Self-medication practices to prevent or manage COVID-19: A systematic review.

BACKGROUND: Previous studies have assessed the prevalence and characteristics of self-medication in COVID-19. However, no systematic review has summarized their findings. OBJECTIVE: We conducted a systematic review to assess the prevalence of self-medication to prevent or manage COVID-19. METHODS: We used different keywords and searched studies published in PubMed, Scopus, Web of Science, Embase, two preprint repositories, Google, and Google Scholar. We included studies that reported original data and assessed self-medication to prevent or manage COVID-19. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) modified for cross-sectional studies. RESULTS: We identified eight studies, all studies were cross-sectional, and only one detailed the question used to assess self-medication. The recall period was heterogeneous across studies. Of the eight studies, seven assessed self-medication without focusing on a specific symptom: four performed in the general population (self-medication prevalence ranged between <4% to 88.3%) and three in specific populations (range: 33.9% to 51.3%). In these seven studies, the most used medications varied widely, including antibiotics, chloroquine or hydroxychloroquine, acetaminophen, vitamins or supplements, ivermectin, and ibuprofen. The last study only assessed self-medication for fever due to COVID-19. Most studies had a risk of bias in the "representativeness of the sample" and "assessment of outcome" items of the NOS. CONCLUSIONS: Studies that assessed self-medication for COVID-19 found heterogeneous results regarding self-medication prevalence and medications used. More well-designed and adequately reported studies are warranted to assess this topic.

Factores asociados a la percepción de la validez científica de la homeopatía en un grupo de médicos generales de Perú / Factors associated with the perception of scientific evidence regarding homeopathy in a group of general practitioners from Peru

Resumen Introducción. La homeopatía es una terapia ampliamente utilizada en diversas partes del mundo; sin embargo, su eficacia no se ha comprobado científicamente. Objetivo. Evaluar los factores asociados a la percepción de la validez científica de la homeopatía en médicos generales de Perú. Materiales y métodos. Estudio transversal analítico. Se realizaron encuestas autoaplicadas a médicos generales que asistieron a los cursos de capacitación y orientación vocacional en especialidad y residentado en salud del Colegio Médico del Perú en 2017. La variable principal del estudio se evaluó por medio de la siguiente pregunta: ¿considera que la eficacia de la homeopatía está científicamente probada? Para evaluar los factores asociados se calcularon razones de pre-valencia crudas (RP) y ajustadas (RPa), así como sus intervalos de confianza al 95% (IC95%). Resultados. Se incluyeron 285 médicos generales (55.1% mujeres) con una edad mediana de 28 años. Del 67.4% que reportó haber escuchado sobre la homeopatía, 22.5% consideró que su eficacia estaba científicamente comprobada. Lo anterior fue más frecuente en mujeres (RPa: 1.80; IC95%: 1.03-3.16) y menos frecuente en quienes habían publicado algún artículo científico (RPa: 0.23; IC95%:0.06-0.88). Conclusiones. Casi un cuarto de los médicos que habían escuchado sobre homeopatía consideraron que esta terapia está científicamente comprobada. Lo anterior puede deberse a vacíos en la educación médica con respecto a las terapias médicas alternativas y complementarias, así como a la influencia de la educación no formal en la toma de decisiones.

Abstract Introduction: Homeopathy is a widely used therapy in different parts of the world. However, its effectiveness has not been scientifically proven. Objective: To assess the factors associated with the perception of homeopathy scientific validity in Peruvian general practice (GP) physicians. Materials and methods: Cross-sectional analytical study. A group of GP physicians who attended training and career guidance courses on medical specialties and residencies offered by Colegio Médico del Perú (Medical Association of Peru) in 2017 were asked to complete a self-administered survey. The main study variable was evaluated using the following question: Do you consider that homeopathy effectiveness has been scientifically proven? Prevalence ratios (PR) and adjusted prevalence ratios (aPR), as well as their 95% confidence intervals (95%CI) were calculated to assess the factors associated with considering homeopathy effectiveness as scientifically proven. Results: 285 GP physicians completed the survey (55.1% were women; median age: 28 years); 67.4% reported having heard about homeopathy, and out of these, 22.5% considered that homeopathy effectiveness was scientifically proven. Perceiving this type of therapy as scientifically valid was more frequent in women (aPR:1.80, 95%CI:1.03-3.16) and less frequent in those who had published at least one scientific paper (aPR:0.23, 95%CI:0.06-0.88). Conclusions: Almost a quarter of the physicians who had heard about homeopathy considered that this therapy had been scientifically proven. This might be caused by gaps in their medical training regarding alternative and complementary medicine therapies, and the influence that non-formal education has on decision-making.

Acupuncture for major depressive disorder: A review of the recommendations stated at clinical practice guidelines.

BACKGROUND: The use of acupuncture to treat depression is not uncommon. However, recommendations regarding acupuncture issued by clinical practice guidelines (CPG) vary widely. OBJECTIVE: To describe the recommendations regarding acupuncture in CPGs for depression in adults, and to assess the methodology used to reach them. METHODS: We conducted a scoping review of CPGs for depression management in adults, which performed systematic reviews (SRs) to answer their review questions, were published between January 2014 and May 2018, and assessed the use of acupuncture as a review question. We limited out search to articles published in English/Spanish. We assessed the SRs quality using the "A MeaSurement Tool to Assess Systematic Reviews-2" (AMSTAR-2), and described how the recommendation regarding acupuncture was reached. FINDINGS: We found five CPGs that fulfilled our inclusion criteria: three from the US, one from Canada, and one from China. Four CPGs fulfilled between two and three items of AMSTAR-2, and one CPG fulfilled seven items. The methodology used to formulate the recommendations varied between CPGs. Regarding acupuncture use recommendations: three CPGs did not issue any recommendation (although one mentions that it should not be used), whilst two were in favor. DISCUSSIONS: The lack of a clearly stated review question presented in the majority of CPGs prevents the reader from understanding what the CPG developing group was trying to answer. Moreover, the arguments presented to support a decision are usually not detailed enough. Therefore, the assessment of the recommendations was extremely difficult. CLINICAL IMPLICATIONS: Given that the formulation of recommendations is not always reliable, clinicians should carefully read and assess the recommendations presented in CPGs before implementing them.

Use of medicinal plants in patients with chronic kidney disease from Peru.

OBJECTIVE: To describe the use of medicinal plants in patients with chronic kidney disease (CKD) in public healthcare centers in Peru. METHODS: A cross-sectional study was conducted in patients with CKD in healthcare centers of three Peruvian regions: Lima, Arequipa, and Ucayali. A structured questionnaire which included socio-demographic data, medical antecedents and characteristics of the use of medicinal plants was used. Prevalence ratios (PR) and 95 % confidence intervals (95% CI) were calculated using crude Poisson regressions with robust variances. RESULTS: A total of 599 patients with CKD were evaluated, of which 300 (50.1%) reported the use of medicinal plants (160 [30.3%] used these plants for CKD), 379 reported that medicinal plants were not harmful, while 166 (27.8%) stopped using allopathic medicine to use medicinal plants only. In the adjusted analysis, the frequency of the use of medicinal plants for CKD was similar between Lima and Arequipa but was lower in Ucayali than in Lima (PR: 0.32, 95% CI: 0.14 - 0.76). In addition, a higher frequency of the use of medicinal plants for CKD was observed in patients with more advanced stages of CKD (PR: 1.55, 95% CI: 1.06-2.26) and in patients who were aware they had CKD (PR: 2.79 95% CI: 1.39-5.63). CONCLUSIONS: Half of the patients used medicinal plants and about one-third used it for CKD. This use was lower in Ucayali and higher in both the patients who knew they had CKD and those with more advanced stages of the disease. Given these results, physicians should ask and inform regarding medicinal plants consumption to their CKD patients.

Guía de práctica clínica para el diagnóstico y manejo de la osteoartritis en el Seguro Social del Perú (EsSalud) / Clinical practice guidelines for the diagnosis and management of osteoarthritis in Peruvian Social Security (EsSalud)

Este artículo resume la guía de práctica clínica (GPC) para el diagnóstico y manejo de pacientes con osteoartritis (OA) del Seguro Social del Perú (EsSalud). Para su desarrollo se conformó un grupo elaborador de la guía (GEG) que incluyó a especialistas clínicos y metodólogos. Para responder las 13 preguntas clínicas planteadas se realizaron búsquedas sistemáticas en PubMed y repositorios de GPC. Se usó la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE) para evaluar la certeza de la evidencia. Se emitieron 11 recomendaciones: tres fuertes (no solicitar de forma rutinaria radiografías para el diagnóstico de OA, brindar un plan individualizado de medidas de educación y autocuidado, indicar la realización de ejercicio físico) y ocho débiles (intervenciones para reducir el peso en personas con obesidad o sobrepeso, evitar el uso de paracetamol para el manejo de OA, promover el uso de AINE orales para el manejo de OA, evitar el uso de condroitín sulfato para el manejo de OA, evitar el uso de proloterapia para el manejo de OA, en adultos con OA y dolor refractario a manejo farmacológico considerar terapias adyuvantes como ultrasonido o similares, evitar el uso de terapia laser como adyuvante para el manejo de OA, evitar el uso de acupuntura para el manejo de OA); además, 20 puntos de buena práctica clínica y un flujograma de trabajo.

This paper summarizes the clinical practice guideline (CPG) for the diagnosis and management of patients with osteoarthritis (OA) in the Peruvian Social Security health system (EsSalud). A working group was formed for producing this guideline, and this group included both clinical specialists and methodologists. Systematic searches in PubMed and CPG repositories were performed aiming to answer the 13 clinical questions that were asked. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method was used aiming to determine the certainty of evidence. Eleven recommendations were issued: three were strong (do not request X-ray films as routine practice, give an individualized plan including educational and self-care measures, and prescribe physical activity; and eight were weak (weight-reducing interventions for persons with obesity or who are overweight, avoid the use of paracetamol for OA management, promote the use of oral non-steroidal anti-inflammatory drugs for OA management, avoid the use of chondroitin sulfate for OA management, avoid the use of prolotherapy for OA management in affected adults, particularly in those with refractory pain not responding to drug therapy, consider the use of adjuvant therapy, such as ultrasound and the like, avoid the use of laser therapies as adjuvant for OA management, and avoid the use of acupuncture for OA management); also, 20 items for good clinical practice and a workflow sheet were issued.

Effects of dog-assisted therapy in adults with dementia: a systematic review and meta-analysis.

BACKGROUND: Dog-assisted therapy (DAT) is a non-pharmacological intervention based on the interaction between patients and dogs, which has been proposed to help adults with dementia. However, evidence to support it is lacking. Thus, we aim to evaluate the effects of DAT on this population and to assess the certainty of the evidence of the RCTs estimates. METHODS: A systematic search was performed. We included randomized controlled trials (RCTs) and quasi-experimental (QE) controlled studies published up to March 2018, which evaluated the beneficial and deleterious effects of DAT in adults with dementia. Mean differences (MD) or standardized mean differences (SMD) and their 95% confidence intervals (95% CI) were calculated and random effects meta-analyses were performed. Certainty of evidence was assessed for RCTs estimates using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol has been registered in PROSPERO (CRD42018090434). RESULTS: Ten studies (six RCTs and four QE controlled studies) were eligible for inclusion. Meta-analysis of RCTs showed no effect of DAT in daily life activities (SMD: 0.16; 95% CI: -0.80 to 1.12), depression (SMD: -0.45; 95% CI: -2.81 to 1.91), agitation (SDM: -1.12; 95% CI: -2.67 to 0.43), quality of life (SDM: 0.16; 95% CI: -0.41 to 0.73), and cognitive impairment (SDM: -0.52; 95% CI: -1.33 to 0.30), but it found a beneficial effect in apathy (1 study, n = 37, MD: 1.81; 95% CI: 1.26 to 2.36). All outcomes had a very low certainty of evidence according to GRADE methodology. CONCLUSIONS: RCTs evidence of very low certainty suggests that, in adults with dementia, DAT has no effect in daily life activities, depression, agitation, quality of life, and cognitive impairment, although one small study found an apparent beneficial effect in apathy. More well-designed and correctly reported studies are needed in order to provide a conclusion. TRIAL REGISTRATION: CRD42018090434 (PROSPERO).

Investigación en faith-based interventions y faith-placed interventions de salud: situación actual y perspectivas en Latinoamérica / Research on faith-based interventions and faith-placed health interventions: current situation and perspectives in Latin America

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[Clinical practice guideline for the evaluation and management of upper gastrointestinal bleeding for the Peruvian Social Security (EsSalud)]. / Guía de práctica clínica para la evaluación y el manejo de la hemorragia digestiva alta en el Seguro Social del Perú (EsSalud).

OBJECTIVE: To provide evidence-based clinical recommendations for the evaluation and management of patients with upper gastrointestinal bleeding (UGB) in the Peruvian Social Security (EsSalud). MATERIALS AND METHODS: A local guideline development group (local GDG) was established, including specialists in gastroenterology and methodologists. The local GDG formulated 11 clinical questions to be answered by this clinical practice guide (CPG). We searched and selected CPG of UGB published from 2012, which answered the posed questions and obtained a score higher than 60% in domains 1 and 3 of the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. During September 2017, bibliographic searches were conducted in Pubmed, to update 9 clinical questions of the preselected CPGs, and to answer 2 de novo questions. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG reviewed the evidence and formulated the recommendations, points of good clinical practice and the flowchart of evaluation and management, using the GRADE methodology Lastly, the CPG was approved with Resolución N° 80-IETSI-ESSALUD-2017. RESULTS: This CPG addressed 11 clinical questions, divided into four themes: risk assessment, initial management, management of non-variceal UGB, and management of variceal UGB. Based on these questions, 10 recommendations (7 strong recommendations and 3 weak recommendations), 24 points of good clinical practice, and 2 flow charts were formulated. CONCLUSION: This article is the summary of the EsSalud' CPG, where the available scientific evidence on evaluation and management of UGB was evaluated.

[Trends in Google searches on complementary and alternative medicine]. / Tendencias de las búsquedas en Google sobre terapias de medicina alternativa y complementaria.

BACKGROUND: The aim of this article is to evaluate the interest in complementary and alternative medicine (CAM) therapies using Google Trends in spanish-speaking countries. METHODS: An observational study was conducted using GoogleTrends. The search volume of 34 CAM therapies in spanish were evaluated globally and in 21 spanish-speaking countries. Also, the relationship between the median of the most popular searches and the gross domestic product (GDP) per capita in each of the countries was evaluated using Spearman's test. RESULTS: A decreased trend in search volume was observed in homeopathy, herbal medicine, acupunctureand sensory therapies; and an increasing trend in chiropraxy. A direct association was observed between the GDP per capita and the median between the most popular CAM therapies, this relationship was no significant (p = 0.432). CONCLUSIONS: The interest in CAM therapies shows temporal and geographic variations that must be studied in depth. These results can be used for the establishment of an international monitoring for the use of CAM therapies.

Introducción: el objetivo de este artículo es evaluar el interés de la población en terapias de medicina alternativa y complementaria (MAC), a través de la herramienta Google Trends y en países de habla hispana. Métodos: se realizó un estudio observacional mediante la herramienta Google Trends. Se evaluaron las tendencias de búsqueda de 34 terapias de MAC en español, de manera global y en 21 países de habla hispana. Se evaluó la asociación entre la mediana de búsquedas de las terapias más populares y el producto interno bruto (PIB) per cápita en cada país, mediante la prueba de Spearman. Resultados: se observa una tendencia descendente en el volumen de búsquedas de homeopatía, medicina herbaria, acupuntura y terapias sensoriales; así como una tendencia ascendente de la quiropraxia. Además, al analizar los países se observó una asociación directa entre el PIB per cápita y la mediana de la búsqueda de las terapias de MAC más populares, pero esta no fue significativa (p = 0.432). Conclusiones: el interés de terapias de MAC presenta variaciones temporales y geográficas que deben estudiarse a profundidad. Estos resultados pueden ser de utilidad para establecer una vigilancia internacional al respecto.