lo gy, psychiatry and neuro lo gy.

Of the to tal sample, 70% o f patients admitted that they had drunk mo re heavily in the past than during the last year, with 7% saying that they had had a perio d in their life in which they had drunk o n a daily o r almo st daily basis. Just o ver 46% o f these latter patients sco red po sitive o n the AUDIT. Only two percent o f AUDIT po sitive patients said that they had undergo ne so me fo rm o f alco -hol treatment in the past, with Alco-holics Anonymous (AA) and inpatient treatment being mo st co mmo nly cited.

Twenty-o ne percent o f patients were current smo kers but a further32% were ex-smo kers o f varying duratio n, whilst 47% said that they had never smo ked.

Regarding the frequency o f smo king by ward, gastro entero lo gy had the highest level o f smo kers (n = 11, 23%) fo llo wed by general medicine (n = 8, 14%). Us-ing the Fagerströ m Test fo r Nico tine Dependence, 30% o f smo kers were classified as having mild nico tine de-pendence, 44% mo derate and 26% severe. Abo ut 57%

repo rted a perio d o f higher cigarette co nsumptio n co m-pared to their current level. Fo rty-eight percent had al-ready tried to sto p smo king witho ut success and 27% had never tried.

DISCUSSION

Only by kno wing the prevalence o f alco ho l abuse/ dependence and nico tine dependence in a general ho s-pital can we evaluate the need fo r a specialized liaiso n service to identify and treat these patients. Our study sho ws that the frequency o f AUDIT po sitive case was 12% and that 21% o f patients were current smo kers. Alco ho l abuse was mo re frequent amo ng men and amo ng pa-tients o n the gastro entero lo gy and general medical wards.

The AUDIT questio nnaire is simple and quick to use. Its applicatio n do es no t require any specialized train-ing, a fact that facilitates its use in a variety o f settings including develo ping co untries where highly trained staff are in sho rt supply.25-27 If the AUDIT were used as a

screen-ing instrument o n admissio n to ho spital, po tential cases o f alco ho l abuse co uld be referred to a specialized liai-so n service. As mentio ned abo ve, the advantage o f the AUDIT is that it can identify patients befo re alco ho l

de-TABLE 1 – Socio-de mographic data of inpatie nts from a ge ne ral hospital in São Paulo, Brazil (n = 275)

Cha ra cteristic M a le Fema le

n=1 3 5 (%) n=1 4 0 (%)

Age

mean in years 4 2 3 9

M a rita l Sta tus

Sing le 4 0 (3 0 ) 3 4 (2 4 ) Married/ Living To g ether 8 3 (6 2 ) 8 0 (5 7 ) Divo rced/ Separated 7 (5 ) 1 2 (9 )

W ido wed 5 (4 ) 1 4 (1 0 )

Level of schooling

Illiterate 1 1 (8 ) 9 (6 )

“ 1 st g rade” (8 years o f scho o ling ) 9 1 (6 7 ) 9 4 (6 7 ) “ 2 nd g rade” (hig h scho o l) 1 7 (1 3 ) 3 0 (2 1 ) Co lleg e/ University 1 6 (1 2 ) 7 (5 )

Occupa tion

Unemplo yed 5 (4 ) 8 (6 )

Blue co llar jo b 3 5 (2 6 ) 1 8 (1 3 ) W hite co llar jo b 2 7 (2 0 ) 2 3 (1 6 ) Pensio ned/ Student 6 5 (4 8 ) 3 5 (2 5 )

O ther 3 (2 ) 5 6 (4 0 )

Fa mily income

1 to 5 m.w.* 8 1 (6 0 ) 8 8 (6 3 ) 5 to 2 0 m.w. 3 5 (2 6 ) 2 5 (1 8 )

Up to 2 0 m.w. 4 (3 ) 0

Do n’ t kno w 1 5 (1 1 ) 2 7 (1 9 )

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1. Shapiro S, Skinner EA, Kessler LG, et al. Utilizatio n o f health and mental health services: three epidemio lo gical catchment area sites. Arch Gen Psychiatry 1984;41(10):971-8.

2. Rice DP, Kelman S, Miller LS. Estimates o f eco no mic co sts o f alco ho l and drug abuse and mental illness, 1985 and 1988. Public Health Rep 1991;106(3):280-92.

3. Masur J, Tufik S, Ribeiro AB, et al. Co nsumo de álco o l em pacientes de ho spital geral: um pro blema negligenciado ? Rev Asso c Med Bras 1979;25(9):302-6.

4. Silva VA, Laranjeira RR, Do lniko ff M, et al. Alco ho l co nsumptio n during pregnancy and newbo rn o utco me: a study in Brazil. Neuro behav To xico l Terato l 1981;3:169-72.

5. Masur J, Jo rge MR. Dad o s re lac io nad o s a b e b id as alc o ó lic as e alco o lismo no Brasil: uma revisão . Rev ABP-APAL 1986;8(4):157-65.

6. Iaco po ni E, Laranjeira R, Jo rge MR. At-risk drinking in primary care: repo rt fro m a survey in São Paulo , Brazil. Brit J Addict 1989;84:653-8.

7. Noto AR, Carlini EAA. Internações hospitalares provocadas por drogas: análise de sete anos consecutivos (1987-1993). Rev ABP-APAL 1995;17(3):107-14.

REFERENCES

8. Almeida Filho N, Mari JJ, Co utinho E, et al. Estudo multicêntrico de mo rbidade psiquiátrica em áreas urbanas (Brasília, São Paulo , Po rto Alegre). Rev ABP-APAL 1992;14:93-104.

9. Ryder D, Lento n S, Harriso n S, Do rrico tt J. Alco ho l-related pro blems in a general ho spital and a general active: screening and the preventive parado x. Med J Austral 1988;149(3):355-60.

10. Mo o re RD, Bo ne LR, Geller G, Mamo n JA, Sto kes EJ, Levine DM. Prevalence, detectio n and treatment o f alco ho lism in ho spitalized patients. JAMA 1989;261(3):403-7.

11. Chick J. Alco ho l pro b lems in the general ho spital. Brit Med Bull 1994;50(1):200-10.

12. Babo r TF, Grant M. Fro m clinical research to seco ndary preventio n: internatio nal co llabo ratio n in the develo pment o f the alco ho l use diso rders identificatio n test (AUDIT). Alco ho l Health Resear Wo rld 1989;13(4):371- 4.

13. Babo r TF, La Fuente JR, Saunders J, Grant M. AUDIT: the alco ho l use diso rders identificatio n test: guidelines fo r use in primary health care. WHO (Wo rld Health Organizatio n)/PSA/1992;4:1-29.

pendence has develo ped, so that an interventio n can be o ffered befo re the patient has develo ped severe co mpli-catio ns o f alco ho l dependence, i.e. as a fo rm o f seco nd-ary preventio n. Also , in a co untry like Brazil, where cash co nstraints are tight, such an interventio n is relatively cheap and may save mo ney in the lo ng term.

The FTND has been sho wn to be a reliable mea-sure o f nico tine dependence and is also a predicto r o f success in smo king cessatio n. It can also be used to ti-trate nico tine do sage against severity o f dependence in nico tine replacement pro grams designed to help severely dependent smo kers to quit.28 It has been estimated that

if health wo rkers spend three to five minutes advising patients abo ut the advantages o f sto pping smo king and give them self-help materials to reinfo rce this advice, 5 to 8% o f smo kers will quit smo king within 12 mo nths.29,30

Altho ugh this number is quite lo w, the high turno ver o n general medical wards means that a large number o f patients co uld be treated o ver a space o f o ne year.

The National Cancer Institute has developed an of-fice-based intervention for physicians and other health care professionals that provides a brief but effective interven-tion based on the four “A’s”: 1. Ask all patients about their smoking behavior; 2. Advise every smoker to stop smoking; 3. Assist each smoker in setting a stop date; and 4. Arrange a follow-up visit.31 This intervention could be adapted to an

inpatient setting and could also be applied to alcohol abuse. We fo und the highest frequency fo r bo th alco ho l abuse and nico tine dependence was o n the gastro entero lentero gy and general medicine wards, althentero ugh the absentero -lute numbers invo lved were small. Ho wever, this co uld be an indicatio n that a liaiso n service directed to wards identifying and treating alco ho l abuse and smo king wo uld be mo re co st effective, and reach a greater

num-ber o f cases, if implemented o n these wards.

There are several limitatio ns to this study. First,only patients fro m o ne ho spital in São Paulo were screened, and therefo re we canno t generalize o ur findings to o ther types o f ho spital o r o ther regio ns o f the co untry where demo graphic characteristics and health service pro visio n may differ. Seco nd,this study wasperfo rmed o n two days in the winter mo nth o f July. Altho ugh the subtro pical win-ter in São Paulo is no t severe, there may still be seaso nal variations in diseases that lead to hospital admission, such as chest infectio ns. This co uld have an effect o n the pro -po rtio n o f patients admitted to ho spital who were smo k-ers o r alco ho l abusk-ers. Ho wever, the o nly seaso nal varia-tio n in ho spital admissio ns repo rted in São Paulo are fo r children with rotavirus infection and respiratory disease,32-34

who wo uld no t have been eligible fo r this study. The fact that there were no cases o f alco ho l abuse o n the psychiat-ric ward is pro bably related to the fact that o nly wo men are admitted to this unit, amo ng who m the prevalence o f alco ho l abuse wo uld be lo w. No attempt was made to relate the use o f alco ho l o r cigarettes to the illness that had led to the patient’s admissio n, altho ugh we did find that the gastro entero lo gy unit had the highest prevalence o f alco ho l abuse, as might have been predicted. The small number o f AUDIT po sitive cases wo uld no t have allo wed any meaningful statistical investigatio n o f this questio n.

CONCLUSION

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14. Saunders JB, Aasland OG, Babo r TF, et al. Develo pment o f the Alco ho l Use Diso rders Identificatio n Test (AUDIT): WHO co llabo rative pro ject o n early detectio n o f perso ns with harmful alco ho l co nsumptio n. Part II. Addictio n 1993;88:791-804.

15. Skip se y K, Burle so n JA, Kranzle r HR. Utility o f the AUDIT fo r Identificatio n o f hazardo us o r harmful drinking in drug dependent patients. Drug and Alco h Depend 1997;45:157-63.

16. Co nigrave KM, Saunders JB, Reznic RB. Predictive capacity o f the AUDIT questio nnaire fo r alco ho l related harm. Addictio n 1995;90:1479-85.

17. Schmidt A, Barry KL, Fleming, MF. Detectio n o f pro blems drinkers: The Alco ho l use Diso rders Identificatio n Test (AUDIT). So uthern Med J 1995;88(1):52-9.

18. Bo hn MJ, Barb o r TF, Kranzle r HR. The alc o ho l us e d is o rd e rs identificatio n test (AUDIT): validatio n o f a screening instrument fo r use in medical settings. J Stud Alco h 1995;56(4):423-31.

19. U.S. Department o f Health and Human Services. Smo king cessatio n. Clinical Practice Guideline; 1996.

20. McGinnis JM, Fo ege WH. Actual causes o f death in the United States. JAMA 1993;270(18):2007-12.

21. Fagerströ m KO. Measuring degree o f physical dependence to to bacco smo king with reference to individualizatio n o f treatment. Addict Behavio rs 1978;3:235-41.

22. He athe rto n TF, Ko zlo wski LT, Fre c ke r RC, Fage rströ m KO . The Fagerströ m Test fo r nico tine dependence: a revisio n o f the Fagerströ m to lerance questio nnaire. Br J Addict 1991;86:1119-27.

23. Heatherto n TF, Ko zlo wski LT, Frecker RC, et al. Measuring the heaviness o f smo king using self-repo rted time to the first cigarette o f the day and number o f cigarettes smo ked per day. Br J Addict 1989;84:791-800.

24. Saxo n JA, McGuffin R, Walker RD. An o pen trial transdermal nico tine replacement therapy fo r smo king cessatio n amo ng alco ho l and drug dependent inpatients. J Subst Abuse Treat 1997;14(4):333-7.

25. Fleming MF, Barry KL, McDonald R. The Alcohol Use Disorders Identification Test (AUDIT) in a co llege sample. Int J Addict 1991;26:1173-85.

26. Cherpitel CJ. Analysis o f cut po ints fo r screening instruments fo r alco ho l pro blems in the emergency ro o m. J Stud Alco ho l 1995;56:695-700.

27. Seppa K, Makela R, Sillanaukee P. Effectiveness o f the Alco ho l Use Diso rders Identificatio n Test in o ccupatio nal health screenings. Alco ho l Clin Exp Res 1995;19(4):999-1003.

28. Ko zlo wski LT, Po rter CQ, Orleans CT, et al. Predicting smo king cessatio n with FTND and HSI. Drug Alco ho l Depend 1994;34:211-6.

29. Demers RY, Neale AV, Adams R, Trembath C, Herman SC. The impact o f physicians brief smo king cessatio n co unseling: a MIRNET study. J Fam Pract 1990;31:625-9.

30. Law M, Tang JL. An analysis o f the effectiveness o f interventio ns intended to help peo ple sto p smo king. Arch Intern Med 1995;155:1933-41.

31. Hurt RD, Ro chester M. Smo king cessatio n in primary care. Ind Med 1996;Mar/Apr:165-8.

32. Nascimento JD, Siqueira MM, Sutmoller F, et al. Longitudinal study of acute respiratory diseases in Rio de Janeiro: occurrence of respiratory viruses during four consecutive years. Rev Inst Med Trop São Paulo 1991;33(4):287-96.

33. Sutmo ller F, Ferro ZP, Asensi MD, et al. Etio lo gy o f acute respirato ry tract infectio ns amo ng children in a co mbined co mmunity and ho spital study in Rio de Janeiro . Clin Infect Dis 1995;20(4):854-60.

34. Pereira HG, Linhares AC, Candeias JA, Glass RI. Natio nal Labo rato ry surveillance o f viral agents o f gastro enteritis in Brazil. Bull Pan Am Health Organ 1993;27(3):224-233.

r e s u m o

CON TEXTO: Embora o CAG E seja um dos instrumentos de rastreamento do co nsumo alco ó lico mais utilizado , o mesmo tem so frido críticas po r não identificar pesso as que po ssuem um co nsumo no civo o u pesso as que apresentam pro blemas relacio nado s ao co nsumo alco ó lico sem ter desenvo lvido um quadro de dependência alco ó lica. O questio nário AUDIT (Alc o ho l Use Id e ntific a tio n Te st) fo i d e se nvo lvid o p e la O rganização Mundial de Saúde co mo instrumento de rastreamento especificamente para identificar pessoas com consumo nocivo do álcool, co mo também aquelas que po ssuem dependência do álco o l.

OBJETIVO: Mensurar a freqüência de uso no civo / dependência de álco o l e nico tina através do AUDIT e Fag erströ m.

TIPO DE ESTUDO: Estudo de co rte transversal retro spectivo .

LOCAL: Ho spital esco la do serviço público federal, São Paulo , Brasil.

AM OSTRA: 2 7 5 pacientes internado s de ambo s sexo s.

VARIÁVEIS ESTUDADAS: Dado s só cio -demo g ráfico s, AUDIT e Fag erströ m Test fo r N ico tine Dependence.

RESULTADOS: Fo ram entrevistado s 2 7 5 pacientes que se enco ntravam internado s, sendo que 4 9 % destes eram ho mens e 5 1 % mulheres. 3 4 pacientes fo ram identificado s co mo “ caso s” através do AUDIT, que co rrespo nderam a 2 2 % do s pacientes do sexo masculino e 3 % do sexo feminino . Apenas 2 1 % do s pacientes fo ram co nsiderado s fumantes. As enfermarias de gastro entero lo gia (2 6 %) e clínica médica (1 6 %) fo ram co nsideradas co mo detento ras de maio r número de caso s quando co mparadas co m as o utras enfermarias.

CON CLUSÕES: So mente co m o co nhecimento da prevalência de uso no civo / dependência de álco o l e de nico tina, em um ho spital geral, é po ssível estimar a necessidade de um serviço de interco nsulta que pudesse identificar e tratar esses pacientes.

PA LAV RA S- CH AV E: A UDIT. Fa g e rströ m. Instrume nto d e rastreamento . Interco nsulta. Pacientes internado s.

Ne liana Buzi Figlie , MD. Mental Health – Psycho lo gist and researcher at Alco ho l and Drug Research Unit, Universidade Federal de São Paulo /Esco la Paulista de Medicina, São Paulo , Brazil.

Sandra Cristina Pillon, MD. Gastro entero lo gy – Nurse and researcher at Alco ho l and Drug Research Unit, Universidade Federal de São Paulo /Esco la Paulista de Medicina, São Paulo , Brazil.

John Dunn, PhD. Researcher at Alco ho l and Drug Research Unit, Universidade Federal de São Paulo /Esco la Paulista de Medicina, São Paulo , Brazil.

Ronaldo Laranje ira, MD, PhD. Co o rdinato r o f Alco ho l and Drug Research Unit, Universidade Federal de São Paulo /Esco la Paulista de Medicina, São Paulo , Brazil.

Source s of funding: FAPESP (97/14219-0)

Conflict of inte re st: No t declared

Last re ce ive d: 07 January 2000

Acce pte d: 07 February 2000

Addre ss for corre sponde nce :

Neliana Buzi Figlie

Universidade Federal de São Paulo / Esco la Paulista de Medicina Departamento de Psiquiatria

Unidade de Pesquisa em Alco o l e Dro gas (UNIAD) Rua Bo tucatu, 394

São Paulo /SP – Brasil - CEP 04023-900 E-mail: neliana@ psiquiatria.epm.br

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TABLE 1 –  Socio-de mographic data of inpatie nts from a ge ne ral hospital in São Paulo, Brazil (n = 275)

Referências

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