The association of telomere length with substance use disorders: a systematic review and meta-analysis of observational studies.

BACKGROUND AND AIMS: Several recent studies have investigated the relationship between telomere length and substance use disorders with inconsistent results. We aimed to assess this association and to identify moderators of the relationship. METHODS: Systematic review and meta-analysis. Selection criteria were observational studies reporting telomere length in people with a substance use disorder compared with a control group. Studies focused solely on nicotine addiction, employing other study designs, and non-human studies were excluded. Study selection and data extraction were independently conducted by two researchers following a standardized protocol and included studies until December 2019. Standardized mean differences were used as the effect size index [d; 95% confidence interval (CI)] and random-effects models were used for the meta-analysis. Cochran's Q-statistic, I2 index, visual inspection of the forest plot and a 95% prediction interval were applied to verify study heterogeneity. Subgroup analyses and meta-regressions were conducted to explore heterogeneity. Small study effects were examined using the 'funnel plot', the Egger test, Duval & Tweedie's trim-and-fill method and the precision-effect test-precision-effect estimate with standard error (PET-PEESE) method. The risk of bias and the quality of evidence were assessed. RESULTS: Ten studies (12 analysis units with 2671 cases and 4532 controls) met the selection criteria. An overall effect size of moderate magnitude was found (d+  = -0.63; 95% CI = -1.00 and -0.26; P = 0.0008). A potential small study effect was detected, as well as large heterogeneity between studies (Q-statistic P < 0.001, I2  = 97.3%). Selection of controls, reporting laboratory quality control procedures and total sample size significantly affected the effect size. The quality of the evidence was very low, based on risk of bias analysis and the grading of recommendations assessment, development and evaluation (GRADE) system. CONCLUSIONS: People with substance use disorders appear to have shorter telomere length than controls; however, this finding should be interpreted with caution due to the poor quality of the evidence.

Calidad asistencial percibida y satisfacción de las personas sordas con la atención primaria de un Área de Salud de la Región de Murcia / Perceived quality of care and satisfaction for deaf people with regard to primary care in a Health Area in the region of Murcia

Objetivo: Describir la calidad asistencial percibida y la satisfacción frente a los servicios de Atención Primaria del Área de Salud II Cartagena del Servicio Murciano de Salud por parte de las personas sordas de Cartagena y comarca. Método: Estudio observacional, descriptivo y transversal. Los datos se recogieron mediante la traducción simultánea a la lengua de signos española del Cuestionario de Evaluación y Mejora de la Calidad Asistencial de Calidad Percibida en Atención Primaria. Se analizaron las variables: edad, sexo, nivel de estudios, tipo de sordera, primera lengua y uso, sistemas o apoyos comunicativos, calidad de atención percibida, percepción de la profesionalidad y trato humano por parte del profesional de la medicina, enfermería y administración y la satisfacción global percibida con su Centro de Atención Primaria. Resultados: La profesionalidad y trato humano recibido por parte del personal médico y administrativo fue percibido como deficiente, considerándose bueno en caso de las enfermeras. La satisfacción global es menor a la de la población general. Existen diferencias estadísticamente significativas entre el tipo de sordera y la profesionalidad percibida, el trato humano y la profesionalidad percibida y entre el sistema o apoyo comunicativo y la calidad de la atención percibida. Conclusiones: Es necesario adaptar la atención en salud que se presta a este colectivo con necesidades especiales a fin de que perciban una atención sanitaria de calidad que derive en un mayor acceso y seguimiento de personas sordas en el sistema sanitario

Objective: To describe the quality of care and satisfaction with regard to the primary care services of the Health Area II Cartagena of the Murcia Health Service as perceived by deaf people of Cartagena and the region. Method: Observational, descriptive and cross-sectional study. The data were collected through the simultaneous translation of the Questionnaire on Evaluation and Improvement of the Quality of Care (EMCA) relative to the Perceived Quality in Primary Care. The variables analyzed were: age, sex, level of education, kind of deafness, first language and use, communication systems or supports, quality of perceived service, perception of professionalism and humane treatment by doctors, nurses and administrative personnel and overall satisfaction perceived regarding their Health Center.Results: Professionalism and humane treatment on behalf of doctors and administrative staff was perceived as deficient, yet this perception was good in the case of nurses. Overall satisfaction is lower than that in the general population. There are statistically significant differences between the type of deafness and the perceived professionalism, the humane treatment and the perceived professionalism and between the communication system or support and the perceived quality of care.Conclusions: The health care provided to this group with special needs must be adapted so that they perceive quality health care leading to increased access and monitoring of deaf people in the health system