Case for investment in tobacco cessation: a population-based analysis in low- and middle-income countries.

This study aimed to estimate the return on investments of three population-level tobacco cessation strategies and three pharmacological interventions. The analysis included 124 low- and middle-income countries, and assumed a 10-year investment period (2021-2030). The results indicate that all six cessation programmes could help about 152 million tobacco users quit and save 2.7 million lives during 2021-2030. If quitters were followed until 65 years of age, 16 million lives could be saved from quitting. The combined investment cost was estimated at 1.68 United States dollars (US$) per capita a year, or US$ 115 billion over the period 2021-2030, with Caribbean countries showing the lowest investment cost at US$ 0.50 per capita a year. Return on investments was estimated at 0.79 (at the end of 2030) and 7.50 if benefits were assessed by the time quitters reach the age of 65 years. Disaggregated results by country income level and region also showed a return on investments less than 1.0 in the short term and greater than 1.0 in the medium-to-long term. In all countries, population-level interventions were less expensive and yielded a return on investments greater than 1.0 in the short and long term, with investment cost estimated at US$ 0.21 per capita a year, or US$ 14.3 billion over 2021-2030. Pharmacological interventions were more expensive and became cost beneficial over a longer time. These results are likely conservative and provide support for a phased approach implementing population-level strategies first, where most countries would reach break-even before 2030.

Este estudio tenía como objetivo estimar el rendimiento de la inversión de tres estrategias para el abandono del tabaco dirigidas a la población y de tres intervenciones farmacológicas. El análisis incluyó a 124 países de ingreso bajo y mediano y consideró que el período de inversión era de 10 años (2021-2030). Los resultados muestran que los seis programas sobre el abandono del tabaco podrían ayudar a unos 152 millones de personas a dejar el tabaco y salvar 2,7 millones de vidas en el período 2021-2030. Si se siguiera a las personas que dejan el tabaco hasta que cumpliesen 65 años, el número de vidas que se podrían salvar sería de 16 millones. Se estimó que el costo combinado de la inversión era de 1,68 dólares estadounidenses (US$) per cápita al año, o US$ 115 billones durante el período 2021-2030, y que el costo de inversión más bajo se encontraba en los países del Caribe (US$ 0,50 per cápita al año). Se estimó que el rendimiento de la inversión era de 0,79 (a finales de 2030) y de 7,50 si se tenían en cuenta los beneficios que obtienen las personas que dejan el tabaco hasta que alcanzan los 65 años. Los resultados desglosados por nivel de ingresos de los países y región también mostraron que el rendimiento de la inversión era inferior a 1,0 a corto plazo y superior a 1,0 de mediano a largo plazo. En todos los países, las intervenciones dirigidas a la población fueron menos costosas y produjeron un rendimiento de la inversión superior a 1,0 a corto y largo plazo, con un costo de las inversiones estimado en US$ 0,21 per cápita al año, o US$ 14,3 billones durante el período 2021-2030. Las intervenciones farmacológicas fueron más costosas y solo fueron generaron beneficios en función de los costos a más largo plazo. Probablemente son unos resultados prudentes, pero sirven de base para adoptar un enfoque gradual en la aplicación de estrategias dirigidas a la población primero donde la mayoría de los países alcanzarían el punto de equilibrio antes del 2030.

Este estudo teve como objetivo estimar o retorno dos investimentos de três estratégias de cessação do tabagismo no nível populacional e de três intervenções farmacológicas. A análise incluiu 124 países de baixa e média renda e presumiu um período de investimento de 10 anos (2021-2030). Os resultados indicam que todos os seis programas de cessação poderiam ajudar cerca de 152 milhões de usuários de tabaco a parar de fumar e salvar 2,7 milhões de vidas entre 2021 e 2030. Se houvesse acompanhamento até os 65 anos de idade daqueles que parassem de fumar, 16 milhões de vidas poderiam ser salvas. O custo de investimento combinado foi estimado em 1,68 dólares americanos (US$) per capita por ano, ou US$ 115 bilhões no período 2021-2030, com os países do Caribe apresentando o menor custo de investimento, a US$ 0,50 per capita por ano. O retorno dos investimentos foi estimado em 0,79 (no fim de 2030) e 7,50 se os benefícios fossem avaliados até o momento em que aqueles que pararam de fumar chegassem aos 65 anos de idade. Os resultados desagregados por nível de renda nacional e por região também mostraram um retorno dos investimentos inferior a 1,0 no curto prazo e superior a 1,0 no médio e longo prazos. Em todos os países, as intervenções no nível populacional foram menos caras e renderam um retorno dos investimentos superior a 1,0 no curto e longo prazos, com um custo de investimento estimado em US$ 0,21 per capita por ano, ou US$ 14,3 bilhões entre 2021 e 2030. As intervenções farmacológicas foram mais caras e tiveram um bom custo-benefício durante um período mais longo. Estes resultados são provavelmente conservadores e servem de apoio para uma abordagem em fases que implemente primeiramente estratégias no nível populacional, onde a maioria dos países atingiria o ponto de equilíbrio antes de 2030.

Case for investment in tobacco cessation: a population-based analysis in low- and middle-income countries / Argumentos a favor de la inversión en iniciativas para el abandono del tabaco: un análisis basado en la población en países de ingreso bajo y mediano / Análise de viabilidade de investimento na cessação do tabagismo: um estudo populacional em países de baixa e média renda

ABSTRACT This study aimed to estimate the return on investments of three population-level tobacco cessation strategies and three pharmacological interventions. The analysis included 124 low- and middle-income countries, and assumed a 10-year investment period (2021-2030). The results indicate that all six cessation programmes could help about 152 million tobacco users quit and save 2.7 million lives during 2021-2030. If quitters were followed until 65 years of age, 16 million lives could be saved from quitting. The combined investment cost was estimated at 1.68 United States dollars (US$) per capita a year, or US$ 115 billion over the period 2021-2030, with Caribbean countries showing the lowest investment cost at US$ 0.50 per capita a year. Return on investments was estimated at 0.79 (at the end of 2030) and 7.50 if benefits were assessed by the time quitters reach the age of 65 years. Disaggregated results by country income level and region also showed a return on investments less than 1.0 in the short term and greater than 1.0 in the medium-to-long term. In all countries, population-level interventions were less expensive and yielded a return on investments greater than 1.0 in the short and long term, with investment cost estimated at US$ 0.21 per capita a year, or US$ 14.3 billion over 2021-2030. Pharmacological interventions were more expensive and became cost beneficial over a longer time. These results are likely conservative and provide support for a phased approach implementing population-level strategies first, where most countries would reach break-even before 2030.

RESUMEN Este estudio tenía como objetivo estimar el rendimiento de la inversión de tres estrategias para el abandono del tabaco dirigidas a la población y de tres intervenciones farmacológicas. El análisis incluyó a 124 países de ingreso bajo y mediano y consideró que el período de inversión era de 10 años (2021-2030). Los resultados muestran que los seis programas sobre el abandono del tabaco podrían ayudar a unos 152 millones de personas a dejar el tabaco y salvar 2,7 millones de vidas en el período 2021-2030. Si se siguiera a las personas que dejan el tabaco hasta que cumpliesen 65 años, el número de vidas que se podrían salvar sería de 16 millones. Se estimó que el costo combinado de la inversión era de 1,68 dólares estadounidenses (US$) per cápita al año, o US$ 115 billones durante el período 2021-2030, y que el costo de inversión más bajo se encontraba en los países del Caribe (US$ 0,50 per cápita al año). Se estimó que el rendimiento de la inversión era de 0,79 (a finales de 2030) y de 7,50 si se tenían en cuenta los beneficios que obtienen las personas que dejan el tabaco hasta que alcanzan los 65 años. Los resultados desglosados por nivel de ingresos de los países y región también mostraron que el rendimiento de la inversión era inferior a 1,0 a corto plazo y superior a 1,0 de mediano a largo plazo. En todos los países, las intervenciones dirigidas a la población fueron menos costosas y produjeron un rendimiento de la inversión superior a 1,0 a corto y largo plazo, con un costo de las inversiones estimado en US$ 0,21 per cápita al año, o US$ 14,3 billones durante el período 2021-2030. Las intervenciones farmacológicas fueron más costosas y solo fueron generaron beneficios en función de los costos a más largo plazo. Probablemente son unos resultados prudentes, pero sirven de base para adoptar un enfoque gradual en la aplicación de estrategias dirigidas a la población primero donde la mayoría de los países alcanzarían el punto de equilibrio antes del 2030.

RESUMO Este estudo teve como objetivo estimar o retorno dos investimentos de três estratégias de cessação do tabagismo no nível populacional e de três intervenções farmacológicas. A análise incluiu 124 países de baixa e média renda e presumiu um período de investimento de 10 anos (2021-2030). Os resultados indicam que todos os seis programas de cessação poderiam ajudar cerca de 152 milhões de usuários de tabaco a parar de fumar e salvar 2,7 milhões de vidas entre 2021 e 2030. Se houvesse acompanhamento até os 65 anos de idade daqueles que parassem de fumar, 16 milhões de vidas poderiam ser salvas. O custo de investimento combinado foi estimado em 1,68 dólares americanos (US$) per capita por ano, ou US$ 115 bilhões no período 2021-2030, com os países do Caribe apresentando o menor custo de investimento, a US$ 0,50 per capita por ano. O retorno dos investimentos foi estimado em 0,79 (no fim de 2030) e 7,50 se os benefícios fossem avaliados até o momento em que aqueles que pararam de fumar chegassem aos 65 anos de idade. Os resultados desagregados por nível de renda nacional e por região também mostraram um retorno dos investimentos inferior a 1,0 no curto prazo e superior a 1,0 no médio e longo prazos. Em todos os países, as intervenções no nível populacional foram menos caras e renderam um retorno dos investimentos superior a 1,0 no curto e longo prazos, com um custo de investimento estimado em US$ 0,21 per capita por ano, ou US$ 14,3 bilhões entre 2021 e 2030. As intervenções farmacológicas foram mais caras e tiveram um bom custo-benefício durante um período mais longo. Estes resultados são provavelmente conservadores e servem de apoio para uma abordagem em fases que implemente primeiramente estratégias no nível populacional, onde a maioria dos países atingiria o ponto de equilíbrio antes de 2030.

Smoking cessation services in the Eastern Mediterranean Region: highlights and findings from the WHO Report on the Global Tobacco Epidemic 2019.

The report aimed to review and assess the status of tobacco cessation services in the Eastern Mediterranean Region (EMR). Nearly 70% of people in the Region have legal access to nicotine-replacement therapy but for 77% of these people the costs of the treatment are not covered. Bupropion and Varenicline are legally available in 10 and 11 EMR countries respectively. Just under 50% of people in the Region have access to at least some cessation support in primary health care facilities. Around 32% of people have access to a national toll-free quit line. Costs for cessation services are fully covered in few EMR countries; however, cessation services in the Region must be improved. Member States should aim to increase the availability of, and financial support for, cessation treatments and support, which should be prioritized in primary health care facilities.

The WHO-ERS Smoking Cessation Training Project: the first year of experience.

Strategic @ERSTalk-@WHO alliance to address tobacco use by training health professionals on brief advice resulted in establishing smoking cessation in real care settings with quit rates higher than the literature and high propensity for wider dissemination http://ow.ly/lWDF30krq5V.

Effectiveness of using group visit model to support diabetes patient self-management in rural communities of Shanghai: a randomized controlled trial.

BACKGROUND: Diabetes has become a major public health problem in China. Support of patient self-management is a key component of effective diabetes care and improved patient outcomes. A series of peer-led community-based disease-specific self-management programs including diabetes have been widely disseminated in urban communities of Shanghai since 1999. However, the strategy of using trained lay leaders to support patient self-management faces challenges in rural communities in Shanghai. This study developed a Chinese diabetes group visit program as an alternative approach to support patient self-management and examined its effectiveness on self-management behaviors, self-efficacy and health status for patients with type 2 diabetes in rural communities of Shanghai. METHODS: 208 patients with type 2 diabetes aged 35-80 years were randomly assigned to the intervention group (n=119) of 12 monthly group visit sessions or to a control group (n=89) of usual care. The trial was undertaken in two rural communities in Shanghai, China. Randomization and allocation to study group were carried out by using a random number table. Analysis of covariance was used to compare changes in the 17 self-management behavior, self-efficacy and health status related variables in two groups at 12 months' follow-up based on 176 patients (n=98; n=78). RESULTS: Compared with controls, the intervention patients, on average, increased their duration of aerobic exercise by more than 40 minutes per week (p=0.001); had significant increase of 0.71 in mean score on self-efficacy to manage diabetes (p=0.02); and had significant improvements in measures of illness intrusiveness and systolic blood pressure. The intervention patients attended an average of 10.1 of the 12 program sessions with 75.6% of them attended 10 and more sessions. CONCLUSION: The Chinese diabetes group visit model is a feasible, acceptable and effective alternative for supporting diabetes patient self-management in Chinese rural communities. The model requires larger studies to determine its effect on blood glucose control and health care utilization. TRIAL REGISTRATION: ISRCTN87909028.

[Discussion on necessity of introduction of qualitative research into clinical research of traditional Chinese medicine].

Currently, the model of the research evaluation system of traditional Chinese medicine (TCM) is set up through imitating that of western medicine. The application of quantitative research to TCM does promote the advance of modernization of TCM, which explore the part of TCM that can be measured in quantitative method. However, TCM has a background of profound philosophy and culture. The priority of TCM can not be expressed through quantitative research alone. On the contrary, qualitative research is more suitable to most research area of TCM. In TCM clinical research, the priority of TCM should be fully explored. It is very significant to set up the effectiveness evaluation system of TCM, especially by applying qualitative research to the diagnosis and the evaluation of treatment results and combining quantitative research.

Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of the Shanghai Chronic Disease Self-Management Program (CDSMP). METHODS: A randomized controlled trial with six-month follow-up compared patients who received treatment with those who did not receive treatment (waiting-list controls) in five urban communities in Shanghai, China. Participants in the treatment group received education from a lay-led CDSMP course and one copy of a help book immediately; those in the control group received the same education and book six months later. FINDINGS: In total, 954 volunteer patients with a medical record that confirmed a diagnosis of hypertension, heart disease, chronic lung disease, arthritis, stroke, or diabetes who lived in communities were assigned randomly to treatment (n = 526) and control (n = 428) groups. Overall, 430 (81.7%) and 349 (81.5%) patients in the treatment and control groups completed the six-month study. Patients who received treatment had significant improvements in weekly minutes of aerobic exercise, practice of cognitive symptom management, self-efficacy to manage own symptoms, and self-efficacy to manage own disease in general compared with controls. They also had significant improvements in eight indices of health status and, on average, fewer hospitalizations. CONCLUSION: When implemented in Shanghai, the CDSMP was acceptable culturally to Chinese patients. The programme improved participants' health behaviour, self-efficacy, and health status and reduced the number of hospitalizations six months after the course. The locally based delivery model was integrated into the routine of community government organizations and community health services. Chinese lay leaders taught the CDSMP courses as successfully as professionals.

[Study on the prevalence of arthritis and relevant factors in Shanghai].

OBJECTIVE: This study aimed to understand the prevalence rate, epidemiological characteristics and relevant factors of arthritis in Shanghai. METHODS: A sample of 7 575 residents aged 15 years and above was drawn from 6 communities under multiple stage cluster sampling. A household survey with questionnaire was carried out to differentiate both undiagnosed patients and those with definite arthritis. Those who had not been diagnosed before were asked to carry further clinical examinations by a rheumatologist. RESULTS: The prevalence rate of arthritis was 6.11%, including osteoarthritis (OA) 4.18%, rheumatoid arthritis (RA) 0.52%, gout 0.28%, ankylosing spondylitis (AS) 0.28%, rheumatic arthritis 0.49% and other types arthritis 0.82%. Arthritis was significantly related to cardiovascular disease, pulmonary disease and gastrointestinal disease. Age, female and obesity might serve as risk factors for arthritis. Physical labors and living in rural area might have protecting effects. CONCLUSION: Elderly and female seemed to be at high risk for arthritis. Weight control and more exercise should be encouraged to reduce the risks. For arthritis patients, treatment to other chronic diseases should not be ignored.