Say Yes to No–smoking: Case Study Croatia

Smoking is the main health risk factor that can be avoided, but remains the largest single cause of premature death in developed countries, accounting for almost 20% of all mortality. Smoking increases the risk of approximately 30 diseases, for some of them even by 10 to 30 times. There exist different measures/intervention programmes to tackle the problem of smoking, anti-smoking campaigns being one of them. Every year, 13,000-14,000 people in Croatia die from the consequences of smoking. Although the advantages of quitting smoking are wellknown, large number of smokers find hard to give up smoking. As a response to this problem, in Croatia the campaign »Say Yes to No-smoking« was organized. As a part of this campaign, a first national »Smoke Out Day« was organized on March 2003 under the slogan »Croatia Breathes«

Say Yes to No–smoking: Case Study Croatia

Smoking is the main health risk factor that can be avoided, but remains the largest single cause of premature death in developed countries, accounting for almost 20% of all mortality. Smoking increases the risk of approximately 30 diseases, for some of them even by 10 to 30 times. There exist different measures/intervention programmes to tackle the problem of smoking, anti-smoking campaigns being one of them. Every year, 13,000-14,000 people in Croatia die from the consequences of smoking. Although the advantages of quitting smoking are wellknown, large number of smokers find hard to give up smoking. As a response to this problem, in Croatia the campaign »Say Yes to No-smoking« was organized. As a part of this campaign, a first national »Smoke Out Day« was organized on March 2003 under the slogan »Croatia Breathes«

Acute promyelocytic leukemia after whole brain irradiation of primary brain lymphomainan HIV-infected patient

The occurrence of acute promyelocytic leukemia (APL) in HIV-infected patients has been reported in only five cases. Due to a very small number of reported HIV/APL patients who have been treated with different therapies with the variable outcome, the prognosis of APL in the setting of the HIV-infection is unclear. Here, we report a case of an HIV-patient who developed APL and upon treatment entered a complete remission. A 25-years old male patient was diagnosed with HIV-infection in 1996, but remained untreated. In 2004, the patient was diagnosed with primary central nervous system lymphoma. We treated the patient with antiretroviral therapy and whole-brain irradiation, resulting in complete remission of the lymphoma. In 2006, prompted by a sudden neutropenia, we carried out a set of diagnostic procedures, revealing APL. Induction therapy consisted of standard treatment with all-trans-retinoic-acid (ATRA) and idarubicin. Subsequent cytological and molecular analysis of bone marrow demonstrated complete hematological and molecular remission. Due to the poor general condition, consolidation treatment with ATRA was given in March and April 2007. The last follow-up 14 months later, showed sustained molecular APL remission. In conclusion, we demonstrated that a complete molecular APL remission in an HIV-patient was achieved by using reduced-intensity treatment

Creating a database of internet-based clinical trials to support a public-led research programme: A descriptive analysis

Background: Online trials are rapidly growing in number, offering potential benefits but also methodological, ethical and social challenges. The International Network for Knowledge on Well-being (ThinkWell™) aims to increase public and patient participation in the prioritisation, design and conduct of research through the use of technologies. Objective: We aim to provide a baseline understanding of the online trial environment, determining how many trials have used internet-based technologies; how they have been used; and how use has developed over time. Methods: We searched a range of bibliographic databases to March 2015, with no date limits, supplemented by citation searching and references provided by experts in the field. Results were screened against inclusion and exclusion criteria, and included studies mapped against a number of key dimensions, with key themes developed iteratively throughout the process. Results: We identified 1992 internet-based trials to March 2015. The number of reported studies increased substantially over the study timeframe. The largest number of trials were conducted in the USA (49.7%), followed by The Netherlands (10.2%); Australia (8.5%); the United Kingdom (5.8%); Sweden (4.6%); Canada (4%); and Germany (2.6%). South Korea (1.5%) has the highest number of reported trials for other continents. There is a predominance of interventions addressing core public health challenges including obesity (8.6%), smoking cessation (5.9%), alcohol abuse (7.7%) and physical activity (10.2%); in mental health issues such as depression (10.9%) and anxiety (5.6%); and conditions where self-management (16.6%) or monitoring (8.1%) is a major feature of care. Conclusions: The results confirm an increase in the use of the internet in trials. Key themes have emerged from the analysis and further research will be undertaken in order to investigate how the data can be used to improve trial design and recruitment, and to build an open access resource to support the public-led research agenda

Internet-based interventions for smoking cessation

Background Tobacco use is estimated to kill 7 million people a year. Nicotin e is highly addictive, but surveys indicate that almost 70% of U S and UK smokers would like to stop smoking. Although many smokers attempt to give up on their own, advice from a health professio nal increases the chances of quitting. As of 2016 there were 3.5 bill ion Internet users worldwide, making the Internet a potenti al platform to help people quit smoking. Objectives To determine the effectiveness of Internet-based interventi ons for smoking cessation, whether intervention effectivene ss is altered by tailoring or interactive features, and if there is a differen ce in effectiveness between adolescents, young adults, and adu lts. Search methods We searched the Cochrane Tobacco Addiction Group Specialised Regi ster, which included searches of MEDLINE, Embase and PsycINFO (through OVID). There were no restrictions placed on lan guage, publication status or publication date. The most recent search was conducted in August 2016. Selection criteria We included randomised controlled trials (RCTs). Participants w ere people who smoked, with no exclusions based on age, gender , ethnicity, language or health status. Any type of Internet in tervention was eligible. The comparison condition could be a no -intervention control, a different Internet intervention, or a non-Interne t intervention. To be included, studies must have measured sm oking cessation at four weeks or longer. Data collection and analysis Two review authors independently assessed and extracted dat a. We extracted and, where appropriate, pooled smoking cessat ion outcomes of six-month follow-up or more, reporting short-term outcomes n arratively where longer-term outcomes were not available. We reported study effects as a risk ratio (RR) with a 95% confidence interval (CI )

Croatian Recommendations for Dialysis of HIV-Positive Patients

Abstract Human immunodeficiency virus (HIV) infection may be associated with renal impairment since about 0.4% of all HIV-positive patients develop end-stage renal disease. The share of patients with HIV infection in hemodialysis centers throughout the world ranges from 0.3% to as high as 38%. In Croatia, renal replacement therapy was needed by 1% of all the HIV-positive patients from 1985 until the end of 2014. Healthcare professionals (HP) should be aware of the risks of occupational exposure to blood-borne infections in their daily work. Performing dialysis in HIV-positive patients increases the risk of exposure to HIV during the extracorporeal circulation of the infected blood. However, post-exposure prophylaxis (PEP) with effective antiretroviral drugs significantly reduces the risk of infection after occupational exposure. On behalf of the Croatian Society of Nephrology, Dialysis and Transplantation, the authors of this paper have proposed recommendations for the management of HIVpositive patients on dialysis, which aim to prevent the transmission of HIV among patients and HPs. The important recommendations include the following: 1. when the need arises, it is necessary to provide HIV-positive patients with dialysis in the vicinity of their place of residence. 2. HIV-positive patients should be dialyzed with a separate hemodialysis machine in an isolated area. Alternatively, they can be dialyzed in an area for the hemodialysis of HCV-positive and/or HBVpositive patients. 3. Specialized and trained personnel should be provided during the hemodialysis procedure, together with strict compliance with the standard precautions for the prevention of blood-borne infections. 4. There should be a good and prompt cooperation with the National Referral Center for HIV infection

Enhanced smoking cessation support for newly abstinent smokers discharged from hospital (The Hospital to Home trial): A randomised controlled trial

Background and aimsThe United Kingdom's National Institute for Health and Care Excellence guidance (NICE PH48) recommends that pharmacotherapy combined with behavioural support be provided for all smokers admitted to hospital; however, relapse to smoking after discharge remains common. This study aimed to assess the effect of adding home support for newly?abstinent smokers to conventional NICE?recommended support in smokers discharged from hospital.Designindividually?randomised parallel group trial.SettingOne UK acute hospital.Participants404 smokers aged >18 admitted to acute medical wards between June 2016 and July 2017 were randomised in equal numbers to each treatment group.Interventions and comparatorsThe intervention provided 12 weeks of at?home cessation support which included help in maintaining a smoke?free home, help in accessing and using medication, further behavioural support and personalised feedback on home air quality. The comparator was NICE PH48 care as usual.MeasuresThe primary outcome was self?reported continuous abstinence from smoking validated by an exhaled carbon monoxide level ?6ppm four?weeks after discharge from hospital.FindingsIn an intention?to?treat analysis at the four?week primary endpoint, 38 participants (18.8%) in the usual care group and 43 (21.3%) in the intervention group reported continuous abstinence from smoking (odds ratio 1.17, 95% confidence interval 0.72 to 1.90, Bayes factor 0.33). There were no significant differences in any secondary outcomes, including self?reported cessation at 3 months, having a smoke?free home, or number of cigarettes smoked per day in those who did not quit.ConclusionsProvision of a home visit and continued support to prevent relapse to smoking after hospital discharge did not appear to increase subsequent abstinence rate above usual care in accordance with UK guidance from the National Institute of Health and Care Excellence

Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe

There has been an increase in reported TBE cases in Europe since 2015, reaching a peak in some countries in 2020, highlighting the need for better management of TBE risk in Europe. TBE surveillance is currently limited, in part, due to varying diagnostic guidelines, access to testing, and awareness of TBE. Consequently, TBE prevalence is underestimated and vaccination recommendations inadequate. TBE vaccine uptake is unsatisfactory in many TBE-endemic European countries. This review summarizes the findings of a scientific workshop of experts to improve TBE surveillance and vaccine uptake in Europe. Strategies to improve TBE surveillance and vaccine uptake should focus on: aligning diagnostic criteria and testing across Europe; expanding current vaccine recommendations and reducing their complexity; and increasing public education of the potential risks posed by TBEV infection.Peer reviewe

Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe

There has been an increase in reported TBE cases in Europe since 2015, reaching a peak in some countries in 2020, highlighting the need for better management of TBE risk in Europe. TBE surveillance is currently limited, in part, due to varying diagnostic guidelines, access to testing, and awareness of TBE. Consequently, TBE prevalence is underestimated and vaccination recommendations inadequate. TBE vaccine uptake is unsatisfactory in many TBE-endemic European countries. This review summarizes the findings of a scientific workshop of experts to improve TBE surveillance and vaccine uptake in Europe. Strategies to improve TBE surveillance and vaccine uptake should focus on: aligning diagnostic criteria and testing across Europe; expanding current vaccine recommendations and reducing their complexity; and increasing public education of the potential risks posed by TBEV infection.Peer reviewe

Internet-based interventions for the secondary prevention of coronary heart disease

Background The Internet could provide a means of delivering secondary prevention programmes to people with coronary heart disease (CHD). Objectives To determine the effectiveness of Internet-based interventions targeting lifestyle changes and medicines management for the secondary prevention of CHD. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, in December 2014. We also searched six other databases in October 2014, and three trials registers in January 2015 together with reference checking and handsearching to identify additional studies. Selection criteria Randomised controlled trials (RCTs) evaluating Internet-delivered secondary prevention interventions aimed at people with CHD. Data collection and analysis Two review authors independently assessed risk of bias and extracted data according to the Cochrane Handbook for Systematic Reviews of Interventions. We assessed evidence quality using the GRADE approach and presented this in a 'Summary of findings' table