[Smoking cessation during pregnancy]. / Sevrage tabagique au cours de la grossesse.

Smoking during pregnancy is associated with negative pregnancy and perinatal health outcomes. Physiological and societal particularities can modify the smoking behavior of pregnant women. Pregnancy is a teachable moment for smoking cessation. Increased nicotine clearance may lead to exacerbated tobacco withdrawal symptoms and desire to smoke, which need to be taken into account when helping pregnant smokers to quit. Although most pregnant smokers try to quit on their own, 12% of pregnant women in France reported smoking in 2021 during the 3rd trimester of pregnancy. Health care professionals should screen for tobacco consumption and assess the level of addiction. Management of smoking cessation can be multidisciplinary, including non-pharmacological support such as counselling, behavioral support, financial reward contingent on abstinence, and medication (nicotine replacement therapies). Assessment and limitation of secondhand smoke exposure (SHS) is needed because SHS can also have negative maternal and fetal consequences. Management of relapse during the postpartum period is also to be anticipated; in 2021, it concerned 22.4% of women who had stopped smoking during pregnancy. While electronic cigarette use is increasing overall and among pregnant women who smoke (5.4 before pregnancy, 1.3% during the 3rd trimester in 2021), well-conducted smoking cessation studies are necessary to assess its benefits and potential risks in this specific group of smokers.

Heat Waves: A Bibliometric Analysis of Thermotherapy Research.

This bibliometric study analyzes the evolving field of thermotherapy, a medical treatment that utilizes heat to treat various conditions, including cancer, by applying controlled temperatures to targeted tissues. Utilizing bibliographic data from the core collection of Web of Science and analysis software Biblioshiny and VOSviewer, we analyzed several key metrics to gain insights into the development and trends in thermotherapy research. The annual scientific production revealed a significant increase in publications over the past two decades, reflecting growing interest in this field. Analysis of the most relevant authors and sources highlighted key contributors and influential journals. Trend topics demonstrated a shift from early focus areas like hyperthermia and laser-induced thermotherapy to recent advancements involving nanoparticles and combination therapies. The thematic map provided insights into core, emerging, and niche areas within the research landscape. A historiograph traced the chronological development of significant publications, while the co-occurrence of keywords and bibliographic coupling of documents identified major themes and interconnections in the literature. International collaborations were mapped, showing the global nature of thermotherapy research. The study identified several research gaps, including the need for large-scale clinical trials, interdisciplinary approaches, and standardized treatment protocols. Practical implications suggest focusing on targeted delivery systems, expanding cancer research, and fostering collaborative projects to advance the field.

Smoking and smoking cessation in pregnancy. Synthesis of a systematic review.

OBJECTIVES: To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy and the post-partum period. STUDY DESIGN: A systematic review of the international literature was undertaken between January 2003 and April 2019. MEDLINE, EMBASE databases and the Cochrane library were searched for a range of predefined key words. All relevant reports in English and French were classified according to their level of evidence ranging from 1(highest) to 4(lowest). The strength of each recommendation was classified according to the Haute Autorité de Santé (French National Authority for Health) ranging from A (highest) to C (lowest). RESULTS: "Counselling", including all types of non-pharmacological interventions, has a moderate benefit on smoking cessation, birth weight and prematurity. The systematic use of measuring expired air CO concentration does not influence smoking abstinence, however, it may be useful in assessing smoked tobacco exposure prior to and after quitting. The use of self-help therapies and health education are recommended in helping pregnant smokers quit and should be advised by healthcare professionals. Nicotine replacement therapies (NRT) may be prescribed to pregnant women who have failed to stop smoking after trying non-pharmacological interventions. Different modes of delivery and dosages can be used in optimizing their efficacy. Smoking in the postpartum period is essential to consider. The same treatment options as during pregnancy can be used. CONCLUSION: Smoking during pregnancy concerns more than a hundred thousand women each year in France resulting in a major public health burden. Healthcare professionals should be mobilised to employ a range of methods to reduce or even eradicate it.

[What Policy for the Management of Smoking During Pregnancy? - CNGOF-SFT Expert Report and Guidelines on the management for Smoking Management During Pregnancy]. / Quelle politique de prise en charge du tabagisme pendant la grossesse ? ­ Rapport d'experts et recommandations CNGOF-SFT sur la prise en charge du tabagisme en cours de grossesse.

Smoking during pregnancy is a public health problem. Individual screening is carried out in France during pregnancy consultations, followed by non-systemic care (with or without nicotine replacement therapy). In the UK, pregnant smokers are routinely screened during pregnancy follow-up and then referred to smoking cessation services. In order to improve their adherence, and smoking cessation, patients can be contacted, in particular by phone. We therefore recommend to systematically screen for smoking during pregnancy by asking the question of smoking or by measuring the CO exhaled during the various consultations, to offer care in collaboration with a local smoking cessation service and renew the requests if necessary. We need to develop these care networks in France.

[CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy-Short Text]. / Rapport d'experts et recommandations CNGOF-SFT sur la prise en charge du tabagisme en cours de grossesse­texte court.

OBJECTIVES: To provide up-to-date evidence-based guidelines for the management of smoking cessation during pregnancy. METHODS: Systematic review of the international literature. We identified papers published between January 2003 and April 2019 in Cochrane PubMed, and Embase databases with predefined keywords. All reports published in French and English relevant to the areas of focus were included and classified according the level of evidence ranging from 1 (highest) to 4 (lowest). The strength of the recommendations was classified according to the Haute Autorité de santé, France (ranging from A, highest to C, lowest). RESULTS: "Counseling", involving globally all kind of non-pharmacological interventions, has a modest benefit on smoking cessation, birth weight and prematurity. Moderate physical activity did not show a significant effect on smoking cessation. The systematic use of feedback by measuring the expired air carbon monoxide concentration do not influence smoking abstinence but it may be used in establishing a therapeutic alliance. The use of self-help interventions and health education are recommended in helping pregnant smokers quit. The prescription of nicotine replacement therapies (NRT) may be offered to any pregnant woman who has failed stopping smoking without medication This prescription can be initiated by the health care professional taking care of the pregnant woman in early pregnancy. There is no scientific evidence to propose the electronic cigarette for smoking cessation to pregnant smokers; it is recommended to provide the same advice and to use methods that have already been evaluated. The use of waterpipe (shisha/narghile) during pregnancy is associated with decreased fetal growth. It is recommended not to use waterpipe during pregnancy. Breastfeeding is possible in smokers, but less often initiated by them. Although its benefit for the child's development is not demonstrated to date, breastfeeding allows the mother to reduce or stop smoking. The risk of postpartum relapse is high (up to 82% at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. CONCLUSIONS: Smoking during pregnancy concerns more than hundred thousand women and their children per year in France. It is a major public health burden. Health care professionals should be mobilized for reducing or even eradicating it.

[Maternal smoking during pregnancy: A risk factor for respiratory disorders in children]. / Tabagisme maternel pendant la grossesse : un facteur de risque des troubles respiratoires de l'enfant après la naissance.

Maternal smoking during pregnancy (MSDP) is a well-established risk factor for negative pregnancy outcomes, but its negative effects on the health of the child after birth are less well known by both health professionals and the general public. Large cohort studies over the past 10 years have shown that MSDP is an independent risk factor for several childhood health problems such as e.g. obesity and smoking. A large number of recent studies and 3 meta-analyses demonstrate that MSDP is an independent risk factor of wheezing and asthma of the child exposed in utero to maternal smoking. MSDP is associated with epigenetic toxicities the currently most plausible hypothesis to explain the diversity of its postnatal negative effects. The eradication of MSDP could contribute to the reduction of health problems in the next generation, including the incidence of childhood respiratory disorders.

[Electronic cigarettes: A therapeutic tool, a social phenomenon or a business?]. / La cigarette électronique : outil thérapeutique, phénomène social ou business ?

Smoking is the first avoidable cause of morbidity and mortality. It is estimated that there were around 14 million smokers in France in 2012 and that smoking results in 70,000 deaths per year. All types of interventions reducing with efficacy the incidence and prevalence of smoking are to consider in prolonging life expectancy. Electronic cigarettes (e.cig.) are a social phenomenon but they also are a system delivering pharmacologically active substances; their use concerns today several millions of individuals in France. By this fact, it became important for clinical practitioners to acquire some knowledge about e. cig. Most of the e.cig. contains nicotine, thus, e.cig. are now called in the medical literature as electronic nicotine delivery system (ENDS). It is highly plausible that ENDS, which are, as of today, consumer products and not health products, deliver nicotine with a good bioavailability and could, if largely used, help to reduce smoking prevalence. However, because of current lack of regulations, as of today, the risk/benefit ratio of ENDS as an aid to help smokers quit and their adverse effect profile cannot be established. It is of public health responsibility to promote evidence based knowledge about e.cig. to know with confidence their risk/benefit ratio.

[Smoking, obesity and diabetes: a clinically important interaction]. / Tabagisme, obésité et diabète: une interaction cliniquement importante.

Smoking, obesity and diabetes are among the leading cause of premature death worldwide. Smokers have globally a lower body weight compared with non smokers but they tend to accumulate more fat in the abdomen. Most smokers gain weight when they quit smoking, however this does not seem to diminish the health benefits associated with smoking cessation. Smoking increases the risk of developing type 2 diabetes. Among people with diabetes, smoking significantly increases the risks of complications and mortality. Interventions with pharmacologic help should be offered to all smokers, with or without diabetes, in order to increase smoking cessation rates and limit weight gain.

[Nicotine replacement therapies during pregnancy: what do we know about the balance between benefits and risks?]. / Les traitements substitutifs nicotiniques pendant la grossesse: que sait-on du rapport bénéfice-risque?

Maternal smoking during pregnancy induces obstetrical and fetal complications but also has an impact on newborns, infants, children and adults. Nicotine replacement therapies are authorized during pregnancy in France, the purpose being to reduce fetal exposure to toxic compounds in tobacco smoke. However, it is not proven that nicotine replacement therapy is harmless to the fetus and to date, no study has demonstrated any beneficial effect in terms of abstinence. It is suggested that benefit and risks of nicotine replacement therapies during pregnancy should be evaluated.

Identification of factors associated with impaired hypoglycaemia awareness in patients with type 1 and type 2 diabetes mellitus.

OBJECTIVES: To assess clinical factors associated with impaired hypoglycaemia awareness (HA). METHODS: Survey of 241 type 1 and type 2 diabetic patients hospitalised in a diabetes department for a diabetes education program. Demographic, diabetes and psychiatric characteristics and subjective hypoglycaemic symptoms were recorded by a self-report questionnaire. RESULTS: Age and body mass index (BMI) was greater and glycated haemoglobin was lower in diabetic patients reporting impaired HA, however, these latter differences became not significant when age was included as a covariate. There were significantly more current smokers among those with impaired HA and controlling for age accentuated this difference. Current treatment by insulin was not associated with impaired HA. Backward stepwise logistic regression showed that type 2 diabetic patients were twice as likely to have impaired HA than type 1 diabetic patients (OR = 2.195, 95% CI: 1.017-4.734, P = 0.04). Moreover, higher age, current smoking and type 2 diabetes interacted significantly in increasing the likelihood of impaired HA. Among those with impaired HA more patients experienced drowsiness and nervousness and less patients reported tremor during the hypoglycaemic episodes. No other symptoms were associated with impaired HA. CONCLUSION: Type 2 diabetic patients, whether on insulin or not, and especially if they are of advanced age and if they smoke, are at increased risk of impaired HA.

Efficacy of bupropion and predictors of successful outcome in a sample of French smokers: a randomized placebo-controlled trial.

BACKGROUND: Previous published studies assessed the efficacy of bupropion in smoking cessation only in North American populations of smokers. Results of therapeutic drug trials are not always directly applicable in other populations. AIMS: To confirm the efficacy of bupropion in smoking cessation in European smokers. DESIGN: A multi-centre, randomized, double-blind placebo-controlled trial. SETTING: Seventy-four smoking cessation out-patient clinics in France. PARTICIPANTS: The study included 509 smokers motivated to quit smoking. Intervention Subjects were randomized to either slow-release bupropion 150 mg b.i.d. (B) or to placebo (Pl) in a 2 : 1 ratio, treated for 7 weeks, and followed-up for 26 weeks. MAIN OUTCOME MEASURE: 6 months' point prevalence abstinence, determined by self-report and expired air carbon monoxide measurement. SECONDARY OUTCOME MEASURES: weeks 4-7 and weeks 4-26 continuous abstinence rates, craving, withdrawal symptoms, weight and cigarette consumption in smokers unable to quit. Adverse events were recorded systematically. FINDINGS: Six months' point prevalence abstinence rates were 31% and 16%[odds ratio = 2.3, confidence interval (CI) 95%: 1.4-3.7] in the B and Pl groups, respectively. Continuous abstinence rates were 41% (B) and 21% (P) with OR = 2.5 (CI 95%: 1.6-3.9) for weeks 4-7, and 25% (B) and 13% (P) with OR = 2.2 (CI 95%: 1.3-3.6) for weeks 4-26, respectively. Craving decreased significantly more with B than with Pl during treatment period, but there was no difference for total withdrawal symptoms score. Abstinent subjects gained significantly less weight at week 7 with B than with Pl. Low level of nicotine dependence, high motivation, absence of smoking-related disease, long duration of previous quit attempts, male gender, low level of current alcohol problems and living as a couple were predictive of successful cessation. With the exception of marital status, no interaction was observed between any of these predictive factors and the efficacy of bupropion. More of those who continued smoking in the B group than the P group reduced their consumption by at least 50%. CONCLUSIONS: Sustained-release bupropion is efficacious as an aid to smoking cessation in European smokers. No outcome predictors were identified that might indicate that certain subgroups of smokers would benefit more than others from treatment with bupropion.

Correlates of expired air carbon monoxide: effect of ethnicity and relationship with saliva cotinine and nicotine.

AIMS: To assess the accuracy of expired air carbon monoxide (CO) measurement vs. saliva cotinine and nicotine and to estimate the degree of misclassifications of smoking status as a function of ethnicity. DESIGN AND MEASUREMENTS: Comparison for accuracy of expired air CO, saliva nicotine and cotinine in simultaneously collected specimens. SETTING: Outpatient clinic of a clinical research ward. PARTICIPANTS: 228 current African-American and Caucasian cigarette smokers. RESULTS: Expired-air CO concentration was significantly associated with saliva cotinine, but not with saliva nicotine. Saliva cotinine but not expired CO or saliva nicotine showed a significant between-ethnic difference when adjusted for number of cigarettes smoked and for time since last cigarette. Agreement between expired air CO and saliva cotinine was substantial at expired CO < or = 8 ppm but only moderate at < or = 10 ppm. False negative rates were twice as high at < or = 10 ppm than at < or = 8 ppm at each saliva cotinine cut-off tested. At saliva cotinine of < or = 15 ng/ml, more African-Americans were classified as false negative. CONCLUSIONS: Expired CO is strongly associated with saliva cotinine but not with saliva nicotine. Despite this association, misclassifications for no smoking are frequent if true classification is based on saliva cotinine. False negative results occur more frequently in African-Americans.

Monoamine oxidases and tobacco smoking.

Although nicotine has been identified as the main ingredient in tobacco responsible for aspects of the tobacco dependence syndrome, not all of the psychopharmacological effects of smoking can be explained by nicotine alone. Accumulating preclinical and clinical evidence has demonstrated that smoking also leads to potent inhibition of both types (A and B) of monoamine oxidase (MAO). Smokers have 30-40 % lower MAOB and 20-30 % lower MAOA activity than non-smokers. Reduced MAO activity in smokers has been shown by direct measures (platelets, positron emission tomographic studies) or by indirect measures (concentration of monoamine catabolites in plasma or CSF). We examine the hypothesis that chronic habitual smoking can be better understood in the context of two pharmacological factors: nicotine and reduced MAO activity. We speculate that MAO inhibition by compounds found in either tobacco or tobacco smoke can potentiate nicotine's effects. Based on this concept, more effective anti-smoking drug strategies may be developed. As a practical consequence of tobacco smoke's MAO-inhibitory properties, comparative psychiatric research studies need to screen and control for tobacco use.

Platelet monoamine oxidase B activity is inversely associated with plasma cotinine concentration.

Cigarette smoke but not nicotine inhibits irreversibly platelet monoamine oxidase B (MAO-B) activity. Current smokers have decreased platelet MAO-B activity which normalizes when smokers quit. Normalization of platelet MAO-B activity probably depends on platelet turnover. Platelet MAO-B activity has been found to be correlated with plasma thiocyanate concentration. The aim of this study was to investigate in smokers whether platelet MAO-B activity is related to plasma cotinine concentration, an indirect index of use of smoked tobacco. We determined simultaneously plasma cotinine concentration and platelet MAO-B activity in 85 cigarette smokers [mean (+/- SD) age 39 +/- 8.8 years, 55 men]. Platelet MAO-B activity was lower in male than in female smokers (14.1 +/- 7.9 versus 17.8 +/- 7.2 nmol/h/10(9) platelets, p = 0.03). Platelet MAO-B activity correlated positively with age (r = 0.26, p = 0.01) and inversely with plasma cotinine concentration (r = -0.32, p = 0.002) but not with number of cigarettes smoked or with Fagerström Tolerance Questionnaire score. Multiple linear regression analysis showed that 49% of the age-adjusted variance in platelet MAO-B activity (R2 = 0.489, p < 0.0001) was explained by plasma cotinine concentration (p < 0.001) and gender (p = 0.037). It was concluded that platelet MAO-B activity in smokers is inversely associated with plasma cotinine level, an index of smoked tobacco use. Further studies are needed to investigate whether measurement of platelet MAO-B activity can be used as a long-term index of tobacco use and smoke exposure.

Anal carcinoma: a 15-year retrospective analysis.

BACKGROUND: Using a 15-year experience in two teaching hospitals to illustrate the clinicopathologic, treatment and survival characteristics of cloacogenic and squamous cell carcinoma of the anus. METHOD: A retrospective analysis over a 15-year period from St Vincent's Hospital (SVH) and the Catholic Medical Center (CMC) in New York City. The patients in the study all had a diagnosis of either squamous or cloacogenic cell carcinoma of the anus. RESULTS: Cloacogenic and squamous cell carcinoma accounted for 2.5% of all large bowel cancers. In the population sample, 28/92 (30.4%) were of the cloacogenic type and 64/92 (69.6%) were of the squamous cell type. The male-to-female ratio was 1:1.5 in those with cloacogenic cancer and 1.8:1 in those with squamous cell carcinoma. The mean age of presentation was 57 +/- 2.8 years for the squamous cell carcinoma patients and 66.3 +/- 3.4 years in those with cloacogenic carcinoma (P < 0.02); 3/28 (10.7%) of patients with cloacogenic cancer were human immune deficiency virus (HIV) positive while 15/64 (23.4%) of the squamous cell cancer patients were HIV positive. The most common clinical presentation in both groups were rectal bleeding, pain, constipation and the presence of an anal mass. Of patients with squamous cell cancer 25% had evidence of infection with the human papilloma virus (HPV) while none of those with cloacogenic cancer had evidence of HPV infection (P < 0.0005). The treatment modality and survival were similar in both histologic groups. The most important factors that affect survival in both groups are female sex and stage of disease. CONCLUSION: Cloacogenic and squamous cell carcinoma account for only a small proportion of large bowel cancers. The squamous cell type is the more common type and presents at a younger age in both sexes. The squamous cell type is also more common in males and is associated with human papilloma and HIV infection. Treatment modality and survival is, however, similar in both histologic variants of anal cancer.

African-American teen smokers: issues to consider for cessation treatment.

Previous reports have indicated ethnic differences in both tobacco-related morbidity and treatment outcome for smoking cessation among adults. We assessed smoking-related characteristics in African-American and non-African American teenagers applying to a cessation trial. 115 teens (15.9 +/- 1.8 years, 68% females, 27% African-American) responded via telephone to media ads. Self-reported sociodemographic, medical and smoking-related data were obtained to determine pre-eligibility for a full intake screen prior to trial participation. Compared to non-African American, African American teen applicants were older (16.4 +/- 1.7 years versus 15.6 +/- 1.6; p = 0.015), had lower Fagerström Test for Nicotine Dependence (FTND) scores (5.3 +/- 2.3 versus 6.1 +/- 1.8; p = 0.018, ANOVA controlling for age) and smoked fewer cigarettes on the weekend (27 +/- 16 versus 38 +/- 17; p = 0.001). African American teens reported similar duration of smoking (3.3 +/- 1.4 versus 3.1 +/- 1.5 years) and time elapsed between first cigarette ever smoked and daily smoking (0.7 +/- 0.9 versus 0.6 +/- 0.7 years). African American and non-African American teens had similar motivation to quit scores and frequency of reported health problems (e.g., asthma, psychiatric conditions). These data suggest that cessation treatment programs designed for African American youth should include lower Fagerstrom-defined levels, and possibly other criteria for tobacco dependence. These observations also highlight the importance of ethnocultural issues in treatment research programs.