Effectiveness of antidepressants in improving the prognosis of COVID-19: A systematic review and meta-analysis.

OBJECTIVE, AND MATERIAL AND METHODS: A systematic review and meta-analysis was performed to evaluate the effectiveness of antidepressants in reducing the poor evolution of COVID-19 disease (a composite variable including death, hospitalization and need for mechanical ventilation), and mortality, according the guidelines for Systematic Reviews of Interventions published by the Cochrane library. SOURCE OF DATA: MEDLINE, EMBASE and COCHRANE LIBRARY were consulted up to February 25, 2022. Unpublished studies were searched on clinicaltrials.gov platform. SELECTION OF STUDIES: Seven masked and unmasked, observational and experimental studies evaluating death, hospitalization and need for mechanical ventilation were selected. A second subgroup analysis with mortality variable was performed. DATA EXTRACTION: A full risk of bias assessment was performed addressing issues such as information and confounding bias. ROB2 and Robins-I tools for randomized and no randomized studies were employed respectively. In the quantitative analysis, the risk of publication bias, heterogeneity, estimation of pooled measure and a sensitivity analysis was performed. The pooled final measure was calculated as odds ratio with its correspondent 95% confidence interval. A random effects model was used for this purpose due to the heterogeneity between included studies. Finally, a sensitivity analysis was performed to assess the robustness of final pooled measure. RESULTS: Seven studies were finally considered to calculate the final pooled measure. The effect of intervention was OR 0.73; 95% CI 0.56-0.94. CONCLUSIONS: The use of antidepressants, and specially SSRI could be effective for reducing the risk of poor progression of COVID-19 disease.

Development, validation and transfer to clinical practice of a mobile application for the treatment of smoking / Desarrollo, validación y transferencia a la práctica clínica de una aplicación móvil para el tratamiento del tabaquismo

Objective: The main objective is to transfer to clinical practice a new smoking cessation application (“Vive sin Tabaco” a) in all health centers of the public Basque Health Service. Design: An implementation study of a smoking cessation program previously validated. After implementation, a retrospective study has been carried out to evaluate its use under normal conditions. Site: The process of transfer to clinical practice has been held in several phases; first a pilotage in four health centers of Alava and subsequently, when all reported incidents were resolved, it was extended to all health centers of the Basque Health Service. Intervention and main measurement: Development of “Vive sin Tabaco”; a corporate tool for smoking cessation, and its transfer to clinical practice. All interested health care workers received training on how to use the application. User manuals for both patients and professionals were developed. Smoking cessation rates at 12 months during implementation were also collected.ResultsThe percentage of patients of post pilot phase who quit smoking at 12 months was 14.1%. Conclusions: The conception of “Vive sin tabaco” as a corporate tool for smoking cessation, available in all health centers of Basque Health Service, has been long and arduous, and has required the participation of health professionals and patients as end-users in order to obtain a tool that adapts to their expectations and guarantees greater usability and satisfaction. This application is being effective as an adjuvant tool to health advice.(AU)

Objetivo: El objetivo principal es transferir a la práctica clínica una herramienta corporativa para deshabituación tabáquica («Vive sin Tabaco») en la red sanitaria pública del País Vasco. Diseño: Estudio de implementación de un programa de deshabituación tabáquica previamente validado. Posteriormente se llevó a cabo un estudio retrospectivo para evaluar su efectividad en condiciones de práctica clínica. Emplazamiento: La transferencia a la práctica clínica se ha realizado en varias fases; primero se realizó un pilotaje en 4 centros de salud de Álava y, posteriormente, tras resolver todas las incidencias notificadas, se extendió al resto de centros de salud de la red sanitaria pública vasca. Intervención y principales medidas: Desarrollo de una aplicación móvil corporativa para dejar de fumar «Vive sin Tabaco», y transferencia a la práctica clínica. Todo el personal sanitario interesado recibió formación sobre el uso de la aplicación. Se elaboraron manuales de uso para pacientes y profesionales. Se recogieron las tasas de abandono del tabaco a los 12 meses. Resultados: El porcentaje de pacientes de la fase pospilotaje que dejó de fumar a los 12 meses fue del 14.1%. Conclusiones: La concepción de «Vive sin Tabaco» como herramienta corporativa para la deshabituación tabáquica, ha sido larga y ardua, y ha requerido la participación de los profesionales sanitarios y de los pacientes para conseguir una herramienta que se adapte a sus expectativas, y garantice una mayor usabilidad y satisfacción. Esta aplicación está siendo eficaz como herramienta coadyuvante del consejo sanitario.(AU)

Development, validation and transfer to clinical practice of a mobile application for the treatment of smoking.

OBJECTIVE: The main objective is to transfer to clinical practice a new smoking cessation application ("Vive sin Tabaco" a) in all health centers of the public Basque Health Service. DESIGN: An implementation study of a smoking cessation program previously validated. After implementation, a retrospective study has been carried out to evaluate its use under normal conditions. SITE: The process of transfer to clinical practice has been held in several phases; first a pilotage in four health centers of Alava and subsequently, when all reported incidents were resolved, it was extended to all health centers of the Basque Health Service. INTERVENTION AND MAIN MEASUREMENT: Development of "Vive sin Tabaco"; a corporate tool for smoking cessation, and its transfer to clinical practice. All interested health care workers received training on how to use the application. User manuals for both patients and professionals were developed. Smoking cessation rates at 12 months during implementation were also collected. RESULTS: The percentage of patients of post pilot phase who quit smoking at 12 months was 14.1%. CONCLUSIONS: The conception of "Vive sin tabaco" as a corporate tool for smoking cessation, available in all health centers of Basque Health Service, has been long and arduous, and has required the participation of health professionals and patients as end-users in order to obtain a tool that adapts to their expectations and guarantees greater usability and satisfaction. This application is being effective as an adjuvant tool to health advice.

Corrigendum: Effectiveness of mobile applications to quit smoking: Systematic review and meta-analysis.

[This corrects the article DOI: 10.18332/tpc/127770.].

Cost-effectiveness analysis of text messaging to support health advice for smoking cessation.

BACKGROUND: Smoking in one of the most serious public health problems. It is well known that it constitutes a major risk factor for chronic diseases and the leading cause of preventable death worldwide. Due to high prevalence of smokers, new cost-effective strategies seeking to increase smoking cessation rates are needed. METHODS: We performed a Markov model-based cost-effectiveness analysis comparing two treatments: health advice provided by general practitioners and nurses in primary care, and health advice reinforced by sending motivational text messages to smokers' mobile phones. A Markov model was used in which smokers transitioned between three mutually exclusive health states (smoker, former smoker and dead) after 6-month cycles. We calculated the cost-effectiveness ratio associated with the sending of motivational messages. Health care and society perspectives (separately) was adopted. Costs taken into account were direct health care costs and direct health care cost and costs for lost productivity, respectively. Additionally, deterministic sensitivity analysis was performed modifying the probability of smoking cessation with each option. RESULTS: Sending of text messages as a tool to support health advice was found to be cost-effective as it was associated with increases in costs of €7.4 and €1,327 per QALY gained (ICUR) for men and women respectively from a healthcare perspective, significantly far from the published cost-effectiveness threshold. From a societal perspective, the combined programmed was dominant. CONCLUSIONS: Sending text messages is a cost-effective approach. These findings support the implantation of the combined program across primary care health centres.

Effectiveness of mobile applications to quit smoking: Systematic review and meta-analysis.

INTRODUCTION: Tobacco is the leading cause of preventable mortality. The use of mobile phones has grown exponentially, becoming a powerful tool to be used in health care. METHODS: In order to assess the effectiveness of mobile phones to quit smoking, we have carried out a systematic review and meta-analysis of randomized clinical trials evaluating interventions based on mobile applications for smartphones, that were not a smaller version of the same application, against other types of therapy. To address this, a bibliographic search was carried out in MEDLINE, EMBASE and COCHRANE LIBRARY. To obtain the combined effect, the relative risk and the 95% confidence interval were used. A heterogeneity and sensitivity analysis were also conducted. RESULTS: A total of nine studies were identified, but five were excluded. Qualitative review was performed with four selected studies, but quantitative analysis was carried out for only three, given the impossibility of calculating the RR in one of the studies. After combining the results, an RR of 0.901 (95% CI: 0.57-1.423) was calculated comparing the effectiveness of mobile applications versus others type of interventions. This measure was robust, as shown by the sensitivity analysis. CONCLUSIONS: According to the results, it cannot be concluded that apps are effective for quitting tobacco. There are very few clinical trials published evaluating the effectiveness of mobile applications compared to other alternatives. Several clinical trials are still in progress, therefore their results have not been included in the present meta-analysis.

Effectiveness of randomized controlled trial of a mobile app to promote healthy lifestyle in obese and overweight patients.

BACKGROUND: Health advice is useful for establishing behavioural changes, but such changes tend not to last. It would therefore be good to identify mechanisms for reinforcing advice and one option is the use of information and communication technologies. Given the limited evidence on the effectiveness of such technologies, we decided to conduct a clinical trial to assess the efficacy of a mobile application (app) for supporting the provision health advice for weight loss. METHODS: A randomized clinical trial with 110 obese and overweight patients from the Basque public health care network (Araba). Patients were randomly allocated to the control (health advice) or intervention (health advice + app) groups. Primary (weight) and secondary (blood cholesterol level, blood pressure, haemoglobin A1c (HbA1c) and adherence to dietary and exercise recommendations) outcome variables were assessed at 1, 3 and 6 months after the end of the intervention. RESULTS: There were no significant differences in weight (0.357 kg; P = 0.7), blood cholesterol (2.6 mg/dl; P = 0.617), blood pressure (2.3 mmHg; P = 0.369) or adherence to recommendations on diet (84.6% in control and 92.9% the intervention group, P = 0.413) or physical activity (56% in controls and 75% the intervention group, P = 0.145). On the other hand, there were significant differences in HbA1c in favour of the control group (-0.095%; %; P = 0.046). DISCUSSION: The use of AKTIDIET® to support health advice for weight loss cannot be recommended. More high quality studies are needed, and patients should be involved in the design of apps to increase their efficacy and usability. CLINICAL TRIAL REGISTRATION: NCT02308176.

Length of exposure to antiphospholipid antibodies, rather than age, is a risk factor for thrombosis: a retrospective single-centre observational study.

To investigate the association of age and other factors with thrombosis risk in antiphospholipid antibody (aPL) carriers, a retrospective observational study was conducted in a cohort of patients with medium-high aPL titres recruited in a tertiary care hospital. Assuming an age difference of 9.8 years between patients with and without thrombosis, we estimated that a sample size of 70 participants was required. Several variables besides age including gender, vascular risk factors, inherited thrombophilias, non-thrombotic clinical manifestations, laboratory parameters, aPL profile, length of aPL exposure, antithrombotic drugs and partial aPL score were assessed by univariate analysis followed by multivariate logistic regression. Outcomes were analysed by whether thromboses occurred before (model 1) or after (model 2) aPL detection. Seventy patients [50 females; median (interquartile range) baseline age: 46.99 (39.39-66.20) years] were followed for 2.59 (0.67-5.86) years. Overall, 18 and 5 thromboses were diagnosed applying models 1 and 2, respectively. Time to thrombosis after aPL detection was 2.10 (1.03-8.24) years. Age did not differ between patients with and without thrombosis using models 1 (p = 0.92) or 2 (p = 0.67). Instead, we identified other predictors of thrombosis, namely, lack of thromboprophylaxis [odds ratio (OR) 13.50, 95%  confidence interval (95% CI) 1.02-178.05, p = 0.048] and length of aPL exposure (OR 1.41, 95% CI 1.04-1.92, p = 0.026) in model 2, while lupus anticoagulant showed a tendency to increase the risk (OR 7.10, 95% CI 0.86-58.78, p = 0.069) in model 1. Unlike age, lack of thromboprophylaxis, prolonged aPL exposure and lupus anticoagulant may increase the risk of thrombosis in aPL carriers.

Efectividad de la mensajería móvil para el control glucémico en pacientes diabéticos en atención primaria. Ensayo clínico aleatorizado / Effectiveness of mobile messaging for glycemic control in diabetic patients in primary care. Randomized clinical trial

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Effectiveness and efficiency of platelet rich plasma in the treatment of diabetic ulcers.

"There is a growing body of evidence suggesting that wound healing in chronic diabetic foot ulcers is growth factor dependent, and that the therapeutic delivery of these growth factors to wounds topically, has the potential ability to accelerate wound healing in conjunction with conventional wound care". There is, however, confusion about the utility of platelet rich plasma because the studies that have evaluated them use a wide range of products (different platelet and leukocyte concentrations, different techniques and frequencies of application, very heterogeneous simple, and different endpoints) making almost impossible to compare data and draw conclusions. In this study, we have analyzed the different platelet rich plasma products from a new perspective: cost-efficiency. According to our data, we observe that platelet rich plasma is a cost-effective option that allows faster healing of ulcers, and that should be taken into account in patients with long evolution ulcers.

Role of haptoglobin in polycystic ovary syndrome (PCOS), obesity and disorders of glucose tolerance in premenopausal women.

BACKGROUND: Hp(2) alleles of the haptoglobin alpha-chain polymorphism reduce the anti-oxidant properties and increase the pro-inflammatory actions of this acute-phase protein in a gene-dosage fashion. We hypothesized that the haptoglobin polymorphism might contribute to the increased oxidative stress and low-grade chronic inflammation frequently associated with polycystic ovary syndrome, obesity, and abnormalities of glucose tolerance. METHODOLOGY/PRINCIPAL FINDINGS: Serum haptoglobin and the haptoglobin alpha-chain polymorphism were determined in 141 patients with polycystic ovary syndrome and 102 non-hyperandrogenic women. Of the whole group of 243 premenopausal women, 117 were obese and 51 showed abnormal glucose tolerance. Although serum haptoglobin concentrations were similar in PCOS patients and controls, the former presented with an increased frequency of Hp(2) alleles (62% vs. 52%, P = 0.023). Circulating haptoglobin levels increased with obesity (P<0.001), yet no association was found between obesity and haptoglobin genotypes. No differences were observed in haptoglobin levels or genotype frequencies depending on glucose tolerance. Fifty percent of the variation in serum haptoglobin concentrations was explained by the variability in serum C-reactive protein concentrations, BMI, insulin sensitivity and haptoglobin genotypes. CONCLUSIONS/SIGNIFICANCE: Serum haptoglobin concentrations in premenopausal women are largely dependent on the haptoglobin polymorphism and on the presence of obesity, with insulin resistance and chronic inflammation possibly modulating this relationship. The association of polycystic ovary syndrome with Hp(2) alleles suggests that the anti-oxidant and anti-inflammatory properties of haptoglobin may be reduced in these patients.