Following a wave of terrorist bombings in the mid-1990s, France established Medical-Psychological Emergency Units (MPEUs - “Cellule d’Urgence Médico-Psychologique - CUMP”). These units aim to provide immediate mental health and psychosocial support to victims and emergency responders. During the COVID-19 pandemic, the Bordeaux MPEU pioneered the use of cloud computing to coordinate real-time activity across thirteen regional mental health units that serve 6 million people.

Based on 30 years of disaster psychiatry expertise and national guidelines, this innovative approach was recognized by the governmental Regional Health Agency, leading to the development of an information system application (ISA) specifically tailored for managing mental health and psychosocial support during crisis events.

The alpha version of the ISA for MPEU is being tested locally during the Paris 2024 Olympics. It is a multi-media app that offers various functionalities according to user profile. Volunteers are mobilized via the app on their smartphone, have real-time event tracking, and can record their clinical activity. For unit managers, it facilitates triggering the network, deploying resources, and coordinating real-time responses to the evolving crisis. For institutions, it enables monitoring of the ongoing crisis and adjusting responses. The app, designed for major multi-site events, will be beta tested in a full-scale disaster simulation in Bordeaux.

Data will be collected and reported In October, 2024

The ISA-MPEU improves the network’s capacity to provide rapid and effective support in emergencies, while at the same time providing a research tool through its database of mental health responses.

The reform of mental health care is a key health policy target. Mental health care provision in Spain is designed with national and regional strategies that stablish the objectives to develop. The Castilla y Leon regional strategy 2022-2026 aim to stabilsh the priorities for objectives and actions with stakeholders from th eregional society.

To evaluate priorities in the implementation of a Mental Health strategy with the consensus of professionals and society.

An initial consensus was achieved with the regional health goverment and local mental health representatives, considering the 2022-2026 national strategy and other mental health plans from nearby regions. Lines in the strategy included transversal lines (part of all the mental health scope) and action lines (priorities focused in one relevant field)

Priorities were stablished by different representatives from mental health and other healthcare professionals, social and educational stakeholders, scientific societies, people with mental health disorders and families. After agreeing to participate in the process, they had to answer an online survey. For each line, they have to score from 0 to 10.

500 subjects participated (44% Healthcare workers, 5.8% education or social services, 3.8% Justice, 8,6% workers for associations, 14% Mental Health Care users). All the lines were highly appreciated (mean score >7). Within the transversal lines, the highest score was for the Humanization line (8.81±1.43) and the lowest for the Digitalization line (7.18±1.92). In the Action Lines, the highest score was for Suicide (9.03±11.5) and the lowest for Elder people (8.04±1.94).

Prevention line had higher scores by Education, Justice, Associations and Healthcare professionals and the lowest was for users (F: 2.754; p=0.012). In the Digitalization line the higher scores were in the health professionals and scientific societies and the lowest in the users (F:4.665; p<0.001). In the research, innovation and Training line, the higher scores were for professionals, societies and users and the lowest in the education and justice groups. The only differences found in the Action lines was for the Addiction line, with higher scores for societies, social services, professionals and users and lower in Associations and Justice (F:2.219; p=0,040)

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Highest transversal priority for the MH Strategy was Humanization of Mental Health Services, and the most critical action was Suicide prevention. Professionals, Scientific societies and Users considered more important research, innovation and training compared with other society groups, whereas the less important areas for the users were digitalization and prevention users. These priorities will help to design the implementation and schedule for the lines of the Mental Health Strategy in Castilla y León.

None Declared

Humanization in Mental Health is a concept that treat to conceal in the last decades the quality, efficiency and safety of care of complex diseases and conditions with individual values, needs and preferences and involves the patient and society in the decision-making priority.

to stablish and evaluate the priorities of different groups of interest in the development of a new humanization plan for mental health

During 2022 a Humanization plan for the Spanish region of Castilla y Leon (2.400.000 habs) was developed with a Delphi model. Participants included 36 stakeholders including mental health services, administration, social services, associations, patients and families. They stablished 32 objectives distributed in 7 strategic lines: 1. “People First” (Rights, Autonomy and Information); 2. “From People to Services” (Participation of users in mental heal services); 3. “Person-Centered-Assistance” 4. “Processes sensible to change” (reduction of coercion); 5. “Human ambient” (Improvement of units, psychosocial interventions). 6. Innovation, training and climate (not evaluated here). 7. “People without marks” (battle against stigma).

Priorities in the lines were stablished by representatives from mental health and other healthcare professionals, social and educational stakeholders, scientific societies, patients and families. After agreeing to participate in the process, they had to answer an online survey. For each line, they have to score it from 0 to 10.

500 subjects participated (38.6% Healthcare workers, 14% Mental Health Care users, 9.8% Social Services, 8.8% Associations, 7.8% Drug Services 6% Management of Health System, 5.8% Education Services, 3.8 Justice). Humanization was the most appreciated plan within the mental health plan 2022-2026 in Castilla y Leon (8.81±1.43).

The Highest priority score was given to the Rights (8.68 + 1.54), Information (8.44 + 1.60) and Stigma (8.43 + 1.89) lines and the lowest were the evaluation of satisfaction (7.62 + 1.90) and Reduction of Coercion (7.29 + 2.12). Differences were found between groups. Scores in Rights and Autonomy (F:3.474; p<0.001) were highest in the Associations (9.32 +1.01) and lowest in the Justice group (7.68 + 1.67). In the information line the highest score (F:2.431; p=0,014) was in the Education Services (9.03 +0,94) compared to Scientific Societies (7,65 + 2,13). Highest score for Participation of Users (F:2,968; p=0,003) was in Social Services (8.76 +1.48) compared to Justice (7.47 +1.95). There were differences in the coercion reduction line (F:2.165; p=0,029) but no pairwise differences were found

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Humanization approaches are well appreciated by different stakeholders. Priorities in our region start with rights, information and integration and mental health users in the health system and society

None Declared

Patients with bipolar disorder (BD) have an increased risk for cardiovascular morbimortality. Clinical risk factors, specifically for arrhythmias and sudden cardiac death remain understudied.

This study was conducted to assess differences in cardiac conduction among BD patients.

We included patients with BD in a cross-sectional design, confirmed by structured interview, age 18 through 80. Clinical characteristics were obtained using a structured questionnaire or medical records review. ECG intervals duration and morphology were manually assessed by cardiologists and compared among clinical subgroups using Chi-square, Mann-Whitney, and Kruskall-Wallis tests. Exploratory multivariable linear and logistic regression models were fitted to adjust for potential confounders.

We included 117 patients (60.7% women, 76.9% bipolar I, 50% history of psychosis, 22.6% suicide attempts). We found a significantly longer QTc interval in BD patients with hypertension (difference: 9.5 ms, p=0.006), obesity (difference: 25 ms, p=0.001), and metabolic syndrome (difference: 13 ms, p=0.007). Hypertension remained a significant predictor of longer QTc after adjusting for age, gender, and antipsychotic use (estimate 17.718, p=0.018). We observed a significantly shorter PR interval in women (difference: 6 ms, p=0.029), early age of onset (difference 6 ms, p=0.025), non-users of lithium (difference 4 ms, p=0.002), and early trauma (difference 4 ms, p=0.038). Finally, we identified significant correlations between symptom severity, blood glucose and PR interval (r=0.298, p=0.001; r=0.278, p=0.003; respectively).

Patients with BD and hypertension may have an increased risk for QTc prolongation. Careful cardiovascular monitoring may be warranted.

No significant relationships.

Recurrent laryngeal nerve injury leading to vocal cord paralysis is a known complication of cardiothoracic surgery. Its occurrence during interventional catheterisation procedures has been documented in case reports, but there have been no studies to determine an incidence.

To establish the incidence of left recurrent laryngeal nerve injury leading to vocal cord paralysis after left pulmonary artery stenting, patent ductus arteriosus device closure and the combination of the procedures either consecutively or simultaneously.

Members of the Congenital Cardiovascular Interventional Study Consortium were asked to perform a retrospective analysis to identify cases of recurrent laryngeal nerve injury after the aforementioned procedures. Twelve institutions participated in the analysis. They also contributed the total number of each procedure performed at their respective institutions for statistical purposes.

Of the 1337 patients who underwent left pulmonary artery stent placement, six patients (0.45%) had confirmed vocal cord paralysis. 4001 patients underwent patent ductus arteriosus device closure, and two patients (0.05%) developed left vocal cord paralysis. Patients who underwent both left pulmonary artery stent placement and patent ductus arteriosus device closure had the highest incidence of vocal cord paralysis which occurred in 4 of the 26 patients (15.4%). Overall, 92% of affected patients in our study population had resolution of symptoms.

Recurrent laryngeal nerve injury is a rare complication of left pulmonary artery stent placement or patent ductus arteriosus device closure. However, the incidence is highest in patients undergoing both procedures either consecutively or simultaneously. Additional research is necessary to determine contributing factors that might reduce the risk of recurrent laryngeal nerve injury.

This study examined the change in dementia literacy and dementia worry over a 5-year span among older Chinese Americans living in Arizona.

This study used survey data collected among a purposive sample of 703 community-dwelling Chinese Americans aged 55 years or older living in the metropolitan areas of Phoenix, Arizona, from 2013 to 2017. The average age of participants was 73.1 (SD = 8.7) and 64.2% were female. Dementia literacy was measured by dementia knowledge (knowledge about Alzheimer’s disease and related dementia) and dementia beliefs (biased attitude toward dementia). Dementia worry was measured by assessing participants’ fear toward and concerns of developing dementia.

Regression analyses found dementia knowledge decreased (p < 0.05) and dementia beliefs remained unchanged (p > 0.05) from 2013 to 2017 among participants. Dementia worry only increased among those who lived alone. Significant correlates of dementia worry included low formal education level, depressive symptoms, and family conflict.

Public health education targeting older Chinese Americans should aim to enhance dementia knowledge and to rectify their biased attitudes toward dementia. Psychosocial education or counseling should be available to older Chinese Americans who present dementia worry, particularly for those who live alone. More studies using diverse study designs, such as a longitudinal design, are needed to examine change in dementia literacy and worry among this population.

We present an open prospective and muti – center study with a follow – up of 2 years in patients with a first psychoses episode. Assessments were made every three months for 2 year. We used a protocol including: PANSS, GAF-EEAG, CGI, Young mania, Hamilton scale for the depression, UKU, OCS, Premorbid Adjustment scale, the Information Subtest and Psychosocial Stress Global Assessment (DSM III R). The assessment of prodromal symptoms was retrospectively. The symptoms were based on the late prodromal style described by McGorry (1). A statistical analysis of data was performed.

Objetives

1. • Evaluate the gender differences in the prodomal state and analyse the prognosis according to them.

231 patients were included (32.5% women). The following symptoms were more frequent in men (p<0.05): isolation, odd behaviour, deterioration of cleanness, language vague, and lack of spontaneity. The outcome after 2 year was worse when patients had the following symptoms in the group of the men: lack of spontaneity, language vague and deterioration of cleanness. However, women have the same outcome independently of prodromal symptoms in the illness onset.

The presence of prodromal symptoms could influence on outcome of men after two years. They have a worse outcome when they have some prodromal symptoms. The intervention on this phase could be an opportunity to improve the outcome of men with first psychosis episode.

To describe validation process of the new apathy scale for institutionalized dementia patients (APADEM-NH).

100 elderly, institutionalized patients with diagnosis of probable Alzheimer Disease (AD) (57%), possible AD (13%), AD with cerebral vascular disease (CVD) (17%), Lewy Bodies Dementia (11%) and Parkinson associated to dementia (PDD) (2%). All stages of the disease severity according to the Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR) were assessed. The Apathy Inventory (AI), Neuropsychiatric Inventory (NPI), Cornell scale for depression, and the tested scale were applied. Re-test and inter-rater reliability was carried out in 50 patients. The feasibility and acceptability, reliability, validity, and measurement precision were analyzed.

APADEM-NH final version consists of 26 items and 3 dimensions: Deficit of Thinking and Self-Generated behaviors (DT): 13 items, Emotional Blunting (EB): 7 items, and Cognitive Inertia (CI): 6 items. Mean application time was 9.56 minutes and 74% of applications were fully computable. All subscales showed floor and ceiling effect lower than 15%. Internal consistency was excellent for each dimension (Cronbach’s α DT = 0.88, α EB = 0.83, α CI= 0.88);Test-retest reliability for the items was kW=0,48-0,92; Inter-rater reliability reached kW values 0.84-1.00; The APADEM-NH total score showed a low/moderate correlation with apathy scales (Spearman ρ, AI =0.33; NPI-Apathy= 0,31), no correlation with depression scales (NPI-Dementia = -0.003; Cornell= 0,10), and high internal validity (ρ =0.69 0.80).

APADEM-NH is a brief, psychometrically acceptable, and valid scale to assess apathy in patients from mild to severe dementia and discerning between apathy and depression.

Sleep disturbance is one of the key DSM-IV criteria for generalized anxiety disorder (GAD), and represents the chief complaint in approximately one-third of patients presenting in the primary care setting.

To evaluate the extent to which improvement in anxiety is a direct effect of treatment with pregabalin, or is an indirect effect mediated by improvement in sleep disturbance, and vice-versa.

Data were pooled from 4 double-blind, placebo-controlled (n = 406) short-term trials of pregabalin (all doses combined; n = 853) in the treatment of generalized anxiety disorder (GAD). The effect of treatment on anxiety was measured using the Hamilton Anxiety Rating Scale (HAM-A), effect of treatment on sleep disturbance was measured using the 3-item Hamilton Depression Rating Scale (HAM-D) sleep factor. Path analyses, using a set of multivariate regression models, were used to evaluate the reciprocal effects of pregabalin on improvement in anxiety in the presence of improvement in sleep disturbance, and vice-versa.

Sleep disturbance was common in this GAD sample, with 51.2% (placebo) and 52.2% (pregabalin) of patients, respectively, reporting moderate-to-severe insomnia (HAM-D sleep factor score ≥3). The results of the path analysis indicated that 91.7% (P < 0.0001) of improvement in anxiety was a direct effect of treatment with pregabalin, while 8.3% of improvement in anxiety was an indirect effect, mediated by improvement in sleep disturbance.

In this pooled 4-study data set, the anxiolytic efficacy of pregabalin appears to be primarily a direct effect, with only a small (8.3%) indirect effect, mediated by improvement in sleep disturbance.

Evaluate the sex differences in first episode psychosis.

We present an open prospective and muti – center study with a follow – up of 2 years in patients with a first psychoses episode. The patients were treated with risperidone and assessments were made in the first month and then every three months for 2 year. Therefore, we used a protocol including the following scales: PANSS, Global Assessment of Functioning scale (GAF-EEAG), CGI, Young mania rating scale, Hamilton scale for the depression, UKU, OCS, Premorbid Adjustment scale (Cannon-Spoor), the Information Subtest (WAIS) and Psychosocial Stress Global Assessment (DSM III R).

231 patients were included (32.5% women). Males have consistently an earlier onset even after controlling the cofounding factors and poorer premorbid functioning. Women have a shorter DUP, and they are more likely to be married than men and to live with their couples or children. Women have also better adherence to treatment than men. Males don't show differences in negative, positive symptoms or cognitive deficits. There was no difference between the sexes in the dose of the prescribed antipsychotic. There are no clear sex differences in family history and obstetric complications. Sex doesn't have influence on the course of illness in middle-term (2 years).

This paper supports the presence of significant differences between schizophrenic males and women, but there aren't differences in the outcome of the disease.

Pregabalin is indicated for the treatment of GAD in adults in Europe. The efficacy and safety of pregabalin for the treatment of adults and elderly patients with GAD has been demonstrated in 6 of 7 short-term clinical trials of 4 to 8 weeks.

To characterise the long-term efficacy and safety of pregabalin in subjects with GAD.

Subjects were randomised to double-blind treatment with either high-dose pregabalin (450-600 mg/d), low-dose pregabalin (150-300 mg/d), or lorazepam (3-4 mg/d) for 3 months. Treatment was extended with drug or blinded placebo for a further 3 months.

At 3 months, mean change from baseline Hamilton Anxiety Rating Scale (HAM-A) for pregabalin high- and low-dose, and for lorazepam ranged from -16.0 to -17.4. Mean change from baseline Clinical Global Impression-Severity (CGI-S) scores ranged from -2.1 to -2.3 and mean CGI-Improvement (CGI-I) scores were 1.9 for each active treatment group. At 6 months, improvement was retained for all 3 active drug groups, even when switched to placebo. HAM-A and CGI-S change from baseline scores ranged from -14.9 to -19.0 and -2.0 to -2.5, respectively. Mean CGI-I scores ranged from 1.5 to 2.3. The most frequently reported adverse events were insomnia, fatigue, dizziness, headache, and somnolence.

Efficacy was observed at 3 months, with maintained improvement in anxiety symptoms over 6 months of treatment. These results are consistent with previously reported efficacy and safety trials of shorter duration with pregabalin and lorazepam in subjects with GAD.

This study was funded by Pfizer Inc.

Short-term clinical trials have demonstrated the efficacy and safety of pregabalin for the treatment of generalized anxiety disorder (GAD).

This study examines the long-term safety and efficacy of pregabalin (150–600 mg/day) in patients diagnosed with GAD.

Patients completing two short-term, double-blind efficacy trials of pregabalin for the treatment of GAD (n = 329) were enrolled in this 1-year, non-randomized, open-label safety extension study. Disease severity was assessed at baseline, week 27, and week 52 using the Clinical Global Impression of Severity (CGI-S) score (7-point scale). Patients were characterized as “responders” or “non-responders” based on CGI-S scores of ≤2 an >2, respectively. Safety and tolerability were also assessed.

Patients were predominately white (98.5%), female, (67.8%) and had a mean (SD) age of 55 (17) years. Mean (SD) CGI-S scores at baseline (n = 329) and endpoint (n = 319) were 3.55 (1.07) and 2.58 (1.18), respectively, for all patients. One hundred fifty-four (46.8%) patients were characterized as CGI-S responders at endpoint compared to 50 (15.2%) patients at baseline. The number of patients shifting from a non-responder to a responder was 122 (37.1%). Conversely, the number of patients shifting from a responder to a non-responder was 14 (4.3%).

Pregabalin's anxiolytic efficacy was maintained over the 1 year study period. The severity of anxiety symptoms decreased with extended pregabalin treatment, evident by decreased CGI-S score and an increased number of CGI-S responders at endpoint compared to baseline.This study was funded by Pfizer Inc.

In the general population the 12-month prevalence of GAD is estimated to be about 2%. Higher prevalences have been found in primary care settings, with estimates of well over 6%. The role of sleep problems and pain in GAD remains understudied.

To evaluate the frequency of sleep problems and pain in newly diagnosed GAD patients in 5 European countries.

Non-interventional, cross-sectional survey of 1650 adult patients newly diagnosed with GAD in primary care settings. Assessment included clinical interview rating and self report data.

Mean age of the sample was 49.2 years (SD; 14.5). Mean GAD-7 score was 14.8 (SD; 3.1) and the median duration of symptoms was 12.0 months. The proportion with sleep disturbance and pain were 85.9% and 75.9%, respectively. Disturbed sleep had persisted for a median of 9.0 months and was mainly classified as “difficulty in falling asleep” (76.1%) or “nocturnal awakening” (58.8%). The median duration of pain was 6.0 months, and located mainly in the cervical region (47.0%) and upper back/limbs (40.1%). The mean number of days that patients were unable to work because of GAD-related health problems during the preceding 3 month period was 10.8 (95%CI; 9.6-12.0). The proportion of patients that visited the primary care physician and specialist during the preceding 3 months was 93.8% and 40.3%, respectively.

Sleep problems and pain are extremely frequent characteristics of GAD, contributing to the disability and work productivity profile associated with GAD as well as the patients’ use of health care resources.

A critical review of current models of clinical staging of depressive disorders and their potential contribution to routine clinical practice will be presented.

The main objective was to establish the correlation between the clinical staging model proposed by Hetrick and McGorry (modified by our group) with the severity of depression, the associated disability and the treatment resistance degree.

It is a descriptive cross-sectional study carried out in a sample of 135 patients, 15 or more years old, with a diagnosis of DSM-IV-Major Depression (single or recurrent episode) that were in contact with the outpatient and inpatient Units of the Institute of Psychiatry of the San Carlos Clínico Hospital in Madrid. Socio-demographic and clinical variables were collected: diagnosis, global impression of illness, severity of depressive symptoms, functionality and disability degrees and resistanceto treatment.

In spite the sample size limitations, it can clearly note that clinical stage model correlates in a statistically significant way with the scores of the Clinical Global Impression (CGI), and especially with the Global Assessment of Function (GAF) and the resistance to treatment degree.

We will discuss the utility of clinical staging model in the clinical practice and the interest to study the correlations between this proposed model and the established biomarkers of Major Depression.

Even at therapeutic doses, mood stabilizers do not completely address symptoms in bipolar depression. Some guidelines recommend add-on antidepressant therapy or quetiapine.

Early effectiveness of quetiapine extended release (quetiapine XR) vs. sertraline in adults with bipolar depression; treated with lithium or valproate at clinically therapeutic blood levels (change from baseline in the MADRS global score at week 2 (LOCF) endpoint). Others (secondary objectives) were measured at week 8.

Prospective, open label, randomized study of 8 weeks follow-up (D1443L00058).

27 patients were randomized to quetiapine XR (14) or sertraline (13). Mean age was 46.07 years. 17 patients (62.96%) were male. 20 (74.07%) were diagnosed with bipolar disorder type I. Mean number of previous events were 9.74. Mean baseline MADRS score was 28.23 (SD 5.86) and 29.50 (SD 5.00) for sertraline and quetiapine XR groups, respectively (p = 0.59).

Mean change in MADRS score (2 weeks from baseline) was: -6.62 (sertraline group) and -13.14 (quetiapine XR group) (p = 0.08). Final change from baseline was: -10.62 (sertraline) and -17.14 (quetiapine XR) (p = 0.1). Patients with at least one AE and one AE leading to study withdrawal were 12 and 3, respectively (quetiapine XR group); and 9 and 2, respectively (sertraline group). the most frequent AEs were somnolence, dry mouth (35.7%, 21.4%, respectively) (quetiapine XR group), and insomnia, diarrhea, dyspepsia (14.3% for each one) (sertraline group).

Numeric differences (though not significant) in favour of quetiapine XR exist for the early effectiveness of quetiapine XR in bipolar depression. Sponsorship by AstraZeneca.

Pregabalin is indicated for the treatment of generalised anxiety disorder (GAD) in adults in Europe. When pregabalin is discontinued, a 1-week (minimum) taper is recommended to prevent potential discontinuation symptoms.

To evaluate whether a 1-week pregabalin taper, after 3 or 6 months of treatment, is associated with the development of discontinuation symptoms (including rebound anxiety) in subjects with GAD.

Subjects were randomised to double-blind treatment with low- (150-300 mg/d) or high-dose pregabalin (450-600 mg/d) or lorazepam (3-4 mg/d) for 3 months. After 3 months ~25% of subjects in each group (per the original randomisation) underwent a double-blind, 1-week taper, with substitution of placebo. The remaining subjects continued on active treatment for another 3 months and underwent the 1-week taper at 6 months.

Discontinuation after 3 months was associated with low mean changes in Physician Withdrawal Checklist (PWC) scores (range: +1.4 to +2.3) and Hamilton Anxiety Rating Scale (HAM A) scores (range: +0.9 to +2.3) for each pregabalin dose and lorazepam. Discontinuation after 6 months was associated with low mean changes in PWC scores (range: -1.0 to +3.0) and HAM A scores (range: -0.8 to +3.0) for all active drugs and placebo. Incidence of rebound anxiety during pregabalin taper was low and did not appear related to treatment dose or duration.

A 1-week taper following 3 or 6 months of pregabalin treatment was not associated with clinically meaningful discontinuation symptoms as evaluated by changes in the PWC and HAM A rating scales.

This study was funded by Pfizer Inc.

A website was designed to offer psychoeducation and advice to women who demand more information about health after traditional visit to GPs. A total of 564 patients visited the website in three months. Women asked for information and interacted with different topics on the platform. Only the women who completed all the form (age, previous diseases, current treatment) were analyzed. A total of 226 e-patients were included.

The most demanded information was about: excess weight, fibromyalgia, depression, anxiety, bipolar disorder and the menopause although other topics related to medicine such as HTA, breast cancer, and pregnancy were part of the website contents.

Even when many topics about medicine were available on the website, women were more interested in, and showed the need for information about mental health.

Online psychoeducation could help the clinician to save time at the personal consultation and could be especially useful in following the patient for a long time.

However, there are technological barriers and at least one first face-to-face interview is required in complicated cases to determine a correct diagnosis.

A high demand for e-mental online health education does exist. It would be useful for professionals to be trained in information technology in order to cover that demand and avoid misinforming patients.

It would be interesting to undertake a meta-analysis with all the studies around the world and determine the profile of the patient that could be helped through online attention.

The authors have not supplied their declaration of competing interest.