ABSTRACT
BACKGROUND: Context-specific evidence-based guidelines on how to prevent and treat substance misuse among adolescents are currently lacking in many countries. Due to the time consuming nature of de novo guideline development, the ADAPTE collaboration introduced a methodology to adapt existing guidelines to a local context. An important step in this method is a systematic review to identify relevant high-quality evidence-based guidelines. This study describes the results of this step for the development of guidelines on adolescent alcohol and drug misuse in Belgium. METHODS: Rigorous systematic review methodology was used. This included searches of electronic databases (Medline, Embase, Cinahl, PsychInfo, and ERIC in June 2011), websites of relevant organizations, and reference lists of key publications. Experts in the field were also contacted. Included were Dutch, English, French, or German evidence-based practice guidelines from 2006 or later on the prevention, screening, assessment, or treatment of alcohol or illicit drug misuse in persons aged 12-18 years. Two independent reviewers assessed the quality of the guidelines using the AGREE II (Appraisal of Guidelines for Research and Evaluation) instrument. SCOPE: This overview provides a framework of current knowledge in adolescent alcohol and drug misuse prevention and treatment. RESULTS: This systematic review identified 32 relevant evidence-based guidelines on substance misuse among adolescents. Nine guidelines were judged to be of high quality; of which four had recommendations specifically on adolescents: one on school-based prevention, one on substance misuse prevention in vulnerable young people and two on alcohol misuse with specific sections for the adolescent population. There were few commonalities as guidelines focused on different target groups, professional disciplines and type and level of substance misuse. Evidence to support the recommendations was sparse, and many recommendations were based on expert consensus or on studies among adults. Also, the link between evidence and recommendations was often unclear. CONCLUSIONS: There are a substantial number of guidelines addressing substance misuse in adolescents. However, only four high-quality guidelines included recommendations specific for adolescents. The current level of evidence that underpins the recommendations in these high-quality guidelines is low.
Subject(s)
Evidence-Based Practice/standards , Practice Guidelines as Topic/standards , Substance-Related Disorders , Adolescent , Alcoholism/prevention & control , Alcoholism/therapy , Belgium , Humans , Substance-Related Disorders/prevention & control , Substance-Related Disorders/therapyABSTRACT
BACKGROUND: The presence of ADHD has been linked to a 100% increase in a person's chance of developing a substance use disorder. The prevalence of childhood and adult ADHD in substance-abusing populations has been estimated to be three times higher than in the general population. In addiction centres ADHD is often unrecognized and untreated. AIM: To describe the obstacles to the diagnosis and treatment of ADHD in addicts. METHOD: Using a historical approach, we analysed the evolution of the diagnostic descriptions of the two disorders, giving attention to the influence of social change and scientific research. RESULTS: The two disorders have developed in remarkably similar ways; people have been and still are much inclined to make moral judgments about these disorders than about other psychic disorders. Neurobiological research has added a extra dimension to the debate on topics such as impulsivity, personal responsibility and free will. CONCLUSION: It is only recently that ADHD has been recognised as having a place in addiction treatment and, as a result, there is a growing need for explanatory models.
Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/epidemiology , Substance-Related Disorders/epidemiology , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/genetics , Comorbidity , HumansABSTRACT
Introducción El cáncer de mama ocupa el primer lugar en mortalidad por neoplasias en la mujer en México. La quimioterapia neoadyuvante ha reportado una eficacia de alrededor 70%; sin embargo, aquellas pacientes que no responden adecuadamente deben someterse a métodos coadyuvantes que afectan su calidad de vida. El óxido nítrico, brevemente, en concentraciones altas es capaz de tener efectos citotóxicos y tumoricidas, favoreciendo una respuesta adecuada al tratamiento antineoplásico. La L-arginina es precursor del óxido nítrico, por lo que la suplementación puede influir en la síntesis y, por tanto, en su concentración.ObjetivosEvaluar la eficacia de la suplementación de L-arginina sobre la respuesta al tratamiento con quimioterapia neoadyuvante.Materiales y métodosEnsayo clínico de asignación aleatoria que administró un suplemento de 30g de L-arginina en cada ciclo de quimioterapia neoadyuvante. Se determinó la concentración de nitritos antes y después de ingerir el suplemento, así como el tamaño tumoral antes de iniciar el tratamiento y una vez concluido el mismo. Se realizó una prueba chi-cuadrado para evaluar la asociación entre la suplementación y una respuesta adecuada al tratamiento; los nitritos plasmáticos fueron evaluados mediante pruebas t-student.ResultadosSe evaluaron 45 pacientes. Veintiuno tuvieron una respuesta adecuada al tratamiento oncológico; sin embargo, no se encontró una asociación significativa entre la suplementación y dicha respuesta. La concentración de nitritos plasmáticos aumentó de manera significativa (p<0,05) en el grupo que recibió el suplemento con L-arginina.Conclusiones(..) (AU)
Background Breast cancer is the first cause of mortality from malignant neoplasms among women in Mexico. Neoadjuvant chemotherapy has a reported efficacy of approximately 70%; however, patients with inadequate response must undergo additional coadjuvant methods that negatively affect their quality of life. High concentrations of nitric oxide have shown cytotoxic and tumoricidal effects, thus favoring an adequate response to antineoplastic treatment. L-arginine is a nitric oxide precursor and therefore supplementation with this substance can augment nitric oxide synthesis and consequently its plasma concentration.ObjectivesTo evaluate the efficacy of L-arginine supplementation in response to neoadjuvant chemotherapeutic treatment.Materials and methodsWe conducted a randomized clinical trial in which 30g of L-arginine was administered in each neoadjuvant chemotherapy cycle. Plasma nitrite concentrations were determined before and after supplementation, as well as tumoral size before the start of antineoplastic treatment and after its completion. A chi-square test was performed to evaluate the association between the supplementation and adequate treatment response; plasma nitrites were evaluated by performing Student's T-tests.ResultsForty-five patients were assessed, of whom 21 had an adequate response to antineoplastic treatment. No statistically significant association was found between supplementation and adequate response. Nitrite concentrations in plasma were significantly increased (p<0.05) in patients receiving the supplement than in those who receiving placebo.Conclusions(..) (AU)
