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Corvera de Asturias, Spain

Dale-Perera A.,Addictions and Offender Care | Alam F.,Soho Center for Health | Barker P.,Public Health Direc.
Journal of Substance Use | Year: 2015

Background: Project Access UK was designed to provide real-world observations on the status of medication-assisted treatment (MAT) of opioid dependence.Methods: 544 respondents from three groups (physicians, patients in MAT and out-of-treatment users) were interviewed or completed questionnaires.Results: Patient reasons for seeking treatment included ending their dependence and improving their health and well-being. Patients and users reported a mean of 4.0 versus 2.7 prior MAT episodes, but patient awareness of the main treatment options varied from 94% for methadone to 46% for buprenorphine-naloxone. Among patients, 49% requested a specific medication (mostly methadone) and 78% of requests were granted. Forty percent of patients were not currently receiving psychosocial or key- working support. Daily supervised dosing was most commonly cited as a condition of staying in treatment with the biggest impact on daily life (36%). Among patients, 56% continued to use illicit drugs on top of their MAT and few (7%) were in employment. The majority of patients (56%) and users (51%) had been in prison (an average of 6.8 times).Conclusion: Patients are motivated to recover. However, the full range of evidence-based interventions are not fully utilised and many patients cycle repeatedly through periods of treatment, relapse and imprisonment. © 2015 Taylor & Francis Group, LLC. Source

El Hassan I.M.,Jazan University | Sahly A.,Ministry of Health | Alzahrani M.H.,Public Health Direc. | Alhakeem R.F.,Ministry of Health | And 16 more authors.
Malaria Journal | Year: 2015

Background: The draft Global Technical Strategy for malaria aims to eliminate malaria from at least 10 countries by 2020. Yemen and Saudi Arabia remain the last two countries on the Arabian Peninsula yet to achieve elimination. Over the last 50 years, systematic efforts to control malaria in the Kingdom of Saudi Arabia has successfully reduced malaria cases to a point where malaria is now constrained largely to Jazan Province, the most south-western area along the Red Sea. The progress toward elimination in this province is reviewed between 2000 and 2014. Methods: Data were obtained from the Ministry of Health case-reporting systems, activity reports, unpublished consultants reports, and relevant scientific published papers. Sub-provincial population data were obtained the national household censuses undertaken in 2004 and 2010. Rainfall data were obtained from the Meteorological Department in Jazan. Results: Between 2000 and 2014 there were 5522 locally acquired cases of malaria and 9936 cases of imported malaria. A significant reduction in locally acquired malaria cases was observed from 2000 to 2014, resulting in an average annual incidence (2010-2014) of 0.3 cases per 10,000 population. Conversely imported cases, since 2000, remain consistent and higher than locally acquired cases, averaging between 250 and 830 cases per year. The incidence of locally acquired cases is heterogeneous across the Province, with only a few health districts contributing the majority of the cases. The overall decline in malaria case incidence can be attributed to coincidental expansion of control efforts and periods of exceptionally low rainfall. Conclusions: Jazan province is poised to achieve malaria elimination. There is a need to change from a policy of passive case detection to reactively and proactively detecting infectious reservoirs that require new approaches to surveillance. These should be combined with advanced epidemiological tools to improve the definitions of epidemiological receptive and hotspot malaria risk mapping. The single largest threat currently remains the risks posed by imported infections from Yemen. © 2015 El Hassan et al. Source

Ambatipudi S.,International Agency for Research on Cancer IARC | Cuenin C.,International Agency for Research on Cancer IARC | Hernandez-Vargas H.,International Agency for Research on Cancer IARC | Ghantous A.,International Agency for Research on Cancer IARC | And 36 more authors.
Epigenomics | Year: 2016

Aim: Epigenetic changes may occur in response to environmental stressors, and an altered epigenome pattern may represent a stable signature of environmental exposure. Materials & methods: Here, we examined the potential of DNA methylation changes in 910 prediagnostic peripheral blood samples as a marker of exposure to tobacco smoke in a large multinational cohort. Results: We identified 748 CpG sites that were differentially methylated between smokers and nonsmokers, among which we identified novel regionally clustered CpGs associated with active smoking. Importantly, we found a marked reversibility of methylation changes after smoking cessation, although specific genes remained differentially methylated up to 22 years after cessation. Conclusion: Our study has comprehensively cataloged the smoking-associated DNA methylation alterations and showed that these alterations are reversible after smoking cessation. © 2016 International Agency for Research on Cancer. Source

Matcham F.,Kings College London | McNally L.,Public Health Direc. | Vogt F.,Kings College London
British Journal of Health Psychology | Year: 2014

Objectives The National Health Service (NHS) Stop Smoking Service (SSS) is an extremely cost-effective method of enabling smoking cessation. However, the SSS is only used by a minority of smokers. Developing interventions to maintain service attendance may help to increase the number of quitters. This study pilots an intervention aimed at maintaining attendance by (1) increasing motivation to attend through a booklet providing evidence of service effectiveness and (2) strengthening the link between motivation to attend and attendance through forming an implementation intention.Design A factorial randomized controlled trial.Methods A total of 160 newly enrolled smokers at the Surrey NHS SSS were recruited and randomly assigned to one of four conditions: (1) standard care (SC), (2) SC + effectiveness booklet, (3) SC + implementation intention, and (4) SC + effectiveness booklet + implementation intention. The outcome measures included attendance at the SSS and the 4-week quit rate.Results The booklet increased service attendance (OR = 2.93, p <.01, 95% CI = 1.45-5.93; Number Needed to Treat = 3.3) but had no impact on the 4-week quit rate (OR = 1.55, 95% CI = 0.75-3.21). Forming an implementation intention had no impact on service attendance or the 4-week quit rate. Attending the service was associated with a higher 4-week quit rate (ρ = 87.52, p <.001).Conclusions Presenting information about the effectiveness of the service improved service attendance. A larger trial now needs to evaluate whether this intervention can also increase the quit rate. Statement of contribution What is already known on this subject? The NHS Stop Smoking Service is an effective yet underused method of enabling smoking cessation. Low uptake levels may be due to smokers' misconception that the service will not improve their chances of quitting successfully. Improving smokers' perceptions of service efficacy may be valuable for maintaining service attendance, and subsequently improving smoking cessation levels in the United Kingdom. What does this study add? This pilot randomized controlled trial is the first to target service attendance rather than cessation levels. The results demonstrate that providing evidence of service efficacy in a simple icon array format can significantly improve service attendance. © 2013 The British Psychological Society. Source

Duarte-Salles T.,International Agency for Research on Cancer IARC WHO | Fedirko V.,Emory University | Stepien M.,International Agency for Research on Cancer IARC WHO | Trichopoulou A.,National and Kapodistrian University of Athens | And 57 more authors.
International Journal of Cancer | Year: 2014

Intake of dairy products has been associated with risk of some cancers, but findings are often inconsistent and information on hepatocellular carcinoma (HCC) risk is limited, particularly from prospective settings. The aim of our study was to investigate the association between consumption of total and specific dairy products (milk/cheese/yogurt) and their components (calcium/vitamin D/fats/protein), with first incident HCC (Ncases = 191) in the European Prospective Investigation into Cancer and Nutrition cohort, including a nested case-control subset (Ncases = 122) with the assessment of hepatitis B virus/hepatitis C virus infections status, liver damage and circulating insulin-like growth factor (IGF)-I levels. For cohort analyses, multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI). For nested case-control analyses, conditional logistic regression was used to calculate odds ratios and 95% CI. A total of 477,206 participants were followed-up for an average of 11 years (person-years follow-up = 5,415,385). In the cohort study, a significant positive HCC risk association was observed for total dairy products (highest vs. lowest tertile, HR = 1.66, 95% CI: 1.13-2.43; ptrend = 0.012), milk (HR = 1.51, 95% CI: 1.02-2.24; ptrend = 0.049), and cheese (HR = 1.56, 95% CI: 1.02-2.38; ptrend = 0.101), but not yogurt (HR = 0.94, 95% CI: 0.65-1.35). Dietary calcium, vitamin D, fat and protein from dairy sources were associated with increased HCC risk, whereas the same nutrients from nondairy sources showed inverse or null associations. In the nested case-control study, similar results were observed among hepatitis-free individuals. Results from this large prospective cohort study suggest that higher consumption of dairy products, particularly milk and cheese, may be associated with increased HCC risk. Validation of these findings in other populations is necessary. Potential biologic mechanisms require further exploration. What's New? Currently, the role of dairy product intake in the development of hepatocellular carcinoma (HCC) is unclear. Using detailed data from a large multi-centric prospective cohort, this study investigated the association between consumption of total and specific dairy products with first incident HCC. The study found that higher dairy product consumption, particularly milk and cheese, was associated with increased HCC risk. Dietary calcium, vitamin D, fat and protein did not explain the observed associations. However, higher circulating IGF-I levels may play a role. © 2014 UICC. Source

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