[Quitting Attempts and Utilisation of Smoking Cessation Aids among Smokers in Germany: Results from the 2012 Epidemiological Survey of Substance Abuse]. / Ausstiegsversuche und Hilfsmittelnutzung unter Rauchern in Deutschland: Ergebnisse aus dem Epidemiologischen Suchtsurvey 2012.

Aim: This study presents current data on smoking cessation and usage of smoking cessation aids among smokers in a representative sample of German smokers. Data of 2012 will be compared with data of the year 2000. Methods: The sample of the 2012 Epidemiological Survey of Substance Abuse (ESA) was randomly drawn from population registers and consisted of 9 084 individuals aged 18-64 years. A mixed-mode design including questionnaires, telephone and Internet interviews was applied. The response rate was 53,6%. Number of smoking cessation attempts and usage of smoking cessation aids were assessed among actual and former smokers. Results: Of the 4 261 persons who had smoked in their lifetime 54,1% are actual and 45,9% former smokers. Among actual smokers 64,5% have tried to quit smoking at least once; 24,3% within the last 12 months. Quit attempts were mostly undertaken without formal help (53,7%). Users of smoking cessation aids report that they used social support (22,6%), self-help material (13,3%), nicotine replacement products (11,3%) and E-cigarettes (8,4%). Conclusions: Compared to the year 2000 the number of former smokers has increased. While the number of smoking cessation attempts among smokers is unchanged, more smokers use smoking cessation aids. Using E-cigarettes for smoking cessation is becoming more important.

[Psychotherapy and pharmacotherapy for harmful tobacco use and tobacco dependency]. / Psycho- und Pharmakotherapie bei schädlichem Tabakgebrauch und -abhängigkeit.

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

[Use of medication in combination with a modern group programme for smoking cessation]. / Anwendung von Medikamenten in Kombination mit einem modernen Gruppenprogramm zur Tabakentwöhnung.

This study examined the acceptance, use and -adherence with regard to stop-smoking medication in addition to a smoking cessation programme. In a multi-centre field study with quasi-experimental control group design, the participants of a smoking cessation programme were asked about their smoking behaviour at the beginning and at the end of the course. A sample of 1 319 participants was contacted via telephone one year after the end of the course. Among the 1 052 participants, who could be interviewed, 312 subjects (29.7%) reported to have used stop-smoking medication while 85.2% of the medication users preferred nicotine replacement therapy. The objective medication adherence was 13.2%. 79.3% of the medication users believed that they had used the medication adherently. There were no significant differences between participants who started use of medication and non-users (long-term abstinence rate: no medication 34.6% vs. medication 31.7%; p=0.34). The outcome of a modern smoking cessation group programme could not be improved by providing additional stop-smoking medication. This finding and the lack of medication adherence raise doubts about the effectiveness of offering stop-smoking medication in addition to an intensive cognitive-behavioural-based smoking cessation programme that focusses on behavioural changes.

[Smoking cessation in rehabilitation centres: outcome and predictors of participation]. / Tabakentwöhnung in Rehabilitationskliniken: Outcome und Prädiktoren der Teilnahme.

OBJECTIVE: The focus of investigation in this study were the characteristics of participants and non-participants in a modern smoking cessation programme for inpatient rehabilitation centres as well as the effects of the programme on participants' smoking behavior. METHODS: Smoking patients (N=313) from 10 Bavarian rehabilitation centres including 203 participants and 110 non-participants of a newly implemented group programme were asked about socio-demographics, smoking behaviour and willingness to change both at the beginning and at the end of their inpatient stay. RESULTS: Univariate analyses showed there to be no difference between participants and non-participants with regard to socio-demographics and smoking behaviour. Multivariate analyses detected a higher intention to quit smoking, the stage of contemplation, and the marital status "single" to be significant predictors of participation. 42.6% of participants stopped smoking during their stay, 18.2% were abstinent until the time of discharge. These rates are significantly lower among non-participants (stop: 16.9%; abstinence 1.8%). CONCLUSION: Participation in a smoking cessation programme essentially depends on a smoker's motivation to quit. The investigated programme can provide useful support for smokers willing to quit.

[Evaluation of a none sequential smoking cessation programme in rehabilitation centres]. / Überprüfung eines nicht sequenziell aufgebauten Tabakentwöhnungsprogramms in Rehabilitationskliniken.

AIMS: The present study aims at developing and evaluating a non-sequential smoking cessa-ti-on programme for in-patient rehabilitation centres. The new programme challenges the standard phased approach with the stages motivation, quit day, stabilisation. METHODS: A prospective multi-centre study is conducted with quasi experimental control group design. The newly developed smoking cessation programme (intervention group, IG) is compared against the treatment-as-usual (control group, CG) of participating rehabilitation centres. Data from 850 smokers in 19 in-patient rehabilitation centres are analysed. RESULTS: The process evaluation of the non-sequential programme shows good acceptance among trainers and patients and easy implementation in the rehabilitation setting. Abstinence rates at the end of treatment are comparable for the IG (19.1%) and the CG (17.9%). The amount of cigarettes smoked among remaining smokers also reduced to a comparable degree in both groups. Patients in the IG showed significant improvement with regard to stages of change and self-efficacy. CONCLUSIONS: The non-sequential smoking cessation programme is accepted and can be implemented in an in-patient rehabilitation setting. With regard to major outcome criteria, the programme is comparable to treatment-as-usual. Secondary outcome criteria and satisfaction ratings favour the new programme. Due to a low-threshold access to smoking cessation, the non-sequential approach offers a structural advantage.

Smoking cessation in groups--who benefits in the long term?

The 'Rauchfrei Programm' is the most widespread cognitive behavioral group program for smoking cessation in Germany. The aim of this study was to evaluate smoking cessation in the routine care setting and to investigate whether certain characteristics predict long-term abstinence. The study is a longitudinal field study with a one group pre-post-follow-up design. Participants were 1319 smokers, who were asked to complete questionnaires before and after the program. Twelve months later, participants were followed-up by phone. 48.1% of participants attended every session. At the end of the program, 60.9% of the participants were smoke-free. After one year, the abstinence rate accounted for 31.8% (Intention-to-treat). A logistic regression analysis showed that male gender, higher age, being married, lower level of nicotine dependence as well as adherence to the program significantly increased the likelihood of abstinence, whereas education and employment did not. No significant influence of self-payment on the rates of abstinence was observed. It is concluded that the modern smoking cessation program is highly recommendable as it achieves sufficient abstinence rates in a real-life setting. However, it still remains a challenge to increase adherence rates and to achieve comparable success rates in smokers with different characteristics.

The situation of sanitary systems in rural areas in the Miyun catchment, China.

The Miyun Reservoir provides most of Beijing's drinking water. Despite its importance, the Miyun reservoir suffers from decreasing water quality caused by uncontrolled wastewater discharges, inadequate land use and over fertilization, which increase the pressure on soil and water resources. The major pollutants are nitrogen and phosphorus which emanate to some extent from untreated sewage. So far there is little data about the existing wastewater quantity and quality in rural settlements in northern China. This study was conducted in typical villages situated along upstream rivers in the catchment of the Miyun Reservoir. The main objective was to determine the current situation and efficiency of the wastewater treatment system in rural settlements.

[Psychopathology and psychotherapy of borderline personality disorder: state of the art]. / Psychopathologie und Psychotherapie der Borderline-Persönlichkeitsstörung: Zum gegenwärtigen Stand der Forschung.

With a lifetime prevalence of about 3%, borderline personality disorder is a frequent and often debilitating psychiatric disorder, especially during adolescence. Most features of typical borderline pathology can be classified into three dimensions: disturbed affect regulation, identity disturbance and problems in social interaction. Within the last decade several treatment programs have been tailored to the specific needs of borderline therapy and three of them have meanwhile shown empirically proven evidence: dialectical behavior therapy (DBT), mentalization-based therapy (MBT) and schema therapy. Although the studies showed clear superiority of specifically designed treatment programs compared to non-structured standard care, implementation of these programs in the German health care system is far from sufficient. Only one out of every thousand patients suffering from borderline personality disorder receives evidence-based outpatient psychotherapy. This is mirrored by the annual costs for inpatient treatment extending to 4 billion Euros, which is approximately 20% of the total costs for psychiatric care in Germany.

[Smoking cessation therapies in Germany]. / Tabakentwöhnungsmassnahmen in Deutschland.

Reducing the consumption of tobacco products in Germany is a health objective that is achievable with smoking cessation treatments for smokers. This objective turns out to be more successful when using different interventions for smoking cessation than with self-initiated smoking cessation methods. This survey describes the range of smoking cessation treatments in Germany and evaluates them on the basis of international guidelines.

[Assessing the health target "Reduce tobacco consumption"]. / Evaluation des Gesundheitsziels "Tabakkonsum reduzieren".

The consortium gesundheitsziele.de has defined health targets and actions to reduce tobacco consumption of the general population. Five primary fields of action were defined: (1) tax increase, (2) ban of advertisements, (3) protection against second-hand smoking, (SHS) (4) support of smoking cessation, and (5) actions to avoid taking up smoking. The achievements in recent years are described by means of epidemiological studies and other specific data. (1) Tax increases led to a significant rise of cigarette prices. (2) A complete ban of advertisements has not yet been achieved. The tobacco industry shifted expenditures to fields where advertising is still allowed. (3) Many actions to foster protection against SHS could be implemented. Public awareness has been raised, the acceptance of smoking bans has grown, and exposure to SHS has been reduced. (4) Demand and supply of smoking cessation interventions have been enhanced. (5) Actions to avoid taking up smoking seem to be successful as the rate of smokers among young people has decreased, the number of never-smokers has increased, and a more critical attitude of non-smokers towards smoking could be observed. It is recommended that the above actions be continued because the capabilities of the structural, mass media, and behavioral interventions have not been fully exhausted.

Nitric acid trihydrate (NAT) in polar stratospheric clouds.

A comprehensive investigation of polar stratospheric clouds was performed on 25 January 2000 with instruments onboard a balloon gondola flown from Kiruna, Sweden. Cloud layers were repeatedly encountered at altitudes between 20 and 24 kilometers over a wide range of atmospheric temperatures (185 to 197 kelvin). Particle composition analysis showed that a large fraction of the cloud layers was composed of nitric acid trihydrate (NAT) particles, containing water and nitric acid at a molar ratio of 3:1; this confirmed that these long-sought solid crystals exist well above ice formation temperatures. The presence of NAT particles enhances the potential for chlorine activation with subsequent ozone destruction in polar regions, particularly in early and late winter.

[Proportion of smokers, stages of preparedness to change and utilisation of a smoking cessation intervention in mother-child rehabilitation]. / Anteil von Raucherinnen, Stadien der Veränderungsbereitschaft und Inanspruchnahme von Tabakentwöhnung in der Mutter-Kind-Rehabilitation.

BACKGROUND: Smoking mothers put their own health as well as that of their children at risk. Mother-child inpatient rehabilitation centres can be a suitable setting for reaching this target group and providing support for smoking cessation. AIM: The aim of the study is to describe for the first time the smoking prevalence and motivation to change of patients in German mother-child inpatient rehabilitation centres and to investigate the actual utilisation of an offered smoking cessation programme. METHOD: In a cross-sectional field study with a consecutive sample from 22 mother-child inpatient rehabilitation centres (N=4329 mothers) smoking prevalence, stage of preparedness to change according to the transtheoretical model and consideration to seek help for cessation were assessed via a questionnaire. In addition, the number of smokers who can be reached by the offer of a quit-smoking programme was assessed by means of reports of the course instructors. RESULTS: 29.2% of patients in mother-child rehabilitation are smokers. Compared to the female general population, a higher proportion of the women were in an advanced stage of preparedness to change (19.4% are in preparation) and the majority of smokers are willing to seek help to quit smoking. 37.6% of smoking mothers participated in the offered smoking cessation intervention. CONCLUSION: There is a high proportion of smokers and a high readiness to change in German mother-child rehabilitation centres. The actual participation rate in an offered smoking cessation programme is quite remarkable, but nevertheless has to be enhanced further. One possible approach is measures to enhance smoking mothers' motivation to quit.

Elemental analysis of airborne particulates in Chile.

Aerosol samples collected in three characteristic Chilean cities-including urban and remote zones-have been analyzed by the PIXE spectroscopic technique. Elemental composition, total suspended particulate matter (TSP), particle size distribution, and the peculiar geographic and meteorological parameters have been included in this study. Santiago--the polluted capital of Chile--registered high TSP indexes and important amounts of hazardous elements in air such as S, V, Cr, Zn, Br and Pb. The atmosphere of Antofagasta city showed marine and mineral activity influence. Results from Chillán city are similar to those from rural environments. Protons and deuterons-provided by the isochronous cyclotron of the University of Chile-were used to excite X-ray radiation from the sample. Signals were processed by an energy dispersive detection system, including a cryogenic Si(Li) detector, electronic for pulse amplification and an analog to digital converter. The absolute elemental concentration of the particulate matter in air was obtained through a fundamental parameter equation. Samples consist of particulate material collected directly on Nuclepore filters or deposited over Kapton foils. Typical elements analyzed were Mg, Al, Si, S, Cl, K, Ca, Ti, V, Cr, Mn, Fe, Cu, Zn, As, Br and Pb.

[Effectiveness of telephone aftercare following a smoking cessation program for women on inpatient rehabilitation]. / Wirksamkeit telefonischer Nachsorge im Anschluss an ein Tabakentwöhnungsprogramm für Frauen in stationärer Rehabilitation.

BACKGROUND AND AIMS: Rehabilitation centres for mothers are a suitable setting to offer smoking cessation treatment to these women. Telephone aftercare could enhance the effectiveness of an inpatient smoking cessation program. We investigated whether non-directive, supportive aftercare or a structured, smoking specific counselling give more benefit. PATIENTS AND METHOD: 527 smoking mothers participated in a smoking cessation program during their stay in a prevention/rehabilitation centre. Afterwards they were randomly assigned to one of three aftercare conditions: no aftercare (control group), structured telephone aftercare or non-directive telephone aftercare. At the end of the inpatient program and 6 months later the smoking status of the participants was assessed. RESULTS: The structured telephone aftercare resulted in the highest abstinence rates after 6 months (31.5%; odds ratio 2.0; confidence interval: 1.1 - 3.8). The non-directive telephone counselling had no significant effect on abstinence rates. CONCLUSIONS: A structured telephone aftercare proves to be an effective intervention for women, which stabilizes the abstinence rate following a clinic based smoking cessation program.

[Evaluation of the health target "tobacco control"]. / Evaluation des Gesundheitsziels "Tabakkonsum reduzieren".

UNLABELLED: "Tobacco control" is one of six health targets of the forum gesundheitsziele.de (health targets). Key stakeholders from health policy and from the health system are involved in the process of defining and deciding about health targets. The goal of gesundheitsziele.de is the improvement of the health of the population through integrated action. Goals are supplemented with recommendations for intervention measures, and indicators to mea sure whether goals had been achieved. The evaluation board of gesundheitsziele.de is committed to assess the availability and appropriateness of German data bases for the evaluation of the health target "tobacco control", and to submit a concept for the evaluation. In particular, the German health monitoring system, and the evaluation and quality assurance of the Federal Center for Health Education provide a good data base for the evaluation of the health target. Lack of data exists regarding outcome and impact evaluation of structural (policy, legal) interventions. RECOMMENDATIONS: Evaluation of health targets requires continuing conduction of representative population surveys. The evaluation of national intervention campaigns and the extension of the topic "tobacco control" within the German health report system are necessary. The collection and documentation of information about intervention measures, programs, and evaluation results is recommended. The evaluation board favors follow-up studies, and the coordination of existing data resources; the creation of new evaluation systems is not required.

[Smoking cessation during treatment of alcohol dependence in drug and alcohol rehabilitation centres--a review]. / Tabakentwöhnung bei Personen mit einer Alkoholabhängigkeit im Setting der Suchtrehabilitation--Ein Uberblick.

PURPOSE: Review of the international literature on smoking cessation with smokers having a concurrent alcohol abuse disorder. The three aims are: 1. discussion of the pros and cons of concurrent smoking cessation and treatment of alcohol use disorder, 2. smoking cessation strategies and 3. description of national and international studies evaluating smoking cessation interventions with patients who are at the same time treated for their alcohol abuse disorder. METHOD: The results are collected on the basis of an extensive literature research in PsychInfo, Science Direct and Medicine. RESULTS: Considering the pros and cons, it can be concluded that smoking cessation should be offered to this subgroup of high risk smokers. The open question is which kind of interventions are effective. Intervention strategies should consist of a multi-level approach including structural as well as person-specific components. Evaluation studies show that a 12% abstinence rate at one year follow-up can be achieved in case of an intensive intervention in combination with a restrictive tobacco policy. Alcohol abstinence is not jeopardised by a concurrent smoking cessation, when smoking cessation is voluntary. CONCLUSIONS: On the basis of empiric research the common arguments against smoking cessation within the subgroup of alcohol-addicted smokers cannot be maintained on the basis of empiric research. Rehabilitation centres treating substance abuse disorders provide an excellent setting for the treatment of nicotine dependence. Interventions should include structural as well as subgroup-specific components.

Atrial natriuretic peptide during and after maximal and submaximal exercise under normoxic and hypoxic conditions.

The present study was designed to investigate the influence of exercise intensity and duration as well as of inspiratory oxygen content on plasma atrial natriuretic peptide concentration [( ANP]) and furthermore to compare ANP with the effect on aldosterone concentration [( Aldo]). Ten untrained male subjects performed a maximal exercise test (ME) on a cycle ergometer and a submaximal test of 60-min duration at 60% of maximal performance (SE) under normoxia (N) and normobaric hypoxia (H) (partial pressure of oxygen: 12.3 kPa). Five subjects were exposed to hypoxia at rest for 90 min. The [ANP] was mostly affected by exercise intensity (5 min after ME-N, +298.1%, SEM 39.1%) and less by exercise duration (at the end of SE-N: +229.5%, SEM 33.2%). Hypoxia had no effect at rest and reduced the exercise response (ME-H, +184.3%, SEM 27.2%; SE-H, +172.4%, SEM 15.7%). In contrast to ANP, the Aldo response was affected more by duration at submaximal level (+290.1%, SEM 34.0%) than by short maximal exercise (+235.7%, SEM 22.2%). Exposure to hypoxia rapidly decreased [Aldo] (-28.5%, SEM 3.7% after 30 min, P less than 0.01), but did not influence the exercise effects (ME-H, +206.2%, SEM 26.4%; SE-H, +321.6%, SEM 51.6%). The [ANP] increase was faster than that of [Aldo] during the maximal tests and there was no difference during submaximal exercise. Changes in plasma volume (PV), sodium concentration, and osmolality (Osm) were most pronounced during maximal exercise (for ME-N: PV -13.1%, SD 3.6%, sodium +6.2 mmol.l-1, SD 2.7, Osm +18.4 mosmol.kg H2O-1, SD 6.5). Regression analysis showed high correlations between changes in [ANP] and in Osm during and after maximal exercise and between changes in [ANP] and heart rate for submaximal exercise. It is concluded that besides other mechanisms increased Osm might be involved in the exercise-dependent increase of plasma [ANP].