Nocturnal sleep-disturbing nicotine craving: a newly described symptom of extreme nicotine dependence.

In our research on smoking and nicotine dependence we have noticed a sleep disturbance, which is a further symptom of extreme nicotine dependence. We call this symptom "nocturnal sleep-disturbing nicotine craving" (NSDNC). NSDNC is characterised by craving for cigarettes during the individual sleep times. The smoker awakes (one or several times per week) during his regular sleep time, and has to smoke a cigarette before he/she continues sleeping. This symptom can be explained by the decreasing nicotine levels during the sleep time, which results in nicotine craving. However, NSDNC should be carefully separated from other sleep disturbances, or sleep disturbing events (nycturia, medication side effects), when nicotine craving is not the main reason for awakening.

[Primary prevention from the viewpoint of social medicine--examples of prevention projects]. / Primärprävention aus sozialmedizinischer Sicht--Beispiele für erfolgreiche Vorsorgeprojekte.

Life style factors play an essential role in etiology and prognosis of cardiovascular diseases; therefore, from a public health point of view, primary preventive measures are of especial importance. Health reports in the form of specific health reports (such as the Viennese Men's Health Report, the Lower Austrian Public Health Report) represent an important foundation for the matter of health promoting projects. In Austria, various preventive projects were suggested and successfully carried out because of these reports. Furthermore, the introduction of the WEBS organisation (scientific dietary counselling service) has shown that professional dietary counselling can indeed induce a change for the better in dietary behaviour and selection of foodstuffs. By the establishment of the first Austrian Institute for the Treatment of Tobacco and Nicotine Addiction (Nicotine Institute Vienna) not only is the diagnosis and treatment of tobacco addiction ensured, but it also provides information for the populace and those active in the health sector. These social public projects provide a valuable contribution to the prevention of cardiovascular diseases.

[Analysis of the needs for diagnosis and therapy of tobacco dependence in Austria]. / Diagnostik und Therapie der Tabakabhängigkeit--eine Analyse des Bedarfs in Osterreich.

In Austria we find 2.3 Mio. tobacco users (29% of the population). 1.3 Mio. are dissonant smokers, they want to stop (18%) or reduce (37%) tobacco consumption. The assumption that 10% of dissonant smokers (130,000 tobacco users) need a diagnosis and therapy leads to a bottleneck: 130,000 patients versus 20 therapists. Demanded consequences of this disproportion are training for health-care workers, implementation of diagnosis and treatment, financing and refunding. Diagnosis and therapy of tobacco dependence should be offered in highly specialised organisations such as the prototypical Nicotine Institute in Vienna, in hospitals and in primary health care.

[Early-summer meningo-encephalitis (ESME) and ESME-vaccination: status 2000]. / Frühsommer-Meningo-Enzephalitis (FSME) und FSME-Schutzimpfung: Status 2000.

Tick-borne encephalitis (TBE) is a public health problem very well under control in Austria because of a vaccination programme using a safe, efficient and well tolerated vaccine and a carefully designed social marketing concept. The Austrian vaccine underwent another technological updating and is now marketed under a new brand name (TicoVac) on the basis of an EU registration. A second product is also available (Encepur), but some limitations of use have to be taken into account. To improve the epidemiological situation even further (only 41 hospital cases in 1999) special attention has to be given to the age group 50 years and older as this is the segment of the population where the majority of cases is observed. TBE is a growing international health problem as awareness increases and cases are identified in many European countries, even in regions where TBE so far was not diagnosed. An "International Scientific Working-group on Tick-borne encephalitis (ISW-TBE)" was established to coordinate research and public health activities.

[Influenza pandemic: does Austria need an emergency plan?]. / Influenza-Pandemie: Braucht Osterreich einen Vorsorgeplan?

Even in present times and given the current state of medical science, an influenza pandemic may be expected to occur in addition to the usual annual epidemic of the disease. A pandemic is defined as a concentrated worldwide occurrence of a disease within a short period. Such a pandemic has been registered three times in this century. The influenza epidemic of 1918 to 1919 ("Spanish flu") killed 20 to 40 million people. A similar pandemic occurred in 1957 to 1958 (Hong Kong) and in 1968 (Asia). Although the current state of medicine is such that the high morbidity and mortality of 1918 is unlikely to recur, adequate preventive measures are warranted in health care as well as in social and political fields. In the event of such a pandemic, a large number of persons in Austria may be expected to be affected by the disease. In contrast to other countries, a detailed plan of prevention does not exist in Austria at the present time. A sudden influenza pandemic would give rise to a number of grave problems in the medical field (increase in mortality rates) as well as in social and political areas (maintaining the infrastructure of the country). In light of this fact it appears necessary to investigate the possibility of an influenza pandemic and to take suitable precautionary measures.

Comparison of anti-HBV activity of beta-D- and beta-L-DDA-5'monophosphate prodrugs and effectiveness in combination with lamivudine.

We have investigated the effects of several beta-D-ddA 5'-monophospate (beta-D-ddAMP), and their corresponding beta-L-enantiomers prodrugs against HBV replication. All ddAMP prodrugs inhibited HBV replication in a dose-dependent manner.

[Reduced smoking--a possible strategy for control of tobacco-associated illnesses?]. / Reduziertes Rauchen--eine mögliche Strategie zur Kontrolle tabakassoziierter Gesundheitsstörungen?

The aim of the publication is to discuss reduced smoking as a concept to control tobacco-related diseases. New scientific studies show that nicotine-replacement medications may be an untapped source in efforts to reduce smoking. This new indication for nicotine-replacement therapy was licensed for the first time in Denmark by the registration authority. Austrian data have shown that approximately 10 years after implementation, a 1% reduction in smoking could prevent 14 male cancers deaths each year. A 50% reduction could save 700 male lives. 100,000 lives (male and females) could be saved in the European Union annually by a reduction like this including other tobacco-related diseases. Even a 1% reduction would save 1,000 lives. These data are supplemented by the new hypothesis of longer induction time (of lung cancer): Even if this theory fails for the individual smoker, a remarkable gain in years of life will result for society if illness is a probability-based event. A new term of delayed and/or reduced incidence will be a result of this hypothesis. Nevertheless, primary abstinence will remain the most desirable goal in efforts to control tobacco-related diseases. However, most primary prevention campaigns failed, and it will take 30-40 years to translate primary prevention into major health benefits. Reduced smoking should be licensed as a valid method for those unwilling or unable to stop smoking.

Use of USPIO-induced magnetic susceptibility artifacts to identify sentinel lymph nodes and lymphatic drainage patterns. I. Dependence of artifact size with subcutaneous Combidex dose in rats.

Subcutaneously administered Combidex contrast agent produced characteristic magnetic susceptibility artifacts in gradient-echo (GE) images of rat brachial and axillary lymph nodes. These artifacts were useful in the rapid location and identification of normal sentinel lymph nodes. A linear dose response was observed with maximum artifact size in transverse images and was used noninvasively to study lymphatic drainage patterns.

[Vienna standard in diagnosis of nicotine dependence: Vienna Standard Smoking Inventory]. / Wiener Standard zur Diagnostik der Nikotinabhängigkeit: Wiener Standard Raucher-Inventar (WSR).

The Standard Vienna Smokers' Inventory (VSSI) ("Wiener Standard Raucher-Inventar" [WSR]) is based on the authors' experience and was designed to optimize primary and additional diagnostic procedures associated with smoking cessation treatment. The aim of this inventory is to enable therapists interested in smoking cessation interventions to initiate diagnostic procedures as well as to use efficient therapeutic modalities. The study also highlights those areas of the patient's history which should be given special attention and the theoretical background of these areas. The various comprehensive sections of the WSR include general data pertaining to the patient's life, the basic situation (basic rate), especially with regard to nicotine dependence, pre-abstinence syndrome and "tar" exposition values, follow-up of smoking habits, earlier attempts to give up smoking, and possible barriers to cessation of smoking--such as insufficient motivation, "nocturnal sleep disturbing nicotine craving" or carbohydrate dependence. Furthermore, previous illnesses, pre-existing risk factors and regular intake of drugs are also discussed. Finally, the study emphasizes that the WSR should be used by the therapist according to his/her level of training and experience, thus providing the possibility to use specific, individual approaches to deal with specific individuals and situations.

Measurement of expired carbon monoxide among medical students to assess smoking behaviour.

CO-Measurement of medical students was taken during a compulsory public health training at the University of Vienna. The students were not informed previously, so a non-response bias was excluded. Measurements were done with Bedfont EC50-MICRO Carbon monoxide monitor. The cut off point was set at 11 ppM. One hundred and seventy-three students were measured. Define indication of active smoking was found in 9%. With exception of one student all the others with carbon monoxide over 10 ppM called themselves active smokers. CO measurement will replace at some stage the usual question regarding the number of cigarettes consumed. Students also had the opportunity to learn a new diagnostic technique.

Alternative nicotine delivery systems (ANDS)--public health-aspects.

This paper deals with a relatively new category of pharmaceuticals, namely alternative nicotine delivery systems (ANDS). We do not refer to products like smokeless tobacco or other smoking devices. ANDS are designed to provide nicotine without the harmful substances contained in cigarette smoke. Several different nicotine replacement preparations exist, which are used in nicotine replacement therapy to obtain tobacco abstinence. There is a bulk of scientific literature on the clinical use of ANDS, but very little has been published on the public health aspects of the same. Nicotine dependence is associated with heavy consumption, tolerance, regulation of intake and withdrawal. We described a new symptom of extreme nicotine dependence, namely the nocturnal sleep disturbing nicotine craving (NSDNC), and developed a concept of a nicotine pre-abstinence syndrome (NPAS). Five nicotine replacement preparations are currently available: gum, patch, nasal spray, oral inhaler and sublingual tablet. As far as safety issues are concerned, scientific evidence shows that the use of ANDS involves almost no risk for consumers and patients, especially when compared with the consumption of tobacco products. New concepts developed by our group are the following: definition of possible endpoints of smoking control measures, reduced smoking, nicotine dependence and preventive oncology, chemoprevention of lung cancer by ANDS, public health impact by OTC availability of ANDS and the "let them choose approach" of ANDS focusing on the specific preferences and needs of the individual client. One may also speculate whether ANDS will, at some stage, replace cigarettes as the major source of nicotine for people who need this psychoactive drug.