Rates of HIV and Hepatitis Infections in Clients Entering Heroin-Assisted Treatment between 2003 and 2013 and Risk Factors for Hepatitis C Infection.

BACKGROUND/AIMS: We report on the rates of hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in 1,313 clients entering heroin-assisted treatment (HAT) in Switzerland from 2003 to 2013. We identify predictors of HCV infection. METHODS: Data were collected using questionnaires within 2 weeks of clients' first entry into HAT. Prevalence of HAV, HBV, HCV and HIV was calculated using laboratory test results collected at entry or using reports of older test results. Predictors of HCV status were identified through multiple logistic regression analysis. RESULTS: Results show stable rates of HIV-positive clients and decreasing proportions of HAV- and HBV-infected clients. In 2013, there were 12% (n = 8) HIV-, 20% (n = 12) HAV-, 20% (n = 12) HBV- and 52% HCV- (n = 34) positive clients. Vaccination against HAV and HBV had become more frequent. Predictors of positive HCV status included older age, female gender, earlier year of entry, having spent 1 month or more in detention or prison, use of injected heroin and more years of intravenous use. CONCLUSION: Our results highlight the fact that efforts to prevent and test for infections and to promote vaccination against HAV and HBV in heroin users need to be continued.

Queer quit: a pilot study of a smoking cessation programme tailored to gay men.

BACKGROUND: The prevalence of cigarette smoking among adult gay males is higher than that of heterosexuals. There is a need for interventions adapted to gay culture. We conducted a pilot study using a modified version of a British smoking intervention programme tailored to gay men in Switzerland. As the main outcome, we assessed point prevalence smoking abstinence six months following programme attendance. METHODS: Seventy gay smokers attended seven weekly sessions in groups (median size = 5) taught by gay facilitators. A quit day was set in session 3. Integral components of the intervention were: discussing nicotine replacement therapy, performing carbon monoxide tests and forming 'quit teams'. Seven-day point prevalence smoking abstinence, mental and physical health and the frequency of alcohol and drug use were assessed at baseline, in session 7 and at a six-month follow-up. RESULTS: Point prevalence abstinence significantly increased throughout the study (p = .00). At six months, 20 participants (28.6%) reported smoking abstinence over the previous 7 days. We observed increases in participants' mental health between baseline and the six-month follow-up (p = .00). Participants who dropped out during the programme or were lost to follow-up smoked more cigarettes and were more nicotine dependent than the participants who were retained throughout the study duration (p ≤ .05). CONCLUSIONS: This smoking cessation programme for gay men produced rates of point prevalence abstinence that were similar to interventions for non-gay groups. The programme presented an opportunity for gay men to quit smoking and interact with other gay non-smokers. Our results confirm the need to test this programme more systematically with a view toward implementing it on a larger scale in Switzerland. TRIAL REGISTRATION: Current Controlled Trials ISRCTN36851118 (02 October 2013).

Group hypnosis vs. relaxation for smoking cessation in adults: a cluster-randomised controlled trial.

BACKGROUND: Despite the popularity of hypnotherapy for smoking cessation, the efficacy of this method is unclear. We aimed to investigate the efficacy of a single-session of group hypnotherapy for smoking cessation compared to relaxation in Swiss adult smokers. METHODS: This was a cluster-randomised, parallel-group, controlled trial. A single session of hypnosis or relaxation for smoking cessation was delivered to groups of smokers (median size = 11). Participants were 223 smokers consuming ≥ 5 cigarettes per day, willing to quit and not using cessation aids (47.1% females, M = 37.5 years [SD = 11.8], 86.1% Swiss). Nicotine withdrawal, smoking abstinence self-efficacy, and adverse reactions were assessed at a 2-week follow-up. The main outcome, self-reported 30-day point prevalence of smoking abstinence, was assessed at a 6-month follow up. Abstinence was validated through salivary analysis. Secondary outcomes included number of cigarettes smoked per day, smoking abstinence self-efficacy, and nicotine withdrawal. RESULTS: At the 6-month follow up, 14.7% in the hypnosis group and 17.8% in the relaxation group were abstinent. The intervention had no effect on smoking status (p = .73) or on the number of cigarettes smoked per day (p = .56). Smoking abstinence self-efficacy did not differ between the interventions (p = .14) at the 2-week follow-up, but non-smokers in the hypnosis group experienced reduced withdrawal (p = .02). Both interventions produced few adverse reactions (p = .81). CONCLUSIONS: A single session of group hypnotherapy does not appear to be more effective for smoking cessation than a group relaxation session. TRIAL REGISTRATION: Current Controlled Trials ISRCTN72839675.

Group hypnotherapy versus group relaxation for smoking cessation: an RCT study protocol.

BACKGROUND: A significant number of smokers would like to stop smoking. Despite the demonstrated efficacy of pharmacological smoking cessation treatments, many smokers are unwilling to use them; however, they are inclined to try alternative methods. Hypnosis has a long-standing reputation in smoking cessation therapy, but its efficacy has not been scientifically proven. We designed this randomised controlled trial to evaluate the effects of group hypnosis as a method for smoking cessation, and we will compare the results of group hypnosis with group relaxation. METHODS/DESIGN: This is a randomised controlled trial (RCT) to compare the efficacy of a single session of hypnosis with that of relaxation performed in groups of 8-15 smokers. We intend to include at least 220 participants in our trial. The inclusion criteria include smoking at least 5 cigarettes per day, not using other cessation methods and being willing to quit smoking. The intervention is performed by a trained hypnotist/relaxation therapist. Both groups first receive 40 min of mental preparation that is based on motivational interviewing. Then, a state of deep relaxation is induced in the hypnosis condition, and superficial relaxation is induced in the control condition. Suggestions are made in the hypnosis condition that aim to switch the mental self-image of the participants from that of smokers to that of non-smokers. Each intervention lasts for 40 min. The participants also complete questionnaires that assess their smoking status and symptoms of depression and anxiety at baseline, 2 weeks and 6 months post-intervention. In addition, saliva samples are collected to assess cotinine levels at baseline and at 6 months post-intervention. We also assess nicotine withdrawal symptoms at 2 weeks post-intervention. DISCUSSION: To the best of our knowledge, this RCT is the first to test the efficacy of group hypnosis versus group relaxation. Issues requiring discussion in the outcome paper include the lack of standardisation of hypnotic interventions in smoking cessation, the debriefing of the participants, the effects of group dynamics and the reasons for dropouts. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN72839675.

Development and validation of a short, consumer-oriented nutrition knowledge questionnaire.

A short scale was developed and validated that assesses consumers' knowledge about nutrition. Sixty-four nutrition knowledge items were derived from consumer interviews and expert recommendations about healthy eating. Items were administered as a postal survey to a sample of consumers randomly drawn from the directory (response rate=37%, N=1043). Twenty items were retained to build the final nutrition knowledge scale. Internal reliability, criterion and construct validity were acceptable. Associations of the scale with self-reported food consumption frequencies indicated limited correlation of nutrition knowledge with food choice. Widespread nutrition knowledge gaps in consumers were revealed.

Derivation and validation of a composite index of severity in chronic obstructive pulmonary disease: the DOSE Index.

RATIONALE: Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a multicomponent disease with systemic consequences and effects on quality of life. Single measures such as lung function provide a limited reflection of how the disease affects patients. Composite measures have the potential to account for many of the facets of COPD. OBJECTIVES: To derive and validate a multicomponent assessment tool of COPD severity that is applicable to all patients and health care settings. METHODS: The index was derived using data from 375 patients with COPD in primary care. Regression analysis led to a model explaining 48% of the variance in health status as measured by the Clinical COPD Questionnaire with four components: dyspnea (D), airflow obstruction (O), smoking status (S), and exacerbation frequency (E). The DOSE Index was validated in cross-sectional and longitudinal samples in various health care settings in Holland, Japan, and the United Kingdom. MEASUREMENTS AND MAIN RESULTS: The DOSE Index correlated with health status in all data sets. A high DOSE Index score (> or = 4) was associated with a greater risk of hospital admission (odds ratio, 8.3 [4.1-17]) or respiratory failure (odds ratio, 7.8 [3.4-18.3]). The index predicted exacerbations in the subsequent year (P < or = 0.014). CONCLUSIONS: The DOSE Index is a simple, valid tool for assessing the severity of COPD. The index is related to a range of clinically important outcomes such as health care consumption and predicts future events.

Phthalate exposure through food and consumers' risk perception of chemicals in food.

Phthalates have been detected in various types of retail foods. Consumers' exposure to phthalates is common. Consumers are concerned about chemicals in food. Our aim was to investigate the relationships between consumers' exposure to phthalates through food, consumers' interest in a natural and healthy diet, risk perception of food chemicals, and consumers' diet patterns. We collected data through a mail survey in the adult Swiss-German population (N = 1,200). We modeled exposure to di(2-ethylhexyl) phthalate (DEHP), dibutyl phthalate (DBP), benzyl butyl phthalate (BBP), and diethyl phthalate (DEP) based on a food frequency questionnaire and phthalate concentrations reported from food surveys. Using rating scales, we assessed risk perceptions of chemicals in food and interest in a natural and healthy diet. Higher risk perceptions and higher natural and healthy diet interest were associated with higher daily doses of DEHP, BBP, and DEP. No health risk from phthalates in food was identified for the vast majority of the population. Four consumers' diet clusters were discerned, with differences in phthalate exposure, risk perceptions, and interest in a natural and healthy diet. This study shows that even those consumers who express strong interest in natural food and low acceptance of food chemicals, and who try to make respective food choices, are exposed to contaminants such as phthalates.

Accuracy of diagnostic registers and management of chronic obstructive pulmonary disease: the Devon primary care audit.

BACKGROUND: Guidelines on COPD diagnosis and management encourage primary care physicians to detect the disease at an early stage and to treat patients according to their condition and needs. Problems in guideline implementation include difficulties in diagnosis, using spirometry and the disputed role of reversibility testing. These lead to inaccurate diagnostic registers and inadequacy of administered treatments. This study represents an audit of COPD diagnosis and management in primary care practices in Devon. METHODS: Six hundred and thirty two patients on COPD registers in primary care practices were seen by a visiting Respiratory Specialist Nurse. Diagnoses were made according to the NICE guidelines. Reversibility testing was carried out either routinely or based on clinical indication in two sub-samples. Dyspnoea was assessed. Data were entered into a novel IT-based software which computed guideline-based treatment recommendations. Current and recommended treatments were compared. RESULTS: Five hundred and eighty patients had spirometry. Diagnoses of COPD were confirmed in 422 patients (73%). Thirty nine patients were identified as asthma only, 94 had normal spirometry, 23 were restrictive and 2 had a cardiac disorder. Reversibility testing changed diagnosis of 11% of patients with airflow obstruction, and severity grading in 18%. Three quarters of patients with COPD had been offered practical help with smoking cessation. Short and long-acting anticholinergics and long acting beta-2 agonists had been under-prescribed; in 15-18% of patients they were indicated but not received. Inhaled steroids had been over-prescribed (recommended in 17%; taken by 60%), whereas only 4% of patients with a chronic productive cough were receiving mucolytics. Pulmonary rehabilitation was not available in some areas and was under-used in other areas. CONCLUSION: Diagnostic registers of COPD in primary care contain mistakes leading to inaccurate prevalence estimates and inappropriate treatment decisions. Use of pre-bronchodilator readings for diagnosis overestimates the prevalence and severity in a significant minority, thus post bronchodilator readings should be used. Management of stable COPD does often not correspond to guidelines. The IT system used in this study has the potential to improve diagnosis and management of COPD in primary care.