Greenlandic patients exhibited a positive response to adjuvant oncologic treatment; however, its utilization in palliative care was less commonplace compared to that of Danish patients. The radical operation for PDAC yielded contrasting survival statistics for Greenlandic and Danish patients. At one year, survival was 544% in Greenlandic patients, versus 746% in Danish patients. At two years, survival rates were 234% and 486%, respectively. At five years, both groups had 00% and 234% survival, respectively. The overall survival times for patients with non-resectable pancreatic ductal adenocarcinoma (PDAC) were 59 months and 88 months, respectively. Greenlandic patients, despite receiving the same level of specialized pancreatic and periampullary cancer treatment as Danish patients, experience a less favorable post-treatment prognosis, as the research determined.
Unhealthy alcohol use, resulting in adverse physical, psychological, social, or societal consequences, is defined as harmful alcohol use; it stands as a major global risk factor for disease, disability, and premature death. The detrimental effects of alcohol consumption are rising in low- and middle-income countries (LMICs), leading to a substantial unmet need for effective prevention and treatment strategies in these regions. Research on effective and sustainable interventions to address harmful alcohol use, as well as other unhealthy patterns of alcohol consumption, in LMICs is insufficient, exacerbating the existing service gap.
To compare the efficacy and safety of psychosocial and pharmacological interventions, along with indicated preventive strategies, against control groups (waitlist, placebo, no treatment, standard care, or active control), for the purpose of reducing harmful alcohol consumption in low- and middle-income countries.
A review of randomized controlled trials (RCTs) in the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, CENTRAL (Cochrane Library), PubMed, Embase, PsycINFO, CINAHL, and LILACS was conducted, ending December 12, 2021. We scrutinized clinicaltrials.gov, seeking out applicable clinical trial data. To identify unpublished or ongoing studies, we performed a search across the World Health Organization International Clinical Trials Registry Platform, Web of Science, and the Opengrey database. By examining the reference lists of the included studies and related review articles, we sought to discover suitable research.
In low- and middle-income countries (LMICs), randomized controlled trials (RCTs) comparing indicated prevention or treatment interventions (pharmacological or psychosocial) against a control condition for individuals with harmful alcohol use were included.
We followed the standard methodological procedures stipulated by Cochrane.
Our analysis encompassed 66 randomized controlled trials, involving a total of 17,626 participants. The meta-analysis leveraged findings from sixty-two of these trials. Within the set of studies, a significant portion, namely sixty-three, were focused on middle-income countries (MICs), while low-income countries (LICs) had only three studies. Every one of the twenty-five trials focused solely on the enrollment of participants with alcohol use disorder. The 51 remaining trials recruited participants who displayed harmful alcohol use; some participants met the criteria for alcohol use disorder, whereas others exhibited hazardous patterns of alcohol use, falling short of a formal disorder diagnosis. In 52 randomized controlled trials, the effectiveness of psychosocial interventions was examined; 27 of these trials specifically tested brief interventions, primarily based on motivational interviewing, and compared them to interventions providing only brief advice, information, or assessment. β-Nicotinamide The effectiveness of brief interventions in reducing harmful alcohol use is unclear, given the substantial variation among the studies analyzed. (Studies assessing continuous outcomes displayed Tau = 0.15, Q = 13964, df = 16, P < .001). In the study of 3913 participants and 17 trials, a result of 89% (I) was found, demonstrating very low confidence levels. The study of dichotomous outcomes displayed significant heterogeneity (Tau=0.18, Q=5826, df=3, P<.001). With 4 trials and 1349 participants, the resulting 95% confidence level reflects a very low degree of certainty. Therapeutic approaches within psychosocial interventions included, but were not limited to, behavioral risk reduction, cognitive-behavioral therapy, contingency management, rational emotive therapy, and relapse prevention. These interventions were routinely benchmarked against usual care, a mix of psychoeducation, counseling, and pharmacotherapy. Our analysis of the effect of psychosocial treatments on harmful alcohol use is complicated by the marked heterogeneity across the included studies (Heterogeneity Tau = 115; Q = 44432, df = 11, P<.001; I=98%, 2106 participants, 12 trials). Consequently, we lack confidence in attributing any reduction to these treatments, yielding a very low certainty conclusion. bio-active surface Eight experiments measured the effects of incorporating pharmacologic and psychosocial interventions together, assessing their results against placebo conditions, individual psychosocial interventions, and a separate pharmacologic treatment. The pharmacologic study conditions comprised the use of disulfiram, naltrexone, ondansetron, or topiramate as active agents. Psychosocial elements of these interventions included counseling, support for Alcoholics Anonymous, motivational interviewing, brief cognitive-behavioral therapy, or alternative unspecified psychotherapies. A comparative analysis of studies evaluating a combined pharmacological and psychosocial intervention versus a psychosocial intervention alone revealed a potential for greater reduction in harmful alcohol use with the combined approach (standardized mean difference (SMD) = -0.43, 95% confidence interval (CI) -0.61 to -0.24; 475 participants; 4 trials; low certainty). Cholestasis intrahepatic A comparison of pharmacologic intervention against placebo was conducted in four trials, as was a comparison of pharmacologic intervention against another pharmacotherapy in three trials. The drugs under evaluation included acamprosate, amitriptyline, baclofen, disulfiram, gabapentin, mirtazapine, and naltrexone. No evaluation of the primary clinical outcome, harmful alcohol use, occurred in any of these trials. Retention in the intervention was examined, and rates were documented in thirty-one trials. Study retention rates were consistent across different intervention types, according to meta-analytic results. Pharmacologic intervention alone yielded a risk ratio of 1.13 (95% CI 0.89 to 1.44), based on 247 participants and 3 trials; this is classified as low certainty. Combining pharmacologic with psychosocial interventions resulted in a risk ratio of 1.15 (95% CI 0.95 to 1.40), from 3 trials and 363 participants, which is considered moderate certainty. Significant heterogeneity prevented the calculation of pooled estimates for retention in short-term interventions (Heterogeneity Tau = 000; Q = 17259, df = 11, P<.001). A list of sentences, as per the JSON schema, is presented here.
With 12 trials, comprising 5380 participants, the study produced a very low certainty level concerning interventions, specifically highlighting the presence of significant psychosocial intervention heterogeneity. Here's a compilation of sentences, each showing a different structural arrangement and wording, all distinct from the original sentence.
A study of 1664 participants and 9 trials produced results indicating a remarkably low level of certainty in a substantial 77% of subjects. Concerning side effects, two pharmacological trials and three trials integrating pharmacological and psychosocial methodologies provided reports. While amitriptyline exhibited a higher frequency of side effects compared to mirtazapine, naltrexone, and topiramate, placebo demonstrated no distinct side effect patterns when contrasted with acamprosate or ondansetron. Across all intervention types, a considerable risk of bias was evident. The study's reliability suffered from a lack of blinding, and the prevalence of differing and considerable attrition rates.
In low-resource settings, the evidence supporting the effectiveness of combined psychosocial and pharmacological interventions in reducing harmful alcohol use is uncertain relative to psychosocial interventions used independently. Determining the effectiveness of pharmacological or psychosocial interventions to curb harmful alcohol use remains challenging due to the significant variation in outcomes, comparisons, and interventions, preventing comprehensive data pooling for meta-analyses. The majority of studies employ brief interventions, largely focused on men, and measures that haven't been validated in the targeted population. The observed heterogeneity in results, both across different studies and within studies concerning various outcome measures, coupled with the possibility of bias, diminishes confidence in the outcomes. To elevate the certainty of pharmacologic intervention outcomes, a deeper investigation into distinct psychosocial approaches is paramount.
Low-certainty evidence suggests that combining psychosocial and pharmacological interventions in low- and middle-income countries might not be more effective than psychosocial interventions alone in curbing harmful alcohol use. The efficacy of pharmacological or psychosocial strategies in reducing harmful alcohol use remains uncertain, largely because of substantial discrepancies in outcomes, treatment comparisons, and intervention types, preventing the combination of these data for meta-analyses. The majority of studies are concentrated on men and utilize brief interventions, with assessment tools that have not been validated in the target group. The considerable heterogeneity across studies, together with the risk of bias and the variety of outcomes seen on diverse outcome measures within studies, weakens confidence in these results. To improve the confidence in the outcomes of pharmacological treatments, more research is needed on the efficacy of varied psychosocial interventions.