RESUMEN
This systematic review analyses and describes the application and diagnostic accuracy of Artificial Intelligence (AI) methods used for detection and grading of potentially malignant (pre-cancerous) and cancerous head and neck lesions using whole slide images (WSI) of human tissue slides. Electronic databases MEDLINE via OVID, Scopus and Web of Science were searched between October 2009 - April 2020. Tailored search-strings were developed using database-specific terms. Studies were selected using a strict inclusion criterion following PRISMA Guidelines. Risk of bias assessment was conducted using a tailored QUADAS-2 tool. Out of 315 records, 11 fulfilled the inclusion criteria. AI-based methods were employed for analysis of specific histological features for oral epithelial dysplasia (n = 1), oral submucous fibrosis (n = 5), oral squamous cell carcinoma (n = 4) and oropharyngeal squamous cell carcinoma (n = 1). A combination of heuristics, supervised and unsupervised learning methods were employed, including more than 10 different classification and segmentation techniques. Most studies used uni-centric datasets (range 40-270 images) comprising small sub-images within WSI with accuracy between 79 and 100%. This review provides early evidence to support the potential application of supervised machine learning methods as a diagnostic aid for some oral potentially malignant and malignant lesions; however, there is a paucity of evidence using AI for diagnosis of other head and neck pathologies. Overall, the quality of evidence is low, with most studies showing a high risk of bias which is likely to have overestimated accuracy rates. This review highlights the need for development of state-of-the-art deep learning techniques in future head and neck research.
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Inteligencia Artificial , Neoplasias de Cabeza y Cuello/diagnóstico , Lesiones Precancerosas/diagnóstico , Algoritmos , Bases de Datos Genéticas , Aprendizaje Profundo , Manejo de la Enfermedad , Susceptibilidad a Enfermedades , Neoplasias de Cabeza y Cuello/etiología , Humanos , Clasificación del Tumor , Estadificación de NeoplasiasRESUMEN
AIM: To describe the knowledge as well as current and potential use of self-sampling kits among men who have sex with men (MSM) and to analyse their preferred biological sample and result communication method. METHODS: We analyse data of MSM of HIV negative or unknown serostatus from an online survey conducted in eight countries (Belgium, Denmark, Germany, Greece, Portugal, Romania, Slovenia and Spain) between April and December 2016. It was advertised mainly in gay dating websites. We conduct a descriptive analysis of the main characteristics of the participants, and present data on indicators of knowledge, use and potential use of HIV self-sampling as well as their preferences regarding blood or saliva sample and face or non-face-to-face result communication by country of residence. RESULTS: A total of 8.226 participants of HIV negative or unknown serostatus were included in the analysis. Overall, 25.5% of participants knew about self-sampling (range: 18.8-47.2%) and 1.1% had used it in the past (range: 0.3-8.9%). Potential use was high, with 66.6% of all participants reporting that they would have already used it if available in the past (range: 62.1-82.1%). Most (78.6%) reported that they would prefer using a blood-based kit, and receiving the result of the test through a non-face-to-face-method (70.8%), even in the case of receiving a reactive result. CONCLUSION: The high potential use reported by MSM recruited in eight different European countries suggests that self-sampling kits are a highly acceptable testing methodology that could contribute to the promotion of HIV testing in this population.
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Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina , Utilización de Procedimientos y Técnicas , Autoadministración/estadística & datos numéricos , Adulto , Anciano , Pruebas Diagnósticas de Rutina/psicología , Europa (Continente) , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Autoadministración/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Factors explaining disparities in risk of substance use between immigrants and natives and between immigrant subgroups are poorly understood. We aimed to describe such disparities and identify some explanatory factors in Spain. METHODS: Participants were residents aged 15-64 years from 2005 to 07 nationally representative surveys. Outcomes were prevalences of alcohol, tobacco, sedative-hypnotics, cannabis and other illegal substance use. Immigrants were recent if <5 years of Spanish stay and long term if ≥10 years. Country-of-origin income per capita and population level of substance use were taken from international databases. Adjusted prevalence ratios (aPRs) and percent change from Poisson regression with robust variance were used to estimate risk disparities and effects of immigration variables. RESULTS: Most immigrants had lower substance use than natives, although it generally increased with increasing Spanish stay, especially for illegal substances. This lower risk could be partially explained by country-of-origin contextual factors as a lower level of income or substance use and religious or cultural factors such as Islam. By origin, recent immigrant aPRs and convergence-divergence risk patterns were, respectively, as follows: lower aPRs with upward convergence (often incomplete) toward natives' risk in immigrants from Muslim area, Eastern-Europe and Latin-America excluding South-Cone, lower/similar aPRs with upward overtaking or divergent patterns in South-Cone Americans and similar/higher aPRs with stable or upward divergent patterns in Non-Eastern-Europeans. CONCLUSION: Spain is a host context that seems to facilitate increased substance use among immigrants, even those from countries with prevalences close to Spain. However, country-of-origin context is important in explaining disparities in substance use among immigrants.
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Emigrantes e Inmigrantes/estadística & datos numéricos , Trastornos Relacionados con Sustancias/etnología , Adolescente , Adulto , Alcoholismo/etnología , Femenino , Disparidades en el Estado de Salud , Humanos , Drogas Ilícitas , Masculino , Persona de Mediana Edad , Distribución de Poisson , Prevalencia , Factores de Riesgo , Fumar/etnología , España/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Both cocaine use and strokes impact public health. Cocaine is a putative cause of strokes, but no systematic review of the scientific evidence has been published. METHODS: All relevant bibliographic-databases were searched until January 2014 for articles on the epidemiological association between cocaine use and strokes. Search strings were supervised by expert librarians. Three researchers independently reviewed studies for inclusion and data extraction following STROBE recommendations. Quality appraisal included study validity and bias. Both ischemic and hemorrhagic strokes were considered. RESULTS: Of 996 articles, 9 were selected: 7 case-control studies (CCS) and 2 cross-sectional (CSS) studies. One CCS (aOR=6.1; 95% CI: 3.3-11.8) and one CSS (aOR=2.33; 95% CI: 1.74-3.11) showed an association between cocaine and hemorrhagic strokes. The latter study also found a positive relationship with ischemic stroke (aOR=2.03; 95% CI: 1.48-2.79). Another CCS found the exposure to be associated with stroke without distinguishing between types (aOR=13.9; 95% CI: 2.8-69.4). One forensic CCS found that deaths with cocaine-positive toxicology presented a 14.3-fold (95% CI: 5.6-37) and 4.6-fold (95% CI: 2.5-8.5) increased risk of atherosclerosis compared to opioid-related deaths and hanging-deaths respectively. One CCS did not provide an aOR but found a statistically significant association between cocaine and hemorrhagic stroke. Three CCS and one CSS did not find any relationship between cocaine and strokes. Inadequate control for confounding was not uncommon. CONCLUSIONS: Epidemiological evidence suggests that cocaine use increases the risk of stroke. Larger, more rigorous observational studies, including cohort approaches, are needed to better quantify this risk, and should consider stroke type, hypertension variation, frequency/length of cocaine use, amphetamines co-use, and other factors.
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Trastornos Relacionados con Cocaína/complicaciones , Cocaína/efectos adversos , Accidente Cerebrovascular/etiología , Humanos , RiesgoRESUMEN
BACKGROUND: Institutional monographs/medical textbooks mention seizures as a neurological complication of cocaine, but no systematic reviews (SRs) have been published on this issue. We aimed to conduct a SR of the literature on the relationship between cocaine use and seizures and to summarize the biological plausibility of that relationship. METHODS: The pathophysiological mechanisms that may underlie an association between cocaine and seizures were summarized; a SR was then performed using three databases (EMBASE, Medline, PsycINFO) and the Cochrane-library to search for published papers (1980-2012) aimed at quantifying the associations between cocaine use and seizures. The inclusion criteria for selection were: articles based on clinical trials, cohort, case-control (CC) or cross-sectional (CS) studies, participants ≥ 14 years old and not pregnant, and use of cocaine in the last 72 h. Information was extracted, evaluated and cross-checked independently by two researchers. RESULTS: Of the 1243 potentially relevant articles initially identified; one CC and 22 CS studies were finally selected. The CC study did not find cocaine use to be a risk-factor for seizures. In addition to the limitations of the CS design, these studies had important methodological weaknesses and biases. CONCLUSIONS: Despite its biological plausibility, no rigorous scientific evidence supports a causal relationship between cocaine use and seizures. The misinterpretation of the role of cocaine may have important implications in medical services. Well-conducted studies are urgently needed.