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The use of complementary therapies is highly prevalent among patients with rheumatoid arthritis (RA). Nevertheless, the use of complementary medicine could involve problems in the following of scientifically accepted treatments. To date, there is limited information regarding the association of nonconventional therapies with problems regarding compliance with the treatment. Therefore, the objective of this study was to identify whether the utilization of complementary therapies is associated with a high risk of problems regarding therapeutic adherence to conventional synthetic disease-modifying anti-rheumatic drugs (cs-DMARDs) in RA patients. A survey was performed with RA patients in an outpatient rheumatology clinic in a university hospital; the use of complementary therapies, as well as their type, was identified. To assess problems with therapeutic adherence, we used the four-item Morisky–Green scale. A comprehensive assessment of clinical and therapeutic characteristics was performed. Univariable and multivariable models were performed to identify the risk of problems with therapeutic adherence in users of complementary therapies. In total, 250 RA patients were included; 92% used complementary therapies. Of them, the most frequently used were herbal medicine (65%), homeopathy (64%), and cannabis and its derivatives (51%). In the univariable logistic regression analysis, the factors associated with problems in the therapeutic adherence to cs-DMARDs were age (p = 0.019), the presence of other comorbidities (p = 0.047), and the use of complementary therapies (p = 0.042). After controlling for potential confounders, the use of complementary therapies increased the risk of problems with therapeutic adherence to cs-DMARDs (adjusted OR = 2.84, 95% CI = 1.06–7.63, p = 0.037). We concluded that the use of complementary therapies increases the risk of problems with therapeutic adherence. Therefore, for physicians and healthcare professionals, the early identification of the use of nonconventional therapies in their RA patients is required, followed by a directed discussion with their patients about the risks and benefits to which they could be exposed to complementary therapies. [ABSTRACT FROM AUTHOR]

The article analyzes the influence and political-cultural impact of Trumpism on American society and world politics. Topics such as migration, international trade, the fight against organized crime, and the trafficking of synthetic drugs are mentioned. Political vandalism is criticized, and it is highlighted that Trumpism has been carried out by non-democratic political actors. The impact of Trumpism on global and regional geopolitics is also mentioned, emphasizing the violation and cancellation of international agreements. The relationship between Trump and Andrés Manuel López Obrador is analyzed, highlighting their similarities and mutual tolerance for their respective excesses. It is mentioned that Mexico accepted the imposition of a migration agenda by Trump, while Trump used blackmail against Mexico to obtain surveillance and repression of Central American migrants. However, it is noted that this relationship has changed with the arrival of President Biden. The article also includes essays that analyze Trump's anti-immigrant rhetoric, its impact on remittances to Mexico, and its handling of social media. [Extracted from the article]

Background: The Mexican National Centre of Pharmacovigilance (CNFV) receives suspected adverse drug reaction (ADR) reports from the pharmaceutical industry, Federal States Centre of Pharmacovigilance (CEFV) and Healthcare Institution Centres of Pharmacovigilance (CIFV). The completeness of these suspected ADR reports is particularly important for the proper evaluation of drug safety. Objective: The aim of the study was to evaluate the completeness of the information reported in a representative sample of suspected ADR reports submitted to the CNFV during 2007 and 2008, to evaluate the completeness of the suspected ADR reports submitted to the CNFV from different sources during these 2 years and to identify the therapeutic subgroups with the highest number of suspected ADR reports during the study years. Methods: A cross-sectional period-prevalence study was conducted at the CNFV. Only reports of suspected ADRs submitted by the CEFV, pharmaceutical industry and CIFV during 2007 and 2008 were included in the present study (reports related to vaccines were excluded). The sample sizes to be used for each year were determined using the formula for population rate at 95% significance level. The samples for each year were randomly selected from the reports related to synthetic drugs submitted that year. The suspected ADR reports were classified according to the standing Mexican Official Norm (Norma Oficial Mexicana [NOM]) guidelines, which were used to divide the reports into four categories (0, 1, 2 and 3) based on their completeness. The seriousness of the suspected ADRs reported was also evaluated; a suspected ADR was classified as 'non-serious' when signs and symptoms are likely to be tolerated, 'moderate' when ADR is not life threatening and needs pharmacological treatment, 'serious' when ADR is life threatening and leads to hospitalization and 'fatal' when ADR contributes directly or indirectly to the patient's death. Results: A total sample size of 370 and 371 suspected ADR reports from 2007 and 2008, respectively, were examined. Our analysis revealed that the pharmaceutical industry sent the highest number of suspected ADR reports for both years (58% and 63%, respectively). Results of the information completeness analysis by using the NOM categories showed that, in both study years, among the total suspected ADR reports about 32% (119) and 40% (148), respectively, were categorized as grade 0 (information insufficient to generate risk signals). Analyses of the seriousness of all suspected ADR reports revealed that 2% of reports were classified as fatal each year, whereas 6% and 5% were classified as serious and 25% and 29% were classified as moderate in 2007 and 2008, respectively. The therapeutic subgroups, according to the Anatomical Therapeutic Chemical classification, with the highest frequencies of suspected ADR reports in both study years were sex hormones and modulators of the genital system, antibacterial for systemic use, antiepileptics and psychoanaleptics, and antihypertensives. Conclusions: The completeness of the information provided in the suspected ADR reports submitted during the sample study years was incomplete and, in general, did not fulfil the requirements established by the NOM guidelines. Among the pharmaceutical industry, CEFV and CIFV, the suspected ADR reports were mainly provided by the pharmaceutical industry. It is necessary to improve the pharmacovigilance system in Mexico to achieve a high level of completeness of suspected ADR reports that totally fulfil the standing regulations. [ABSTRACT FROM AUTHOR]

International commerce and travel have been restricted in order to limit the spread of COVID-19. The illegal trafficking in drugs, which is often concealed in other commercial activity, will be affected by these disruptions. This is particularly true for precursor chemicals, controlled substances of synthetic origin, and new psychoactive substances coming from Asia. China hosts large and under-regulated pharmaceutical and chemical sectors that provide many of the active ingredients used both in legitimate medicines and illicit fentanyl and methamphetamine. Unregulated producers and vendors in China have been supplying drug trafficking organizations in Mexico or using the internet and postal service to directly sell fentanyl to buyers in North America. The magnitude of supply shortages and interrupted trade of chemicals and synthetic drugs coming from China will depend on the breadth and depth of COVID-19's disruptions. In turn, this could impact vulnerable drug-using populations. Drawing on historical accounts of prior supply disruptions, this commentary offers some initial speculation as to the possible effects of COVID-19 on the supply of synthetic drugs like fentanyl and precursor chemicals supplied to North America from China, which may have important lessons for other parts of the globe. Prior supply disruptions coincided with elevated prices and reduced purities of street drugs as well as increases in the number of users entering treatment. However, it is challenging to predict how developments will unfold given the unprecedented nature of this pandemic. A short-term breakdown in supply chains, interrupted trade, or social distancing mandates may not have much of an effect on the availability of synthetic drugs. Yet, disruptions in trade for months or years could shape how drugs are supplied or used. Drug policy will need to evaluate market indicators as soon as they are available but responding now with expanded medication therapies, like methadone, may help save lives. The drug policy landscape could look different in a post-COVID world., Competing Interests: Declarations of Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)