Myanca Rodrigues

Objective: To assess the comparative benefits and harms of opioid substitution and antagonist therapies (OSATs) for opioid use disorder (OUD) using a network meta-analysis (NMA) of randomized controlled trials (RCTs). Data Sources: Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, and the National Institutes of Health Clinical Trials Registry were searched through 10 August 2025, for trials assessing the effectiveness or safety of any OSAT for people with OUD. Data Extraction and Synthesis: Pairs of reviewers independently screened studies, extracted data, and assessed risk of bias. Frequentist random-effects NMAs were conducted, and certainty of evidence for treatment effects was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Main Outcomes and Measures: Treatment retention (people remaining in follow-up at study end), opioid abstinence (during follow-up), criminal activity, all-cause mortality, and overdose-related death. Results: We included 103 RCTs assessing 13 interventions across 26,624 people with OUD. Compared with placebo, moderate-certainty evidence demonstrated that heroin was most effective for treatment retention (Odds Ratio [OR] = 31.47; 95% confidence interval [CI] = 12.29,80.58). Heroin + methadone (OR = 8.00; 95% CI = 3.21,19.93) and high-dose methadone (HMET) (OR = 6.94; 95% CI = 3.76, 12.82) also ranked highly (moderate certainty). High- and low-dose buprenorphine (moderate certainty) and HMET (low certainty), improved abstinence as measured by urine drug screens. No intervention reduced criminal activity (moderate certainty), all-cause mortality (low certainty), or overdose-related death. Conclusions and Relevance: Heroin-assisted therapy, alone or with methadone, and HMET were most effective for treatment retention. Buprenorphine and HMET improved abstinence, although certainty was lower. Evidence for mortality, overdose, and other patient-important outcomes remains limited. Heroin-assisted therapy exclusively enrolled people with heroin dependence and should not be initiated in those without prior use. Larger trials directly comparing methadone, buprenorphine, and heroin-assisted therapy, and enrolling patients with fentanyl use, are needed in the evolving toxic drug supply. PROSPERO Registration: CRD42013006507.

Objectives: Equitable representation in research leadership is essential across all areas of medical science. In the context of HIV—where women are disproportionately affected—examining gender distribution in the leadership of HIV trials is essential to assess progress towards equity and identify persisting barriers.Methods: We conducted a methodological study of trials from the CASCADE database, which evaluates interventions to improve the HIV care cascade. We extracted first and last authors' names and used Genderize.io to determine their gender, classifying authors as ‘women’ if the probability was 60% or greater. The primary outcome was the proportion of trials with women in leadership (first or last author), with secondary outcomes examining the proportions of trials with women as: first authors, last authors and in both roles. We also assessed associations with country income level, focus on women participants, study setting, pragmatism and team size.Results: Gender for both authorship roles could be determined in 332 trials, of which 233/332 (70.2%) had a woman first or last author; 169/334 (50.6%) had a woman first author; 143/337 (42.4%) had a woman last author and 74/332 (22.3%) featured women in both roles. Women's leadership increased over time but was not associated with country income level, gender focus, study setting or impact factor. Effectiveness trials and those with fewer authors were more likely to have women in leadership.Conclusions: Women's leadership in HIV trials has increased, reflecting progress in gender equity. However, smaller author teams appear to facilitate women's leadership, suggesting barriers in larger collaborations. Continued efforts are needed to ensure sustained progress and equitable representation.

Background: Multimorbidity, the presence of two or more (2+) chronic conditions, presents significant challenges for healthcare delivery, particularly among populations with opioid use disorder (OUD). Multimorbidity patterns among individuals with OUD are not well established, and minimal research exists examining the impact of clustering methods on identifying these patterns. Objective: Our study aimed to assess multimorbidity prevalence, explore associated sociodemographic and clinical characteristics, and determine multimorbidity patterns using hierarchical cluster analysis (HCA) and K-means clustering among people receiving treatment for OUD in Ontario, Canada between 2011 and 2021. Methods: Data from two prospective cohort studies were merged and linked to Ontario provincial health administrative databases. We identified 16 chronic conditions, used in prior research examining multimorbidity in Ontario, using ICD-10-CA diagnostic codes and the diagnostic codes of physician billing claims using a 2-year lookback. Multimorbidity was defined as the presence of 2+ of the above conditions, excluding the diagnosis of OUD. We conducted a retrospective cohort study, following the participants for eight years in the data holdings to ascertain the prevalence of multimorbidity. Sociodemographic and clinical characteristics were analyzed using modified Poisson regression models, and multimorbidity patterns were identified through HCA and K-means clustering. Results: Among 3,430 people with OUD, 32.5% (n = 1,114, 95% confidence interval (CI)=30.9, 34.1) experienced multimorbidity over an eight-year period, with older age (Prevalence Ratio (PR)=3.39, 95% CI = 2.36, 4.87) and unemployment (PR = 1.31, 95% CI = 1.13, 1.54) associated with increased prevalence. HCA identified six distinct disease clusters, whereas K-means clustering identified four clusters. Both methods identified groupings of cardiovascular (coronary syndrome), cardiometabolic (diabetes, hypertension), and respiratory (chronic obstructive pulmonary disease) diseases, reflecting shared comorbidities among people with OUD. Discussion: Our findings highlight the substantial burden of multimorbidity among populations with OUD, and the importance of considering sociodemographic factors in understanding multimorbidity prevalence. Moreover, the choice of clustering method significantly influences the identification and interpretation of multimorbidity patterns, with HCA providing more clinically meaningful groupings compared to K-means clustering. Our findings highlight the need for clinicians to tailor care plans and for policymakers to prioritize integrated healthcare delivery strategies to address the complex health needs of people with OUD.

Bayesian analyses offer a robust framework for integrating data from multiple sources to better inform population-level estimates of disease prevalence. This methodological approach is particularly suited to instances where data from observational studies is linked to administrative health records, with the capacity to advance our understanding of psychiatric disorders. The objective of our paper was to provide an introductory overview and tutorial on Bayesian analysis for primary observational studies in mental health research. We provided: (i) an overview of Bayesian statistics, (ii) the utility of Bayesian methods for psychiatric epidemiology, (iii) a tutorial example of a Bayesian approach to estimating the prevalence of mood and/or anxiety disorders in observational research, and (iv) suggestions for reporting Bayesian analyses in health research.

Objective To characterise sex and gender-based analysis (SGBA) and diversity metric reporting, representation of female/women participants in acute care trials and temporal changes in reporting before and after publication of the 2016 Sex and Gender Equity in Research guideline. Design Systematic review. Data sources We searched MEDLINE for trials published in five leading medical journals in 2014, 2018 and 2020. Study selection Trials that enrolled acutely ill adults, compared two or more interventions and reported at least one clinical outcome. Data abstraction and synthesis 4 reviewers screened citations and 22 reviewers abstracted data, in duplicate. We compared reporting differences between intensive care unit (ICU) and cardiology trials. Results We included 88 trials (75 (85.2%) ICU and 13 (14.8%) cardiology) (n=111 428; 38 140 (34.2%) females/women). Of 23 (26.1%) trials that reported an SGBA, most used a forest plot (22 (95.7%)), were prespecified (21 (91.3%)) and reported a sex-by-intervention interaction with a significance test (19 (82.6%)). Discordant sex and gender terminology were found between headings and subheadings within baseline characteristics tables (17/32 (53.1%)) and between baseline characteristics tables and SGBA (4/23 (17.4%)). Only 25 acute care trials (28.4%) reported race or ethnicity. Participants were predominantly white (78.8%) and male/men (65.8%). No trial reported gendered-social factors. SGBA reporting and female/women representation did not improve temporally. Compared with ICU trials, cardiology trials reported significantly more SGBA (15/75 (20%) vs 8/13 (61.5%) p=0.005). Conclusions Acute care trials in leading medical journals infrequently included SGBA, female/women and non-white trial participants, reported race or ethnicity and never reported gender-related factors. Substantial opportunity exists to improve SGBA and diversity metric reporting and recruitment of female/women participants in acute care trials. PROSPERO registration number CRD42022282565.

Masked hypertension (MH) occurs when office blood pressure is normal, but hypertension is confirmed using out-of-office blood pressure measures. Hypertension is a risk factor for subclinical cardiovascular outcomes, including left ventricular hypertrophy, increased left ventricular mass index, carotid intima media thickness, and pulse wave velocity. However, the risk factors for ambulatory blood pressure monitoring defined MH and its association with subclinical cardiovascular outcomes are unclear. A systematic literature search on 9 databases included English publications from 1974 to 2023. Pediatric MH prevalence was stratified by disease comorbidities and compared with the general pediatric population. We also compared the prevalence of left ventricular hypertrophy, and mean differences in left ventricular mass index, carotid intima media thickness, and pulse wave velocity between MH versus normotensive pediatric patients. Of 2199 screened studies, 136 studies (n=28 612; ages 4–25 years) were included. The prevalence of MH in the general pediatric population was 10.4% (95% CI, 8.00–12.80). Compared with the general pediatric population, the risk ratio (RR) of MH was significantly greater in children with coarctation of the aorta (RR, 1.91), solid-organ or stem-cell transplant (RR, 2.34), chronic kidney disease (RR, 2.44), and sickle cell disease (RR, 1.33). MH patients had increased risk of subclinical cardiovascular outcomes compared with normotensive patients, including higher left ventricular mass index (mean difference, 3.86 g/m ^2.7 [95% CI, 2.51–5.22]), left ventricular hypertrophy (odds ratio, 2.44 [95% CI, 1.50–3.96]), and higher pulse wave velocity (mean difference, 0.30 m/s [95% CI, 0.14–0.45]). The prevalence of MH is significantly elevated among children with various comorbidities. Children with MH have evidence of subclinical cardiovascular outcomes, which increases their risk of long-term cardiovascular disease.