Background:Tobacco consumption is a leading cause of death and disease, killing >8 million people each year. Smoking cessation significantly reduces the risk of developing smoking-related diseases. Although combined treatment for addiction is promising, evidence of its effectiveness is still emerging. Currently, there is no published research comparing the effectiveness of blended smoking cessation treatments (BSCTs) with face-to-face (F2F) treatments, where web-based components replace 50% of the F2F components in blended treatment.Objective:The primary objective of this 2-arm noninferiority randomized controlled trial was to determine whether a BSCT is noninferior to an F2F treatment with identical ingredients in achieving abstinence rates.Methods:This study included 344 individuals who smoke (at least 1 cigarette per day) attending an outpatient smoking cessation clinic in the Netherlands. The participants received either a blended 50% F2F and 50% web-based BSCT or only F2F treatment with similar content and intensity. The primary outcome measure was cotinine-validated abstinence rates from all smoking products at 3 and 15 months after treatment initiation. Additional measures included carbon monoxide–validated point prevalence abstinence; self-reported point prevalence abstinence; and self-reported continuous abstinence rates at 3, 6, 9, and 15 months after treatment initiation.Results:None of the 13 outcomes showed statistically confirmed noninferiority of the BSCT, whereas 4 outcomes showed significantly (P<.001) inferior abstinence rates of the BSCT: cotinine-validated point prevalence abstinence rate at 3 months (difference 12.7, 95% CI 6.2-19.4), self-reported point prevalence abstinence rate at 6 months (difference 19.3, 95% CI 11.5-27.0) and at 15 months (difference 11.7, 95% CI 5.8-17.9), and self-reported continuous abstinence rate at 6 months (difference 13.8, 95% CI 6.8-20.8). The remaining 9 outcomes, including the cotinine-validated point prevalence abstinence rate at 15 months, were inconclusive.Conclusions:In this high-intensity outpatient smoking cessation trial, the blended mode was predominantly less effective than the traditional F2F mode. The results contradict the widely assumed potential benefits of blended treatment and suggest that further research is needed to identify the critical factors in the design of blended interventions.Trial Registration:Netherlands Trial Register 27150; https://onderzoekmetmensen.nl/nl/trial/27150
Accidental allergic reactions to food are one of the major problems in adult patients diagnosed with food allergy. Such reactions occur frequently, are often severe and are associated with higher medical and non-medical costs. The aim of this Perspective is to provide insight into the different factors involved in the occurrence of accidental allergic reactions and to present an overview of practical implications for effective preventive measures. Several factors affect the occurrence of accidental reactions. These factors are related to the patient, health care, or food. The most important patient-related factors are age, social barriers to disclosing their allergy and non-adherence to the elimination diet. With regards to healthcare, the degree to which clinical practice is tailored to the individual patient is an important factor. The major food-related factor is the absence of adequate precautionary allergen labeling (PAL) guidelines. Since many factors are involved in accidental allergic reactions, different preventive strategies are needed. It is highly recommended that health care be tailored to the individual patient, with regard to education about the elimination diet, support on behavioral and psychosocial aspects, usage of shared decision-making and taking into account health literacy. In addition, it is crucial that steps are taken to improve policies and guidelines for PAL.
MULTIFILE
Probation and after-care service is of great social importance and you want to do a proper job. ‘Doing a proper job’ tends to revolve around effective interventions or instruments. Which is important, but doing a proper and effective job involves more than that. We distinguish three forms of effectiveness: -Effective methods: what works? For example, working according to the principles of Risk, Needs and Responsivity6. Or structured behavioural training according to the cognitive-behavioural model. Or working according to the Good Lives Model7. Or the network approach. Methods are referred to as ‘effective’ if there is scientific evidence that they increase the chances of achieving the probation objectives. The risk of recidivism decreases if you work according to these methods. Proper coordination of the working method with specific clients is always part of an effective methodology. -Effective professionals: who works? Methodologies do not lead a life of their own, they only become effective in the hands of professionals8. Effective professionals are rooted in professional values, work with theoretically consistent methods, stand behind their working methods, are able to interact with different types of people (also with people who find this difficult) and systematically provide specific feedback on their actions and results. The importance of effective and open client feedback is important in this. Furthermore, an effective professional attempts to connect his own experiential knowledge to scientific knowledge to the best of his ability. A professional who meets these characteristics is in a better position than other professionals to ‘ensure the effectiveness’ of the method. -Effective interactions: the working alliance (how does it work?) Methodologies and professionals gain meaning in proper interaction with clients and other stakeholders (for example, social network and volunteers). A proper quality of the working alliance increases the chance of successful completion of a probation programme. The risk of problems within the process is reduced and the risk of dropout (no-show or a negative report) decreases.
