Implementing primary healthcare-based measurement, advice and treatment for heavy drinking and comorbid depression at the municipal level in three Latin American countries: final protocol for a quasiexperimental study (SCALA study).
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SUBMITTER: Jane-Llopis E
PROVIDER: S-EPMC7390229 | biostudies-literature | 2020 Jul
REPOSITORIES: biostudies-literature
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Implementing primary healthcare-based measurement, advice and treatment for heavy drinking and comorbid depression at the municipal level in three Latin American countries: final protocol for a quasiexperimental study (SCALA study).
Jané-Llopis Eva E Anderson Peter P Piazza Marina M O'Donnell Amy A Gual Antoni A Schulte Bernd B Pérez Gómez Augusto A de Vries Hein H Natera Rey Guillermina G Kokole Daša D V Bustamante Ines I Braddick Fleur F Mejía Trujillo Juliana J Solovei Adriana A Pérez De León Alexandra A Kaner Eileen Fs EF Matrai Silvia S Manthey Jakob J Mercken Liesbeth L López-Pelayo Hugo H Rowlands Gillian G Schmidt Christiane C Rehm Jürgen J
BMJ open 20200728 7
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Project description:BackgroundEffective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru.ObjectiveTo describe the process of development and cultural adaptation of the clinical intervention and training package.MethodsWe drew on Barrero and Castro's four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement's Going to Scale Framework.ResultsIn Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway.ConclusionOur experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.
| S-EPMC9310809 | biostudies-literature
Project description:Background: While primary health care (PHC)-based prevention and management of heavy drinking is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of heavy drinking in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion: This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment. Study status: The four-year study will start on 1 st December 2017.
| S-EPMC5686480 | biostudies-literature
Project description:PurposeWe aimed to test the effects of providing municipal support and training to primary health care providers compared to both training alone and to care as usual on the proportion of adult patients having their alcohol consumption measured.MethodsWe undertook a quasi-experimental study reporting on a 5-month implementation period in 58 primary health care centres from municipal areas within Bogotá (Colombia), Mexico City (Mexico), and Lima (Peru). Within the municipal areas, units were randomized to four arms: (1) care as usual (control); (2) training alone; (3) training and municipal support, designed specifically for the study, using a less intensive clinical and training package; and (4) training and municipal support, designed specifically for the study, using a more intense clinical and training package. The primary outcome was the cumulative proportion of consulting adult patients out of the population registered within the centre whose alcohol consumption was measured (coverage).ResultsThe combination of municipal support and training did not result in higher coverage than training alone (incidence rate ratio (IRR) = 1.0, 95% CI = 0.6 to 0.8). Training alone resulted in higher coverage than no training (IRR = 9.8, 95% CI = 4.1 to 24.7). Coverage did not differ by intensity of the clinical and training package (coefficient = 0.8, 95% CI 0.4 to 1.5).ConclusionsTraining of providers is key to increasing coverage of alcohol measurement amongst primary health care patients. Although municipal support provided no added value, it is too early to conclude this finding, since full implementation was shortened due to COVID-19 restrictions.Trial registrationClinical Trials.gov ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.
| S-EPMC7815287 | biostudies-literature
Project description:OBJECTIVE:Trauma exposure is common, with estimates of 28% to 90% of adults reporting at least one traumatic event over their lifetime. Those exposed to traumatic events are at risk for alcohol misuse (i.e., binge drinking), posttraumatic stress disorder (PTSD), or both. A potential underlying mechanism for this comorbidity is increased impulsivity-the tendency to act rashly. Little work to date has examined the impact of different impulsogenic traits on this comorbidity. METHODS:This study (n = 162) investigated trauma-exposed young adults (aged 21-30) who had endorsed a lifetime interpersonal trauma. In addition, three impulsogenic traits (motor, nonplanning, and attentional) were measured. RESULTS:Over and above the covariates for age, gender, race, and traumatic events, greater attentional impulsivity was associated with greater likelihood of meeting criteria for PTSD and binge drinking, compared to meeting criteria for PTSD, binge drinking, or neither. Neither nonplanning impulsivity nor motor impulsivity exerted unique effects. CONCLUSIONS:Young adults who report difficulty attending to immediate stimuli within their environment may be unable to think about and/or process the traumatic event, potentially increasing risk for PTSD and maladaptive coping skills to manage this distress (e.g., alcohol misuse, binge drinking).
| S-EPMC6322969 | biostudies-literature
Project description:Circular data are common in biological studies. The most fundamental question that can be asked of a sample of circular data is whether it suggests that the underlying population is uniformly distributed around the circle, or whether it is concentrated around at least one preferred direction (e.g. a migratory goal or activity phase). We compared the statistical power of five commonly used tests (the Rayleigh test, the V-test, Watson's test, Kuiper's test and Rao's spacing test) across a range of different unimodal scenarios. The V-test showed higher power for symmetrical distributions, Rao's spacing performed worst for all explored unimodal distributions tested and the remaining three tests showed very similar performance. However, the V-test only applies if the hypothesis is restricted to one (pre-specified) direction of interest. In all other unimodal cases, we recommend using the Rayleigh test. Much less explored is the multimodal case with data concentrated around several directions. We performed power simulations for a variety of multimodal situations, testing the performance of the widely used Rayleigh, Rao's, Watson, and Kuiper's tests as well as the more recent Bogdan and Hermans-Rasson tests. Our analyses of alternative statistical methods show that the commonly used tests lack statistical power in many of multimodal cases. Transformation of the raw data (e.g. doubling the angles) can overcome some of the issues, but only in the case of perfect f-fold symmetry. However, the Hermans-Rasson method, which is not yet implemented in any software package, outcompetes the alternative tests (often by substantial margins) in most of the multimodal situations explored. We recommend the wider uptake of the powerful but hitherto neglected Hermans-Rasson method. In summary, we provide guidance for biologists helping them to make decisions when testing circular data for single or multiple departures from uniformity.
| S-EPMC6060829 | biostudies-literature
Project description:Empirical evidence suggests that individuals who consume relatively large amounts of alcohol are more likely to use expensive acute medical care and less likely to use preventive or ambulatory services than other individuals. The few studies that investigated the associations between heavy drinking and health promotion activities did not try to address omitted-variable biases that may confound the relationships. To fill this void in the literature, we examined the effects of heavy alcohol use on three health promotion activities (routine physical exam, flu shot, regular seatbelt use) using the US 2006 Behavioral Risk Factor Surveillance Survey. Although specification tests indicated that omitted variable bias was not present in the majority of the single-equation probit models, we cautiously interpret our findings as evidence of strong associations rather than causal effects. Among both men and women, heavy alcohol use is negatively and significantly associated with each of our three outcomes. These findings suggest that heavy drinkers may be investing less in health promotion activities relative to abstainers and other drinkers. Policy options to address the associated externalities may be warranted.
| S-EPMC2908481 | biostudies-literature
Project description:Data from the 1997 to 2004 National Health Interview Survey Sample Adult questionnaires were linked to the National Death Index (N = 242,397) to examine mortality risks associated with average and episodic heavy drinking. Cox proportional hazard models (Stata 12.0) revealed that (average) heavier drinkers and episodic heavy drinkers (5+ in a day) had increased mortality risks but when examined together, episodic heavy drinking added only modestly to the mortality risks of light and moderate drinkers. Limitations and implications of results for survey measurement of potentially harmful levels of alcohol use are noted. This was a Federal study that received no outside funding.
| S-EPMC4677481 | biostudies-literature
Project description:IntroductionUnderstanding how patterns of drinking are associated with risky gambling in Australia is needed to inform an effective approach to minimise harm.MethodsThis cross-sectional questionnaire study reports on 2,704 subsampled participants who completed survey questions about their patterns of drinking. With logistic regressions, we examined whether frequency of heavy episodic drinking (HED) and alcohol use while gambling were associated with risky gambling while controlling for sociodemographic variables.ResultsOccasional HED and monthly HED were associated with any gambling (versus no gambling), but frequent HED was not significantly associated with gambling. The opposite pattern was found when predicting risky gambling. Occasional HED (i.e. less than monthly) was not significantly associated, but a higher frequency of HED (at least weekly) was associated with a higher likelihood of risky gambling. Drinking alcohol while gambling was associated with risky gambling, over and above HED. The combination of HED and use of alcohol while gambling appeared to significantly increase the likelihood of risky gambling.ConclusionsThe association of HED and alcohol use while gambling with risky gambling highlights the importance of preventing heavy alcohol use among gamblers. The links between these forms of drinking and risky gambling further suggests that individuals who engage in both activities are specifically prone to gambling harm. Policies should therefore discourage alcohol use while gambling for example by prohibiting serving alcohol at reduced prices or to gamblers who show signs of being affected by alcohol and informing individuals of the risks associated with alcohol use while gambling.
| S-EPMC10628030 | biostudies-literature
Project description:AbstractThe most common statistical procedure with a sample of circular data is to test the null hypothesis that points are spread uniformly around the circle without a preferred direction. An array of tests for this has been developed. However, these tests were designed for continuously distributed data, whereas often (e.g. due to limited precision of measurement techniques) collected data is aggregated into a set of discrete values (e.g. rounded to the nearest degree). This disparity can cause an uncontrolled increase in type I error rate, an effect that is particularly problematic for tests that are based on the distribution of arc lengths between adjacent points (such as the Rao spacing test). Here, we demonstrate that an easy-to-apply modification can correct this problem, and we recommend this modification when using any test, other than the Rayleigh test, of circular uniformity on aggregated data. We provide R functions for this modification for several commonly used tests. In addition, we tested the power of a recently proposed test, the Gini test. However, we concluded that it lacks sufficient increase in power to replace any of the tests already in common use. In conclusion, using any of the standard circular tests (except the Rayleigh test) without modifications on rounded/aggregated data, especially with larger sample sizes, will increase the proportion of false-positive results-but we demonstrate that a simple and general modification avoids this problem.Significance statementCircular data are widespread across biological disciplines, e.g. in orientation studies or circadian rhythms. Often these data are rounded to the nearest 1-10 degrees. We have shown previously that this leads to an inflation of false-positive results when testing whether the data is significantly different from a random distribution using the Rao test. Here we present a modification that avoids this increase in false-positives for rounded data while retaining statistical power for a variety of tests. In sum, we provide comprehensive guidance on how best to test for departure from uniformity in non-continuous data.
| S-EPMC7373216 | biostudies-literature
Project description:BackgroundSocioeconomic factors contribute to a more severe impact of COVID-19 in Latin American and Caribbean (LA&C) countries than in developed countries. Patients with a severe or critical illness can develop respiratory and cardiovascular complications.ObjectiveTo describe a LA&C population with COVID-19 to provide information related to this disease, in-hospital cardiovascular complications, and in-hospital mortality.MethodsThe CARDIO COVID-19-20 Registry is an observational, multicenter, prospective, and hospital-based registry of patients with confirmed COVID-19 infection that required in-hospital treatment in LA&C. Enrollment of patients started on May 01, 2020, and ended on June 30, 2021.ResultsThe CARDIO COVID-19-20 Registry included 3260 patients from 44 institutions of 14 LA&C countries. 63.2% patients were male and median age was 61.0 years old. Most common comorbidities were overweight/obesity (49.7%), hypertension (49.0%), and diabetes mellitus (26.7%). Most frequent cardiovascular complications during hospitalization or reported at discharge were cardiac arrhythmia (9.1%), decompensated heart failure (8.5%), and pulmonary embolism (3.9%). The number of patients admitted to the Intensive Care Unit (ICU) was 1745 (53.5%), and median length of their stay at the ICU was 10.0 days. Support required in ICU included invasive mechanical ventilation (34.2%), vasopressors (27.6%), inotropics (10.3%), and vasodilators (3.7%). Rehospitalization after 30-day post discharge was 7.3%. In-hospital mortality and 30-day post discharge were 25.5% and 2.6%, respectively.ConclusionsAccording to our findings, more than half of the LA&C population with COVID-19 assessed required management in ICU, with higher requirement of invasive mechanical ventilation and vasoactive support, resulting in a high in-hospital mortality and a considerable high 30-day post discharge rehospitalization and mortality.
| S-EPMC10624135 | biostudies-literature