Publications by authors named "João Matias"

21 Publications

  • Page 1 of 1

Changes in drug use in European cities during early COVID-19 lockdowns - A snapshot from wastewater analysis.

Environ Int 2021 Mar 26;153:106540. Epub 2021 Mar 26.

Environmental and Public Health Analytical Chemistry, Research Institute for Pesticides and Water, University Jaume I, Castellón, Spain; Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, the Netherlands. Electronic address:

The COVID-19 outbreak has forced countries to introduce severe restrictive measures to contain its spread. In particular, physical distancing and restriction of movement have had important consequences on human behaviour and potentially also on illicit drug use and supply. These changes can be associated with additional risks for users, in particular due to reduced access to prevention and harm reduction activities. Furthermore, there have been limitations in the amount of data about drug use which can be collected due to restrictions. To goal of this study was to obtain information about potential changes in illicit drug use impacted by COVID-19 restrictions. Wastewater samples were collected in seven cities in the Netherlands, Belgium, Spain and Italy at the beginning of lockdowns (March-May 2020). Using previously established and validated methods, levels of amphetamine (AMP), methamphetamine (METH), MDMA, benzoylecgonine (BE, the main metabolite of cocaine) and 11-nor-9-carboxy-Δ-tetrahydrocannabinol (THC-COOH, main metabolite of tetrahydrocannabinol (THC)) were measured and compared with findings from previous years. Important differences in levels of consumed drugs were observed across the considered countries. Whilst for some substances and locations, marked decreases in consumption could be observed (e.g., 50% decrease in MDMA levels compared to previous years). In some cases, similar or even higher levels compared to previous years could be found. Changes in weekly patterns were also observed, however these were not clearly defined for all locations and/or substances. Findings confirm that the current situation is highly heterogeneous and that it remains very difficult to explain and/or predict the effect that the present pandemic has on illicit drug use and availability. However, given the current difficulty in obtaining data due to restrictions, wastewater analysis can provide relevant information about the situation at the local level, which would be hard to obtain otherwise.
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http://dx.doi.org/10.1016/j.envint.2021.106540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997602PMC
March 2021

"Tell Me How Much Your Friends Consume"-Personal, Behavioral, Social, and Attitudinal Factors Associated with Alcohol and Cannabis Use among European School Students.

Int J Environ Res Public Health 2021 02 10;18(4). Epub 2021 Feb 10.

European Monitoring Centre for Drugs and Drug Addiction, 1249-289 Lisbon, Portugal.

Background: Substance use in European adolescents remains a serious health concern. Assessing what affects adolescents' substance use is crucial for implementing effective prevention. This study aims to examine alcohol and cannabis use-related behavioral, social, and attitudinal variables that might directly be considered to guide prevention responses for adolescents.

Methods: Cross-sectional data of 78,554 15-16-year-old school students from the 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD) from 26 European countries were analyzed. Self-reported drunkenness in the last 30 days and cannabis use in the last 12 months served as dependent variables. To investigate which factors are associated with risky substance use, multivariable logistic regressions were used.

Results: 17.7% of respondents reported drunkenness in the last 30 days, and 14.9% used cannabis in the last 12 months. The most important predictor for risky substance use was the perception that most/all of their friends engaged in substance use behavior, followed by lack of parental support, low personal adherence to rules, and low school performance.

Conclusion: Interventions addressing the perceived descriptive norms either directly or by changing environmental cues, opportunities, and regulations, as well as effective parenting and academic support may prevent and reduce risky substance use behavior among adolescents.
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http://dx.doi.org/10.3390/ijerph18041684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916343PMC
February 2021

Efficacy and safety of cold versus hot snare polypectomy for small (5-9 mm) colorectal polyps: a multicenter randomized controlled trial.

Endoscopy 2020 Dec 2. Epub 2020 Dec 2.

Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain.

Background:  Resection techniques for small polyps include cold snare polypectomy (CSP) and hot snare polypectomy (HSP). This study compared CSP and HSP in 5-9 mm polyps in terms of complete resection and adverse events.

Methods:  This was a multicenter, randomized trial conducted in seven Spanish centers between February and November 2019. Patients with ≥ 15-9 mm polyp were randomized to CSP or HSP, regardless of morphology or pit pattern. After polypectomy, two marginal biopsies were submitted to a pathologist who was blinded to polyp histology. Complete resection was defined as normal mucosa or burn artifacts in the biopsies. Abdominal pain was only assessed in patients without < 5 mm or > 9 mm polyps.

Results:  496 patients were randomized: 237 (394 polyps) to CSP and 259 (397 polyps) to HSP. Complete polypectomy rates were 92.5 % with CSP and 94.0 % with HSP (difference 1.5 %, 95 % confidence interval -1.9 % to 4.9 %). Intraprocedural bleeding occurred during three CSPs (0.8 %) and seven HSPs (1.8 %) ( = 0.34). One lesion per group (0.4 %) presented delayed hemorrhage. Post-colonoscopy abdominal pain presented similarly in both groups 1 hour after the procedure (CSP 18.8 % vs. HSP 18.4 %) but was higher in the HSP group after 5 hours (5.9 % vs. 16.5 %;  = 0.02). A higher proportion of patients were asymptomatic 24 hours after CSP than after HSP (97 % vs. 86.4 %;  = 0.01).

Conclusions:  We observed no differences in complete resection and bleeding rates between CSP and HSP. CSP reduced the intensity and duration of post-colonoscopy abdominal pain.
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http://dx.doi.org/10.1055/a-1327-8357DOI Listing
December 2020

Sources of drug acquisition among females and males in the European Web Survey on Drugs.

Int J Drug Policy 2020 07 23;81:102777. Epub 2020 May 23.

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289, Lisbon, Portugal. Electronic address:

Background: Social networks determine the availability of drugs, which in turn affects use patterns. Yet, there is some limited evidence that as frequency of drug use increases, people who use drugs increasingly utilize drug dealers. Further, females more often report receiving drugs for free. Studies on these two phenomena are limited by the substances they examine and the countries in which they have been conducted, and they have not been considered together. We examine whether gender differences in sources is moderated by increased frequency of use across four different substances in a web survey of sixteen European countries.

Methods: The European Web Survey on Drugs was collected from 2016-2018 among the national partners of the European Monitoring Centre for Drugs and Drug Addiction. Individuals who use drugs in sixteen European countries completed an online survey. For herbal cannabis, cannabis resin, cocaine, and MDMA, we examine drug acquisition sources by gender and frequency of use. Sources include through dealers and sharing or free, as well as growing and online markets for cannabis. We model each source with logistic regression with chained multiple imputation and a country fixed-effect and clustered standard errors.

Results: Across all substances, females who use drugs at low frequencies had significantly lower probabilities than males in using dealers; however, females were equally likely to use dealers when use is frequent. The probability of acquiring drugs for free was higher for females except among those who use most frequently, where the difference became non-significant except for herbal cannabis.

Conclusions: Females and males use dealers to acquire illicit drugs at similar rates when use is more frequent. Except for highest frequency use, females are typically more likely than males to acquire drugs for free. Examinations of supply should consider these gendered differences in acquisition.
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http://dx.doi.org/10.1016/j.drugpo.2020.102777DOI Listing
July 2020

The use of multi-national web surveys for comparative analysis: Lessons from the European Web Survey on Drugs.

Int J Drug Policy 2019 11 9;73:235-244. Epub 2019 Apr 9.

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289, Lisbon, Portugal.

Background: Most comparative drug policy analyses utilise measures of drug use, often from general population surveys (GPS). However, the limitations of GPS are well-recognised, including the small numbers of people who use illicit drugs sampled. Web surveys offer a potential solution to such issues. Therefore EMCDDA conducted a study to assess the potential for using such surveys to supplement information obtained from GPS.

Methods: The European Web Survey on Drugs (EWSD) asked about use of cannabis, amphetamines, cocaine and MDMA in 14 countries from 2016 to 2018. Each participant country translated the questionnaire as necessary and devised its own sampling strategy. Individuals aged 18+, resident in the participant country, who had used one or more of the drugs covered by the survey in the past 12 months were included in the analysis. Participation was anonymous and voluntary.

Results: More than 40,000 people completed the survey, with recruitment mostly through social media. Larger samples of users of all drug types than found in GPS were generally obtained. However, the respondent profiles differed markedly between countries, e.g. the proportion aged 18-24 ranged from 30% to 80%. The results relating to use showed both inter-country similarities and differences, e.g. mean daily amounts of cocaine used varied between countries but increases in amounts used with increased frequency of use were similar. Price data showed good external validity.

Conclusion: Web surveys offer the possibility of collecting information from large numbers people who use illicit drugs quickly and cheaply and can fill important gaps in our knowledge of patterns of use, particularly by recreational users. However, they also have limitations. Standardising questionnaires and approaches to data cleaning and analysis facilitates comparisons between countries but obtaining comparable samples may be challenging. Multinational surveys need to balance standardisation of methods with responsiveness to differing country contexts; our collaborative model does this.
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http://dx.doi.org/10.1016/j.drugpo.2019.03.014DOI Listing
November 2019

Surveying drug consumption: Assessing reliability and validity of the European Web Survey on Drugs questionnaire.

Int J Drug Policy 2019 11 6;73:228-234. Epub 2019 Apr 6.

Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Apolinarska 4, 128 00 Praha 2, Czech Republic; National Monitoring Centre for Drugs and Addiction, Office of the Government, nábřeží Edvarda Beneše 4, 118 01 Prague 1, Czech Republic; National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic.

Background: The European Web Survey on Drugs aimed to obtain in-depth data on consumption of cannabis, ecstasy/MDMA, cocaine, and amphetamines in different populations of drug users in 16 European countries. This paper examines test-retest reliability, the consistency and the comprehensibility of the prevalence and frequency of use questions in the Czech part of the survey.

Methods: A baseline web survey was performed (N = 610) with follow-up data collection in a sub-sample of volunteers providing email addresses (N = 158). The baseline sample was self-selecting, responding to advertisements made available through multiple channels designed to attract diverse samples of drug users. Test-retest analysis was conducted for core questionnaire items.

Results: Respondents to the follow-up were predominantly socially integrated; 91% reported last year cannabis use, 42% used Ecstasy/MDMA, 23% amphetamines, and 27% reported cocaine use. Test-retest reliability was rated moderate to good (reliability coefficients between 0.55-0.87) for most prevalence items with sufficient sample sizes. Items assessing frequency of use were more reliable for most substances when asking about the exact number of days used, compared to categorical items that implicitly assume a regular pattern of use and were interpreted differently by different respondents.

Conclusions: Simplicity and unambiguity of questions increase the reliability of results. Tools measuring drug consumption need to take into consideration the irregularity of drug using patterns. Question testing is important to increase validity and support a correct interpretation of the data.
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http://dx.doi.org/10.1016/j.drugpo.2019.03.005DOI Listing
November 2019

Inconsistencies in the assumptions linking punitive sanctions and use of cannabis and new psychoactive substances in Europe.

Addiction 2018 12 22;113(12):2155-2157. Epub 2018 Jul 22.

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal.

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http://dx.doi.org/10.1111/add.14372DOI Listing
December 2018

Nine reasons why ecstasy is not quite what it used to be.

Int J Drug Policy 2018 01 20;51:36-41. Epub 2017 Nov 20.

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289 Lisbon, Portugal(1).

This paper explores the recent resurgence in use of ecstasy/MDMA in Europe and highlights keys areas of continuity and divergence between the ecstasy market of the 1990s and the current MDMA market. Based on a scoping study involving a targeted multi-source data collection exercise on MDMA, it highlights nine areas that have undergone some level of change, linked with both supply and demand for the drug. Factors discussed include: innovation in production techniques; changes in precursor chemical availability; the role of online markets; competition with other stimulants and new psychoactive substances; the increased availability of high-strength MDMA; and the shift from subcultural towards more mainstream use of the drug. The paper proposes that the MDMA on Europe's contemporary market is in some respects a third generation product with a different consumer profile, with implications that responses developed at the time of the drug's earlier iteration, may be in need of a review and revamp.
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http://dx.doi.org/10.1016/j.drugpo.2017.09.016DOI Listing
January 2018

Prognostic Factors of Human Immunodeficiency Virus-Infected Patients on Chronic Hemodialysis.

Blood Purif 2017 3;44(3):244-250. Epub 2017 Oct 3.

Department of Nephrology, Hospital de Santa Cruz, Lisbon, Portugal.

Background/aims: The number of human immunodeficiency virus (HIV)-infected patients on hemodialysis (HD) have increased, and their prognostic factors are still poorly clarified. The study aimed to identify factors that can influence the survival of HIV-infected patients on HD.

Methods: We performed a retrospective cohort study of 44 HIV-infected patients on HD.

Results: A total of 17 patients (39%) died. Median survival on HD was 30.8 months and the survival rate at 1 and 5 years was 82.5 and 62.9%, respectively. Male (relative risk [RR] 3.1, p = 0.040) and blacks (RR 2.5, p = 0.037) had higher risk of death. The patients who died had a shorter duration of HIV infection (p = 0.028), had a higher viral load (p = 0.044), more opportunistic infections (p = 0.013), and a lower serum albumin (p = 0.009). Lower serum albumin, nonsexual HIV transmission, viral load, opportunistic infections, and usage of catheters were associated with lower survival.

Conclusion: Several demographic, viral, and dialysis variables may help to predict survival of this population. The intervention in these factors could improve their prognosis.
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http://dx.doi.org/10.1159/000478966DOI Listing
July 2018

Real-World Outcomes of Anti-VEGF Treatment for Retinal Vein Occlusion in Portugal.

Eur J Ophthalmol 2017 Nov;27(6):756-761

7 Department of Ophthalmology, Centro Hospitalar de Lisboa Central, Lisbon - Portugal.

Purpose: Retinal vein occlusion (RVO) is an important cause of visual disability in the modern world. We aim to evaluate the real-world outcomes of patients with RVO treated with anti-vascular endothelial growth factor (VEGF) in Portugal.

Methods: We performed a retrospective, observational, multicenter study including 8 centers across Portugal and 200 patients treated with either ranibizumab or bevacizumab. Data were collected at 3 time points: time of diagnosis (0 time point) and 6 and 12 months after initiating treatment. Demographic and clinical data were collected.

Results: Median visual acuity (VA) and central macular thickness (CMT) improved in the branch RVO (BRVO), central RVO (CRVO), bevacizumab, and ranibizumab groups at 6 and 12 months compared to baseline, with CMT improving further only in the CRVO and ranibizumab groups between 6 and 12 months (p = 0.002 and p = 0.001, respectively). The CMT was lower in the ranibizumab group compared to the bevacizumab group both at 6 and 12 months (p<0.02). Median CMT improved in both the good and poor baseline VA groups at 6 and 12 months compared to baseline (p<0.001). Median VA only improved for the group with poor baseline VA at 6 and 12 months of follow-up (p<0.001). Regression analysis identified several baseline variables as predictors of visual outcomes at 6 and 12 months, with different results depending on the analyzed group.

Conclusions: Both treatments were effective, although less effective than results reported in clinical trials. The morphologic response was better with ranibizumab compared to bevacizumab, although functionally there were no differences.
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http://dx.doi.org/10.5301/ejo.5000943DOI Listing
November 2017

Corneal Elevation Topography in Primary Open Angle Glaucoma.

J Glaucoma 2017 Feb;26(2):e41-e45

Centro Hospitalar Baixo Vouga, Aveiro, Portugal.

Purpose Of The Study: The purpose of the study was to describe and compare anterior and posterior topographic elevation maps in primary open angle glaucoma patients with functional damage staging and in healthy controls.

Methods: A total of 217 subjects were consecutively recruited, including 111 primary open angle glaucoma patients (patients), and 106 healthy individuals (controls). All patients performed Pentacam HR corneal topography. Mean anterior keratometry and anterior and posterior topographic elevation maps were compared in the central 3, 5, and 7 mm. Humphrey automated perimetry results from the patient group were classified according to the Glaucoma Staging System.

Results: Age (patients: 72.32±8.09; controls: 70.82±8.36; P=0.18) and central corneal pachymetry (patients: 541.13±36.98; controls: 548.67±34.56; P=0.12) were similar in both groups. Maximum elevation readings in the central 5 mm were significantly (P<0.05) higher in the anterior (patients: 8.21±8.63; controls: 5.79±3.62) and posterior (patients: 16.17±8.72; controls: 13.92±6.03) corneal topography of the glaucomatous patients, as well as in the anterior (patients: 17.32±20.78; controls: 9.61±5.64) and posterior (patients: 38.81±19.78; controls: 26.38±12.73) central 7 mm. There was a weak but significant correlation between the Glaucoma Staging System stage and both the anterior 5 mm (r=0.397) and 7 mm (r=0.304) maximum, as well as the posterior 5 mm (r=0.233) and 7 mm (r=0.241) maximum.

Conclusions: In patients with primary open angle glaucoma, there is a forward shifting of the posterior and anterior corneal surfaces. This appears to be correlated with more advanced stages of functional damage, pointing to a possible link between corneal structural changes and duration and intensity of elevated intraocular pressure. Further studies may ascertain the potential for this biological marker to be used in monitoring primary open angle glaucoma patients.
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http://dx.doi.org/10.1097/IJG.0000000000000535DOI Listing
February 2017

Trazodone-induced nocturnal enuresis.

Psychiatry Res 2016 Jan 9;235:211-2. Epub 2015 Dec 9.

Department of Psychiatry, Hospital do Divino Espírito Santo de Ponta Delgada, Avenida D. Manuel I, 9500-370 Ponta Delgada, Azores, Portugal.

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http://dx.doi.org/10.1016/j.psychres.2015.12.006DOI Listing
January 2016

[Vitamin D deficiency in chronic liver disease, clinical-epidemiological analysis and report after vitamin d supplementation].

Gastroenterol Hepatol 2016 May 1;39(5):305-10. Epub 2015 Dec 1.

Servicio de Aparato Digestivo, Hospital Universitario de León, León, España.

Introduction: Vitamin D (VD) is known to have multiple extra-skeletal health functions. There is emerging interest in exploring the relationship between vitamin D and chronic liver disease (CLD).

Objectives: To determine the prevalence of VD deficiency in patients with CLD in our setting and to assess whether VD supplementation influences plasma levels and is associated with improved liver function.

Material And Methods: We conducted a study in 2 phases. First, we analysed clinical and epidemiological characteristics in 94 patients with CLD; second, different doses of calcifediol (25-OH-VD) were administered to patients with VD deficiency (<20ng/mL) and insufficiency (20-30ng/mL). Plasma concentrations and liver function (Child-Pugh and MELD) at the end of treatment were compared with baseline data.

Results: Deficient or insufficient VD levels were found in 87% of the patients, with an average concentration of 18.8ng/mL. Levels were lower in patients with cirrhosis (15.9ng/mL) (P=.002) and in alcoholic liver disease. VD levels were inversely proportional to the degree of liver function: Child A (16.52ng/mL) vs C (7.75ng/mL). After VD supplementation, optimal serum levels were achieved in 94% of patients and significant improvements were observed in platelet count, albumin levels (P<.05) and functional status assessed by the Child-Pugh scale (P<.05).

Conclusion: Given the high prevalence of VD deficiency or insufficiency, the need for screening should be considered in the population with CLD. VD supplementation could be safe and effective.
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http://dx.doi.org/10.1016/j.gastrohep.2015.10.003DOI Listing
May 2016

[A comparison of medical versus surgical treatment in Barrett's esophagus acid control].

Gastroenterol Hepatol 2016 May 3;39(5):311-7. Epub 2015 Nov 3.

Servicio de Aparato Digestivo, Hospital Universitario de León, León, España.

Introduction: Barrett's oesophagus (BE) is an oesophageal injury caused by gastroesophageal acid reflux. One of the main aims of treatment in BE is to achieve adequate acid reflux control.

Objective: To assess acid reflux control in patients with BE based on the therapy employed: medical or surgical.

Methods: A retrospective study was performed in patients with an endoscopic and histological diagnosis of BE. Medical therapy with proton pump inhibitors (PPI) was compared with surgical treatment (Nissen fundoplication). Epidemiological data and the results of pH monitoring (pH time <4, prolonged reflux >5min, DeMeester score) were evaluated in each group. Treatment failure was defined as a pH lower than 4 for more than 5% of the recording time.

Results: A total of 128 patients with BE were included (75 PPI-treated and 53 surgically-treated patients). Patients included in the two comparison groups were homogeneous in terms of demographic characteristics. DeMeester scores, fraction of time pH<4 and the number of prolonged refluxes were significantly lower in patients with fundoplication versus those receiving PPIs (P<.001). Treatment failure occurred in 29% of patients and was significantly higher in those receiving medical therapy (40% vs 13%; P<.001).

Conclusions: Treatment results were significantly worse with medical treatment than with anti-reflux surgery and should be optimized to improve acid reflux control in BE. Additional evidence is needed to fully elucidate the utility of PPI in this disease.
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http://dx.doi.org/10.1016/j.gastrohep.2015.07.007DOI Listing
May 2016

Lower serum magnesium is associated with cardiovascular risk factors and mortality in haemodialysis patients.

Blood Purif 2014 6;38(3-4):244-52. Epub 2015 Jan 6.

Nephrocare - Vila Franca de Xira - Dialysis Unit, Vila Franca de Xira, Portugal.

Background: Hypomagnesaemia is a cardiovascular (CV) risk factor in the general population. The aim of this study was to evaluate the relationship between pre-dialysis magnesium (Mg) and CV risk markers, [including pulse pressure (PP), left ventricular mass index (LVMI) and vascular calcifications (VC)], and mortality in haemodialysis (HD) patients.

Methods: We performed a 48-month prospective study in 206 patients under pre-dilution haemodiafiltration with a dialysate Mg concentration of 1 mmol/l.

Results: Lower Mg concentrations were predictors of an increased PP (≥65 mm Hg) (p = 0.002) and LVMI (≥140 g/m(2)) (p = 0.03) and of a higher VC score (≥3) (p = 0.01). Patients with Mg <1.15 mmol/l had a lower survival at the end of the study (p = 0.01). Serum Mg <1.15 mmol/l was an independent predictor of all-cause (p = 0.01) and CV mortality (p = 0.02) when adjusted for multiple CV risk factors.

Conclusions: Lower Mg levels seem to be associated with increased CV risk markers, like PP, LVMI and VC, and with higher mortality in HD patients.
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http://dx.doi.org/10.1159/000366124DOI Listing
October 2015

[Hepatitis induced by glatiramer acetate].

Gastroenterol Hepatol 2015 Apr 17;38(4):280-1. Epub 2014 Jul 17.

Servicio de Aparato Digestivo, Complejo Universitario de León, León, España.

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http://dx.doi.org/10.1016/j.gastrohep.2014.06.001DOI Listing
April 2015

Nutritional status and overhydration: can bioimpedance spectroscopy be useful in haemodialysis patients?

Nefrologia 2013 ;33(5):667-74

Background: Protein-energy wasting (PEW), associated with inflammation and overhydration, is common in haemodialysis (HD) patients and is associated with high morbidity and mortality.

Objective: Assess the relationship between nutritional status, markers of inflammation and body composition through bioimpedance spectroscopy (BIS) in HD patients.

Methods: This observational, cross-sectional, single centre study, carried out in an HD centre in Forte da Casa (Portugal), involved 75 patients on an HD programme. In all participating patients, the following laboratory tests were conducted: haemoglobin, albumin, C-reactive protein (CRP) and 25-hydroxyvitamin D3 [25(OH)D3]. The body mass index of all patients was calculated and a modified version of subjective global assessment (SGA) was produced for patients on dialysis. Intracellular water (ICW) and extracellular water (ECW) were measured by BIS (Body Composition Monitor®, Fresenius Medical Care®) after the HD session. In statistical analysis, Spearman's correlation was used for the univariate analysis and linear regression for the multivariate analysis (SPSS 14.0). A P value of <.05 was considered statistically significant.

Results: PEW, inversely assessed through the ICW/body weight (BW) ratio, was positively related to age (P<.001), presence of diabetes (P=.004), BMI (P=.01) and CRP (P=.008) and negatively related to albumin (p=.006) and 25(OH)D3 (P=.007). Overhydration, assessed directly through the ECW/BW ratio, was positively related with CRP (P=.009) and SGA (P=.03), and negatively with 25(OH)D3 (P=.006) and BMI (P=.01). In multivariate analysis, PEW was associated with older age (P<.001), the presence of diabetes (P=.003), lower 25(OH)D3 (P=.008), higher CRP (P=.001) and lower albumin levels (P=.004). Overhydration was associated with higher CRP (P=.001) and lower levels of 25(OH)D3 (P=.003).

Conclusions: Taking these results into account, the ICW/BW and ECW/BW ratios, assessed with BIS, have proven to be good markers of the nutritional and inflammatory status of HD patients. BIS may be a useful tool for regularly assessing the nutritional and hydration status in these patients and may allow nutritional advice to be improved and adjusted.
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http://dx.doi.org/10.3265/Nefrologia.pre2013.Jun.12008DOI Listing
August 2014

Cocaine-related health emergencies in Europe: a review of sources of information, trends and implications for service development.

Eur Addict Res 2013 5;19(2):74-81. Epub 2012 Oct 5.

European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.

Background: Cocaine-related health consequences are difficult to observe. Data on drug users in health-emergency settings may be a useful source of information on consequences that are not visible via other information sources.

Methods: Thirty European countries submit an annual national report on the drug situation to the EMCDDA. All reports for the period 2007-2010 were analyzed, with particular attention given to auditing cocaine-related mentions. Analysis was also performed in order to identify sources and case definitions, assess coverage, audit cases and, where possible, to identify long-term trends.

Results: Considerable heterogeneity existed between countries in their approach to recording drug-related emergencies, with only Spain and the Netherlands having established formal indicators. The highest annual numbers of cocaine-related episodes were reported by the UK (3,502), Spain (2,845) and the Netherlands (1,211). A considerable (2- to 3-fold) increase in the numbers of cocaine-related episodes has been reported since the end of the 1990s in these countries; these increases peaked in Spain and England around 2007/08.

Conclusions: The analysis reported here suggests the need to develop more standardized approaches to monitoring drug-related emergencies. It points to the potential value of developing effective referral links between the emergency and specialized drug services working with cocaine users.
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http://dx.doi.org/10.1159/000341719DOI Listing
October 2013

Cocaine-related health emergencies in Europe: a review of sources of information, trends and implications for service development.

Eur Addict Res 2013 5;19(2):74-81. Epub 2012 Oct 5.

European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.

Background: Cocaine-related health consequences are difficult to observe. Data on drug users in health-emergency settings may be a useful source of information on consequences that are not visible via other information sources.

Methods: Thirty European countries submit an annual national report on the drug situation to the EMCDDA. All reports for the period 2007-2010 were analyzed, with particular attention given to auditing cocaine-related mentions. Analysis was also performed in order to identify sources and case definitions, assess coverage, audit cases and, where possible, to identify long-term trends.

Results: Considerable heterogeneity existed between countries in their approach to recording drug-related emergencies, with only Spain and the Netherlands having established formal indicators. The highest annual numbers of cocaine-related episodes were reported by the UK (3,502), Spain (2,845) and the Netherlands (1,211). A considerable (2- to 3-fold) increase in the numbers of cocaine-related episodes has been reported since the end of the 1990s in these countries; these increases peaked in Spain and England around 2007/08.

Conclusions: The analysis reported here suggests the need to develop more standardized approaches to monitoring drug-related emergencies. It points to the potential value of developing effective referral links between the emergency and specialized drug services working with cocaine users.
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http://dx.doi.org/10.1159/000341719DOI Listing
October 2013

Reducing drug related mortality in Europe - a seemingly intractable public health issue.

Adicciones 2012 ;24(1):3-7

Drawing on an analysis of data from over 30 cohort studies, it can be estimated that between 10.000 and 20.000 opioid users die each year in Europe. Typically, annual mortality rates are between 10-20/1000, representing an excess mortality 10 to 20 times greater than expected. Most deaths occur among males in their mid-thirties. Four broad categories of cause of death can be identified: overdoses, diseases, suicide and trauma. While the long term trend in HIV related mortality among drug users is downwards, other causes of mortality have shown little sign of decreasing in recent years. Of particular concern are overdoses which account for 6300 to 8400 deaths reported annually. The fact that deaths have not decreased is surprising given the scaling up of treatment and other services. Opioid substitution treatment in particular is known to be protective and the numbers of those in substitution treatment in Europe has increased dramatically. A number of interrelated factors may help explain this intractable problem. These include: the possibility of an aging cohort becoming more vulnerable; the use of alcohol and other drugs; high levels of ill-health, risk behaviour, and co-morbidity; and social exclusion and marginalisation. Reducing overall morbidity among heroin users remains a key issue for Europe's public health services. More efforts are required to better understand and target both the direct and indirect factors associated with mortality among problem drugs users, if this major health cost associated with drug consumption is to be reduced.
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August 2012