Uso de cocaína o estimulantes de tipo anfetamínico y riesgo de crisis convulsivas o de enfermedad cerebrovascular. Revisiones sistemáticas

Los psicoestimulantes son un grupo de sustancias neurofarmacológicamente muy similares cuyo uso se encuentra muy extendido en todo el mundo. En este trabajo nos centramos en el uso de Cocaína y Estimulantes de Tipo Anfetamínico, que son los de consumo más frecuente y causantes desde los años 70 verdaderas epidemias de consumo problemático, conquistando regiones enteras y subgrupos de población. En los últimos años su consumo ha experimentado un importante aumento contribuyendo de manera significativa a la carga global de enfermedades y representa un reto para la salud pública en varias zonas del mundo. No se trata solo del incremento en el consumo de sustancias ilegales, determinadas variedades de estimulantes tipo anfetamínico son medicamentos recetables, lo cual comporta nuevas implicaciones. Entre las complicaciones médicas con las que se relaciona su uso, destacan las complicaciones neurológicas agudas, en concreto las crisis convulsivas y las enfermedades cerebrovasculares. No obstante, la mayoría de las publicaciones científicas que se refieren a la asociación entre el consumo de psicoestimulantes y la aparición de enfermedades cerebrovasculares o crisis convulsivas, se basan en evidencia procedente de estudios con diseños metodológicos poco adecuados o de muy baja calidad. Existen tantos estudios que se limitan a describir casos o series de casos como escasez de otros con metodologías adecuadas para establecer relaciones de causalidad. Por ese motivo es necesario conocer el estado de la situación de las complicaciones neurológicas agudas en relación al uso de psicoestimulantes siguiendo una metodología sistemática que permita llegar a conclusiones sobre el estado de la cuestión y poder marcar el camino para futuras investigaciones. Objetivos: En este trabajo se pretende compilar, revisar y resumir la evidencia científica disponible sobre la relación entre el uso de psicoestimulantes y la ocurrencia de complicaciones neurológicas agudas. Concretamente evaluar la evidencia científica disponible para las siguientes tres asociaciones: 1. En estudios clínico-epidemiológicos sobre la relación entre el consumo de cocaína y la ocurrencia de crisis convulsivas. 2. En estudios clínico-epidemiológicos sobre la relación entre el consumo de cocaína y la ocurrencia de enfermedad cerebrovascular. 3. En estudios clínico-epidemiológicos sobre la relación entre el consumo de ETA y la ocurrencia de enfermedad cerebrovascular..

Machine learning computational tools to assist the performance of systematic reviews : A mapping review

Within evidence-based practice (EBP), systematic reviews (SR) are considered the highest level of evidence in that they summarize the best available research and describe the progress in a determined field. Due its methodology, SR require significant time and resources to be performed; they also require repetitive steps that may introduce biases and human errors. Machine learning (ML) algorithms therefore present a promising alternative and a potential game changer to speed up and automate the SR process. This review aims to map the current availability of computational tools that use ML techniques to assist in the performance of SR, and to support authors in the selection of the right software for the performance of evidence synthesis. The mapping review was based on comprehensive searches in electronic databases and software repositories to obtain relevant literature and records, followed by screening for eligibility based on titles, abstracts, and full text by two reviewers. The data extraction consisted of listing and extracting the name and basic characteristics of the included tools, for example a tool's applicability to the various SR stages, pricing options, open-source availability, and type of software. These tools were classified and graphically represented to facilitate the description of our findings. A total of 9653 studies and 585 records were obtained from the structured searches performed on selected bibliometric databases and software repositories respectively. After screening, a total of 119 descriptions from publications and records allowed us to identify 63 tools that assist the SR process using ML techniques. This review provides a high-quality map of currently available ML software to assist the performance of SR. ML algorithms are arguably one of the best techniques at present for the automation of SR. The most promising tools were easily accessible and included a high number of user-friendly features permitting the automation of SR and other kinds of evidence synthesis reviews. The online version contains supplementary material available at 10.1186/s12874-022-01805-4

Closing the gap between needs and supply of training in addiction medicine

Substance use disorders pose a significant global social and economic burden. Although effective interventions exist, treatment coverage remains limited. The lack of an adequately trained workforce is one of the prominent reasons. Recent initiatives have been taken worldwide to improve training, but further efforts are required to build curricula that are internationally applicable. We believe that the training needs of professionals in the area have not yet been explored in sufficient detail. We propose that a peer-led survey to assess those needs, using a standardised structured tool, would help to overcome this deficiency. The findings from such a survey could be used to develop a core set of competencies which is sufficiently flexible in its implementation to address the specific needs of the wide range of professionals working in addiction medicine worldwide.European Commission Horizon 202

The association between dietary intakes of methionine, choline and betaine and breast cancer risk : a systematic review and meta-analysis

Background and aim: This study evaluates the associations between dietary intakes and circulating blood levels of methionine, choline or betaine and breast cancer risk, which remains currently unclear. Methods: Systematic searches for observational epidemiological studies were performed of the MEDLINE, Embase, and Web of Science databases through July, 2022. Two review authors independently screened titles and abstracts against the eligibility criteria at a first stage, and screened full texts of potentially eligible records at a second stage, followed by data extraction from qualified studies. Quality of evidence was assessed using the Newcastle-Ottawa scale quality assessment tool. Risk estimates were calculated using random-effects meta-analysis. Results: In total, 21 studies were selected for qualitative analyses and 18 studies were included in the meta-analyses. Random-effects analysis combining prospective cohort (N = 8) or case-control studies (N = 10) showed little evidence of an association between dietary intake of methionine or betaine and the risk of breast cancer. However, inconclusive evidence for a significant inverse association between choline intake and breast cancer risk was found in case-control studies (odds ratio [OR] estimates for highest vs. lowest intakes = 0.38; 95 % CI: 0.16-0.86) but not in prospective cohort studies (hazard ratio [HR] estimates for highest vs. lowest intakes = 1.01; 95 % CI: 0.92-1.12). Conclusion: This study did not suggest an effect of dietary intake of methionine, choline, nor betaine on breast cancer risk, mainly due to the lack of precision of the combined risk estimates as few studies are available. To overcome this uncertainty, more well-designed studies with relevant individual-level covariates are needed

Closing the gap between training needs and training provision in addiction medicine.

Substance use disorders pose a significant global social and economic burden. Although effective interventions exist, treatment coverage remains limited. The lack of an adequately trained workforce is one of the prominent reasons. Recent initiatives have been taken worldwide to improve training, but further efforts are required to build curricula that are internationally applicable. We believe that the training needs of professionals in the area have not yet been explored in sufficient detail. We propose that a peer-led survey to assess those needs, using a standardised structured tool, would help to overcome this deficiency. The findings from such a survey could be used to develop a core set of competencies which is sufficiently flexible in its implementation to address the specific needs of the wide range of professionals working in addiction medicine worldwide

Machine learning computational tools to assist the performance of systematic reviews: A mapping review

Mapping review of machine learning systematic review tools. This project aims to map the currently available machine learning software tools that assist the systematic review process, following structured mapping review methods. *For further details, please see the attached protocol

Retraso en el acceso al primer tratamiento por trastorno por uso de opiáceos

XLI Reunión anual de la Sociedad Española de Epidemiología (SEE) y XVIII Congresso da Associação Portuguesa de Epidemiología (APE). Porto (Portugal), del 5 al 8 de septiembre de 2023.Antecedentes/Objetivos: La demanda precoz de tratamiento para el trastorno por uso de opiáceos se relaciona con un aumento de las posibilidades de éxito en el mismo. Los nuevos pacientes que buscan este tratamiento, y el tiempo que tardan en hacerlo, han sido escasamente descritos en España y Europa. El objetivo del presente estudio es identificar los factores individuales relacionados con el retraso en acudir por primera vez a tratamiento por trastorno por uso de opiáceos. Métodos: Estudio transversal realizado en pacientes admitidos por primera vez a tratamiento por Trastorno por uso de opiáceos en centros públicos de la Comunidad de Madrid (España) entre los años 2017-2019. Se estableció como variable dependiente el tiempo desde el inicio del consumo hasta el tratamiento (THT). Se realizó un análisis descriptivo general de los usuarios, seguido de un análisis bivariado tras dividir la muestra en dos grupos (THT 49 años (OR: 5,87; IC95% 1,73-20,00), desempleo (OR: 2,54; IC95% 1,11-5,83), bajo nivel educativo (OR: 2,18; IC95% 1,04-4,59), no tener hogar (OR: 4,18; IC95% 1,29-13,57), primer consumo en la calle, frente a primeros consumos en domicilios (OR: 2,54; IC95% 1,11-5,84) y VHC positivo (OR: 2,97; IC95% 1,00-8,82). A pesar de la gran diferencia en THT entre hombres y mujeres, al ajustar por otras variables en el análisis multivariante no se observaron diferencias por género. Conclusiones/Recomendaciones: Los barrios y entornos desfavorecidos, los usuarios de más edad y aquellos en riesgo de exclusión social se revelan como principales objetivos de las intervenciones. Es un momento de incertidumbre ante el incremento en el consumo de los opiáceos medicamentosos y el miedo a su posible efecto en un aumento de adicciones. Por eso los servicios asistenciales tienen que seguir siendo muy accesibles y tener el menor número de barreras. Para atender a los pacientes y, a la vez, detectar un posible incremento en su número.Financiación: Proyecto financiado por Acción Estratégica en Salud (PI19/00982).N

Understanding the use of evidence in the WHO Classification of Tumours: a protocol for an evidence gap map of the classification of tumours of the lung

Introduction: There are gaps in the evidence base of tumour classification despite being essential for cancer diagnosis, treatment and patient care. The WHO in charge of the production of an updated international classification, the WHO Classification of Tumours (WCT), aims to adapt evidence gap map (EGM) methodology to inform future editions of the WCT, by providing a visual summary of the existing evidence. Methods and analysis: Bibliographical references used in the WCT fifth edition of Tumours of the Lung (Thoracic Tumours volume) will be used as search results of a literature search. A descriptive analysis of the cited evidence for tumour types and descriptors will be drafted and plotted in EPPI-Reviewer to develop a visual evidence map. The resulting EGM will reflect the number of cited studies in the size of the spheres, and the level of evidence by applying a four-colour code (red=low level evidence, orange=moderate level, green=high level and blue=unclassifiable). Overview of the findings will be provided in narrative form and a report will discuss the overall stage of cited research in the WCT and will include analysis of gaps, under-researched categories of tumour descriptors and pockets of low-level evidence. Ethics and dissemination: No ethics approval will be required as this is a study of previously published material. Findings of the EGM will be published and used to guide editors, stakeholders and researchers for future research planning and related decision-making, especially for the development of future editions of the WCT.S