https://www.healio.com/psychiatry/journals/psycann/1976-12-6-12/{806b8887-c02e-40c8-a228-57f1cdb2bdba}/the-stress-of-life.pdf

The stress of life

Aims This study provides a systematic review of existing research that has empirically evaluated interventions designed to reduce stigma related to substance use disorders. Methods A comprehensive review of electronic databases was conducted to identify evaluations of substance use disorder related stigma interventions. Studies that met inclusion criteria were synthesized and assessed using systematic review methods. Results Thirteen studies met the inclusion criteria. The methodological quality of the studies was moderately strong. Interventions of three studies (23%) focused on people with substance use disorders (self-stigma), three studies (23%) targeted the general public (social stigma) and seven studies (54%) focused on medical students and other professional groups (structural stigma). Nine interventions (69%) used approaches that included education and/or direct contact with people who have substance use disorders. All but one study indicated their interventions produced positive effects on at least one stigma outcome measure. None of the interventions have been evaluated across different settings or populations. Conclusions Arangeof interventionsdemonstratepromiseforachievingmeaningfulimprovementsinstigmarelated to substance use disorders. The limited evidence indicates that self-stigma can be reduced through therapeutic interventions such as group-based acceptance and commitment therapy. Effective strategies for addressing social stigma include motivational interviewing and communicating positive stories of people with substance use disorders. For changing stigma at a structural level, contact-based training and education programs targeting medical students and professionals (e.g. police, counsellors) are effective. add_3601 39..50

/pdf/the-effectiveness-of-interventions-for-reducing-stigma-2dk0tspmv8.pdf

The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review

Background
The Mini Mental State Examination (MMSE) is a cognitive test that is commonly used as part of the evaluation for possible dementia.

Objectives
To determine the diagnostic accuracy of the Mini-Mental State Examination (MMSE) at various cut points for dementia in people aged 65 years and over in community and primary care settings who had not undergone prior testing for dementia.

Search methods
We searched the specialised register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), LILACS (BIREME), ALOIS, BIOSIS previews (Thomson Reuters Web of Science), and Web of Science Core Collection, including the Science Citation Index and the Conference Proceedings Citation Index (Thomson Reuters Web of Science). We also searched specialised sources of diagnostic test accuracy studies and reviews: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). We attempted to locate possibly relevant but unpublished data by contacting researchers in this field. We first performed the searches in November 2012 and then fully updated them in May 2014. We did not apply any language or date restrictions to the electronic searches, and we did not use any methodological filters as a method to restrict the search overall.

Selection criteria
We included studies that compared the 11-item (maximum score 30) MMSE test (at any cut point) in people who had not undergone prior testing versus a commonly accepted clinical reference standard for all-cause dementia and subtypes (Alzheimer disease dementia, Lewy body dementia, vascular dementia, frontotemporal dementia). Clinical diagnosis included all-cause (unspecified) dementia, as defined by any version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); International Classification of Diseases (ICD) and the Clinical Dementia Rating.

Data collection and analysis
At least three authors screened all citations.Two authors handled data extraction and quality assessment. We performed meta-analysis using the hierarchical summary receiver-operator curves (HSROC) method and the bivariate method.

Main results
We retrieved 24,310 citations after removal of duplicates. We reviewed the full text of 317 full-text articles and finally included 70 records, referring to 48 studies, in our synthesis. We were able to perform meta-analysis on 28 studies in the community setting (44 articles) and on 6 studies in primary care (8 articles), but we could not extract usable 2 x 2 data for the remaining 14 community studies, which we did not include in the meta-analysis. All of the studies in the community were in asymptomatic people, whereas two of the six studies in primary care were conducted in people who had symptoms of possible dementia. We judged two studies to be at high risk of bias in the patient selection domain, three studies to be at high risk of bias in the index test domain and nine studies to be at high risk of bias regarding flow and timing. We assessed most studies as being applicable to the review question though we had concerns about selection of participants in six studies and target condition in one study.

The accuracy of the MMSE for diagnosing dementia was reported at 18 cut points in the community (MMSE score 10, 14-30 inclusive) and 10 cut points in primary care (MMSE score 17-26 inclusive). The total number of participants in studies included in the meta-analyses ranged from 37 to 2727, median 314 (interquartile range (IQR) 160 to 647). In the community, the pooled accuracy at a cut point of 24 (15 studies) was sensitivity 0.85 (95% confidence interval (CI) 0.74 to 0.92), specificity 0.90 (95% CI 0.82 to 0.95); at a cut point of 25 (10 studies), sensitivity 0.87 (95% CI 0.78 to 0.93), specificity 0.82 (95% CI 0.65 to 0.92); and in seven studies that adjusted accuracy estimates for level of education, sensitivity 0.97 (95% CI 0.83 to 1.00), specificity 0.70 (95% CI 0.50 to 0.85). There was insufficient data to evaluate the accuracy of the MMSE for diagnosing dementia subtypes.We could not estimate summary diagnostic accuracy in primary care due to insufficient data.

Authors' conclusions
The MMSE contributes to a diagnosis of dementia in low prevalence settings, but should not be used in isolation to confirm or exclude disease. We recommend that future work evaluates the diagnostic accuracy of tests in the context of the diagnostic pathway experienced by the patient and that investigators report how undergoing the MMSE changes patient-relevant outcomes.

/pdf/mini-mental-state-examination-mmse-for-the-detection-of-2hf8fes1sc.pdf

Mini‐Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations

Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis

O cuidado das condições crônicas na atenção primária à saúde: o imperativo da consolidação da estratégia da saúde da família

Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil.

Many studies reported that brief interventions are effective in reducing excessive drinking. This study aimed to assess the efficacy of a protocol of brief intervention for college students (BASICS), delivered face-to-face, to reduce risky alcohol consumption and negative consequences. A systematic review with meta-analysis was performed by searching for randomized controlled trials (RCTs) in Medline, PsycInfo, Web of Science and Cochrane Library databases. A quality assessment of RCTs was made by using a validated scale. Combined mean effect sizes, using meta-analysis random-effects models, were calculated. 18 studies were included in the review. The sample sizes ranged from 54 to 1275 (median = 212). All studies presented a good evaluation of methodological quality and four were found to have excellent quality. After approximately 12 months of follow-up, students receiving BASICS showed a significant reduction in alcohol consumption (difference between means = −1.50 drinks per week, 95% CI: -3.24 to −0.29) and alcohol-related problems (difference between means = −0.87, 95% CI: -1.58 to −0.20) compared to controls. Overall, BASICS lowered both alcohol consumption and negative consequences in college students. Gender and peer factors seem to play an important role as moderators of behavior change in college drinking. Characteristics of BASICS procedure have been evaluated as more favorable and acceptable by students in comparison with others interventions or control conditions. Considerations for future researches were discussed.

/pdf/efficacy-of-brief-alcohol-screening-intervention-for-college-1buxxiiemq.pdf

Efficacy of brief alcohol screening intervention for college students (BASICS): a meta-analysis of randomized controlled trials.

https://www.scielo.br/pdf/rbp/v26s1/en_a08v26s1.pdf

Brief interventions for alcohol related problems

OBJETIVO: Investigar a relacao entre consumo de alcool e problemas emocionais em gestantes, verificando se as gestantes com consumo problematico de alcool (uso nocivo ou dependencia) tiveram mais problemas emocionais quando comparadas aquelas cujo consumo nao era problematico. METODOS: Estudo transversal, observacional, sobre uma amostra clinica de um servico obstetrico publico de Ribeirao Preto, SP. A amostra foi nao probabilistica, de conveniencia, do tipo consecutiva, composta por 450 gestantes. Foram aplicados tres questionarios: para dados sociodemograficos, o Questionario de Morbidade Psiquiatrica (QMPA) e um questionario padronizado como parte da anamnese para avaliacao de problemas relacionados ao uso de alcool (uso nocivo ou sindrome de dependencia) de acordo com os criterios da CID-10. Foram utilizados testes univariados (ANOVA) para o exame comparativo entre grupos utilizando medidas de distribuicao central e intervalo de confianca de 95%. RESULTADOS: Foram encontradas 172 gestantes (38,2%) problematicas (escore >7) pelo QMPA. Detectaram-se conforme criterios da CID-10, 41 (9,1%) gestantes com consumo problematico de alcool, sendo 27 (6,0%) com diagnostico de uso nocivo e 14 (3,1%) com dependencia ao alcool. A presenca de diagnostico de uso nocivo ou sindrome de dependencia ao alcool relacionou-se a maior intensidade de sofrimento emocional das gestantes, ou seja, maior media de pontuacao nas subescalas ansiedade, depressao e alcool do QMPA. CONCLUSOES: Considerando a prevalencia de problemas emocionais, o consumo de alcool durante a gestacao e os riscos de problemas a saude materno-infantil sugere-se que sejam realizadas avaliacoes mais criteriosas pelos profissionais de saude.

/pdf/morbidade-psiquiatrica-e-uso-de-alcool-em-gestantes-usuarias-427gmgrkdz.pdf

Morbidade psiquiátrica e uso de álcool em gestantes usuárias do Sistema Único de Saúde

To identify the demographic, psychological, and social maternal risk factors associated with the development of Fetal Alcohol Spectrum Disorders (FASD). A bibliographic search was conducted in PubMed, SciELO, Lilacs, Web of Knowledge, and PsycINFO. The Newcastle–Ottawa Quality Assessment Scale (NOS) was used to evaluate the quality of the studies with case–control design. Articles were selected based on their relevance and presentation of data related to statistical comparisons of at least one or more demographic, psychological, or social maternal risk factors for FASD. 738 references were identified, of which 15 met the criteria to be included in the present review. Mothers of FASD children tend to: be older at the time of birth of the affected child, present lower educational level, have other family relatives with alcohol abuse, have other children with FASD, present a pattern of little prenatal care and a distinguishing pattern of alcohol consumption (alcohol use before and during pregnancy, failure to reduce alcohol use during pregnancy, and frequent episodes of binge drinking). Application of the NOS scale of methodological quality indicated that 8 studies (53 %) met the criterion for selection, 4 (27 %) were suitable for the criterion for comparability and only 4 studies were suitable for the exposition criterion. Mothers of FASD children have a distinctive pattern of drinking and accumulate several social risk factors. Maternal age at birth of the child seems to accentuate the risk. There are, however, few controlled studies that are adequate according to the NOS requirements for methodological quality. Fewer are based on the verification of a theoretical model. Clinicians should be aware of the relevance of preventive assessment of FASD risk mothers.

Erikson Felipe Furtado

Papers

Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil.

Efficacy of brief alcohol screening intervention for college students (BASICS): a meta-analysis of randomized controlled trials.

Brief interventions for alcohol related problems

Morbidade psiquiátrica e uso de álcool em gestantes usuárias do Sistema Único de Saúde

Identifying maternal risk factors associated with Fetal Alcohol Spectrum Disorders: a systematic review