Economic recession, illicit drug use and the young population: a systematic literature review and meta-analysis.

AIMS: Economic recessions impact on drug use through different channels, with potential conflicting outcomes. Previous studies have reached mixed outcomes, and a clear and comprehensive picture is difficult to depict. METHODS: We use a systematic review of literature - conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines - and a hierarchical mixed-effects meta-analysis to provide a comprehensive quantitative assessment of the relationship between business cycle and the use of drugs by young populations. The heterogeneity of studies was assessed by the I2 statistic, and the publication bias was evaluated with contour-enhanced funnel plots. RESULTS: We identify 25 studies, published over the period 2008-2020. These articles carried out an empirical analysis of the impact of the business cycle on illegal drug consumption in Organisation for Economic Co-operation Development (OECD) countries. Most of the studies (17 studies) covered the 2007 financial crisis. Among the outcomes, 9 studies traced a countercyclical relationship between economic recessions and drug use, 3 showed a procyclical relationship and 13 studies found mixed results. Unemployment was the most widely used variable to assess macroeconomic conditions in most of the studies (21 studies). The meta-analysis shows a partial correlation of .03 (95% confidence interval (CI): .0147-.0453) between the unemployment rate and drug use among young individuals. Therefore, we conclude that, on average, recessions tend to boost drug use. This impact is more marked with cannabis use than it is with cocaine, opioids or other drugs. CONCLUSION: This study provides robust evidence that in periods of economic downturns, the young populations tend to increase the use of illegal drugs, with cannabis as their main preference. Therefore, in periods of economic severity, society may particularly benefit from implementing widely reaching public prevention programmes and demand reduction interventions, targeting this subgroup of the population.

The impact of socioeconomic position on non-communicable diseases: what do we know about it?

AIMS: Non-communicable diseases (NCDs) have become a primary health concern for most countries around the world. The aim of this research is to analyze the relevant evidence that determines the effect of socioeconomic position (SEP) on the incidence and prevalence of NCDs. METHODS: A systematic literature search was performed using PubMed, Cochrane Library, and Web of Science to identify evidence regarding the relationship between income inequalities and NCDs, between 2005 and 2015. The final selection of papers was based on applied studies focusing on Organisation for Economic Co-operation and Development (OECD) countries and articles referring to three main groups of chronic diseases: cardiovascular and heart diseases, cancer, and diabetes. RESULTS: A final set of 47 selected studies were fully taken into account in this review. Despite significant heterogeneity in exposure and outcomes measures, overall the evidence suggests that having low SEP increases the risk of developing cardiovascular diseases (CVDs), lung and breast cancer, and type 2 diabetes. SEP is also associated with multiple NCD risk factors such as smoking and physical inactivity. CONCLUSION: Low socioeconomic status appears to have a significant consistent impact on mortality and morbidity caused by NCDs in OECD countries. Social and economic disadvantages are associated with health inequalities in terms of access to care, increased incident risk of NCDs, and early death. These findings point to the need for public health strategies and research to address socioeconomic status disparity among individuals.

Lesión de la arteria subclavia tras traumatismo torácico cerrado: a propósito de un caso / Lesion in the subclavian artery following closed thoracic traumatism: a case report

Introducción. Las lesiones traumáticas localizadas en la arteria subclavia son muy infrecuentes. La exposiciónquirúrgica presenta dificultades técnicas y se asocia a una morbimortalidad de entre el 5 y el 30%. El tratamientoendovascular es una alternativa a la cirugía convencional que puede ser aplicada en pacientes estables con un determinadotipo de lesiones, lo que representa aproximadamente el 50% de los casos. Caso clínico. Varón de 20 años politraumatizadocon sección transversal completa en el origen de la arteria subclavia derecha tras traumatismo torácico cerrado.Se reparó mediante cirugía abierta con la realización de un bypass entre el tronco innominado y la arteria subclavia;se empleó como abordaje una esternotomía media con una prolongación supraclavicular. La evolución postoperatoriafue favorable y no presentó secuelas vasculares ni neurológicas en dicho miembro. Conclusión. Las secciones transversalescompletas suponen una limitación en la terapia endovascular, por lo que la cirugía convencional sigue siendo elmejor tratamiento para este tipo de lesiones

Introduction. Traumatic injuries located in the subclavian artery are very infrequent. Operative exposure istechnically difficult and is associated to a morbidity and mortality rate of between 5% and 30%. Endovascular treatmentis an alternative to conventional surgery that can be applied in stable patients with a particular type of lesions, whichaccounts for around 50% of cases. Case report. A 20-year-old male with multiple traumatisms and complete transversalsectioning at the origin of the right subclavian artery following closed thoracic traumatic injury. It was repaired bymeans of open surgery with a bypass between the innominate artery and the subclavian artery; a median sternotomywith supraclavicular prolongation was used as the approach. Post-operative progression was favourable and the patientdid not present any vascular or neurological sequelae in the limb involved. Conclusions. Complete transversal sectionsrepresent a limitation for endovascular therapy, and conventional surgery therefore continues to be the best treatment for this kind of injuries (AU)

Cirugía del aneurisma de aorta abdominal en pacientes octogenarios / Surgical treatment of abdominal aortic aneurysm in octogenarian patients

Objetivo: Analizar las características de los pacientes octogenarios sometidos a cirugía convencional y valorar la experiencia y los resultados de este tipo de tratamiento en nuestro servicio. Pacientes y métodos. Estudio retrospectivo de todos los pacientes consecutivos mayores de 80 años con un aneurisma de aorta abdominal (AAA) tratados de forma quirúrgica convencional desde enero de 1993 hasta diciembre de 2006 en nuestro centro. Resultados. Se incluyeron 45 pacientes con una edad media de 83,4 +/- 3,4 años. La mayoría eran varones (40 pacientes, 88,9%). Veintiocho pacientes (62,2%) fueron clasificados como ASA (Asociación Americana de Anestesiología) IV. La media del diámetro de los AAA fue de 6,9 +/- 2 cm. Se trató de forma urgente a 29 pacientes (64,4), de los cuales, en 22 casos, la indicación fue por rotura aneurismática. Destacó entre los factores de riesgo cardiovascular la hipertensión, presente en 30 pacientes (66,7%). Treinta y un pacientes (68,9%) padecían alguna cardiopatía. La mortalidad operatoria fue del 6,3% en los pacientes tratados de forma electiva, mientras que en los tratados de forma urgente la mortalidad ascendió a 41,4% (p=0,01). La presencia de ictus previo (11,1%) a la intervención quirúrgica se asoció a mayor mortalidad (p=0,02). Conclusiones. Basándonos en estos resultados, el tratamiento quirúrgico electivo de los pacientes octogenarios parece justificado en nuestro centro cuando no existe una opción terapéutica alternativa menos invasiva

Aims. To analyse the characteristics of octogenaria patients submitted to conventional surgery and to evaluate our experience and the outcomes of this type of treatment in our department. Patients and methods. We conducted a retrospective study of all the consecutive patients over 80 years of age with an abdominal aortic aneurysm (AAA)who were treated using conventional surgery at our health centre beween January 1993 and December 2006. Results. The sample was made up of 45 patients, with a mean age of 83.4 +/- 3.4 years, most of whom were males (40 patients, 88.9%). Twenty-eight patiens (62.2%) were classified as ASA (American Society of Anaesthesiology) IV. The mean diameter of the AAA was 6.9 +/- 2 cm. The aneurysm was treated urgently in 29 patients (64.4%), and in 22 of these cases the indication was due to aneurismal rupture. The most common cardiovascular risk factor was hypertension, which was present in 30 patients (66.7%). Thirty-one patients (68.9%) had some kind of heart disease. The operative mortality rate was6.3% in patients treated electively, whereas among those treated urgently the mortality rate rose to 41.4% (p=0.01). The presence of a stroke (11.1%) prior to the surgical intervention is associated to a higher mortality rate (p=0.01). The presence of a stroke (11.1%) prior to the surgical intervention is associated to a higher mortality rate (p=0.02). Conclusions. On the basis of these results, elective surgical treatment in octogenarian patients seems to be justified in our health centre when no other less invansive therapeutic alternative is available

Disección y trombosis de arteria iliaca común secundaria a traumatismo abdominal cerrado: tratamiento endovascular / Dissection and thrombosis of the common iliac artery secondary to closed abdominal traumatic injury: endovascular treatment

Introducción. Las lesiones traumáticas de las arterias iliacas son poco frecuentes, constituyen alrededor del 10% de todas las lesiones vasculares abdominales y se deben en su mayoría a traumatismos penetrantes. La mayoría de los casos documentados de lesiones iliacas por traumatismos contusos fueron tratados mediante técnicas convencionales. Presentamos un caso de lesión traumática cerrada de la arteria iliaca común resuelta mediante un abordaje mínimamente invasivo. Caso clínico. Varón de 38 años que presenta traumatismo abdominal cerrado tras accidente laboral, con lesiones óseas y abdominales asociadas a disección y trombosis de la arteria iliaca común derecha, que se trata mediante trombectomía e implantación de un stent autoexpandible de nitinol. El control realizado con eco-Doppler a los tres meses demostró la permeabilidad del stent y el eje iliaco tratado. Conclusión. El tratamiento endovascular de lesiones arteriales iliacas secundarias a traumatismos cerrados es una opción válida y debe considerarse particularmente en pacientes politraumatizados con múltiples lesiones, en los que la cirugía abierta se asocia a elevadas tasas de morbimortalidad

Introduction. Traumatic injuries to the iliac arteries are infrequent; they account for about 10% of all injuries to abdominal blood vessels and are mainly due to stab wounds. Most of the cases of iliac injury caused by blunt trauma that have been described to date were treated using conventional techniques. We report a case of closed traumatic injury to the common iliac artery that was resolved by a minimally invasive approach. Case report. We describe the case of a 38-year-old male who presented a closed abdominal trauma as a result of a work accident, with bone and abdominal injuries associated to dissection and thrombosis of the right common iliac artery, which was treated by means of a thrombectomy and placement of a self-expanding nitinol stent. A control Doppler ultrasound scan performed at three months showed that the stent was patent and the iliac axis had been treated. Conclusions. Endovascular treatment of injuries to the iliac artery secondary to closed trauma is a valid option and should be taken into account particularly in the case of patients with multiple traumatic injuries, in whom open surgery is associated to high morbidity and mortality rates

Down syndrome: lip lesions (angular stomatitis and fissures) and Candida albicans.

BACKGROUND: The incidence of angular cheilitis (angular stomatitis, perleche, commissural fissures) appears to be increased in people with Down syndrome (DS). Lip fissures are also (in our clinical impression) a fairly regular feature, yet this is scarcely mentioned in the literature. OBJECTIVES: To establish the incidence of angular cheilitis and lip fissures in a substantial group of patients with DS and to examine the relationship with Candida albicans. PATIENTS AND METHODS: The prevalence of orofacial soft tissue lesions was investigated in a group of 77 DS patients. Swabs were taken from lip lesions, palate and tongue and inoculated on Sabouraud's agar discs for the isolation of C. albicans, identified with commercially available kits. RESULTS: Lip fissures were seen in at least one-quarter of DS patients. Angular cheilitis was also found in a similar percentage. CONCLUSIONS: C. albicans was isolated from a substantial proportion of lesions tested, and was present more frequently than in those without lip lesions, but it is uncertain whether this represents cause or effect.