RESUMEN

Abstract Objective: to carry out a scoping review with the purpose of mapping the scientific evidence on the use of the neutropenic diet in neutropenic pediatric cancer patients. Source of data: The scoping review protocol was prepared in accordance with the PRISMA-ScR and the checklist before the literature search was performed. Articles on nutritional management in adults or on the treatment of other diseases, and articles that were not in Portuguese or English and published before the year 2000, were excluded. Data were extracted based on the Cochrane Consumer and Communication Review Group form. Summary of the findings: Three hundred and forty scientific articles were identified, with the final sample of this review consisting of nine studies. Although the neutropenic diet has been part of the nutritional management of pediatric cancer patients for more than 20 years, there is still great variation in the criteria for indicating use and starting and discontinuing it, as well as in the nutritional composition of the diet. Furthermore, there is no consensus on the impact of using a neutropenic diet on different clinical and nutritional outcomes. Conclusion: In the absence of guidelines that standardize the use of a neutropenic diet in pediatric patients with neutropenia, there are heterogeneous approaches reported in the literature, even within the same institution. The available literature presents an absence of evidence on the use, viability, and effectiveness of the neutropenic diet in oncological children with neutropenia. More studies are needed to identify the real impact of the neutropenic diet on clinical and nutritional outcomes.

RESUMEN

OBJECTIVE: to carry out a scoping review with the purpose of mapping the scientific evidence on the use of the neutropenic diet in neutropenic pediatric cancer patients. SOURCE OF DATA: The scoping review protocol was prepared in accordance with the PRISMA-ScR and the checklist before the literature search was performed. Articles on nutritional management in adults or on the treatment of other diseases, and articles that were not in Portuguese or English and published before the year 2000, were excluded. Data were extracted based on the Cochrane Consumer and Communication Review Group form. SUMMARY OF THE FINDINGS: Three hundred and forty scientific articles were identified, with the final sample of this review consisting of nine studies. Although the neutropenic diet has been part of the nutritional management of pediatric cancer patients for more than 20 years, there is still great variation in the criteria for indicating use and starting and discontinuing it, as well as in the nutritional composition of the diet. Furthermore, there is no consensus on the impact of using a neutropenic diet on different clinical and nutritional outcomes. CONCLUSION: In the absence of guidelines that standardize the use of a neutropenic diet in pediatric patients with neutropenia, there are heterogeneous approaches reported in the literature, even within the same institution. The available literature presents an absence of evidence on the use, viability, and effectiveness of the neutropenic diet in oncological children with neutropenia. More studies are needed to identify the real impact of the neutropenic diet on clinical and nutritional outcomes.

Asunto(s)

RESUMEN

OBJETIVO: Avaliar a capacidade antioxidante total da dieta e fatores associados em pacientes com câncer em tratamento ambulatorial. MÉTODOS: Estudo transversal, realizado com pacientes oncológicos em 2020, sendo avaliados os dados sociodemográficos, tratamento da doença, frequência alimentar e um recordatório de 24 horas. Medidas antropométricas foram aferidas para a classificação do peso. Para a determinação da capacidade antioxidante total da dieta (CATd) foi utilizado um banco de dados com o conteúdo total de antioxidantes de alimentos. Adotada a significância estatística de p<0,05. RESULTADOS: A mediana do consumo de antioxidante foi de 3,29±1,82mmol/g. Os pacientes que apresentaram o CATd acima da mediana tiveram maior consumo de carboidratos, proteínas, lipídios, vitamina C e E (p<0,05). Não houve relação entre o CATd e as medidas antropométricas. CONCLUSÃO: A capacidade antioxidante da dieta esteve associada ao consumo de macronutrientes e de vitamina C e E, mas não apresentou relação com as medidas antropométricas. (AU).

OBJECTIVE: To evaluate the total antioxidant capacity of the diet and associated factors in cancer patients in ambulatory treatment. METHODS: A cross-sectional study carried out with cancer patients in 2020, evaluating sociodemographic data, disease treatment, food frequency and a 24-hour recall. Anthropometric measurements were taken for weight classification. To determine the total antioxidant capacity of the diet (CATd) a database with the total content of food antioxidants was used. Statistical significance of p<0.05 was adopted. RESULTS: The median antioxidant consumption was 3.29±1.82mmol/g. Patients with CATd above the median had higher consumption of carbohydrates, proteins, lipids, vitamin C and E (p<0.05). There was no relationship between CATd and anthropometric measurements. CONCLUSION: The antioxidant capacity of the diet was associated with the consumption of macronutrients and vitamin C and E, but was not related to anthropometric measurements. (AU).

OBJETIVO: Evaluar la capacidad antioxidante total de la dieta y factores asociados en pacientes oncológicos en tratamiento ambulatorio. MÉTODOS: Estudio transversal realizado con pacientes oncológicos en 2020, evaluando datos sociodemográficos, tratamiento de la enfermedad, frecuencia de alimentación y recordatorio de 24 horas. Se tomaron medidas antropométricas para la clasificación de peso. Para determinar la capacidad antioxidante total de la dieta (CATd) se utilizó una base de datos con el contenido total de antioxidantes de los alimentos. Se adoptó la significación estadística de p<0,05. RESULTADOS: La mediana del consumo de antioxidantes fue de 3,29±1,82mmol/g. Los pacientes con CATd por encima de la mediana tenían mayor consumo de carbohidratos, proteínas, lípidos, vitamina C y E (p<0,05). No hubo relación entre CATd y medidas antropométricas. CONCLUSIÓN: La capacidad antioxidante de la dieta se asoció con el consumo de macronutrientes y vitamina C y E, pero no se relacionó con las medidas antropométricas. (AU).

Asunto(s)

RESUMEN

Background: Chronic non-communicable diseases, including cardiovascular diseases (CVDs), have caused many deaths worldwide. Atherosclerotic plaque formation is common in individuals with CVDs. Thus, antioxidant and anti-inflammatory nutritional strategies can be used to prevent or inhibit this process. Due to its higher concentrations of cocoa, dark chocolate is considered a functional food due to the presence and action of phytochemical compounds, with anti-inflammatory and antioxidant actions. However, the recommended amounts of these compounds to prevent atherosclerosis have not yet been fully elucidated. Aim: The aim of the studywas to review the effects of cocoa and dark chocolate intake on the prevention of cardiovascular dysfunction and atherosclerosis. Methods: This narrative review was based on a search of PubMed and Lilacs. The search was conducted from September 2021 to February 2022 using the following keywords: flavonoids, cocoa, atherosclerosis, oxidative stress, and inflammation. The inclusion criteria were original articles, meta-analyses, and experimental and clinical studies published between 2002 and 2022 in English, focusing on the subject addressed. The exclusion criteria were the title and abstract reading and duplication of articles in the databases. Results: The antioxidant and anti-inflammatory functions of phytochemicals in cocoa and dark chocolate are related to the modulation of nitric oxide through activation/phosphorylation and acting as a vasodilator. Furthermore, these phytochemicals reduce the formation of reactive oxygen species and activate antioxidant enzymes. The anti-inflammatory activities are related to the modulation of nuclear factor kappa B in the reduction of inflammatory markers, such as tumor necrosis factor-alpha, C-reactive protein, and pro-inflammatory cytokines, as well as in the reduction of adhesion molecules in the wall of the vases. Conclusion: The main phytochemicals present in cocoa and dark chocolates are catechins and their epicatechin isomers, which are responsible for improving inflammatory, metabolic, and antioxidant profiles. Its consumption can be encouraged, but with caution, owing to the caloric supply and forms of chocolate production, as these factors can reduce the presence of flavonoids in its composition. Relevance for Patients: The antioxidant and anti-inflammatory functions of the phytochemicals in cocoa and dark chocolate are responsible for modulating nitric oxide via activation/phosphorylation and acting as a vasodilator. Reducing the formation of reactive oxygen species, as well as activating antioxidant enzymes. As for the anti-inflammatory activities, they modulate the nuclear factor kappa B, reducing inflammatory markers, thus improving the antioxidant and inflammatory profile of these patients.

RESUMEN

BACKGROUND: many endocrine-metabolic changes are involved in smoking. OBJECTIVES: to evaluate serum concentrations of inflammatory adipokines in smokers at baseline and after four months of treatment for smoking cessation. METHODS: the serum concentrations of inflammatory cytokines were evaluated in smokers and abstinent. Nutritional assessment was based on measurements of body weight, height, and waist circumference (WC), to calculate body mass index (BMI), body adiposity index (BAI) and waist-to-height ratio (WHtR). Biochemical parameters were analyzed: total cholesterol, LDL-c, HDL-c, triglycerides, glucose, cortisol and insulin. The serum levels of leptin, adiponectin and ghrelin were determined by enzyme-linked immunosorbent assay (ELISA). The leptin/adiponectin ratio (L/A) was calculated. RESULTS: a total of 29 subjects were included in this study (22 women and seven men). The mean age of participants was 50.7 ± 10.47 years. The medium values of WHtR and BAI were above of the proposed cutoff point, indicating abdominal obesity. The biochemical parameters did not present statistically significant differences when comparing the initial and final values. At the end of treatment, the abstinent had higher levels of adiponectin when compared to those who remained smoker (p = 0.024). There was an increase in leptin levels and L/A, and a reduction in adiponectin levels after the treatment in abstinent and smokers (p < 0.05). CONCLUSION: this study has demonstrated that smoking cessation improves adiponectin levels when compared with smokers. Leptin and L/A levels increased throughout the treatment in both groups. The increased values of leptin and L/A in abstinent participants may indicate risk of metabolic events associated with smoking history that should be investigated.

Asunto(s)

RESUMEN

Background: many endocrine-metabolic changes are involved in smoking. Objectives: to evaluate serum concentrations of inflammatory adipokines in smokers at baseline and after four months of treatment for smoking cessation. Methods: the serum concentrations of inflammatory cytokines were evaluated in smokers and abstinent. Nutritional assessment was based on measurements of body weight, height, and waist circumference (WC), to calculate body mass index (BMI), body adiposity index (BAI) and waist-to-height ratio (WHtR). Biochemical parameters were analyzed: total cholesterol, LDL-c, HDL-c, triglycerides, glucose, cortisol and insulin. The serum levels of leptin, adiponectin and ghrelin were determined by enzyme-linked immunosorbent assay (ELISA). The leptin/adiponectin ratio (L/A) was calculated. Results: a total of 29 subjects were included in this study (22 women and seven men). The mean age of participants was 50.7 ± 10.47 years. The medium values of WHtR and BAI were above of the proposed cutoff point, indicating abdominal obesity. The biochemical parameters did not present statistically significant differences when comparing the initial and final values. At the end of treatment, the abstinent had higher levels of adiponectin when compared to those who remained smoker (p = 0.024). There was an increase in leptin levels and L/A, and a reduction in adiponectin levels after the treatment in abstinent and smokers (p < 0.05). Conclusion: this study has demonstrated that smoking cessation improves adiponectin levels when compared with smokers. Leptin and L/A levels increased throughout the treatment in both groups. The increased values of leptin and L/A in abstinent participants may indicate risk of metabolic events associated with smoking history that should be investigated

Introducción: en el tabaquismo están involucrados un gran número de cambios endocrino-metabólicos. Objetivos: evaluar las concentraciones séricas de adipocinas inflamatorias en fumadores al inicio y después de cuatro meses de tratamiento para dejar de fumar. Métodos: se evaluaron las concentraciones séricas de citocinas inflamatorias en fumadores y no fumadores. La evaluación nutricional se basó en las mediciones del peso corporal y la altura, para calcular el índice de masa corporal (IMC), la circunferencia de la cintura (CC), el índice de adiposidad corporal (IAC) y la relación cintura/estatura (RCE). Se analizaron los parámetros bioquímicos: colesterol total, LDL-c, HDL-c, triglicéridos, glucosa, cortisol e insulina. Los niveles séricos de leptina, adiponectina y grelina se determinaron mediante ensayo de inmunoabsorción enzimática (ELISA). Se calculó la relación leptina/adiponectina (L/A). Resultados: se incluyeron un total de 29 personas (22 mujeres y siete hombres). La edad media de los participantes fue de 50,7 ± 10,47 años. Los valores medios de CC e IAC se mostraron por encima del punto de corte propuesto, indicando obesidad abdominal. Los parámetros bioquímicos no presentaron diferencias estadísticamente significativas al comparar los valores iniciales y finales. Al final del tratamiento, los abstinentes tenían niveles más altos de adiponectina cuando se comparaban con los de aquellos que seguían fumando (p = 0,024). Hubo un aumento en los niveles de leptina y L/A y reducción de los niveles de adiponectina después del tratamiento en abstinentes y fumadores (p < 0,05). Conclusiones: este estudio ha demostrado que el abandono del hábito de fumar mejora los niveles de adiponectina en comparación con los fumadores. Los niveles de leptina y L/A aumentaron a lo largo del tratamiento en ambos grupos. Los valores aumentados de leptina y L/A en abstinentes pueden indicar riesgo de eventos metabólicos asociados al historial de tabaquismo que deben ser investigados

Asunto(s)

RESUMEN

Introdução: O excesso de peso é um grande fator de risco para doenças cardiovasculares (DCV) e metabólicas, e sua crescente prevalência vista hoje em dia, em todo o mundo, vem acarretar consequências tanto sociais quanto econômicas para a saúde pública brasileira. O objetivo foi avaliar o estado nutricional e prevalência do sobrepeso. Objetivos: Avaliar o excesso de peso e níveis pressóricos de funcionários de uma instituição privada de ensino. Métodos: Foi realizado estudo transversal com os funcionários. Aplicou-se um questionário estruturado, coleta de dados antropométricos e níveis pressóricos. Resultados: Foram avaliados 81 funcionários, onde 39,5% eram do sexo masculino e 60,5% do sexo feminino. A idade apresentou média de 30,9±9,5 anos. A prevalência de sobrepeso foi maior nas mulheres e a obesidade foi maior nos homens. A circunferência da cintura elevada foi encontrada em 40,6% dos homens e 57,1% das mulheres. Conclusão: O elevado número de funcionários com excesso de peso, com destaque para a obesidade abdominal, alerta para o risco desenvolvimento de doenças crônicas não transmissíveis e a necessidade de intervenção nutricional neste público

Introduction: Excess weight is a major risk factor for cardiovascular disease (CVD) and metabolic, and its increasing prevalence seen today around the world, has lead to both social consequences as economic for the Brazilian public health. The objective was to evaluate the nutritional status and prevalence of overweight. Goals: To evaluate the excess weight and pressure levels of employees of a private educational institution. Methods: A cross-sectional study was carried out with the employees. A structured questionnaire, anthropometric data collection and pressure levels were applied. Results: A total of 81 employees, in which 39.5% were male and 60.5% female. The mean age of 30.9 ± 9.5 years. The prevalence of overweight was higher in women and obesity was higher in men. The waist circumference high DC was found in 40.6% of men and 57.1% women. Conclusion: The high number of employees overweight, especially abdominal obesity, alert to the risk of developing chronic diseases and the need for nutritional intervention in public

No disponible

Asunto(s)

RESUMEN

Aim: to evaluate the serum concentration of NO in overweight women, smokers (SG) and nonsmokers (NSG). Methods: blood samples from smokers (n = 20) and nonsmokers (n = 18) were collected to obtain serum, and stored at -80 ºC until analysis. NO was assessed by measuring total nitrite, determined by Greiss method. It was adopted as reference 24.4 µmol/L, mean value found in a study with healthy subjects without excess weight. We used the Student t test to compare the means of age and waist circumference, and the Mann-Whitney U test to compare the median of concentrations of nitrite, number of cigarettes/day and Body Mass Index. We adopted a significance level of p<0.05. Results: the median nitrite in SG was 16.53 (2.79 - 69.72) µmol/L, whereas in NSG was 10.85 (1.44 - 43.25) µmol/L (p = 0.028). BMI median value to SG and NSG, was respectively 29.50 (25.00 - 38.14) kg/m2 and 30.68 (25.10 - 36.98) kg/m2 (p = 0.530), being classified as overweight. The data showing that the average nitrite was below the estimated value for healthy individuals. Conclusion: the results indicate a decrease of NO metabolites in women with excess weight, independently of being smoker. Despite the significant difference found between groups, these women had values well below the reference value of NO for healthy women. Therefore, it seems that smoking does not interfere in nitrite levels in patients already compromised by obesity (AU)

Objetivo: evaluar la concentración sérica de NO en las mujeres con sobrepeso, fumadoras (SG) y no fumadoras (GSN). Método: se recogieron muestras de sangre de las fumadoras (n = 20) y no fumadoras (n = 18) para obtener el suero, y se almacenaron a -80 °C hasta su análisis. NO se evaluó mediante la medición total de nitrito, determinado por el método Greiss. Fue adoptado como referencia de 24,4 µmol/L, valor medio que se encuentra en un estudio con sujetos sanos sin exceso de peso. Se utilizó la prueba t de Student para comparar las medias de edad y la circunferencia de la cintura, así como la prueba de Mann-Whitney para comparar la mediana de las concentraciones de nitrito, número de cigarrillos/día y el Índice de Masa Corporal. Hemos adoptado un nivel de significación de p<0.05. Resultados: la mediana de SG nitrito fue 16,53 (2,79- 69,72) mol/L, mientras que en NSG fue 10,85 (1,44-43,25) µmol/L (p = 0,028). El IMC valor de la mediana de SG y NSG fue, respectivamente, 29,50 (25,00-38,14) kg/m2 y 30,68 (25,10-36,98) kg/m2 (p = 0,530), siendo clasificado como sobrepeso. Los datos muestran que el nitrito promedio estuvo por debajo del valor estimado para individuos sanos. Conclusiones: los resultados indican una disminución de los metabolitos NO en las mujeres con exceso de peso, independientemente de si son fumadoras o no. A pesar de la diferencia significativa entre los grupos, estas mujeres tenían valores muy por debajo del valor de referencia del NO para las mujeres sanas. Por lo tanto, parece que el fumar no interfiere en los niveles de nitritos en pacientes que ya están comprometidas por la obesidad (AU)

Asunto(s)

RESUMEN

Leptin inhibits cortisol release and may increase the craving for cigarettes, hindering the process of smoking cessation. We evaluate the influence of the initial concentration of cortisol and serum leptin on craving and smoking status in individuals after one month of treatment for smoking cessation. The leptin concentration was adjusted by the Initial Body Mass Index (BMI) (leptin/BMI) and the initial percentage of body fat (%BF) (leptin/%BF). The craving was assessed using the Questionnaire of Smoking Urges-Brief (QSU-Brief). The QSU-Brief was assessed about a score of factor 1 (positive reinforcement by tobacco), and factor 2 (negative reinforcement by tobacco). Correlation was found between QSU-Brief (Factor 1 and 2) with the initial concentration of leptin/BF% among those who continued to smoke. There was a negative correlation between cortisol levels and leptin/%BF in individuals who remained smokers after 1 month. There was a positive correlation between leptin/BMI and leptin/%BF with the QSU-Brief (Factor 2) of 1 month in women who remained smokers (r=0.565; p=0.023) and the QSU-Brief (Factor 2) initial among the abstinent women (r=0.551; p=0.033). The highest concentrations of leptin were associated with greater craving and difficulty in achieve abstinence.

Asunto(s)

RESUMEN

OBJETIVO: Avaliar a presença de fatores de risco cardiovascular, com ênfase na hipertensão e na adiposidade corporal, em alcoolistas abstinentes ou não abstinentes em tratamento. MÉTODO: Trata-se de um estudo transversal com 65 pacientes alcoolistas em tratamento no CAP-Sad. O grau de dependência do álcool foi avaliado pelo SADD (Short Alcohol Dependence Data) e o uso de outras drogas, pelo ASSIST (Alcohol Smoking and Substance Involvement Screening Test). Foram avaliados o perfil bioquímico e o antropométrico dos usuários. RESULTADOS: Participaram do estudo 42 homens e 23 mulheres. A maioria dos participantes (67,74%) apresentou dependência alcoólica grave, com uso de álcool associado principalmente a cigarro (66,15%). A média da circunferência da cintura (CC) foi significativamente maior entre os abstinentes, em comparação aos não abstinentes (AB: 88,15 ± 15,95 x NA: 81,04 ± 9,86; p = 0,03). Pacientes abstinentes há mais tempo tiveram maior sobrepeso/obesidade e adiposidade abdominal (CC) do que os não abstinentes e abstinentes recentes, com razão de chances de 5,25. Os abstinentes apresentaram razão de chances de 3,38 para %GC acima da média, independente do tempo de abstinência. CONCLUSÃO: Pacientes alcoolistas abstinentes apresentam mais sobrepeso/ obesidade, adiposidade corporal (%GC) e abdominal (CC) do que os não abstinentes. É importante o acompanhamento multiprofissional no tratamento de alcoolistas com abordagem para fatores de risco cardiovasculares, principalmente evitando o ganho de peso.

OBJECTIVE: Evaluate cardiovascular risk factors, with emphasis on hypertension and adiposity, present in alcoholics abstinent or not abstinent. METHOD: This was a cross-sectional study with 65 alcoholic patients in treatment in CAPSad. The degree of alcohol dependence was assessed by SADD (Short Alcohol Dependence Data) and the use of other drugs by ASSIST (Alcohol Smoking and Substance Involvement Screening Test). We evaluated the biochemical and anthropometric profile users. RESULTS: The study included 42 men and 23 women. The majority of the participants (67.74%) presented severe alcohol dependence with alcohol use mainly associated with smoking (66.15%). The average waist circumference (WC) was significantly higher among abstinent compared to non-abstinent (AB: 88.15 ± 15.95 x NA: 81.04 ± 9.86, p = 0.03). Patients longer abstinent had higher overweight/obesity and abdominal adiposity (WC) than non-abstinent and recent abstinent with odds ratio of 5.25. The abstainers had odds ratios of 3.38 for% BF above average, regardless of time of abstinence. CONCLUSION: Abstinent alcoholic patients have more overweight/obesity, body (% BF) and abdominal (WC) adiposity than non-abstinent. Multidisciplinary care is important in the treatment of alcoholics with approach for cardiovascular risk factors, especially avoiding weight gain.

RESUMEN

Objetivo: Avaliar a influência da fissura na escolha de alimentos doces e alteração do peso corporal em pacientes alcoolistas. Métodos: Vinte e um pacientes alcoolistas em tratamento no Centro de Atenção Psicossocial de álcool e drogas (CAPSad), Ouro Preto/MG, foram selecionados para participar deste estudo (14 homens e 7 mulheres, com idade entre 25 e 64 anos). Foi aplicado questionário para avaliar a fissura (craving) e o consumo alimentar. A alteração do peso corporal e do índice de massa corporal (IMC) foi estimada por métodos antropométricos para avaliar o estado nutricional. As avaliações foram realizadas no momento inicial e final, contemplando até três meses de tratamento. Resultados: As mulheres apresentaram ganho de peso (1,9 ± 1,86 kg) e os homens, perda de peso corporal (-0,13 ± 2,09 kg) (p = 0,04). Não houve diferença estatística quando essa variação de peso foi comparada entre os abstinentes (AB) e não abstinentes (NA) (Homens: AB = 0,39 ± 2,19 kg; NA: -1,06 ± 1,75 kg/Mulheres: AB: 2,73 ± 1,95 kg; NA: 1,42 ± 1,85 kg). A presença de fissura inicial e final foi semelhante entre os que recaíram e os abstinentes. Os abstinentes mantiveram menor fissura e maior sensação de bem-estar com o consumo de alimentos fontes de carboidratos simples ou complexos. Conclusão: Os alcoolistas que conseguiram se abster tiveram menor grau de fissura com maior bem-estar com o consumo de alimentos fontes de carboidratos. Houve mudanças do peso corporal ao longo do tempo de acompanhamento dos alcoolistas em tratamento para a abstinência.

Objective: To assess the craving influence in the choice of simple carbohydrate and changing in body weight in alcoholics patients. Methods: Twenty one patients alcoholics in treatment in a specialized center for alcohol and drugs (CAPSad), Ouro Preto/MG were selected to participate in the study (14 men and 7 women), with aged between 25 and 64 years. A questionnaire was applied to assess craving, and food consumption. The change in body weight and body mass index (BMI) were estimated by anthropometrical methods to assess the nutritional status. Evaluations were performed at baseline and end up covering three months of treatment. Results: It was observed in women the average increase in weight (1.9 ± 1.86 kg), and in men the average loss of weight (-0.13 ± 2.09 kg) (p = 0.04). The statistical analysis showed no difference in the weight change when compared abstinent (A) and non-abstinent (NA) Men: AB = 0.39 ± 2.19 kg; NA: -1,06 ± 1,75 kg/Women: AB: 2.73 ± 1.95 kg; NA: 1.42 ± 1.85 kg. The initial and final craving was similar between those who relapsed and the abstinents. Abstainers maintained lower craving and greater sense of well-being with food sources of simple and complex carbohydrates consumption. Conclusion: There were changes in body weight over time of follow-up treatment for alcoholics in abstinence.