Greenlandic patients readily accepted adjuvant oncologic treatment, though its use in a palliative context was less frequent compared to Danish patients. For Greenlandic and Danish patients who underwent radical PDAC surgery, the postoperative one-, two-, and five-year survival rates demonstrated a significant disparity. The one-year survival was 544% for Greenlandic and 746% for Danish patients. The two-year survival was 234% for Greenlandic patients and 486% for Danish patients. The five-year survival rates were 0% and 234%, respectively. The observed overall survival times for non-resectable pancreatic ductal adenocarcinoma (PDAC) were 59 months and 88 months, respectively. The study's assessment of pancreatic and periampullary cancer treatment outcomes indicates that Greenlandic patients, despite having the same access to specialized treatment as Danish patients, encounter a less favorable prognosis after treatment.
Patterns of alcohol use that are deemed unhealthy, and that culminate in negative impacts on physical, mental, social, and societal dimensions, constitute harmful alcohol use; this is a major contributor globally to disease, disability, and early mortality. 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. The body of knowledge regarding suitable and implementable interventions for harmful and other problematic alcohol use patterns in low- and middle-income countries is restricted, consequently impacting service accessibility.
Assessing the effectiveness and safety of psychosocial and pharmacological therapies, and preventive approaches, compared to various control groups (waitlist, placebo, no treatment, standard care, or active control), focused on diminishing harmful alcohol use in low- and middle-income countries.
We investigated randomized controlled trials (RCTs) indexed in the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, Cochrane CENTRAL, PubMed, Embase, PsycINFO, CINAHL, and LILACS through December 12, 2021, for inclusion. Clinicaltrials.gov was examined in our pursuit of pertinent research. Employing the World Health Organization International Clinical Trials Registry Platform, Web of Science, and Opengrey database, we attempted to discover unpublished or ongoing studies. We scrutinized the reference lists of the included studies and pertinent review articles to identify suitable studies.
For individuals with harmful alcohol use in low- and middle-income countries (LMICs), all randomized controlled trials (RCTs) that compared indicated prevention or treatment interventions (either pharmacological or psychosocial) versus a control group were selected for this review.
Our methodology, as dictated by Cochrane's expectations, utilized standard procedures.
Included in our research were 66 randomized controlled trials, involving 17,626 participants. Sixty-two of these trials were incorporated into the meta-analysis framework. The substantial number of sixty-three studies focused on middle-income countries (MICs), leaving only three studies to be performed in low-income countries (LICs). Enrollment in twenty-five trials was restricted to participants exhibiting alcohol use disorder. Harmful alcohol use was a feature of participants enrolled in the remaining 51 trials, some meeting the criteria for alcohol use disorder and others exhibiting hazardous alcohol use patterns without meeting disorder criteria. 52 randomized controlled trials investigated psychosocial intervention efficacy; 27 of these trials, employing brief interventions grounded in motivational interviewing, were compared to brief advice-only, information-only, or assessment-only interventions. Organic immunity We are hesitant to attribute a decline in harmful alcohol use to brief interventions, considering the extensive heterogeneity across the included studies. (Studies measuring continuous outcomes displayed Tau = 0.15, Q = 13964, df = 16, P < .001). A study of 17 trials involving 3913 participants demonstrated a 89% (I) result with very low certainty. Analysis of dichotomous outcomes revealed statistically significant heterogeneity (Tau=0.18, Q=5826, df=3, P<.001). The findings, based on 4 trials and 1349 participants, display a 95% confidence level, indicating a very low level 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. Usual care, a combination of psychoeducation, counseling, and pharmacotherapy, was the prevalent standard against which these interventions were measured. The significant heterogeneity amongst the studies (Heterogeneity Tau = 115; Q = 44432, df = 11, P<.001; I=98%, 2106 participants, 12 trials) creates uncertainty about whether a decrease in harmful alcohol use is a consequence of psychosocial treatments, with the overall findings having a very low degree of certainty. animal biodiversity Eight trials scrutinized the combined effects of pharmacologic and psychosocial interventions, contrasting them with placebo, standalone psychosocial interventions, and alternative pharmacologic treatments. Among the active pharmacologic study conditions, disulfiram, naltrexone, ondansetron, or topiramate were utilized. Among the psychosocial components of these interventions were counseling, encouragement to join Alcoholics Anonymous, motivational interviewing, brief cognitive-behavioral therapy, or other unspecified types of psychotherapy. Across several studies, comparing a combined approach of pharmacologic and psychosocial interventions to psychosocial interventions alone, evidence suggests a potential correlation between the combined approach and a larger reduction in harmful alcohol use (standardized mean difference (SMD) = -0.43, 95% confidence interval (CI) -0.61 to -0.24; 475 participants; 4 trials; low certainty). check details Placebo was compared with pharmacologic intervention in four investigations; in three further studies, a different pharmacotherapy was the comparator. The evaluation encompassed various drugs, including acamprosate, amitriptyline, baclofen, disulfiram, gabapentin, mirtazapine, and naltrexone. These trials, in their entirety, lacked evaluation of the principal clinical endpoint of interest, harmful alcohol use. Thirty-one trials detailed the retention rates observed within the intervention group. No discernible difference in retention rates between study groups was discovered in meta-analyses. Pharmacologic interventions alone, with 247 participants and three trials, demonstrated a risk ratio of 1.13 (95% CI 0.89-1.44), showing low certainty. The addition of psychosocial interventions to pharmacologic interventions showed a risk ratio of 1.15 (95% CI 0.95-1.40) based on 3 trials and 363 participants, exhibiting moderate certainty. Extensive heterogeneity within the data set prevented us from calculating combined retention estimates in brief interventions (Heterogeneity Tau = 000; Q = 17259, df = 11, P<.001). A list of sentences is the result of this JSON schema.
Participants in 12 trials, numbering 5380, showed a very low level of certainty in the outcomes of the interventions, including psychosocial methods. A list of rewritten sentences, each distinct in structure and wording from the original sentence.
Seventy-seven percent of 1664 participants, across nine trials, demonstrated remarkably low confidence levels. In two pharmacological investigations and three trials combining pharmacological and psychosocial interventions, side effects were a subject of reporting. The research indicated a higher rate of side effects linked to amitriptyline relative to mirtazapine, naltrexone, and topiramate in comparison to a placebo. However, no measurable difference in side effects was noted between placebo and either acamprosate or ondansetron. Concerning bias, all intervention types showed substantial risk. Critical concerns regarding the study's validity stemmed from the absence of blinding procedures and varying attrition rates.
The efficacy of combining psychosocial and pharmacological interventions in reducing harmful alcohol use in low- and middle-income countries is uncertain when compared to the efficacy of psychosocial interventions alone. A lack of conclusive evidence on the effectiveness of pharmacologic or psychosocial treatments in decreasing harmful alcohol consumption stems primarily from the substantial variability in study outcomes, methodologies, and interventions themselves, obstructing the aggregation of these datasets for meta-analysis. Studies, predominantly involving men, are frequently characterized by brief interventions and the use of measures not validated within the target 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. Understanding the efficacy of pharmacological interventions demands further investigation encompassing distinct types of psychosocial support strategies.
In low- and middle-income countries, there is insufficient reliable evidence to definitively state whether combining psychosocial and pharmacological interventions is more effective in reducing harmful alcohol use than psychosocial interventions alone. Due to substantial differences in outcomes, comparisons, and interventions, it is difficult to ascertain the efficacy of pharmacological or psychosocial treatments for decreasing harmful alcohol use, precluding the consolidation of data for meta-analyses. Brief interventions, typically for men, dominate the majority of studies, often employing measurement instruments lacking validation among the intended population. The potential for bias, substantial heterogeneity between studies, and variable outcomes across outcome measures within studies reduces confidence in the reliability of these results. More research into the effectiveness of pharmacological interventions, and specifically into the varied approaches of psychosocial support, is vital to increase the trustworthiness of these findings.