Gamma globulin replacement therapy in uncontrolled, severe asthma associated with humoral immunodeficiency: A series of five case reports.

We report on five adult cases of the rare association of asthma with humoral immunodeficiency (huID). All patients had uncontrolled asthma related to recurrent respiratory infections. Asthma was diagnosed according to the Global Initiative for Asthma (GINA) guidelines, and bronchiectasis was ruled out by a CT chest scan. Two men (aged 28 and 60) presented with pollen allergies, chronic rhinosinusitis, and IgG deficiency (7.8 and 7.6 g/L, respectively). Both patients underwent surgery for nasal polyposis but relapsed with acute sinusitis and severe asthma exacerbations requiring treatment with oral corticosteroids and antibiotics. The immunoglobulin replacement therapy (IRT) partially relieved the asthma by reducing the number of exacerbations. A 55-year-old woman presented with nonallergic, corticosteroid-dependent asthma (20 mg/day prednisone) and IgG deficiency (5.72 g/L). IRT improved asthma control (fall in the Asthma Control Questionnaire (ACQ)-7 score from 3.5 to 1.7) and enabled withdrawal of the corticosteroids. In a 47-year-old woman with an IgG2 subclass deficiency (1.9 g/L) and asthma, IRT increased the degree of asthma control (fall in the ACQ-7 score from 2.8 to 1.1). A 75-year-old woman presented with corticosteroid-dependent asthma (40 mg/day prednisone), IgM and IgG deficiencies (0.28 g/L and 5.36 g/L, respectively), and recurrent respiratory, skin and urinary infections. Again, IRT improved asthma control (fall in the ACQ-7 score from 2.5 to 1.2), reduced the number of hospitalizations for asthma exacerbations, and enabled a 10-mg reduction in the daily dose of prednisone. These observations suggest that IRT may improve disease control in some patients with asthma and associated huID.

Survival Impact of Stations of Pathological Lymph Nodes in N2 Non-small Cell Lung Cancer in a French Hospital.

BACKGROUND: The prognosis of lung cancer remains poor; only 20% of patients can undergo surgery. N2 non-small cell lung cancer (NSCLC) is a heterogeneous disease. We conducted a retrospective study to analyze the impact of N2 location on survival. METHODS: This study included 342 NSCLC with N2 involvement between 1988 and 2014. Patient-related data were collected through the CRB biobank and included demographic, therapeutic, and survival data. Survival was analyzed according to Kaplan-Maier method. Cox's regression analysis and analysis of variance (ANOVA) were used to determine factors significantly associated with survival. RESULTS: The population average age was 61.6 years; 82.2% were men, a majority were former smokers (87.1%), and 45.3% had adenocarcinoma. The main prognostic factors were male gender (p = 0.01), number of nodes (p < 0.0001), and tumor size (p < 0.0001). N2 disease had a poor survival (16 months) compared with N0 (32 months) and N1 (21.1 months) disease (p < 0.0001). The patients with involvement of station 4 (survival = 17.8 months) seemed to have a prognosis between those with station 7 (survival = 10.5 months) and N1 (survival = 22.6 months), p = 0.0005. CONCLUSIONS: N2 location has a prognostic impact in surgically NSCLC, and station 4 involvement has a better prognostic than station 7.

Perceptions of plain packaging among young adult roll-your-own smokers in France: a naturalistic approach.

BACKGROUND: We explored, for the first time, young adult roll-your-own smokers' response to using plain packaging in real-world settings. METHODS: Naturalistic research was employed, where 133 French young adult smokers (18-25 years of age) used plain roll-your-own packs for 10 days; the plain packs they were provided with contained their usual brand of rolling tobacco and displayed the name of their usual brand. Participants were recruited in five cities in France (Paris, Marseille, Metz, Nantes, Toulouse) and completed two questionnaires to measure their response to their own branded packs and the plain packs. Both questionnaires assessed pack perceptions, brand attachment, product perceptions (eg, taste, quality, natural), feelings about smoking (satisfying, pleasurable), feelings when using the pack in front of others (embarrassment, image), warning response (credibility, awareness of risks) and smoking-related behaviour (eg, consumption, quitting). RESULTS: Compared to their own fully branded packs, plain packs were associated with less positive pack and product perceptions, lower brand attachment and less positive feelings about smoking and feelings when using the pack in front of others. Participants were also more likely to report feeling like reducing consumption and quitting when using the plain packs, and more likely to feel like missing out on rolling a cigarette. No significant differences between the two pack types (plain and branded) were found in terms of credibility of warnings and perceptions of level of tar. CONCLUSIONS: The study suggests that the impacts of plain packaging for roll-your-own cigarette smokers are the same as for smokers of factory-made cigarettes.

[Society. Why ban cigarette filters?] / Pourquoi faut-il interdire les filtres de cigarettes ?

WHY BAN CIGARETTE FILTERS? Tobacco consumption in the form of cigarettes is still perceived as being so ordinary that its result, the production of cigarette ends and their disposal, has long been invisible and overlooked. A cigarette end is composed of two parts: a remnant of unsmoked tobacco and a single-use plastic filter made of cellulose acetate. These two components are saturated with the many toxic products generated by cigarette combustion. The relatively recent growing awareness of the major contribution of cigarette filters to plastic pollution of soil, waterways, seas, and oceans has led to active national and international debate on the possibility and desirability of banning the use of these filters for environmental purposes. If such a ban were to be considered, it would be essential to anticipate the possible health consequences for cigarette smokers of such a measure. According to the World Health Organization (WHO), cigarette filters have no beneficial effect on smokers'health, and banning them is therefore becoming an ecologicalemergency.

POURQUOI FAUT-IL INTERDIRE LES FILTRES DE CIGARETTES ? La consommation de tabac sous la forme de cigarettes reste considérée comme tellement banale que ses conséquences, la production de mégots et leur élimination, ont longtemps été invisibles et négligées. Un mégot est constitué de deux parties : un reste de tabac non fumé entouré de papier et un filtre plastique à usage unique composé d'acétate de cellulose. Ces deux composants sont imprégnés par les nombreux produits toxiques résultant de la combustion de la cigarette. La prise de conscience, relativement récente, de l'importance majeure de la responsabilité des filtres de cigarettes dans la pollution plastique et chimique des sols, des cours d'eau, des mers et des océans conduit à une réflexion active, nationale et internationale, sur la possible et souhaitable interdiction de l'usage de c es filtres dans un bu t environnemental. Dans l'hypothèse où une telle interdiction serait envisagée, il est nécessaire d'anticiper les éventuelles conséquences sanitaires pour les fumeurs de cigarettes. Selon l'Organisation mondiale de la santé, les filtres de cigarettes n'ont aucun effet bénéfique sur la santé des fumeurs, et leur interdiction devient une urgence écologique.

Efficacy of a smoking cessation program in a population of adolescent smokers in vocational schools: a public health evaluative controlled study.

BACKGROUND: To evaluate the public health efficacy of a community-based smoking cessation program (TABADO) among vocational school trainees (15 to 20 years old). METHODS: This prospective, controlled, quasi-experimental study was conducted in eight vocational training centres (VTC) in France. The intervention group underwent the TABADO program, which included a general information session for all students and small-group sessions plus individual counselling and nicotine therapy, if needed, for volunteers in an enhanced program. The control group received no specific intervention other than the educational services usually available. The primary outcome was 30-day point prevalence abstinence at 12 months. RESULTS: The mean age of the 1,814 students included was 16.9 years (SD = 1.0); 84.7% were males. At baseline, 52% were smokers and 5.7% ex-smokers. In the intervention group, 24.6% of smokers volunteered for the enhanced program and 18.1% could be included. By 12-month follow-up, with participants lost to follow-up considered non-abstinent, 10.6% of smokers in the intervention group had become abstinent versus 7.4% in the control group (adjusted p = 0.03; odds ratio [OR] = 1.8; 95% confidence interval [CI] = 1.05-3.0); considering lost to follow-up as missing data, 17% of intervention group participants were abstinent versus 11.9% in the control group (univariate p = 0.08; adjusted p = 0.008; OR = 2.1; 95% CI = 1.2-3.6). CONCLUSION: The TABADO program, targeting teenagers in vocational schools, was effective in producing a higher 12-month abstinence rate among all smokers in the intervention group. TRIAL REGISTRATION: Clinical trial identification number is NTC00973570.

Consumer perceptions of cigarette pack design in France: a comparison of regular, limited edition and plain packaging.

BACKGROUND: In the face of comprehensive bans on the marketing of tobacco products, packaging has become an increasingly important promotional tool for the tobacco industry. A ban on the use of branding on tobacco packaging, known as 'plain' packaging, has emerged as a promising regulatory strategy. The current study sought to examine perceptions of cigarette packaging among adults in France. METHODS: Adult smokers and non-smokers (N=836) were surveyed using computer-assisted personal interviewing to assess perceptions of pack design by comparing 'regular' branded packs and 'limited edition' packs (with novel designs or innovations) with 'plain' versions of these packs with all branding, including colour, removed. RESULTS: Plain packs (PP) were less likely than regular packs, and particularly limited edition packs, to be considered attractive, attention grabbing and likely to motivate youth purchase. PPs were also rated as the most effective in convincing non-smokers not to start and smokers to reduce consumption and quit. Logistic regression showed that smokers motivated to quit, in comparison to smokers not motivated to quit, were significantly more likely to consider the PPs as the packs most likely to motivate cessation. CONCLUSIONS: Novel cigarette packaging, in the form of limited edition packs, had the highest ratings of consumer appeal, ahead of regular branded packs and also PPs. Interestingly, PPs were perceived to be the packs most likely to promote cessation among those adults with quitting intentions. Plain packaging, therefore, may be a means of helping existing adult smokers motivated to quit to do so.

Consumer understanding of cigarette emission labelling.

The optimal way to display constituent levels (e.g. tar) on tobacco packaging has not received adequate attention but has important policy implications. Adult smokers and non-smokers (n = 836) were surveyed in France using Computer Assisted Personal Interviewing to assess perceptions of constituent levels displayed numerically (brand-specific tar and nicotine numbers from smoking machines and the current format in European Union), descriptively (a short sentence describing chemicals and their health effects but without any brand-specific numbers) or as a pack insert (a card placed on the inside of the pack describing the presence of chemicals and their health effects in more detail, as well as information on cessation). We also assessed perceptions of identically packaged cigarettes differing only on nicotine levels. Displaying information regarding ingredients either descriptively or on pack inserts was perceived as more comprehensible and informative than displaying them numerically. Numeric yields were associated with false beliefs: almost half the sample perceived packs with lower nicotine levels (0.8 mg vs. 0.9 mg) to be safer.

[Tobacco industry strategies to attract new and young smokers]. / Stratégie de l'industrie du tabac pour recruter de nouveaux et jeunes fumeurs.

"Tobacco industry strategies to attract new and young smokers .Tobacco consumption, the paradigm of an industrial pandemic, has been declining in recent years around the world, following implementation of the recommendations of the WHO Framework Convention on Tobacco Control (FCTC). To survive, the four transnational companies that control the market must adapt their strategy, which they do by shifting from the tobacco trade to the wider nicotine trade through the promotion of new products (electronic cigarettes and heated tobacco products). However, two intangible but well-established facts remain: the initiation to tobacco/nicotine consumption occurs almost exclusively during childhood; on the other hand and that age group is very sensitive to marketing and purchasing impulses. Therefore, the industrials must target young people and ease their access to their products. Once the initial nicotine intake has been established, the drug takes over and enforces continuous consumption due to its highly addictive nature. Nonetheless, as explicit targeting of the youth is not a socially acceptable practice, the industry will conceal its strategy behind the façade of promoting harm reduction for adult smokers who wish to do this. Although communication channels are recent, such as the Internet, social media, platforms and more generally, what is commonly accepted as « communication below the line  ¼, the methods that aim at reinforcing established nicotine consumption as a social norm are of the same nature as those previously used for the promotion of cigarettes: glamour, seduction, youth, motorsports, tech, adventure, independence, maturity. Unfortunately, the rate of smoking among young people in France remains high due to the effectiveness of this marketing, combined with the easy accessibility to the product, due to non-compliance by tobacco sellers with the current legislation prohibiting sales to minors."

"Stratégie de l'industrie du tabac pour recruter de nouveaux et jeunes fumeurs .Paradigme d'une pandémie industrielle, la consommation de tabac baisse depuis quelques années dans le monde, à la suite de la mise en oeuvre des recommandations de la Convention-cadre de l'Organisation mondiale de la santé pour la lutte antitabac (CCLAT). Pour survivre, les quatre compagnies transnationales qui contrôlent le marché doivent adapter leur stratégie, ce qu'elles font en glissant du commerce du tabac vers celui, plus large, de la nicotine à travers la promotion de nouveaux produits (cigarettes électroniques et tabac chauffé). Toutefois, deux faits connus de longue date restent intangibles  : l'initiation à la consommation de tabac/nicotine se fait presque exclusivement dans l'enfance, et cet âge est très sensible au marketing et aux impulsions d'achat. Les industriels doivent donc cibler les jeunes et leur faciliter l'accessibilité à ses produits. Une fois la première consommation de nicotine assurée, celle-ci prend le relais en imposant la poursuite de son usage par son pouvoir addictif majeur. Cependant, cibler les jeunes n'étant pas énonçable, car socialement inacceptable, les industriels vont cacher leur stratégie derrière le faux nez que constitue la promotion d'une réduction des risques aux fumeurs adultes qui le souhaitent. Si les canaux de communication sont nouveaux, tels internet, les réseaux sociaux, les plateformes et, plus globalement, ce qu'il est convenu d'appeler « la communication sous le radar  ¼, les thèmes visant à conforter la consommation de nicotine comme une norme sociale établie sont de même nature que ceux utilisés précédemment pour la promotion des cigarettes  : glamour, séduction, jeunesse, sports mécaniques, technicité, aventure, autonomie, maturité. Malheureusement, le tabagisme des jeunes en France demeure encore élevé du fait de l'efficacité de ce marketing, combinée à la facilité d'achat de ces produits due au non-respect par les buralistes de la réglementation actuelle interdisant leur vente aux mineurs."

["Nicotine industry: risk reduction,an exclusively financial objective"]. / "Industriede la nicotine : réduction des risques, un objectif exclusivement financier".

Nicotine industry: harm reduction, an exclusively financial objective The knowledge of tobacco smoking health effects, combined with the implementation of measures efficient on its use, leads to tobacco sale reduction with tobacco industry financial losses that, in order to survive, has to recruit new young consumers, and maintain current smokers' use. The industry promotes a new way for tobacco use that, according to it, would reduce harm: heat-not-burn tobacco. But, there is currently no independent scientific proof for such a harm reduction. In the meantime, it promotes a confusion among electronic cigarettes and heat-not-burn tobacco. Heat-not-burn tobacco is promoted via foundations, NGOs, prestigious third parties, mechanic sports financing, and publicity with a strong marketing targeting young people through social networks. The current French regulation concerning smoked tobacco, including plain pack and high taxes, doesn't apply on heat-not-burn tobacco.

"Industrie de la nicotine : réduction des risques, un objectif exclusivement financier La connaissance des risques liés au tabac fumé associée à la prise de mesures efficaces pour réduire sa consommation conduit à la baisse des ventes avec chute des profits de l'industrie du tabac qui, pour survivre, doit recruter de nouveaux jeunes consommateurs et maintenir les usagers actuels dans leur consommation. L'industrie propose un nouveau mode de consommation qui, selon elle, permettrait de réduire les risques : le tabac chauffé. Or, aucune preuve scientifique indépendante n'existe d'une telle réduction de risques. En même temps, elle entretient la confusion entre cigarettes électroniques et tabac chauffé. Le tabac chauffé est promu par le biais de fondations, associations, relais prestigieux, financement des sports mécaniques et publicités avec un marketing intense ciblant les jeunes par les réseaux sociaux. La réglementation française concernant le tabac fumé ne s'applique pas au tabac chauffé, lui permettant ainsi d'échapper au paquet neutre et autorisant des profits majeurs par taxation plus légère."

How accurate are physicians in the prediction of patient survival in advanced lung cancer?

BACKGROUND: Because most cases of non-small cell lung cancer (NSCLC) are diagnosed at an advanced stage with a poor prognosis, patient inclusion in clinical trials is critical. Most trials require an estimated life expectancy >3 months, based on clinician estimates of patient survival probability, without providing formal guidelines. The aim of this study was to assess the accuracy of clinicians' predictions of survival in NSCLC patients (stages IIIB, and IV) and the possible impact of patient quality of life on survival estimation. METHODS: At diagnosis, clinical, biological, and quality of life data (QLQ-C30 questionnaire) were recorded, and doctors "forecast" each patient's estimated survival. Concordance between predicted and actual survival was assessed with the intraclass correlation coefficient. RESULTS: Eighty-five patients with a mean age of 62.2 years, 81.1% male, were included (squamous cell carcinoma, 33; adenocarcinoma, 42; large cell carcinoma, 8; neuroendocrine carcinoma, 2). The mean follow-up was 40 months and median survival time was 11.7 (range, 0.4-143.7) weeks. All clinicians (residents, registrars, and consultants) overestimated patient survival time, with a moderate concordance between predicted and actual survival time. A worse global health status was associated with a lower discrepancy between estimated and actual patient survival, and a worse role functioning was associated with a larger difference between estimated and actual patient survival. CONCLUSION: The absence of specific recommendations to estimate patient survival may introduce major selection in clinical studies. Further research should investigate whether the accuracy of patient survival estimates by clinicians would be improved by taking into account patient quality of life.

Tobacco advertising through French TV in 2005: frequent illicit broadcasting; its impact on teenagers and young adults.

BACKGROUND: Sports sponsorship is one of the tobacco industry's main strategies to recruit new smokers among teenagers and young adults. METHODS: Monitoring Motor sports illicit broadcasting based on six channels in 2005; Dakar Rally (DR) and China Grand Prix impact evaluated with a one on one questionnaire administered on 12-24-year-old males and females (n = 805). RESULTS: 75,000 TV tobacco sponsoring appearances (90 h) were observed, total value: euro200.10(6); Mild Seven, Marlboro, West, Lucky Strike, Gauloises Blondes accounted for 92% appearances and 95% of euro values, with illegal broadcasting value worth euro19.10(6). A high interest in DR (71%) and Formula One (F1) (66%) was observed among males (versus females; P < 0.001), increasing with age (P < 0.05). Levels of spontaneous and assisted recall of cigarette brands were high among individuals interested in DR and F1, with better recall of brand names (versus non interested; P < 0.01); all individuals made correct associations between tobacco brands and car colors (P < 0.01). A non-significant higher percentage of daily smokers was observed among respondents interested in DR (34 versus 21%; P < 0.01) and F1 (30 versus 24%; P = 0.10). CONCLUSION: This high level of indirect advertising for tobacco through motor sport sponsoring confirms the urgent need for a worldwide absolute ban on tobacco advertising in motor sports.

[Preventing tobacco sales to minors]. / Pour qu'acheter du tabac ne soit plus un jeu d'enfant !

Preventing tobacco sales to minors. Since 2009, selling tobacco products in France to minors less than 18 years of age is forbidden by law, but this law is poorly enforced even though tobacco use mainly begins at adolescence. The aim of this study was to identify measures implemented by foreign countries leading to a better enforcement of tobacco sale ban to minors. The main measures are: organizing tobacco retailers training programs; using automated age-verification systems; requiring a valid photo ID from anyone who looks under the age of 25; developing communication campaigns directed to the general public in order to explain and promote age control for customers. Furthermore, in all studied countries, the only effective controls rely on "mystery shopping" with underage shoppers accompanied by dedicated inspectors, attempting to purchase tobacco products. In case of non-compliance with the law, these controls must lead to dissuasive financial as well as administrative penalties. In all studied countries, an efficient implementation of these measures has led to reduced tobacco sales to minors, and thus contributed to bring down underage smoking.

Pour qu'acheter du tabac ne soit plus un jeu d'enfant ! En France, la vente de tabac est interdite aux moins de 18 ans depuis 2009, mais la loi est peu respectée alors que la plupart des nouveaux fumeurs commencent leur consommation à l'adolescence. Cette étude a pour objectif d'identifier les mesures mises en œuvre par des pays tiers permettant une meilleure application de l'interdiction de vente de tabac aux mineurs. Parmi ces mesures : la formation des détaillants de tabac ; l'utilisation dans les points de vente de systèmes de vérification automatisée de l'âge ; une vérification de l'âge de toute personne ayant l'apparence d'avoir moins de 25 ans ; le développement de campagnes de communication grand public pour expliquer et promouvoir le contrôle de l'âge des clients. Par ailleurs, les inspections « clients mystères ¼ apparaissent dans tous les pays étudiés comme le seul moyen de contrôle efficace. En cas de non-respect de la loi, ces inspections doivent donner lieu à des sanctions réelles et dissuasives, financières et administratives. Dans les pays étudiés, la mise en place conjointe de ces différentes mesures a permis de réduire la vente de tabac aux mineurs et de contribuer ainsi à diminuer le tabagisme des adolescents.

TABADO: "evaluation of a smoking cessation program among adolescents in vocational training centers": study protocol.

BACKGROUND: Most of the efforts to reduce teenagers' tobacco addiction have focused on smoking prevention and little on smoking cessation. A smoking cessation program (TABADO study), associating pharmacologic and cognitive-behavioural strategy, on a particularly vulnerable population (vocational trainees), was developed. This study aims to evaluate the efficacy of the program which was offered to all smokers in a population aged 15 to 20 years in Vocational Training Centers (VTC). This paper presents the TABADO study protocol. METHODS: The study is quasi-experimental, prospective, evaluative and comparative and takes place during the 2 years of vocational training. The final population will be composed of 2000 trainees entering a VTC in Lorraine, France, during the 2008-2009 period. The intervention group (1000 trainees) benefited from the TABADO program while no specific intervention took place in the "control" group (1000 trainees) other than the treatment and education services usually available. Our primary outcome will be the tobacco abstinence rate at 12 months. DISCUSSION: If the program proves effective, it will be a new tool in the action against smoking in populations that have been seldom targeted until now. In addition, the approach could be expanded to other young subjects from socially disadvantaged backgrounds in the context of a public health policy against smoking among adolescents. TRIAL REGISTRATION: Clinical trial identification number is NTC00973570.

[Tobacco control in France: what's new ?] / Lutte contre le tabagisme en France : quoi de nouveau ?

French governments only very recently introduced comprehensive tobacco control policies including several measures recommended by WHO Framework Convention on Tobacco Control, leading to a speeding-up of tobacco smoking decrease, but still with a high current level of use. In the meantime, research confirms that nicotine is highly addictive, that smoking just a cigarette a day is highly detrimental for health, and that health professionals are efficient in helping smokers to give up. These measures are such diverse as tobacco taxes increases, introducing plain packs, promoting November as month without tobacco, getting tobacco cessation medications paid for by health insurances, implementing a comprehensive advertising ban of tobacco products in retailor shops, and increasing protection of public health policies from tobacco industry intrusion. This industry via frenzied marketing reacts by promoting "heat not burn tobacco" as a harm reduction mean, which it is not, and invests in e-cigarettes, whose most recent ones are as addictive as classic tobacco cigarettes.

LUTTE CONTRE LE TABAGISME EN FRANCE: QUOI DE NOUVEAU ?. Les gouvernements français proposent depuis seulement quelques années des programmes complets de mesures contre l'usage du tabac en s'appuyant sur les recommandations de la convention-cadre de l'Organisation mondiale de la santé pour la lutte anti-tabac, ce qui se traduit par une accélération de la baisse de sa consommation, avec toutefois une prévalence encore élevée. Parallèlement, les études confirment que la nicotine est une drogue forte, que fumer une seule cigarette par jour présente des risques sanitaires majeurs, et que les professionnels de santé peuvent aider les fumeurs à arrêter. Les mesures prises sont variées : augmentation des taxes, paquet neutre, Mois sans tabac, remboursement des traitements de la dépendance au tabac, interdiction de la publicité sur les lieux de vente, protection des politiques publiques de l'ingérence de l'industrie du tabac… Cette industrie réagit en promouvant le tabac chauffé via un marketing forcené sur une réduction des risques inexistante, et investit dans les cigarettes électroniques, dont les plus récentes sont aussi addictogènes que les cigarettes classiques.

Baseline results of the Depiscan study: a French randomized pilot trial of lung cancer screening comparing low dose CT scan (LDCT) and chest X-ray (CXR).

BACKGROUND: Lung cancer has the highest mortality-rate per cancer, with an overall 5-year survival <15%. Several non-randomized studies pointed out the high sensitivity of low dose computed tomography (LDCT) to detect early stage lung cancer. In France, Depiscan, a pilot RCT of LDCT versus chest X-ray (CXR), started on October 2002 to determine the feasibility of enrollment by general practitioners (GPs), investigations and diagnostic procedures by university hospital radiologists and multidisciplinary teams, data management by centralized clinical research assistants, and anticipate the future management of a large national trial. METHODS: GPs and occupational physicians (OPs) selected and enrolled 1000 subjects in 1 year. Eligible subjects were asymptomatic males or females aged 50-75 years with a current or former cigarette smoking history of >/=15 cigarettes per day for at least 20 years (former smokers having quit <15 years prior to enrollment). Based to randomization, annual LDCT or CXR screenings were planned at baseline and annually for 2 years. RESULTS: Between October 2002 and December 2004, 765 subjects were enrolled by 89 out of the 232 participating GPs and OPs. Complete clinical and imaging baseline data were available for 621 individuals out of the 765 enrolled, due to 144 noncompliant subjects who withdrew their consent. At least one nodule was detected in 152 out of 336 subjects (45.2%) in the LDCT screening, versus 21 out of 285 subjects (7.4%) in the CXR screening arm. Eight lung cancers were detected in the LDCT arm and one in the CXR arm. DISCUSSION: This pilot trial allows estimating that non-calcified nodules are 10 [6.36-17.07] times more often detected from LDCT than from CXR. However enrollment by GPs was more difficult than expected with 41% active investigators and a high rate (19%) of noncompliant patients. This experience speaks to the need for a high level of GPs formation and a large, coordinated clinical research team in such a trial. TRIAL REGISTRATION NUMBER: 02526.

Introducing oral tobacco for tobacco harm reduction: what are the main obstacles?

With the number of smokers worldwide currently on the rise, the regular failure of smokers to give up their tobacco addiction, the direct role of smoke (and, to a much lesser extent, nicotine) in most tobacco-related diseases, and the availability of less toxic (but still addictive) oral tobacco products, the use of oral tobacco in lieu of smoking for tobacco harm reduction (HR) merits assessment. Instead of focusing on the activity itself, HR focuses on the risks related to the activity. Currently, tobacco HR is controversial, generally not discussed, and consequently, poorly evaluated. In this paper, we try to pinpoint some of the main reasons for this lack of interest or reluctance to carry out or fund this type of research. In this paper we deal with the following issues: the status of nicotine in society, the reluctance of the mainstream anti-tobacco lobby toward the HR approach, the absence of smokers from the debate, the lack of information disseminated to the general population and politicians, the need to protect young people, the role of physicians, the future of HR research, and the role of tobacco companies.

Guidelines on smoking management during the perioperative period.

Smoking is a public health problem of particular importance during the perioperative period, since it exposes patients scheduled for surgery to risk increases of 20% in hospital mortality and 40% in major postoperative complications. In addition, current smoking increases almost all specific surgical complications. The perioperative period offers a genuine opportunity for smoking cessation. The rate of preoperative smoking cessation can be increased significantly by offering behavior management and the prescription of a nicotine substitute before any scheduled surgical intervention. Preoperative smoking cessation should be routinely recommended independently of the timing of the intervention, even though the benefits increase in proportion with the length of cessation. All professionals of the care pathway (general practitioners, surgeons, anesthetists-intensivists, caregivers) must inform smokers of the positive effects of smoking cessation and offer them dedicated management and personalized follow-up. In children, cessation of parental smoking or removal of the child from environmental tobacco smoke as long before surgery as possible is indispensable.

Would alternate tobacco products use be better than smoking?

Tobacco use is dominated by cigarette smoking. Most toxicity due to cigarette smoking is related to the burning process. Several observations suggest that unburned or oral tobacco is less harmful than cigarette smoking. Up to now, physicians have advised a policy based on two ideas: (i) young people should not start smoking and (ii) the only choice for smokers is to quit. However, numerous smokers cannot or do not want to give up; eventually, one out of two lifelong smokers will die from smoke-related diseases. Thus, it is legitimate to ask if alternate nicotine containing product use would be better than cigarette smoking and limit the tobacco death toll. However, the logic leading to the concept of tobacco harm reduction (THR) turns out to be much more complex than it looks at a first glance.