Comparing nurses attending a specialised mental health programme with and without substance use disorder: a retrospective, observational study in Spain.

OBJECTIVES: To analyse the differences between nurses with and without substance use disorders (SUDs) admitted to a specialised mental health programme. DESIGN: Retrospective, observational study. SETTING: Specialised mental health treatment programme for nurses in Catalonia, Spain. PARTICIPANTS: 1091 nurses admitted to the programme from 2000 to 2021. INTERVENTIONS: None. PRIMARY AND SECONDARY OUTCOMES: Sociodemographic, occupational and clinical variables were analysed. Diagnoses followed Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision criteria. RESULTS: Most nurses admitted to the programme were women (88%, n=960) and came voluntarily (92.1%, n=1005). The mean age at admission was 45 (SD=10.4) years. The most common diagnoses were adjustment disorders (36.6%, n=399), unipolar mood disorders (25.8%, n=282), anxiety disorders (16.4%, n=179) and SUDs (13.8%, n=151). Only 19.2% (n=209) of the sample were hospitalised during their first treatment episode. After multivariate analysis, suffering from a SUD was significantly associated with being a man (OR=4.12; 95% CI 2.49 to 6.82), coming after a directed referral (OR=4.55; 95% CI 2.5 to 7.69), being on sick leave at admission (OR=2.21; 95% CI 1.42 to 3.45) and needing hospitalisation at the beginning of their treatment (OR=12.5; 95% CI 8.3 to 20). CONCLUSIONS: Nurses with SUDs have greater resistance to voluntarily asking for help from specialised mental health treatment programmes and have greater clinical severity compared with those without addictions. SUDs are also more frequent among men. More actions are needed to help prevent and promote earlier help-seeking behaviours among nurses with this type of mental disorder.

Quitline nurses' experiences in providing telephone-based smoking cessation help to mental health patients: A mixed methods study.

WHAT IS KNOWN ON THE SUBJECT?: Quitlines are known to be effective in helping people quit smoking, including those with mental health conditions. It is particularly important to address smoking in this population as the prevalence of smoking ranges from 40% to 75%. However, professionals working in quitlines often face barriers due to their limited training and resources to effectively support these smokers quit, especially if they are not mental health professionals. Therefore, training programmes should be developed to enhance their knowledge and skills in providing smoking cessation support to this vulnerable population. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The '061 QUIT-MENTAL study' evaluated the efficacy of a proactive telephone-based intervention for smoking cessation among smokers with severe mental health disorders. Conducted through a quitline service in Catalonia, Spain, the study focused on training non-mental health specialized nurses and other health professionals to provide evidence-based interventions for promoting smoking cessation among individuals with mental health disorders. The objective of this study is to assess the changes in nurses' knowledge and readiness to treat smokers with mental health conditions, while also capturing their insights and perceptions regarding the facilitators and barriers to providing smoking cessation interventions. The training and insights of the nurses were integral to conducting this research and providing valuable information for the future sustainability of such interventions. This is particularly important as quitlines hold the potential to offer cessation support to these patients at the community level. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While the training programme was successful in improving non-mental health specialized nurses' knowledge and motivation skills to help patients with mental health disorders quit smoking, they encountered obstacles in delivering this intervention over the phone. These difficulties were mainly due to challenges in reaching participants and delivering the intervention as detailed in the protocol. The study highlights the need of reducing barriers for providers in attending to these patients, particularly if they are non-mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco-related diseases among this population. ABSTRACT: Introduction The viewpoint of those who implement a programme for the first time is crucial for understanding its impact and ensuring its long-term viability. The 061 QUIT-MENTAL study was a pragmatic randomized controlled trial evaluating a proactive telephone-based intervention addressed to mental health patients conducted by non-psychiatric specialized nurses. Aim We assessed nurses' knowledge of smoking cessation interventions addressed to this population before and after receiving training and their insights after delivering the intervention. Method Mixed methods study: (1) Pre-post evaluation to assess self-reported knowledge, self-efficacy and opinions about smoking cessation. (2) In-depth interviews with key nurses to ascertain their perceptions regarding the impact of the training received in delivering the study intervention. Results The training enhanced nurses' knowledge of psychological and pharmacological resources to aid these patients, as well as their ability to increase their motivation to quit. However, nurses reported difficulties in delivering population-based interventions to individuals with mental health disorders. These challenges primarily arose from participants being hard to reach, exhibiting low motivation to quit, struggling to comprehend instructions or follow recommendations, and nurses feeling unsure about their capacity to assist individuals with mental illnesses in quitting, despite the training they received. Discussion Despite the training and protocol designed to facilitate the delivery of the intervention, nurses faced difficulties in providing population-based interventions to individuals with mental health disorders. Implications for Practice Future quitline programmes aimed at the population with mental health disorders should strive to reduce barriers for providers in attending to these patients, particularly if they are non-mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco-related diseases among this population.

Help Seeking of Highly Specialized Mental Health Treatment before and during the COVID-19 Pandemic among Health Professionals.

(1) Background: Ongoing specialized programs for health professionals (HPs) adapted their treatment services during the COVID-19 pandemic. (2) Methods: We conducted a retrospective observational study of medical e-records of HPs with mental disorders working in Catalonia that were consecutively admitted to the Galatea Care Program Clinical Unit. The sample (N = 1461) was divided into two periods: 21.5 months before (n = 637) and after (n = 824) 14 March 2020. (3) Results: There was a significant increase (29.4%) in the number of referrals to the specialized Clinical Unit during the pandemic, especially with respect to physicians compared to nurses. The percentage of HP women at admission and the clinical severity of the first treatment episode remained without changes before and after the COVID-19 pandemic. The most prevalent main diagnoses also remained similar: adjustment disorders (41.5%), mood disorders (24.9%), anxiety disorders (14.4%), and substance use disorders (11.8%). (4) Conclusions: HPs, particularly physicians, more frequently sought voluntary help from specialized mental health programs during the COVID-19 pandemic. Future studies are needed to analyze the reasons behind this finding and the evolution of referrals to these types of programs after the COVID-19 outbreak.

Acceptability and participation predictors for a pragmatic randomized controlled trial to test a smoking cessation intervention after discharge from mental health wards.

BACKGROUND AND AIM: Hospitalization is an ideal time to promote smoking cessation, but interventions are limited for supporting cessation maintenance after discharge. This study aimed to evaluate the acceptability of participating in a trial that tested the efficacy of an intensive telephone-based intervention for smokers after discharge. METHODS: Adult smokers admitted to mental health wards of six hospitals were invited to participate in the trial. We studied the study acceptance/decline rates by analyzing the characteristics of participants (e.g., sex, age, psychiatric disorder, smoking pattern) and hospitals (e.g., size, tobacco control implementation). We calculated adjusted odds ratios (aOR) to assess predictors of non-participation. RESULTS: Of 530 smokers that met the study inclusion criteria, 55.5% (n = 294) agreed to participate. Participant and non-participants were not different in sex, age, or psychiatric diagnosis. Compared to non-participants, participants had made more attempts to quit in the past year (66.1% vs 33.9%; p < 0.001) and reported higher abstinence rates during the hospital stay (66.7% vs. 33.3%; p = 0.05). Participation rates by hospital varied from 30.9% to 82.0% (p < 0.001). Predictors of non-participation were not having attempted to quit in the last year (aOR=2.42; 95%CI: 1.66-3.53) and low level of tobacco control in the hospital (aOR range: 1.79-6.39, p < 0.05). CONCLUSIONS: A telephone-based intervention to promote smoking cessation after discharge was accepted by half of the smokers with mental health disorders. Smokers that had attempted to quit previously and those that stayed in hospitals with a strong tobacco control policy were more likely to participate in the trial.

Nurse admissions at a specialized mental health programme: A pre-Covid-19 retrospective review (2000-2019).

AIMS: Nursing is a stressful and emotionally demanding profession. To date, few mental health treatment interventions have been developed for them worldwide. This study aims to explore referral trends in nurses with mental disorders admitted to a pioneer specialized mental health programme in Europe from 2000 to 2019. DESIGN: A retrospective observational study of 1297 medical e-records of nurses with mental health disorders admitted to the Galatea Care Programme in Barcelona was conducted. METHODS: Three periods were analysed: 2000-2006, 2007-2012 and 2013-2019. Socio-demographic and clinical variables were compared. Diagnoses followed Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria. RESULTS: Gender and age at referral did not change over time. Self-referrals grew from 85.1% in the first period to 95.3% in the last period; inpatient admissions decreased from 24.1% to 18.2%, although this was not significant; nurses were less frequently on sick leave on admission over time (59.1% vs. 45.7%); they were more likely to have a temporary contract in the second period (9.5% vs. 4.8% and 4%) and prevalence of main diagnosis changed with a considerable decrease in affective and substance use disorders after 2006 and a progressive increase in adjustment disorders during the whole period. CONCLUSION: Free, voluntary, highly confidential programmes for nurses with mental disorders may enhance voluntary and earlier help seeking. These findings can be considered when implementing specialized interventions for them in other settings. WHAT PROBLEM DID THE STUDY ADDRESS?: Nursing is a stressful and emotionally demanding profession. To date, few specialized mental health services have been developed for them worldwide. This study aims to explore referral trends in nurses with mental disorders admitted to a pioneer programme in Europe, the Galatea Care Programme in Barcelona, from 2000 to 2019. WHAT WERE THE MAIN FINDINGS?: The number of referrals to the programme grew especially after the first 7-year period. Admissions were more likely to be voluntary during the last period. Prevalence of substance use disorders at admission dropped steadily while prevalence of adjustment disorders progressively increased over the two decades. Nurses were also less likely to be on sick leave at admission. WHERE AND ON WHOM WILL THE RESEARCH HAVE IMPACT?: Free, voluntary, highly confidential programmes for nurses with mental disorders may enhance voluntary and earlier help seeking. These findings can be considered when implementing specialized interventions for them in other settings.

Smoking cessation interventions in substance use disorders treatment centers of Catalonia: The abandoned addiction. / Intervenciones para dejar de fumar en los centros de atención a las drogodependencias de Cataluña: La adicción abandonada.

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.

Intervenciones para dejar de fumar en los centros de atencióna las drogodependencias de Cataluña: La adicción abandonada / Smoking cessation interventions in substance use disorders treatment centers of Catalonia: The abandoned addiction

Los centros de tratamiento de drogodependencias son un recurso óptimo para realizar intervenciones para la cesación tabáquica (ICT). Elobjetivo de este estudio fue examinar la implementación de ICT en laRed de centros de Atención a las Drogodependencias (CAS) de Cataluña, así como evaluar las opiniones sobre la adecuación y viabilidad de laprovisión de ICT. Los responsables de los CAS (n = 57) contestaron uncuestionario on-line compuesto por 30 ítems. Se obtuvieron datos de 50centros (87,7% tasa de respuesta). El 46% de los CAS ofrecía algún tipode ICT, pero sólo un 4,8% de los nuevos pacientes eran tratados paradejar de fumar. Además, los responsables informaron que el 73,3% delos profesionales que trabajaban en los CAS no había recibido formación en ICT. El 64% de los responsables estaba de acuerdo que todos losprofesionales deberían realizar ICT. Aquellos centros que ofrecían ICTvisitaban más pacientes y era más probable que tuviesen profesionalesformados en ICT, comparado con los centros que no ofrecían ICT. La implementación de ICT en los CAS de Cataluña era subóptima. Se deberíafacilitar formación continuada a los profesionales de los CAS. No venir sobre el consumo de tabaco en pacientes en tratamiento por otrasdrogodependencias significa perder oportunidades para reducir costesen salud y económicos mientras perpetuamos una cultura fumadora. (AU)

Substance use disorders (SUD) treatment centers are an optimal setting for delivering smoking cessation interventions (SCI). This studyaimed to examine the adoption of SCI in SUD treatment centers inCatalonia (Spain) as well as to assess their managers’ views on theappropriateness and feasibility of providing SCI. Managers directly incharge of SUD treatment centers (n = 57) answered a 30-item on-linequestionnaire. Data was obtained of 50 centers (87.7% response rate).Forty-six per cent of the centers provided some kind of SCI, but only4.8% of the new patients were treated for smoking cessation. Managers reported that 73.3% of mental health professionals working inSUD centers had not been trained in SCI. Sixty-four per cent of managers agreed that all health professionals should deliver SCI. Thosecenters offering SCI attended more patients and were more likely tohave professionals trained in SCI than those not offering SCI. Theimplementation of SCI in SUD treatment centers in Catalonia wassuboptimal. Continuing education and training should be providedfor all health professionals working in SUD centers. Not systematically delivering SCI to patients in treatment for other SUD means missingopportunities to reduce health and economic costs while perpetuating a smoking culture. (AU)

Characteristics of resident physicians accessing a specialised mental health service: a retrospective study.

OBJECTIVES: Little is known about resident physicians being treated at physician health programmes around the world despite the fact that it is a highly demanding training period. This study aims to describe the profiles of resident physicians accessing a specialised mental health service in Spain over a 20-year period and to compare them to consultant-grade physicians. DESIGN: Retrospective observational study. SETTING: Medical records of the Galatea Care Programme for Sick Physicians. PARTICIPANTS: 1846 physicians registered at the Barcelona Medical Council-Association and admitted to the programme from January 1998 to December 2018. PRIMARY AND SECONDARY OUTCOME MEASURES: Number of admissions, sociodemographic and clinical variables, including medical specialty, main diagnosis and need of hospitalisation. RESULTS: Residents accounted for 18.1% (n=335) of the sample and admissions increased over the years. Most residents (n=311; 94.5%) and consultant-grade physicians (n=1391; 92.8%) were self-referred. The most common specialty among residents was family medicine (n=107; 31.9%), followed by internal medicine (n=18; 5.4%), paediatrics (n=14; 4.2%), psychiatry (n=13; 3.9%) and anaesthesiology (n=13; 3.9%). Residents, regardless of year of training, mainly asked for help because of adjustment (n=131; 39.1%), affective (n=77; 23%), anxiety disorders (n=40; 18.8%) and addictions (n=19; 5.7%). There were no significant differences between groups in the main diagnosis and in the variables related to need of hospitalisation. The percentage of residents accessing the programme was higher than in the reference population registered at the Barcelona Medical Council-Association (18.1% vs 7.6%; z=7.2, p<0.001) as was the percentage of family medicine residents (31.9% vs 19.6%; z=5.7, p<0.001). CONCLUSIONS: Residents are more likely than consultant-grade physicians to seek help when suffering from mental disorders. Local primary prevention actions since the beginning of their training period and having access to a well-known highly reliable programme may partly explain these findings.

Assessing high risk of suicide amongst physicians and nurses in treatment.

Little is known about the suicidal behaviour of health professionals admitted to specialised programmes. This study aims to describe the factors associated with high risk of suicide (HRS) of physicians and nurses in treatment at the Galatea Care Programme. We conducted a retrospective naturalistic study with data from 1,214 electronic medical records of physicians and nurses working in Catalonia and in treatment at the Galatea Clinic during 2017 and 2018. HRS was registered in the medical record according to the screening criteria of the Catalonia Risk Suicide Code; 62.4% (n = 757) were physicians and 37.6% (n = 457) were nurses. HRS was identified in 5% physicians and 5.2% nurses. Patients who were in a relationship or were not on a sick leave were less likely to have HRS, whereas those with affective disorders were more likely to have HRS compared with those with anxiety disorders or substance use disorders. Patients with HRS were more likely to have concurrent mental disorders. Specialised treatment programmes for health professionals should regularly screen for suicide risk, especially amongst those having affective disorders, comorbid mental disorders or when their working and interpersonal life areas are impaired.

The impact of the COVID-19 pandemic on the mental health of healthcare professionals.

INTRODUCTION: Healthcare professionals (HPs) have been confronted by unprecedented traumatic experiences during the COVID-19 pandemic, especially in countries that had not experienced similar epidemic outbreaks in recent years. AIM: To analyze the impact of the COVID-19 pandemic on the mental health of HPs. METHOD: We comprehensively reviewed the studies published in MEDLINE (PubMed), Web of Science and Google Scholar between December 2019 and May 2020. RESULTS: Most studies report a high prevalence of anxiety and depressive symptoms among HPs that can be associated with: a) COVID-19 exposure; b) epidemiological issues; c) material resources; d) human resources; and e) personal factors. The role of certain variables, before, during and after the pandemic, remains unexplored. Longitudinal studies will help elucidate which factors are associated with a higher risk of developing long-lasting negative effects. Qualitative studies may contribute to understanding the influence of individual and social narratives in HPs' distress. CONCLUSION: A deeper analysis on the individual, institutional, political and socio-cultural factors, meanings and values influencing HPs distress and resilience during the COVID-19 pandemic is needed.

Family physicians with mental disorders admitted to a physicians' health programme: what can be learned?

BACKGROUND: Family physicians (FPs) are said to be suffering from high rates of mental distress. Physicians' health programmes (PHPs) have been developed in several countries to provide specialized care for those suffering from mental disorders. OBJECTIVE: To describe the profile of FPs admitted to the Integral Care Programme for Sick Physicians (PAIMM) compared to other physicians and the evolution of their referrals during a 20-year period. METHODS: We conducted a retrospective observational study of 1702 medical records of physicians registered at the Medical Council-Association of Barcelona and admitted to the PAIMM from 1998 to 2017. FPs represented 20% (n = 283) of all consultant-grade physicians (n = 1413). RESULTS: FPs' admissions have increased over the years, mainly in the last decade. FPs were younger than other specialists (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.96-0.99) and more likely to be women (OR: 1.42; 95% CI: 1.06-1.89). All PAIMM physicians had a high prevalence of both adjustment and affective disorders and the prevalence of addictions has decreased in the last decade. CONCLUSIONS: The increase in FPs accessing PHPs in recent years is notable; however, the reasons behind this trend require deeper analysis at the personal, professional and institutional levels.

Integral Treatment Programme for Addicted Physicians: Results from The Galatea Care Programme for Sick Physicians.

INTRODUCTION: Addictions among physicians are a matter of public health interest because of their negative impact on the physician's well-being and the potential risk of malpractice. Physicians' Health Programmes (PHP) have been developed in several countries to address this issue. Although they share some similarities, they differ in organisational and clinical aspects. OBJECTIVE: This study aimed to describe the clinical outcomes of the Integral Treatment Programme for Addicted Physicians of The Galatea Care Programme for Sick Physicians (PAIMM). METHODS: A prospective naturalistic longitudinal study was conducted using data from electronic medical records of 126 physicians registered at the Barcelona Medical Association-Council and admitted to the PAIMM between 2008 and 2016. All patients received addiction treatment supervised by a specialised team with individual visits (psychiatrist and psychologist), had regular and random drug screening, attended a 3-step intervention with 2 intensive initial phases and 2-5 year weekly group psychotherapy, and were monitored when they returned to practice. RESULTS: All admitted physicians completed the intensive intervention, and 87.3% were subsequently monitored. The mean treatment length was 48 months. Overall, 72.2% of sick physicians remained abstinent at last contact. Good adherence to follow-up psychotherapy groups predicted both lower risk of lapse during the treatment process and higher rates of abstinence at follow-up. CONCLUSIONS: Initial intensive treatment, long-term follow-up and drug screening, group therapy attendance, and a case management approach are common factors that may explain the positive clinical outcomes for physicians with addictions in treatment at PHPs, regardless of the country.

Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial.

BACKGROUND: Up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. METHODS: A pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, ß = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. DISCUSSION: This trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03230955 . Registered on 24 July 2017.

Cambios autopercibidos en profesionales de Centros de Atención y Seguimiento a las drogodependencias de Cataluña (CAS) tras recibir formación en intervención en tabaquismo / Self-perceived changes in professionals of substance misuse outpatient treatment centres in Catalonia (CAS) after receiving training on smoking intervention

La prevalencia de fumadores en individuos en tratamiento por Trastornos por Consumo de Sustancias es hasta cuatro veces mayor que en población general y permanece estable. La falta de formación en cómo tratar la adicción al tabaco puede explicar en parte el bajo nivel de intervención en los Centros de Atención y Seguimiento de las Drogodependencias (CAS) de Cataluña. El objetivo de este estudio es evaluar los cambios autopercibidos en conocimientos, grado de intervención y autoeficacia a corto y medio plazo en profesionales que reciben una sesión de formación. Se administra un cuestionario antes, después y tres meses después de la formación a los asistentes (n=23). Antes de la formación uno de cada cuatro interviene en el consumo de tabaco de sus pacientes, y tres de cada cuatro tiene poca confianza en sí mismo para intervenir. La formación aumenta globalmente los conocimientos y la auto-eficacia. Aunque el grado de intervención también es mayor tras la formación, se reduce a medio plazo. Asimismo, el 71,4% de los participantes afirman haber intentado difundir parte de la formación a sus equipos, y el 63,2% refiere que su equipo ha realizado alguna acción para mejorar el abordaje del tabaquismo de los pacientes. Las autoridades sanitarias deben apostar por la formación sobre el abordaje del consumo de tabaco dirigida a profesionales de los centros de drogodependencias, para lograr que se integre en la práctica habitual

The prevalence of smoking in individuals treated for Substance Use Disorders is up to four times higher than in the general population and remains stable. The lack of training in smoking cessation may partly explain the low level of intervention in the substance misuse outpatient treatment centres (CAS) in Catalonia. The aim of this study is to evaluate changes in the short and medium term in professionals and their teams after training. A brief questionnaire is administered to attendees (n=23) before, after and three months after the training. Before training, one in four helps their patients to stop smoking, and three out of four report poor self-confidence to treat tobacco dependence. Overall, the training increases knowledge and self-efficacy. Although intervention increases after training, it drops in the medium term. 71.4% of the participants claim they had attempted to spread part of the training to their teams, and 63.2% of professionals reported that their team has taken some action to improve smoking cessation support. Health authorities should commit to offer continuing education training in smoking cessation for staff working at substance misuse treatment centres, to help integrate tobacco use interventions into routine practice

Cigarette dependence and depressive symptoms as predictors of smoking status at five-year follow-up after a workplace smoking cessation program.

Workplace smoking cessation interventions increase quit rates compared to no treatment or minimal interventions. However, most studies report data up to one year. This study aims to evaluate long-term effects of a worksite smoking cessation intervention based on cognitive behavioral cessation groups combined with first-line medications, and determine to what extent cigarette dependence (FTCD) and depressive symptoms may influence results at five-year follow-up. Participants were invited to answer a short survey five years after starting the program. A total of 90.4% (n=227) of those who had attended at least one treatment session and were alive, completed the survey. At the five-year follow-up, 29.5% participants reported continuous abstinence. Low scores in the FTCD and low depressive symptoms at baseline predicted continuous abstinence. Three out of four continuous abstainers at twelve months remained abstinent at the five-year follow-up. The study shows that workplace smoking cessation interventions have long-term effects and supports the traditional one-year follow-up period to assess smoking cessation.

Deconstructing myths, building alliances: a networking model to enhance tobacco control in hospital mental health settings / Desmontando mitos, construyendo alianzas: un modelo en red para mejorar el control del tabaquismo en el ámbito de la salud mental hospitalaria

Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals —the early adopters— based on Rogers’ theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals’ awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings (AU)

La esperanza de vida para las personas con trastornos mentales graves se reduce hasta 25 años en comparación con la población general, principalmente debido a enfermedades causadas o agravadas por el tabaco. Sin embargo, el tabaco es un tema a menudo descuidado en el ámbito de la salud mental. El objetivo de este artículo es describir una estrategia dirigida a mejorar el control del tabaco en servicios de salud mental hospitalarios de Cataluña (España). Por este motivo, la Red Catalana de Hospitales sin Humo puso en marcha en 2007 un grupo de trabajo de profesionales clave, los early adopters, según la teoría de la difusión de las innovaciones de Rogers. En la actualidad, el Grupo de Trabajo, con un enfoque de abajo arriba, está integrado por profesionales de 17 hospitales (el 70,8% de todos los hospitales de la región con unidades de hospitalización de salud mental). Desde 2007, el control del tabaco ha mejorado en diferentes áreas, tales como el aumento de la sensibilización de los profesionales, la formación de profesionales en intervención para dejar de fumar y el cumplimiento de la prohibición de fumar en las salas de ingreso. El Grupo ha elaborado y difundido materiales como guías de práctica clínica y de buenas prácticas, ha implementado programas para dejar de fumar, y ha organizado jornadas y sesiones formativas sobre intervención en tabaquismo en personas con trastornos mentales, entre otras actividades. Los siguientes pasos se centrarán en garantizar un seguimiento eficaz de la cesación tabáquica después del alta hospitalaria. Aunque aún queda mucho trabajo en algunas áreas del control del tabaquismo dentro de estos servicios, este enfoque descrito promueve con éxito mejoras en este ámbito (AU)

Deconstructing myths, building alliances: a networking model to enhance tobacco control in hospital mental health settings.

Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals -the early adopters- based on Rogers' theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals' awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings.

Safety of Varenicline for Smoking Cessation in Psychiatric and Addicts Patients.

UNLABELLED: The safety of varenicline in the treatment of tobacco dependence has been questioned, in psychiatric patients. However, most published studies have not included psychiatric patients. OBJECTIVE: Assess the safety of varenicline for smoking cessation in patients with psychiatric disorders. METHODS: This is a prospective, longitudinal, multicenter study. The sample is composed of three groups (patients with psychotic disorder, patients with alcohol dependence disorder and patients addicts in methadone maintenance treatment). Patients were recruited consecutively between September 2008 and June 2009 from 11 centers. All patients received a standardized smoking cessation program with varenicline and psychological support. Adverse events of the drug were monitored at weeks 1, 2, 4, 6, 8, and 12 of treatment. Bivariate analysis has been used. RESULTS: None of the 90 patients included, presented a serious adverse event. The most frequent adverse effect was dry mouth (28.9%), followed by the presence of flatulence (27.8%), abnormal dreams (27.8%), and nausea (22%), especially between weeks 2 and 6 of treatment. None of the patients referred intense suicidal ideation, although two referred to moderate suicidal ideation, which was solved in one case and in the other, treatment was discontinued. Four participants (4.4%) abandoned treatment because of gastrointestinal symptoms. The initial dose of varenicline was reduced in 25% of patients during the study. CONCLUSIONS: Gastrointestinal adverse events are the most incident in this sample of psychiatric patients and no exacerbation of psychiatric symptoms was detected, thus indicating a good safety record for varenicline use for smoking cessation in psychiatric patients.

Smoking cessation in hospital workers: effectiveness of a coordinated program in 33 hospitals in Catalonia (Spain).

BACKGROUND: The Catalan Network of Smoke-free Hospitals coordinates a smoking cessation program addressed to hospital workers. The program included training in tobacco cessation, a common software, and free access to pharmacological treatments. OBJECTIVE: This study aimed to evaluate the effectiveness of the Catalan Network of Smoke-free Hospitals smoking cessation program for abstinence among workers of the 33 participating hospitals. METHODS: A total of 930 hospital workers (in 33 hospitals) attended the cessation units between July 2005 and December 2007. The program included active follow-up during 6 months after quitting. We calculated 6-month abstinence probabilities by means of Kaplan-Meier curves according to gender, age, years of tobacco consumption, profession, Fagerström Test for Nicotine Dependence (FTND) score, and use of pharmacotherapy. RESULTS: Overall abstinence probability was 0.504 (95% confidence interval [CI]: 0.431-0.570) at 6 months of follow-up. Abstinence was higher in men (0.526, 95% CI = 0.398-0.651) than in women (0.495, 95% CI = 0.410-0.581). Physicians had higher abstinence (0.659, 95% CI = 0.506-0.811) than nurses (0.463, 95% CI = 0.349-0.576). Workers with high nicotine dependence (FTND > 7) had lower abstinence probability (0.376, 95% CI = 0.256-0.495) than workers, with FTND score equal or below 6 (0.529, 95% CI = 0.458-0.599). We observed the highest abstinence probabilities in workers treated with combined pharmacotherapy (0.761, 95% CI = 0.588-0.933). CONCLUSION: Significant predictors of abstinence were smoking 10 to 19 cigarettes/day, having present low or medium FTND score, and using combined treatment (nicotine replacement therapy and bupropion). IMPLICATIONS FOR PRACTICE: The results show the feasibility and success of a smoking cessation program for hospital workers coordinated at the regional level.

Smoke-free policies in psychiatric services: identification of unmet needs.

INTRODUCTION: Smoke-free policies have been extended to enclosed workplaces in many countries; however, smoking continues to be commonly allowed on psychiatric premises. The aim of this study was to describe tobacco control strategies undertaken in psychiatric inpatient services and day centres in Spain. METHODS: This cross-sectional survey included all psychiatric service centres that offered public services in Catalonia, Spain (n=192). Managers responded to a questionnaire of 24 items that covered four dimensions, including clinical intervention, staff training and commitment, smoking area management and communication of smoke-free policies. RESULTS: A total of 186 managers (96.9%) completed the questionnaire. Results showed low tobacco control in psychiatric services: 41.0% usually intervened in patient tobacco use, 34.1% had interventional pharmacotherapy available and 38.9% had indoor smoking areas. Day centres showed the lowest implementation of tobacco control measures. Out of 186 managers, 47.3% stated that the staff had insufficient knowledge on smoking cessation interventions. CONCLUSIONS: The former Spanish partial law has not been sufficiently successful in promoting tobacco control in psychiatric services. There is room for improvement in tobacco control policies, specifically in smoking interventions, staff training and resource availability.