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Objective

In relation with the growing literature suggesting an increased risk of alcohol or other substance use disorder after bariatric surgery, we aimed to review the risk of any substance use disorder in patients undergoing bariatric surgery.

Methods

A systematic review of the relevant literature was conducted from November 2019 to December 2021, using PubMed, Cochrane and Web of science.

Results

In total, 44 articles were included in the review. Most of the studies find out an increased risk of alcohol and drugs use disorders two years after surgery, with a large proportion of new onset. Young age, males, history of psychiatric disorder and bypass surgery were potential risk factors. An increased risk of substance use disorder regarding to analgesics or psychotropic drugs was retrieved in 5 out of 8 studies. Results for tobacco use were conflicting.

Conclusion

We showed that an increased risk of substance use disorder seems to appear 2 years after bariatric surgery, concerning not only preoperative users, but also new users.

The use of OTC analgesics is common worldwide, and the importance of the pharmacy teams is growing. Pharmacist-led medication implies that the pharmacy staff should have the necessary knowledge to deliver appropriate drugs, prevent an inappropriate drug consumption, and identify the patients in need of a medical advice. A randomized controlled study to assess the impact of training on pain knowledge and associated situations at risk among the French pharmacists and dispensers was performed. Participants were randomized into two groups receiving (n = 97) or not (n = 93) a training in the e-learning format. The training consisted of the 4 modules including the general knowledge of pain, headaches, acute musculoskeletal and chronic pain. The training modules were accompanied by the summary leaflets. The success rates were significantly higher in the trained group, with 35 % of participants reaching at least 70 % (primary endpoint) versus 2.3 % in the non-trained group. The results were not influenced by the size of the pharmacy. The knowledge improvement was more pronounced for the modules on the general knowledge of pain and headache management. For the questions associated to the risk situations, the success rates of at least 70 % were also significantly higher in the trained group The highest difference in success rates after the training was observed for the use of nonsteroidal antiinflammatory drugs during pregnancy and breastfeeding. Very low rates were obtained in both groups for the secondary headaches and the analgesic treatment adjustment in particular cases, such as chronic alcoholism or low weight. Results of this pilot study show that a training focused on pain could improve the overall knowledge of pain and suggest that it may contribute to a better pain identification, management and referral to physicians of patients at risk by the pharmacy staff in routine practice. The benefits of such a training should be assessed in a long-term prospective study, and the impact of a similar training in real-life practice remains to be evaluated.

Background

Major depressive disorders (MDDs) are common during the perinatal period, with a prevalence around 12 %. General practitioners are increasingly involved in the management of these disorders, but no specific recommendations have been developed for primary care. The objective was to review the literature on the detection, treatment and follow-up of MDD in pregnant and breastfeeding women in primary care.

Methods

A systematic meta-review was carried out to synthesize the findings of systematic reviews, meta-analyses, and Good Practice Guidelines published between 2002 and 2021. PubMed, Cochrane and ISI Web of Science databases were searched. Methodological and quality assessment was done using the AGREE II, PRISMA and R-AMSTAR grids. A narrative synthesis was elaborated.

Results

In total, 34 articles were included. The use of psychotherapy alone by cognitive-behavioral therapy (CBT) or interpersonal psychotherapy (ITP) was recommended as first-line therapy in mild and moderate MDD in 7 guidelines included in our review. The 14 systematic reviews, meta-analyses included confirm their efficacy with a slight superiority of CBT as compared to IPT (OR, 2.00; 95 % CI, 1.61 to 2.48); Standardized mean differences (SMD) between -2.86 (95 % CI from -4.41 to -1.31) and -0.61 (95 % CI from 0.73 to -0.49), depending on the study) (OR, 0.68; 95 % CI, 0.55 to 0.84); SMD between 0.39 (95 % CI 0.18 to 0.61) and 1.41 (95 % CI % from 0.96 to 1.86)). All of the Good Practice Guidelines included recommend pharmacotherapy in second intention, if it represents the most suitable therapeutic option. Selective serotonin reuptake inhibitors (in particular sertraline) are preferred, because there are suitable during pregnancy and breastfeeding in 6 of the systematic reviews included, nevertheless, they all mention the lack of high-quality clinical trial in their limits. The same limitation was highlighted in the 8 studies that focused on complementary medicine.

Conclusion

This study provides a synthesis on the management of MDD in pregnant and breastfeeding women in primary care. Further high-quality studies are needed on antidepressants drugs use and complementary medicines to elicit their respective role during the perinatal period.

Objective

The Covid-19 pandemic has been accompanied by a rampant spread of misinformation, posing significant risks to public health. This narrative review aims to assess the current state of critical thinking education in medical institutions, exploring its facilitators, barriers, and potential prospects.

Methods

A systematic literature search was conducted to identify relevant studies. Six databases were searched using various keywords from 2007 to 2022, including articles in both English and French. The initial screening of abstracts and titles, as well as the subsequent full-text selection, were carried out through double reading. An inductive thematic approach was utilized for the analysis.

Results

Out of the 559 articles screened, 38 were included in this review. The selected articles exhibited considerable heterogeneity in terms of origin and study type. Following main themes emerged from the analysis: the challenge of defining critical thinking in the healthcare context, its integration into the curriculum, effective teaching methodologies, instructors' qualifications and approaches, methods for assessing its impact. Trainees reported a heightened sense of preparedness in navigating consultation situations impacted by controversies. They readily recognized the significance of cultivating critical thinking as an essential professional skill.

Conclusion

In the post-COVID infodemic context, critical thinking in health education is gaining momentum, emphasizing both mindset and rational reasoning. This study provides a foundation for enhancing the implementation of critical thinking education.

Introduction

Stigma towards individuals with mental illness is a major public health problem and opposition to stigma has become a relevant goal for mental health stakeholders worldwide.

Aim

To examine the effectiveness of interventions designed to reduce mental illness stigma among healthcare students.

Methods

A pre-post study was conducted; healthcare students of the bachelor degrees in nursing, occupational therapy and dietetics of the University of Milan completed the Italian version of the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC) before (T0) and after (T1) 2 months from a specific educational intervention.

Results

Seventy-three students were enrolled (89.02%). Before the educational intervention (T0), the median level of stigma was 21[18;24]; At baseline, stigma levels were significantly lower in subjects who reported clinical experience with mental health issues (p<0.001) and who had relatives/friends with psychiatric disorders (p = 0.021). After two months, OMS-HC scores were significantly lower in the whole sample (Me= 16[13–19] p = 0.01).

Discussion

This study suggests that a brief, tailored 2-hour intervention can positively influence the attitudes of nursing, occupational therapy and dietetics undergraduate students towards mental illness.

Implications for practice

Brief tailored educational interventions should be employed diffusely to reduce stigma towards mental health in bachelor degree students.

Background

In Europe, children benzodiazepines consumption is not consistent with existing recommendations, especially among the most economically deprived families.

Objectives

The objective was to assess the correlation between benzodiazepines dispensing among children in primary care and the European Deprivation Index (EDI), a validated ecological deprivation index that approaches socioeconomic position.

Method

A dataset from the national reimbursement database only available for the year 2012 was used including 540,325 children in a large French region. The association between benzodiazepines dispensing and the EDI (described in deciles) was assessed with a multivariate logistic regression, including confounding and mediation factors identified and available in the database.

Results

Benzodiazepines were dispensed among 2.4% of the children. EDI was associated with the dispensing of benzodiazepines (p <0.0001), but there was some heterogeneity between the deciles.  The covariates that most influenced the probability of being dispensed benzodiazepines among the most deprived patients were the fact of benefiting from the complementary universal insurance coverage (CMU-C) and the number of consultations with a general practitioner (GP). This could be explained by the interaction between the EDI and CMU-C. CMU-C reflects more precariousness at an individual level: it favors benzodiazepines’ dispensing, mediated by the increased number of consultations with GPs.

Conclusion

Social deprivation has an influence over the dispensing of benzodiazepines to children and adolescents. This raises concern about discrepancies in mental health management according to the patients’ social background, particularly by GPs, who are mainly involved.

Objective

This article gives a description of the spontaneous evolution of organic parameters, quality of life and return to work of young patients treated for a breast cancer requiring an adjuvant chemotherapy.

Material and methods

A prospective study of post-breast cancer rehabilitation for a working population of patients was organized in a single town in France. The inclusion criteria allowed to recruit patients immediately after their diagnosis up to three years after the end of their chemotherapy. VO₂max, pain level, sleep quality, WHO performance status, abdominal obesity, level of physical activity, fatigability score, quality of life and metabolic parameters where registered at study entrance as base line data.

Results

These data described the state of this population at variable temporal distance from the treatment within three years’ post-breast cancer before any rehabilitation action, thus describing the spontaneous evolution of this population. There has been an overall progressive improvement in the quality of life along with the spontaneous return to working activities. However, the physical status shows a lasting alteration, even after two years after treatment.

Conclusion

This rather lasting disability justify an offer of rehabilitation cares immediately after the exit of initial treatment phase but also during the years following this exit.