Coordinated treatment between addiction and mental health services vs. uncoordinated treatment for patients with dual diagnosis: higher dropout rates but lower impairement of functional disability.

Dual pathology is often found in addiction and mental health centers. Although there are integrated services for these patients, most countries have developed joint action protocols between addiction and mental health centers. The objective is to analyze the progress of patients diagnosed with dual pathology, comparing the therapeutic outcomes of those who exclusively attend either addiction or mental health centers with those patients who follow a program in which the two services are coordinated. It is hypothesized that patients assisted in coordinate manner will present a better evolution on psychopathological symptomatology, drug use and functional impairment.

Tratamiento coordinado entre centros de adicciones y salud mental vs. tratamiento no coordinado para pacientes con patología dual: mayor abandono, pero menor deterioro de la discapacidad funcional / Coordinated treatment between centres addiction and mental health centres vs. uncoordinated treatment for patients with dual pathology: greater dropout, but less deterioration of functional disability

Introducción: Los pacientes con patología dual son generalmente tratados en centros de salud mental y adicciones.Aunque hay servicios integrados para estos pacientes, lo máscomún es desarrollar protocolos de actuación conjunta entreestos centros. El objetivo de este estudio es analizar el progreso terapéutico de pacientes diagnosticados de patologíadual, comparando los resultados de pacientes atendidos enlos centros de adicciones exclusivamente, de salud mentalo bien atendidos de manera coordinada entre ambos servicios. La hipótesis es que los pacientes atendidos de maneracoordinada presentarán una mejor evolución en términos dela sintomatología psicopatológica, consumo de drogas y discapacidad funcional.Método. La muestra está formada por 182 pacientesatendidos en centros de adicción (n = 62), de salud mental (n= 51) y tratados a través del protocolo de actuación conjunta(n = 62). Los instrumentos administrados fueron la WHODAS2.0, BSI-18 y la SDSS.Resultados. No se encontraron diferencias estadísticamente significativas entre la evaluación basal y el seguimiento ni en la WHODAS 2.0 ni en el BSI-18. Se encontróun incremento del consumo de cocaína en los tres grupos,aunque fue estadísticamente significativa en los pacientesde adicciones y de salud mental. Hubo una mayor tasa deabandono del tratamiento en los pacientes atendidos de manera coordinada. En términos de cambio fiable, entre los pacientes atendidos de manera coordinada hubo más pacientesque mejoraron en la WHODAS 2.0.Conclusiones. Los hándicaps de asistir a dos redes asistenciales pueden estar explicando el mayor abandono de lospacientes que siguen el protocolo de actuación conjunta. Sinembargo, los pacientes que se mantienen en esta modalidadterapéutica muestran un menor deterioro de la funcionalidad en comparación con las otras dos modalidades. (AU)

Background: Dual pathology is often found in addictionand mental health centers. Although there are integratedservices for these patients, most countries have developedjoint action protocols between addiction and mental healthcenters. The objective is to analyze the progress of patientsdiagnosed with dual pathology, comparing the therapeuticoutcomes of those who exclusively attend either addictionor mental health centers with those patients who followa program in which the two services are coordinated. It ishypothesized that patients assisted in coordinate mannerwill present a better evolution on psychopathological symptomatology, drug use and functional impairment. Methods. The sample was 182 dual pathology patientstreated in addictions centers (n=62), mental health centers(n=51) and treated in a coordinated manner (n=62). The instruments administered was WHODAS 2.0, BSI-18 and SDSS.Results. In general, no statistically significant differences were found between baseline and follow up inWHODAS and BSI-18. More cocaine use was found inthree groups but was statistically significant in patientsattended by addictions center and mental health centers.High percentages of abandonment were found in patientsattending coordinate services. In terms of reliable change, among those receiving the coordinated treatment,there were more patients who showed improvements inthe WHODAS 2.0 dimensions.Conclusions. The inconvenience caused by going to different treatment networks may partially explain these resultsrelated with abandonment. However, patients who remain intreatment in coordinated services, show lower functionalitydeterioration than patients in other modalities. (AU)

Meat intake, cooking methods and doneness and risk of colorectal tumours in the Spanish multicase-control study (MCC-Spain).

PURPOSE: Although there is convincing evidence that red and processed meat intake increases the risk of colorectal cancer (CRC), the potential role of meat cooking practices has not been established yet and could partly explain the current heterogeneity of results among studies. Therefore, we aimed to investigate the association between meat consumption and cooking practices and the risk of CRC in a population-based case-control study. METHODS: A total of 1671 CRC cases and 3095 controls recruited in Spain between September 2008 and December 2013 completing a food frequency questionnaire with a meat-specific module were included in the analyses. Odds ratios (OR) and confidence intervals (CI) were estimated by logistic regression models adjusted for known confounders. RESULTS: Total meat intake was associated with increased risk of CRC (OR T3-T1 1.41; 95% CI 1.19-1.67; p trend < 0.001), and similar associations were found for white, red and processed/cured/organ meat. Rare-cooked meat preference was associated with low risk of CRC in red meat (ORrare vs. medium 0.66; 95% CI 0.51-0.85) and total meat (ORrare vs. medium 0.56; 95% CI 0.37-0.86) consumers, these associations being stronger in women than in men. Griddle-grilled/barbecued meat was associated with an increased CRC risk (total meat: OR 1.45; 95% CI 1.13-1.87). Stewing (OR 1.25; 95% CI 1.04-1.51) and oven-baking (OR 1.18; 95% CI 1.00-1.40) were associated with increased CRC risk of white, but not red, meat. CONCLUSIONS: Our study supports an association of white, red, processed/cured/organ and total meat intake with an increased risk of CRC. Moreover, our study showed that cooking practices can modulate such risk.

Adherence to nutrition-based cancer prevention guidelines and breast, prostate and colorectal cancer risk in the MCC-Spain case-control study.

Prostate, breast and colorectal cancer are the most common tumours in Spain. The aim of the present study was to evaluate the association between adherence to nutrition-based guidelines for cancer prevention and prostate, breast and colorectal cancer, in the MCC-Spain case-control study. A total of 1,718 colorectal, 1,343 breast and 864 prostate cancer cases and 3,431 population-based controls recruited between 2007 and 2012, were included in the present study. The World Cancer Research Fund/American Institute for Cancer Research (WCRC/AICR) score based on six recommendations for cancer prevention (on body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods and alcoholic drinks; score range 0-6) was constructed. We used unconditional logistic regression analysis adjusting for potential confounders. One-point increment in the WCRF/AICR score was associated with 25% (95% CI 19-30%) lower risk of colorectal, and 15% (95% CI 7-22%) lower risk of breast cancer; no association with prostate cancer was detected, except for cases with a Gleason score ≥7 (poorly differentiated/undifferentiated tumours) (OR 0.87, 95% CI 0.76-0.99). These results add to the wealth of evidence indicating that a great proportion of common cancer cases could be avoided by adopting healthy lifestyle habits.

Shift work and colorectal cancer risk in the MCC-Spain case-control study.

Objectives Shift work that involves circadian disruption has been associated with a higher cancer risk. Most epidemiological studies to date have focused on breast cancer risk and evidence for other common tumors is limited. We evaluated the risk for colorectal cancer (CRC) in relation to shift work history in a population-based case-control study in Spain. Methods This analysis included 1626 incident CRC cases and 3378 randomly selected population controls of both sexes, enrolled in 11 regions of Spain. Sociodemographic and lifestyle information was assessed in face-to-face interviews. Shift work was assessed in detail throughout lifetime occupational history. We estimated the risk of colon and rectal cancer associated with rotating and permanent shift work (ever, cumulative duration, age of first exposure) using unconditional logistic regression analysis adjusting for potential confounders. Results Having ever performed rotating shift work (morning, evening and/or night) was associated with an increased risk for CRC [odds ratio (OR) 1.22, 95% confidence interval (95% CI) 1.04-1.43], as compared to day workers. Having ever worked permanent night shifts (≥3 nights/month) was not associated with CRC risk (OR 0.79, 95% CI 0.62-1.00). OR increased with increasing lifetime cumulative duration of rotating shift work (P-value for trend 0.005) and were highest among subjects in the top quartiles of exposure (3 rdquartile, 20-34 years, OR 1.38, 95%CI 1.06-1.81; 4 thquartile, ≥35 years, OR 1.36, 95% CI 1.02-1.79). Conclusions These data suggest that rotating shift work may increase the risk of CRC especially after long-term exposures.