Greenlandic patients exhibited a good tolerance of adjuvant oncologic treatment, but its application in palliative situations was less prevalent compared to Danish patients. The five-year, two-year, and one-year survival rates for Greenlandic and Danish patients following radical PDAC surgery varied significantly. One-year survival for Greenlandic patients was 544% and 746% for Danish patients. Two-year survival was 234% and 486% for Greenlandic and Danish patients, respectively. Five-year survival was 0% and 234% for Greenlandic and Danish patients, respectively. A study of non-resectable pancreatic ductal adenocarcinoma (PDAC) patients revealed overall survival times of 59 months and 88 months, respectively. Despite equal access to specialized care for pancreatic and periampullary cancer, patients from Greenland experience a less favorable outcome following treatment compared to Danish patients, as the study concludes.

Unhealthy alcohol use, resulting in adverse physical, psychological, social, or societal consequences, is defined as harmful alcohol use; it stands as a major global risk factor for disease, disability, and premature death. In low- and middle-income countries (LMICs), the burden of harmful alcohol use is escalating, highlighting the persistent absence of adequately targeted preventive and therapeutic interventions to combat this problem. A scarcity of evidence concerning the effectiveness and applicability of interventions for harmful and other forms of unhealthy alcohol use in LMICs compounds the deficit in support services.
To compare the efficacy and safety of psychosocial and pharmacological interventions, along with indicated preventive strategies, against control groups (waitlist, placebo, no treatment, standard care, or active control), for the purpose of reducing harmful alcohol consumption in low- and middle-income countries.
Randomized controlled trials (RCTs) listed in the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, Cochrane Library's CENTRAL, PubMed, Embase, PsycINFO, CINAHL, and LILACS were explored until December 12, 2021. We scrutinized clinicaltrials.gov, seeking out applicable clinical trial data. We sought to find unpublished or ongoing studies through a comprehensive search of the World Health Organization International Clinical Trials Registry Platform, Web of Science, and the Opengrey database. Included studies' reference lists and pertinent review articles were searched thoroughly to locate eligible research.
RCTs focusing on indicated prevention or treatment interventions (pharmacological or psychosocial), compared to a control condition, for harmful alcohol use in low- and middle-income countries (LMICs) were the studies considered.
Employing standard procedures, as outlined by Cochrane, was our methodology.
We integrated 66 randomized controlled trials, with 17,626 participants enrolled, into our study. The meta-analysis leveraged findings from sixty-two of these trials. A noteworthy concentration of sixty-three studies was observed in middle-income countries (MICs), in contrast to the low number of three studies performed in low-income countries (LICs). Every one of the twenty-five trials focused solely on the enrollment of participants with alcohol use disorder. Participants in the remaining 51 trials presented with harmful alcohol use, encompassing individuals with both alcohol use disorder and those exhibiting hazardous alcohol use patterns, though without meeting the diagnostic criteria for a disorder. A study of 52 randomized controlled trials evaluated psychosocial interventions; 27 of the studies focused on brief interventions, predominantly utilizing motivational interviewing, and benchmarked them against interventions offering only brief advice, information, or assessment. forensic medical examination The causal link between brief interventions and a decrease in harmful alcohol use remains questionable due to the substantial heterogeneity of the studies analyzed. (Studies with continuous outcomes demonstrated 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). Four trials with 1349 participants yielded a 95% confidence level, indicating a very low degree of certainty. Psychosocial intervention strategies included a multitude of therapeutic approaches such as behavioral risk reduction, cognitive-behavioral therapy, contingency management, rational emotive therapy, and relapse prevention. Compared to usual care, which included a variety of psychoeducational, counseling, and pharmacological elements, these interventions were most frequently evaluated. The considerable variability among the studies evaluating the connection between psychosocial treatments and reduced harmful alcohol use (Heterogeneity Tau = 115; Q = 44432, df = 11, P<.001; I=98%, 2106 participants, 12 trials) casts significant doubt on the ability to attribute any observed reductions to these treatments, resulting in a very low degree of confidence. multimolecular crowding biosystems In eight trials, the efficacy of combined pharmacologic and psychosocial interventions was examined, with comparisons made against placebo, psychosocial interventions alone, and alternative pharmacologic treatments. Active pharmacologic study conditions were comprised of disulfiram, naltrexone, ondansetron, and topiramate, and no other drugs were used. 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. A review of studies contrasted a combined pharmacologic and psychosocial intervention with a sole psychosocial intervention and found a potential correlation between the combined approach and a greater reduction in harmful alcohol consumption (standardized mean difference (SMD) = -0.43, 95% confidence interval (CI) -0.61 to -0.24; 475 participants; 4 trials; low certainty). find more Pharmacologic intervention's efficacy was assessed against placebo in four trials; concurrently, three other trials assessed its efficacy against a different pharmacotherapy. Among the drugs evaluated were acamprosate, amitriptyline, baclofen, disulfiram, gabapentin, mirtazapine, and naltrexone. None of the trials investigated the critical clinical endpoint, harmful alcohol use. Thirty-one trials tracked the rates of participant retention within the intervention. Meta-analysis found that participant retention rates did not vary significantly among the different intervention groups. Pharmacological interventions, including 247 participants in three trials, exhibited a risk ratio of 1.13 (95% CI 0.89 to 1.44) and are considered low certainty. The addition of psychosocial interventions, with 363 participants across three trials, yielded a risk ratio of 1.15 (95% CI 0.95 to 1.40) and are of moderate certainty. Due to the substantial heterogeneity in the data, calculation of pooled estimates for retention in brief interventions proved inappropriate (Heterogeneity Tau = 000; Q = 17259, df = 11, P<.001). A list of sentences is the result of this JSON schema.
Across 12 trials and 5380 participants, the results were inconclusive regarding the effectiveness of interventions, including psychosocial ones, with a high degree of heterogeneity. A collection of sentences, each possessing a unique structure, distinct from the original.
The trials, encompassing 1664 participants and 9 trials, pointed to a significant level of uncertainty, which was observed in 77%. Side effect reporting emerged from two pharmacological trials, and from three trials utilizing both pharmacological and psychosocial strategies. Amitriptyline exhibited a higher rate of side effects relative to mirtazapine, naltrexone, and topiramate. Conversely, no differences were detected in side effects between placebo and acamprosate or ondansetron. Across all intervention types, a considerable risk of bias was evident. Critical concerns regarding the study's validity stemmed from the absence of blinding procedures and varying attrition rates.
Evidence regarding the effectiveness of a combined psychosocial and pharmacological approach to reducing harmful alcohol use in low- and middle-income countries is uncertain compared to using psychosocial interventions alone. Determining the effectiveness of pharmacological or psychosocial interventions to curb harmful alcohol use remains challenging due to the significant variation in outcomes, comparisons, and interventions, preventing comprehensive data pooling for meta-analyses. Among the majority of studies, brief interventions are prevalent, predominantly targeting men, and employing measures without validation within the target population. The risk of bias, substantial heterogeneity across studies, and varying results within studies on different outcome measures all contribute to a diminished confidence in these findings. To elevate the certainty of pharmacologic intervention outcomes, a deeper investigation into distinct psychosocial approaches is paramount.
Regarding the reduction of harmful alcohol use in low- and middle-income countries, the supporting evidence for combined psychosocial and pharmacological interventions, compared to using psychosocial interventions alone, is of low certainty. Meta-analyses assessing the impact of pharmacological or psychosocial interventions on harmful alcohol use are hampered by the absence of sufficient evidence, primarily stemming from the substantial heterogeneity in outcomes, treatment comparisons, and intervention types. Studies, largely brief interventions concentrating on men, frequently use assessments not validated in their targeted population. These findings are affected by the presence of bias risk, substantial heterogeneity across studies, and the diverse results measured across different outcome measures within each study, all decreasing confidence. A more rigorous examination of pharmacologic interventions, along with a study of the varied types of psychosocial interventions, is required to increase the certainty of these observed outcomes.