Recaída en el consumo de alcohol después del trasplante de hígado por hepatopatía alcohólica / Alcohol relapse after liver transplantation for alcoholic liver disease

Introducción. La enfermedad hepática inducida por uso de alcohol se ha considerado una enferme-dad autoinfligida que limitaba el acceso al trasplante. Actualmente es una de las principales indicacio-nes de trasplante hepático en Colombia y el mundo, con excelente sobrevida. Metodología. Estudio descriptivo observacional donde se realizó una caracterización de los pacientes con trasplante hepá-tico por hepatopatía alcohólica en una institución de cuarto nivel, que incluyó un estudio cualitativo de la recaída en el consumo de alcohol postrasplante. Resultados. De 87 pacientes de una cohorte inicial de 96 pacientes trasplantados entre 2003 y 2021, se describieron características sociodemo-gráficas, comorbilidades previas y adquiridas posterior al trasplante, supervivencia del paciente y del injerto, y factores de riesgo asociados al consumo de alcohol. Adicionalmente, a 65 pacientes se les pudo realizar una entrevista estructurada para evaluar la recaída en el consumo de alcohol, 41,53 % volvieron a consumir alcohol; 23,07 % en patrón de riesgo de recaída y 18,46 % en patrón de slip (desliz). El antecedente de hepatitis alcohólica tuvo un RR de 3,273 (1,464­7,314) y p=0,007 para recaída en el consumo de alcohol, y la comorbilidad psiquiátrica un RR de 2,395 (1,002­5,722) y p=0,047. Finalmente, haber presentado al menos una recaída postrasplante tuvo un RR de 5,556 (1,499­20,588) con p=0,005 para rechazo del injerto. Conclusiones. La recaída en el consumo de alcohol fue frecuente, la hepatitis alcohólica previa y la comorbilidad psiquiátrica son factores de riesgo asociados. La recaída se asoció a rechazo del injerto sin afectar la sobrevida del paciente.

Introduction. Alcohol-induced liver disease has been considered a self-inflicted disease that limited access to transplantation. It is currently one of the main indications for liver transplantation in Colom-bia and the world, with excellent survival. Methodology. Observational descriptive study where a characterization of liver transplant patients due to alcoholic liver disease was carried out in a fourth level institution, which included a qualitative study of relapse in post-transplant alcohol consumption. Results. Of 87 patients from an initial cohort of 96 transplant patients between 2003 and 2021, sociodemographic characteristics, previous and acquired post-transplant comorbidities, patient and graft survival, and risk factors associated with alcohol consumption were described. Additionally, 65 patients were able to undergo a structured interview to assess relapse in alcohol consumption, 41.53% returned to alcohol consumption; 23.07% in risk relapse pattern, and 18.46% in slip pattern. The history of alcoholic hepatitis had a RR of 3.273 (1.464-7.314) and a p=0.007 for relapse in alcohol consumption, and psychiatric comorbidity a RR of 2.395 (1.002-5.722) and a p=0.047. Finally, having presented at least one post-transplant relapse had a RR of 5.556 (1.499-20.588) with ap=0.005 for graft rejection. Conclusions. Relapse in alcohol consumption was fre-quent, previous alcoholic hepatitis and psychiatric comorbidity were associated risk factors. Relapse was associated with graft rejection without affecting patient survival.

An overview of reviews on strategies to reduce health inequalities.

BACKGROUND: Governments are incentivized to develop and implement health action programs focused on equity to ensure progress with effective strategies or interventions. OBJECTIVE: Identify and synthesize strategies or interventions that facilitate the reduction of health inequalities. METHODS: A systematic search strategy was carried out up until August 2019 in MEDLINE (Ovid), Embase (Elsevier), Cochrane Database of Systematic Reviews, LILACS, Scopus, Scielo and Epistemonikos. In addition, a snowball strategy was used. Literature reviews (LRs) of experimental and quasi-experimental studies were included. The identified interventions and outcomes were categorized based on the recommendation by the Cochrane group in "Effective Practice and Organization of Care". The quality of the included LRs was evaluated using the AMSTAR 2 tool. RESULTS: Four thousand ninety-five articles were identified, of which 97 were included in the synthesis of evidence. Most of the studies included focused on the general population, vulnerable populations and minority populations. The subjects of general health and healthy lifestyles were the most commonly addressed. According to the classification of the type of intervention, the domain covered most was the delivery arrangements, followed by the domain of implementation strategies. The most frequent group of outcomes was the reported outcome in (clinical) patients, followed by social outcomes. CONCLUSION: The strategies that facilitate the reduction of health inequalities must be intersectoral and multidisciplinary in nature, including all sectors of the health system. It is essential to continue generating interventions focused on strengthening health systems in order to achieve adequate universal health coverage, with a process of comprehensive and quality care.

Efectividad de las estrategias de transferencia de conocimiento en lenguaje audiovisual comparadas con otras para mejorar desenlaces en la salud individual y de la población general: revisión sistemática / Effectiveness of Knowledge Translation Strategies in Audiovisual Language Compared With Other Languages to Improve Health Outcomes in Individuals and the General Population: Systematic Review

RESUMEN Introducción: La transferencia del conocimiento (KT) corresponde no solo a una serie de accio nes finales en áreas de divulgación, sino a la identificación de estrategias para la realización de este proceso. Objetivo: Evaluar la efectividad de estrategias de KT en lenguaje audiovisual comparadas con otros lenguajes para mejorar los desenlaces en salud de la población general. Métodos: Se realizó una búsqueda en MEDLINE, CENTRAL, PsycARTICLES, WHO International Clinical Trials Registry Platform, EMBASE y LILACS. Resultados: Se incluyeron 63 estudios; se observó gran variabilidad en las poblaciones de estudio, así como en los lenguajes comparados con el lenguaje audiovisual y los instru mentos de medición. Los estudios tienen alto riesgo de sesgo y la calidad de la evidencia identificada no permite llegar a una conclusión respecto a la efectividad de los lenguajes evaluados en KT. Conclusiones: Se identifican diferentes lenguajes que pueden emplearse para transferir cono cimientos. Se evidencia que el conocimiento y los efectos producidos por la intervención disminuyen a medida que avanza el tiempo, independientemente del tipo de lenguaje empleado. Por lo tanto, es el tiempo es un punto importante a tener en cuenta en este tipo de intervenciones.

ABSTRACT Background: Knowledge translation (KT) not only encompasses a series of final actions in areas of dissemination, but also the identification of strategies for the implementation of this process. Objective: To evaluate the effectiveness of KT strategies in audiovisual language compared with other languages to improve health outcomes in the general population. Methods: We performed a search in MEDLINE, CENTRAL, PsycARTICLES, the WHO Interna tional Clinical Trials Registry Platform, EMBASE and LILACS. Results: We included 63 studies encompassing a broad range of study populations, languages that were compared to audiovisual language and measurement scales for outcomes. These studies presented a high risk of bias and the quality of evidence was not sufficient to draw conclusions about the effectiveness of the evaluated languages for knowledge translation. Conclusions: We identified different languages that could be used in knowledge translation. The knowledge and the effects produced as a result of the strategy diminish as time pro gresses, regardless of the type of language used. This is an important point to consider when implementing this type of strategy.

Effectiveness of Knowledge Translation Strategies in Audiovisual Language Compared With Other Languages to Improve Health Outcomes in Individuals and the General Population: Systematic Review. / Efectividad de las estrategias de transferencia de conocimiento en lenguaje audiovisual comparadas con otras para mejorar desenlaces en la salud individual y de la población general: revisión sistemática.

BACKGROUND: Knowledge translation (KT) not only encompasses a series of final actions in areas of dissemination, but also the identification of strategies for the implementation of this process. OBJECTIVE: To evaluate the effectiveness of KT strategies in audiovisual language compared with other languages to improve health outcomes in the general population. METHODS: We performed a search in MEDLINE, CENTRAL, PsycARTICLES, the WHO International Clinical Trials Registry Platform, EMBASE and LILACS. RESULTS: We included 63 studies encompassing a broad range of study populations, languages that were compared to audiovisual language and measurement scales for outcomes. These studies presented a high risk of bias and the quality of evidence was not sufficient to draw conclusions about the effectiveness of the evaluated languages for knowledge translation. CONCLUSIONS: We identified different languages that could be used in knowledge translation. The knowledge and the effects produced as a result of the strategy diminish as time progresses, regardless of the type of language used. This is an important point to consider when implementing this type of strategy.