RESUMO
Substance use disorders (SUD) treatment centers are an optimal setting for delivering smoking cessation interventions (SCI). This study aimed to examine the adoption of SCI in SUD treatment centers in Catalonia (Spain) as well as to assess their managers' views on the appropriateness and feasibility of providing SCI. Managers directly in charge of SUD treatment centers (n = 57) answered a 30-item on-line questionnaire. Data was obtained of 50 centers (87.7% response rate). Forty-six per cent of the centers provided some kind of SCI, but only 4.8% of the new patients were treated for smoking cessation. Managers reported that 73.3% of mental health professionals working in SUD centers had not been trained in SCI. Sixty-four per cent of managers agreed that all health professionals should deliver SCI. Those centers offering SCI attended more patients and were more likely to have professionals trained in SCI than those not offering SCI. The implementation of SCI in SUD treatment centers in Catalonia was suboptimal. Continuing education and training should be provided for all health professionals working in SUD centers. Not systematically delivering SCI to patients in treatment for other SUD means missing opportunities to reduce health and economic costs while perpetuating a smoking culture.
Los centros de tratamiento de drogodependencias son un recurso óptimo para realizar intervenciones para la cesación tabáquica (ICT). El objetivo de este estudio fue examinar la implementación de ICT en la Red de centros de Atención a las Drogodependencias (CAS) de Cataluña, así como evaluar las opiniones sobre la adecuación y viabilidad de la provisión de ICT. Los responsables de los CAS (n = 57) contestaron un cuestionario on-line compuesto por 30 ítems. Se obtuvieron datos de 50 centros (87,7% tasa de respuesta). El 46% de los CAS ofrecía algún tipo de ICT, pero sólo un 4,8% de los nuevos pacientes eran tratados para dejar de fumar. Además, los responsables informaron que el 73,3% de los profesionales que trabajaban en los CAS no había recibido formación en ICT. El 64% de los responsables estaba de acuerdo que todos los profesionales deberían realizar ICT. Aquellos centros que ofrecían ICT visitaban más pacientes y era más probable que tuviesen profesionales formados en ICT, comparado con los centros que no ofrecían ICT. La implementación de ICT en los CAS de Cataluña era subóptima. Se debería facilitar formación continuada a los profesionales de los CAS. No intervenir sobre el consumo de tabaco en pacientes en tratamiento por otras drogodependencias significa perder oportunidades para reducir costes en salud y económicos mientras perpetuamos una cultura fumadora.
Assuntos
Comportamento Aditivo , Abandono do Hábito de Fumar , Transtornos Relacionados ao Uso de Substâncias , Terapia Comportamental , Humanos , Espanha , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
OBJECTIVE: To compare the serum levels of beta2-microglobulin (beta2M), neopterin (NP), TNF-alpha and soluble receptors of TNF-alpha (sTNF-R55 and sTNF-R75) and interleukin-2 (sIL-2R) in a population of intravenous drug abusers according to whether or not they had HIV-1 infection and to the stage of the HIV-1 infection. METHODS: A cross-sectional study was performed at four drug detoxification centers in Barcelona, and the HIV outpatient clinic at Hospital Clínic in Barcelona. Three cohorts of intravenous drug abusers (IVDAs)-105 HIV-1-uninfected patients (cohort A), 174 with asymptomatic HIV-1 infection (cohort B) and 39 with AIDS (cohort C)-were enrolled. On the first visit, the following laboratory tests were performed: hemogram and platelet count, hepatitis B surface antigen (HBsAg), anti-hepatitis C antibodies, B2M, NP, sIL-2R, TNF-alpha, and TNF receptors (sTNF-R55 and sTNF-R75). RESULTS: The three cohorts were homogeneous according to sex, type of drug, average number of intravenous doses of drug in 1 day, and hepatitis B infection. Patients with AIDS were older than those of cohort A and B (p<0.0001). HIV-negative IVDAs were co-infected with hepatitis C virus less frequently than were HIV-positive IVDAs (80% versus 91%, p<0.03). Among HIV-1-negative IVDAs (cohort A), almost all (from 86% to 95%, depending on the marker) individual values were within the normal boundaries of our laboratory. With a single exception (level of sTNF-R55 in cohort B compared with cohort A, p=0.15), levels of all markers were significantly higher in asymptomatic HIV-1-infected (cohort B) when compared with uninfected patients (cohort A), and in AIDS patients (cohort C) when compared with both cohorts A and B. There was a significant positive correlation between levels of ss2M and NP (r=0.56; p<0.01), ss2M and TNF (r=0.65, p<0.01) and NP and TNF (r=0.76, p<0.01). There was no correlation between levels of sIL-2R and levels of ss2M, NP or TNF and its receptors. CONCLUSIONS: Intravenous drug abuse does not modify serum levels of ss2M, NP, sIL-2R, TNF-alpha, and TNF receptors (sTNF-R55 and sTNF-R75). Levels of these markers increase significantly when an HIV-1 infection occurs and when there is progression to AIDS.