Relación entre la cantidad y el tipo de alcohol (destilado versus fermentado) consumido y el riesgo de aparición de deterioro cognitivo compatible con un síndrome demencial en personas mayores de 60 años: revisión sistemática / Relationship between the amount and type of alcohol (distilled versus fermented) consumed and the risk of cognitive impairment compatible with a dementia syndrome in people over 60 years of age: A systematic review

Introducción: el alcohol es la sustancia más consumida en la cultura occidental y su consumo es un factor causal en más de 200 enfermedades y trastornos. El objetivo fue conocer la relación entre la cantidad y el tipo de alcohol (destilado o fermentado) consumido en individuos mayores de 60 años y la aparición del deterioro cognitivo compatible con un síndrome demencial como consecuencia de un consumo excesivo y prolongado.Desarrollo: búsqueda en las bases de datos Medline, PsycInfo y Web of Science. Se acotó la búsqueda a artículos publicados entre los años 2010 y 2021, a partir de la combinación de diversos términos relacionados con la demencia, el consumo y tipo de alcohol y la vejez. Se obtuvieron 157 artículos, se eliminaron aquellos repetidos y los no relacionados con el tema, quedando un total de 9 artículos. Esta revisión sistemática se ha llevado a cabo de acuerdo con los criterios de la declaración PRISMA.Conclusiones: la mayoría de los estudios encontrados (7 de 9) sugirieron una asociación entre el consumo de alcohol y la aparición de la demencia. Respecto al tipo de bebidas, todo y la objetivación de algunos resultados poco concluyentes, en general se sugiere que el consumo de vino (bebida fermentada) se asocia a una disminución del deterioro cognitivo y el consumo de licor (bebida destilada) a un aumento del deterioro cognitivo; no queda claro el papel de la cerveza. Por ello se puede concluir que la asociación entre el consumo de alcohol, y el mayor o menor deterioro cognitivo depende tanto del consumo excesivo y prolongado, como también del tipo de bebidas consumidas (destiladas o fermentadas).(AU)

Introduction: Alcohol is the most consumed substance in Western culture and its consumption is a causal factor in more than 200 diseases and disorders. The objective was to determine the relationship between the amount and type of alcohol (distilled or fermented) consumed, in individuals over 60 years of age, and the appearance of cognitive deterioration compatible with a dementia syndrome as a consequence of excessive and prolonged consumption.Development: Search in Medline, PsycInfo and Web of Science databases. The search was limited to articles published between 2010 and 2021, based on the combination of various terms related to dementia, alcohol consumption and type, and old age. 157 articles were obtained, those repeated and those not related to the topic were eliminated, leaving a total of 9 articles. This systematic review has been carried out in accordance with the criteria of the PRISMA statement.Conclusions: Most of the studies found (7 out of 9) suggested an association between alcohol consumption and the onset of dementia. Regarding the type of beverages, everything and the objectification of some inconclusive results, in general it is suggested that the consumption of wine (fermented beverage) is associated with a decrease of cognitive deterioration and the consumption of liquor (distilled beverage) to a increased cognitive decline; the role of beer is not clear. Therefore, it can be concluded that the association between alcohol consumption and greater or lesser cognitive impairment depends both on excessive and prolonged consumption, as well as on the type of beverages consumed (distilled or fermented).(AU)

Similar COVID-19 incidence to the general population in people with opioid use disorder receiving integrated outpatient clinical care.

INTRODUCTION: During the COVID-19 pandemic, limited access to health care augmented COVID-19 risk in subjects with opioid use disorder (OUD). The aim of the study was to compare COVID-19 incidence in individuals with OUD receiving continuous clinical care with that of the general population. METHODS: A prospective cohort study was carried out from March 2020 to March 2021 comparing COVID-19 cumulative incidence of individuals presenting an OUD receiving integrated clinical care with that of an age-reference general population, in three public outpatient treatment centers for addiction in Barcelona, Spain. RESULTS: Over the study period, 366 individuals received clinical care. Mean age: 48.2±8.9 years, 280 (76.5%) were men and 283 (77.3%) native Spanish. All subjects were on opioid agonist therapy. Prevalence of communicable diseases were: HIV infection in 109 (29.8%) and hepatitis C in 46 (12.6%). Psychiatric comorbidity was present in 207 (56.6%), and 119 (32.5%) had >1 chronic medical disease. COVID-19 WAS DIAGNOSED IN 10 PATIENTS: a cumulative incidence of 2,732 casesx100,000 people/year (C.I.95%: 1,318-4,967). There were no differences compared to the age-general population: 2,856 casesx100,000 people/year (C.I.95%: 2,830-2,880) (p=0.81). In the bivariate analysis, hypertension (5[50.0%] vs. 53[14.9%], p=0.01) and cardiovascular chronic diseases (2 [20.0%] vs. 8 [2.2%], p=0.03) were more prevalent in patients with OUD and COVID-19. CONCLUSIONS: Individuals with OUD who received integrated clinical care had a COVID-19 incidence comparable to the general population. Ensuring comprehensive healthcare is essential to prevent the clinical impact of COVID-19 on individuals with OUD.

Integrated Care on Leaving Hospital Against Medical Advice Among HIV-Infected People with Substance Use Disorders.

HIV-infected people with substance use disorders (HIV-SUDs) are at increased risk of leaving hospital against medical advice (LHAMA). The aim of this study was to evaluate the incidence of LHAMA in HIV-SUDs admitted to a patient-centered hospital where they receive integrated care, including healthcare, substance use treatment, and social support. Observational study was conducted at an urban acute-care university teaching hospital. Integrated care included a specialist in addiction medicine and a social worker incorporated into the medical staff. LHAMA was defined as participants leaving the hospital without the physician's permission and not returning within 6 h. Two hundred and ninety-nine HIV-SUDs were hospitalized, and 79 (26.4%) patients were readmitted, generating a total of 517 admissions during 2010-2016. Over the study period, 45 LHAMA were registered, yielding an incidence of 8.7%. On multiple logistic regression analysis, admission for malignancies (OR:4.2; p .02), retention in substance use treatment (OR:0.3; p .01), intravenous substance use (OR:3.1; 0.05), and marginally being foreign (OR:2.1; p .06) were independent factors associated with LHAMA. Despite the patient-centered hospital care, including integrated care, patients with lack of SUD treatment or with intravenous substance use are at increased risk of LHAMA. So, additional measures are necessary to reduce the risk of LHAMA among HIV-SUD.