Treatment as Prevention: The Breaking of Taboos Is Required in the Fight Against Hepatitis C Among People Who Inject Drugs.
Treatment as prevention: The breaking of taboos is required in the fight against hepatitis C among people who inject drugs.
Hepatology. 2013 May 31;
Bruggmann P
Physician advice for smoking cessation.
Cochrane Database Syst Rev. 2013; 5: CD000165
Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T
BACKGROUND: Healthcare professionals frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation, and to determine the effect of anti-smoking advice on disease-specific and all-cause mortality. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group trials register in January 2013 for trials of interventions involving physicians. We also searched Latin American databases through BVS (Virtual Library in Health) in February 2013. SELECTION CRITERIA: Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of follow-up.The main outcome measure was abstinence from smoking after at least six months follow-up. We also considered the effect of advice on mortality where long-term follow-up data were available. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. People lost to follow-up were counted as smokers. Effects were expressed as relative risks. Where possible, we performed meta-analysis using a Mantel-Haenszel fixed-effect model. MAIN RESULTS: We identified 42 trials, conducted between 1972 and 2012, including over 31,000 smokers. In some trials, participants were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics.Pooled data from 17 trials of brief advice versus no advice (or usual care) detected a significant increase in the rate of quitting (relative risk (RR) 1.66, 95% confidence interval (CI) 1.42 to 1.94). Amongst 11 trials where the intervention was judged to be more intensive the estimated effect was higher (RR 1.84, 95% CI 1.60 to 2.13) but there was no statistical difference between the intensive and minimal subgroups. Direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (RR 1.37, 95% CI 1.20 to 1.56). Direct comparison also suggested a small benefit of follow-up visits. Only one study determined the effect of smoking advice on mortality. This study found no statistically significant differences in death rates at 20 years follow-up. AUTHORS’ CONCLUSIONS: Simple advice has a small effect on cessation rates. Assuming an unassisted quit rate of 2 to 3%, a brief advice intervention can increase quitting by a further 1 to 3%. Additional components appear to have only a small effect, though there is a small additional benefit of more intensive interventions compared to very brief interventions. HubMed – addiction
Education and Practice for Pharmacists Being a Connection between Physicians and Persons Having Unawareness of Mental Illness.
Yakugaku Zasshi. 2013; 133(6): 631-643
Kawamura K
Pharmacists work in places where they often get in contact with people who may have trouble with their illness, patients and patients’ family with prescription, and customers who purchase over-the-counter (OTC) drugs and/or daily goods. Pharmacists can also identify excessive or unsuitable use of OTC drugs resulting from a psychiatric disorder. Moreover, they are in a position in which they can also find the normal-dose addictions and fatigued patient’s family resulting from their daily patient’s care. Since the consultation to a pharmacist is free of charge, many people often go to the pharmacist to talk about their health concerns. If pharmacists can get in contact with persons who are not aware of their mental illness and send them to the primary care physician, the pharmacists may contribute to prevent suicide and find the unrecognized psychiatric disorder. However, since pharmacists have little knowledge regarding to the psychiatric disorder, they cannot actively contact with this type of people. This article will argue about the methodology and education for pharmacists to connect undiagnosed patients to the appropriate medical care. It is proposed that the pharmacists should encourage the undiagnosed psychiatric patients to contact with the primary care physician. In addition, pharmacists should recommend the change of prescription to the medical doctors who examine the patients expected the addiction to the prescribed drug. HubMed – addiction