Cook Penny A, Morleo Michela, Billington David, Sanderson-Shortt Kevin, Jones Colin, Gabbay Mark, Sheron Nick, Bellis Mark A, Phillips-Howard Penelope A, Gilmore Ian T
School of Health Sciences, University of Salford, Salford, UK.
Centre for Public Health, Liverpool John Moores University, Liverpool, UK.
BMC Public Health. 2015 Jun 4;15:532. doi: 10.1186/s12889-015-1860-9.
The direct cost of excessive alcohol consumption to health services is substantial but dwarfed by the cost borne by the workplace as a result of lost productivity. The workplace is also a promising setting for health interventions. The Preventing Alcohol Harm in Liverpool and Knowsley (PrevAIL) project aimed to evaluate a mechanism for detecting the prevalence of alcohol related liver disease using fibrosis biomarkers. Secondary aims were to identify the additive effect of obesity as a risk factor for early liver disease; to assess other impacts of alcohol on work, using a cross-sectional survey.
Participants (aged 36-55 y) from 13 workplaces participated (March 2011-April 2012). BMI, waist circumference, blood pressure and self-reported alcohol consumption in the previous week was recorded. Those consuming more than the accepted UK threshold (men: >21 units; female: >14 units alcohol) provided a 20 ml venous blood sample for a biomarker test (Southampton Traffic Light Test) and completed an alcohol questionnaire (incorporating the Severity of Alcohol Dependence Questionnaire).
The screening mechanism enrolled 363 individuals (52 % women), 39 % of whom drank above the threshold and participated in the liver screen (n = 141, complete data = 124 persons). Workplaces with successful participation were those where employers actively promoted, encouraged and facilitated attendance. Biomarkers detected that 30 % had liver disease (25 %, intermediate; 5 % probable). Liver disease was associated with the frequency of visits to the family physician (P = 0.036) and obesity (P = 0.052).
The workplace is an important setting for addressing alcohol harm, but there are barriers to voluntary screening that need to be addressed. Early detection and support of cases in the community could avert deaths and save health and social costs. Alcohol and obesity should be addressed simultaneously, because of their known multiplicative effect on liver disease risk, and because employers preferred a general health intervention to one that focused solely on alcohol consumption.
过度饮酒给医疗服务带来的直接成本巨大，但与因生产力损失给工作场所带来的成本相比则微不足道。工作场所也是开展健康干预的理想场所。利物浦和诺斯利预防酒精危害（PrevAIL）项目旨在评估一种利用纤维化生物标志物检测酒精性肝病患病率的机制。次要目标是确定肥胖作为早期肝病风险因素的附加效应；通过横断面调查评估酒精对工作的其他影响。
来自13个工作场所的参与者（年龄在36 - 55岁之间）参与了研究（2011年3月 - 2012年4月）。记录了体重指数、腰围、血压以及前一周自我报告的酒精摄入量。那些饮酒量超过英国公认阈值的人（男性：>21单位；女性：>14单位酒精）提供20毫升静脉血样本进行生物标志物检测（南安普敦交通信号灯检测）并完成一份酒精问卷（包含酒精依赖严重程度问卷）。
筛查机制招募了363人（52%为女性），其中39%的人饮酒量超过阈值并参与了肝脏筛查（n = 141，完整数据 = 124人）。成功参与的工作场所是那些雇主积极推广、鼓励并协助员工参与的场所。生物标志物检测发现30%的人患有肝病（25%为中度；5%可能患有肝病）。肝病与看家庭医生的频率（P = 0.036）和肥胖（P = 0.052）相关。
工作场所是解决酒精危害的重要场所，但自愿筛查存在障碍，需要加以解决。在社区中早期发现并支持病例可以避免死亡并节省健康和社会成本。应同时应对酒精和肥胖问题，因为它们对肝病风险具有已知的相乘效应，而且雇主更倾向于全面的健康干预而非仅专注于酒精消费的干预。
