Increasing prevalence of mental disorders in smokers seeking treatment of tobacco dependence: a retrospective observational study.

BACKGROUND: There has been a noticeable relative increase in psychiatric comorbidities among smokers as opposed to the general population. This is likely due to comparatively slower decrease in smoking prevalence among individuals with mental health conditions. This study aims to assess the prevalence trend of past or current mental health disorders in individuals seeking specialized smoking cessation assistance. METHODS: We conducted a retrospective single-centre observational study to assess the presence of mental disorders such as anxiety, depression, bipolar affective disorder, or schizophrenia in personal history of 6,546 smokers who sought treatment at the Centre for Treatment of Tobacco Dependence in Prague, Czech Republic between 2006 and 2019. The study examined the impact of gender, age, and the effect of successive years on the prevalence of the mental disorders using Poisson distribution regression. RESULTS: In the studied cohort, 1,743 patients (26.6%) reported having one or more mental disorders. Compared to patients without a psychiatric disorder, they exhibited similar levels of carbon monoxide in expired air (mean 17 ppm, SD 11 ppm) and scored one point higher on the Fagerström Test of Cigarette Dependence. Among smokers with a mental disorder, women were more prevalent (62%) than men (38%). The prevalence of mental disorders increased on average by 4% every year, rising from 23% in 2006 to 35% in 2019. CONCLUSIONS: Consistent with the observation that the prevalence of smoking among people with any mental disorder is higher and declining at a slower rate than in the general population, there is a steadily increasing percentage of these patients seeking specialized treatment over time. Professionals who offer tobacco dependence treatment should be aware of the upward trend in psychiatric disorders among smokers, as more intensive treatment may be needed. Similarly, psychiatric care should pay attention to smoking of their patients.

Smoking prevention that increases tax revenue: tobacco taxes in the Czech Republic 2004-2020.

OBJECTIVES: Increasing tobacco excise tax is one of the most effective smoking-prevention tools. The aim of the study is to assess the use of this tool in the Czech Republic (CR) by studying trends in cigarette taxes, prices, tax revenue, and the affordability of cigarettes in the CR. METHODS: Data on cigarette consumption, their tax rates, price, and tax revenue in the CR for 2004-2020 come from multiple sources. We used the consumer price index to convert nominal values to real values. Given an average daily consumption of 12.7 cigarettes per smoker, the affordability of cigarettes was measured as a percentage of the average monthly wage needed to buy 19 cigarette packs. RESULTS: Despite recent increases in excise taxes, cigarettes in the CR are becoming more affordable. We found that the affordability of cigarettes was greater in 2020 than in 2008. The values of both the specific and the minimum excise taxes are currently being eroded by inflation. Cigarette consumption has declined from 2015 to 2020, and the government still received a bit more excise tax revenue due to its earlier tax policy. However, if taxes are not increased further, the revenue will start to decline. CONCLUSIONS: Despite the trend of increasing tobacco taxes in the CR, both the affordability of cigarettes and their use are still high in the country. This means that the CR is not using tax policy effectively enough to reduce smoking prevalence. It needs a substantial and sudden tax increase, in addition to the currently planned tax increases, to reduce smoking prevalence and lower the burden of tobacco use in the economy. Such a move would not only improve public health in the CR, but also increase government revenue.

Minnesota Tobacco Withdrawal Scale revision 2020, validated Czech translation.

Most smokers are addicted to tobacco or nicotine not only psychosocially but also physically, what results in withdrawal symptoms after they miss their dose. These are one of the major barriers to quitting. In the treatment of tobacco dependence, the evaluation of the degree of withdrawal symptoms helps to guide psychobehavioral intervention and, above all, the choice of the type, dose, and duration of pharmacotherapy. The Minnesota Withdrawal Symptoms Scale is one of the most widely used for this purpose, revised in 2020. We present a validated translation of this update.

Relationship of Weight Concerns to Body Mass Index in a Tobacco Treatment Program.

Objectives: Our aim was to examine the relationship between weight concerns (WC) and smoking cessation. Methods: WC was assessed before smoking cessation treatment in 671 adult patients who completed a 12-month follow-up visit at the Centre for Tobacco-Dependent, Prague, Czech Republic, from 2013 through 2019. We evaluated the abstinence rate at 12-month follow-up. Results: Among 669 patients with baseline WC (mean age, 43.4 years), 47% were women (145/306) and 21% were men (78/363). No association existed between WC and abstinence at 12 months. Smokers with obesity had increased fear of gaining weight (34% versus 24% of overweight and 23% of healthy-weight smokers) (p=.034) and were less confident in their ability to maintain their current weight (36% versus 55% of overweight smokers and 59% of healthy- weight smokers) (p<.001). Conclusions: Many smokers are concerned about gaining weight after stopping smoking, but in this cohort of patients, having WC was not associated with 12-month abstinence, but obesity or overweight was related to being afraid of postcessation weight-gain and low confidence for maintaining weight. Practitioners should be aware of the prevalence of WC in those stopping smoking and should address concerns, such as poor motivation and low confidence about managing their weight.

Tobacco dependence treatment guidelines.

These recommendations are relevant for all clinical fields and all medical professions, although for some more and for some less. Smoking is the cause of every sixth death in the Czech Republic and is related to diseases of all organ systems. Effective treatment for the diagnosis of F17 exists and should be offered and available to approximately 2 million smokers in the Czech Republic as a standard part of medical and preventive care according to time availability - from brief intervention in frame of each clinical contact with the patient to intensive care. It includes psycho-socio-behavioral support and pharmacotherapy. It should cover all professions in clinical medicine - according to WHO recommendations, especially doctors, nurses, pharmacists and dentists and should be reimbursed within health systems. It should also be offered in other services like e.g., social or addictology care. From an economic point of view, it is one of the most cost-effective interventions in medicine.

SNPs within CHRNA5-A3-B4 and CYP2A6/B6, nicotine metabolite concentrations and nicotine dependence treatment success in smokers.

AIM: Plasma values of nicotine and its metabolites are highly variable, and this variability has a strong genetic influence. In our study, we analysed the impact of common polymorphisms associated with smoking on the plasma values of nicotine, nicotine metabolites and their ratios and investigated the potential effect of these polymorphisms and nicotine metabolite ratios on the successful treatment of tobacco dependence. METHODS: Five variants (rs16969968, rs6474412, rs578776, rs4105144 and rs3733829) were genotyped in a group of highly dependent adult smokers (n=103). All smokers underwent intensive treatment for tobacco dependence; 33 smokers were still abstinent at the 12-month follow-up. RESULTS: The rs4105144 (CYP2A6, P<0.005) and rs3733829 (EGLN2, P<0.05) variants were significantly associated with plasma concentrations of 3OH-cotinine and with 3OH-cotinine: cotinine ratios. Similarly, the unweighted gene score was a significant (P<0.05) predictor of both cotinine:nicotine and 3OH-cotinine:cotinine ratios. No associations between the analysed polymorphisms or nicotine metabolite ratios and nicotine abstinence rate were observed. CONCLUSION: Although CYP2A6 and EGLN2 polymorphisms were associated with nicotine metabolism ratios, neither these polymorphisms nor the ratios were associated with abstinence rates.

Comparison between success rates for smokers re-treated by a smokers' clinic and success rates for smokers treated for the first time.

AIMS: To compare success rates and characteristics of smokers treated a second time by a smokers' clinic with success rates of their first treatment. DESIGN: Retrospective cohort study. SETTING: Tobacco Dependence Treatment clinic in Prague, Czech Republic, between 2005 and 2017. PARTICIPANTS: A total of 5225 smokers treated either once (n = 5006, single treatment sample, SS) or also second time (n = 219, re-treated sample, RS), on average 4.47 years after the first visit. INTERVENTION: Smokers received intensive treatment of tobacco dependence with pharmacotherapy options. Outcomes were evaluated after 1 year. In case of failure or relapse, participants could undergo re-treatment in the same setting at least 1 year after the start of the first treatment. MEASUREMENTS: Twelve-month self-reported continuous abstinence; CO-validated (≤ 6 parts per million); number of visits; type of pharmacotherapy; mental health history; Fagerström Test for Cigarette Dependence; time between first and second treatment. RESULTS: The abstinence rate in the SS was 34.8% [95% confidence interval (CI) = 33.4%, 36.1%] and in the RS was 37% (95% CI = 30.6%, 43.8%) and 39.7% (95% CI = 33.2%, 45.5%) for their first and second treatments, respectively. The samples were comparable on smoking and socio-demographic characteristics and pharmacotherapy used, but the RS in the second treatment had a higher prevalence of diagnosed mental health disorder at 39.3% (95% CI = 32.8%; 46.1%) compared with 23.7% (95% CI = 22.5%; 24.9%) in the SS. Participants who initiated their second quit attempt 1 to 2 years after the first one were less successful than those who initiated their second quit attempt later (25 versus 43%; P < 0.05). The results of the first treatment cycle were not found to be a reliable predictor for outcomes of the second cycle of treatment in univariate or multivariate logistic regression (odds ratio = 1.35, 95% CI = 0.70-2.63, P = 0.373). CONCLUSION: In Prague, Czech Republic, smokers re-attending stop-smoking treatment more than 2 years after their previous quit attempt appear to achieve similar success rates to those being treated for the first time.

Tobacco dependence treatment in the Czech Republic: history, presence, and future.

The tobacco dependence treatment has a relative short history. It has become available in various intensity within our healthcare in the last more than two decades. The Society for the Treatment of Tobacco Dependence in cooperation with the Czech Medical Chamber initiated the establishment of Tobacco Dependence Treatment Centers, managing their database (N = 43) on its website (www.slzt.cz), as well as a directory of outpatient doctors providing this treatment (N = 214), and consulting pharmacies (N ~ 150). On this website, there are also mobile apps for quitting smoking in Czech, the national quit line, addictology clinics dealing with tobacco dependence (N = 3), a link to published treatment recommendations and other information. All doctors, nurses and other healthcare professionals routinely should apply brief intervention lasting at least tens of seconds, and also other diverse forms of assistance should be available from leaflets to intensive treatment. We also focus on the necessary future direction of this field of medicine.

A narrative review of facilitators and barriers to smoking cessation and tobacco-dependence treatment in patients with tuberculosis in low- and middle-income countries.

INTRODUCTION: Smoking is a substantial cause of premature death in patients with tuberculosis (TB), particularly in low- and middle-income countries (LMICs) with high TB prevalence. The importance of incorporating smoking cessation and tobacco-dependence treatment (TDT) into TB care is highlighted in the most recent TB care guidelines. Our objective is to identify the likely key facilitators of and barriers to smoking cessation for patients with TB in LMICs. METHODS: A systematic search of studies with English-language abstracts published between January 2000 and May 2019 was undertaken in the EMBASE, MEDLINE, EBSCO, ProQuest, Cochrane and Web of Science databases. Data extraction was followed by study-quality assessment and a descriptive and narrative synthesis of findings. RESULTS: Out of 267 potentially eligible articles, 36 satisfied the inclusion criteria. Methodological quality of non-randomized studies was variable; low risk of bias was assessed in most randomized controlled studies. Identified facilitators included brief, repeated interventions, personalized behavioural counselling, offer of pharmacotherapy, smoke-free homes and a reasonable awareness of smoking-associated risks. Barriers included craving for a cigarette, low level of education, unemployment, easy access to tobacco in the hospital setting, lack of knowledge about quit strategies, and limited space and privacy at the clinics. Findings show that the risk of smoking relapse could be reduced through consistent follow-up upon completion of TB therapy and receiving a disease-specific smoking cessation message. CONCLUSIONS: Raising awareness of smoking-related health risks in patients with TB and implementing guideline-recommended standardized TDT within national TB programmes could increase smoking cessation rates in this high-risk population.

FCTC implementation: the role of state or non-government organizations? An example of the Czech Republic.

OBJECTIVES: Smoking is the leading cause of premature mortality and morbidity. The aim of this study was to provide the first national description of organizational capacity and involvement in tobacco control (TC) measures outlined by the WHO Framework Convention on Tobacco Control (FCTC) within the Czech Republic. METHODS: Data were collected in a national cross-sectional survey of all 14 organizations engaged in TC activities within the Czech Republic. Organizational capacity (defined as skills, supports, partnerships, resources, and leadership) to implement TC activities, and level of involvement in key FCTC measures were assessed and compared across organizations. RESULTS: Despite the high economic costs of tobacco use, few organizations were involved in TC activities. 50% of all organizations involved in TC activities were non-government or non-profit organizations. Less than one third of organizations reported having a sufficient number of staff or adequate funding to work effectively. Skills for chronic disease prevention (CDP) practice including assessment, identifying relevant practices, developing and implementing initiatives were rated more favourably than skills to evaluate these activities. Level of involvement was ranked highest for activities that focused on creation of smoke-free environments and lowest for activities that focused on raising taxes and sales to minors. Organizations tended to be more involved in individual, rather than population-level prevention strategies. Inadequate funding, insufficient number of staff dedicated to working on TC, and lack of political will were major barriers. CONCLUSIONS: This paper provides the first national description of organizational capacity and level of involvement in FCTC measures within the Czech Republic.

Early weight gain after stopping smoking: a predictor of overall large weight gain? A single-site retrospective cohort study.

OBJECTIVES: Most people gain weight on stopping smoking but the extent of weight gain varies greatly. Interventions aimed at all quitters to prevent weight gain on cessation have proven unpopular but targeting people who have gained excess weight immediately after quitting may improve uptake and cost-effectiveness. We examined whether early large postcessation weight gain predicts overall large weight gain. DESIGN: Retrospective cohort study. SETTING: Primary care setting-smoking cessation centre in Prague, Czech Republic. PARTICIPANTS: Out of 3537 patients treated between 2005 and 2013, 1050 were continuous abstainers (verified by carbon monoxide measurement) at 1-year follow-up and formed the cohort of the current report. 48.7% were women (n=511) with the mean age of 46 (±14.4) years. METHODS: In this retrospective cohort study, all patients underwent usual tobacco dependence treatment using evidence-based methods. Weight was measured prior to smoking cessation and at each visit after quitting. RESULTS: The mean weight gain in the first month (n=763) was 0.79% (±2.03%), in the second month (n=646) was 1.49% (±2.58%), for the third month (n=566) 2.33% (±3.44%) and 4.1% (±5.31%) after 1-year follow-up (n=1050). The regression coefficient per 1% rise in the first 3 months was +0.13% (95% CI -0.04% to 0.30%). A receiver operating curve analysis showed that patients gaining more than 0.98% of their baseline weight during first 3 months had a sensitivity of 66% and specificity of 44% for gaining 7% or more weight by 12 months. In addition, lower body mass index and an increase in appetite at 3 months after quitting were associated with greater weight gain, while using nicotine replacement therapy was associated with less weight gain at 1-year follow-up. CONCLUSIONS: People who stop smoking and gain a larger amount of weight early after quitting are not more likely to gain excessively at 1 year.

Treatment of tobacco dependence as a standard part of oncology care.

After the oncological diagnosis, smoking has a major impact on survival, course and effectiveness of oncology treatment, and quality of the further life. Smoking worsens surgery outcomes, reduces the effectiveness of radiation therapy and chemotherapy, increases the risk of side effects of oncology treatment, and increases the incidence of tumor duplication or other comorbidities like venous thrombosis, cardiovascular diseases or infections. The article contains a summary of practical recommendations for oncology patients, including smoke-free environments, the importance of zero exposure to tobacco smoke, clear advice to stop smoking to smokers and offer of tobacco dependence treatment. Except of brief intervention within few tens of seconds up to 10 minutes, intensive treatment should be available, for example in special tobacco-dependence centers. In the documentation smoking status should be recorded including exposure to passive smoking, interventions to smokers (both active and passive) should be empathically repeated. The motivation to treat tobacco dependence should be mainly related to their specific oncological diagnosis, prognosis, course and effectiveness of its treatment. Treatment of tobacco dependence should be an obvious part of quality oncological care by doctors and nurses in intensity according to their time availability. Keywords: tobacco smoking, smoking cessation, nicotine dependence, chemotherapy, pharmacological interactions, adverse effects, cancer.

Protocol for the mixed-methods process and context evaluation of the TB & Tobacco randomised controlled trial in Bangladesh and Pakistan: a hybrid effectiveness-implementation study.

INTRODUCTION: Tuberculosis (TB) remains a significant public health problem in South Asia. Tobacco use increases the risks of TB infection and TB progression. The TB& Tobacco placebo-controlled randomised trial aims to (1) assess the effectiveness of the tobacco cessation medication cytisine versus placebo when combined with behavioural support and (2) implement tobacco cessation medication and behavioural support as part of general TB care in Bangladesh and Pakistan. This paper summarises the process and context evaluation protocol embedded in the effectiveness-implementation hybrid design. METHODS AND ANALYSIS: We are conducting a mixed-methods process and context evaluation informed by an intervention logic model that draws on the UK Medical Research Council's Process Evaluation Guidance. Our approach includes quantitative and qualitative data collection on context, recruitment, reach, dose delivered, dose received and fidelity. Quantitative data include patient characteristics, reach of recruitment among eligible patients, routine trial data on dose delivered and dose received, and a COM-B ('capability', 'opportunity', 'motivation' and 'behaviour') questionnaire filled in by participating health workers. Qualitative data include semistructured interviews with TB health workers and patients, and with policy-makers at district and central levels in each country. Interviews will be analysed using the framework approach. The behavioural intervention delivery is audio recorded and assessed using a predefined fidelity coding index based on behavioural change technique taxonomy. ETHICS AND DISSEMINATION: The study complies with the guidelines of the Declaration of Helsinki. Ethics approval for the study and process evaluation was granted by the University of Leeds (qualitative components), University of York (trial data and fidelity assessment), Bangladesh Medical Research Council and Bangladesh Drug Administration (trial data and qualitative components) and Pakistan Medical Research Council (trial data and qualitative components). Results of this research will be disseminated through reports to stakeholders and peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: ISRCTN43811467; Pre-results.

Fecal zonulin is elevated in Crohn's disease and in cigarette smokers.

OBJECTIVES: Human zonulin is a protein that increases permeability in the epithelial layer of the small intestine by reversibly modulating the intercellular tight junctions. There is not sufficient information available about zonulin's participation in inflammatory bowel diseases (IBD). The aim of this study was therefore to investigate fecal and serum zonulin in IBD patients and its relation to the disease localization, behavior and smoking status. DESIGN AND METHODS: Forty IBD patients and forty healthy persons were examined for fecal and serum zonulin concentrations by competitive ELISA (DRG International Inc). Values were correlated to IBD type, localization and behavior, and smoking. RESULTS: Serum and fecal zonulin were significantly higher in patients with Crohn's disease compared to ulcerative colitis (p = 0.038 for fecal zonulin, and p = 0.041 for serum zonulin concentrations). No association of serum or fecal zonulin was found with respect to IBD localization and behavior. The only difference was found with respect to smoking. Both the IBD cohort and healthy smokers showed significantly higher fecal zonulin levels (median 203 ng/mL) compared to non-smokers (median 35.8 ng/mL), p < 0.001. CONCLUSIONS: Fecal and serum zonulin levels are elevated in patients with active Crohn's disease but not with ulcerative colitis. High fecal zonulin levels in smokers irrespective of IBD point to the significant and undesirable up-regulation of gut permeability in cigarette smokers.

Treatment of Tobacco Dependence, a Critical Gap in Czech Clinical Practice Guidelines.

OBJECTIVE: Tobacco related comorbidities and treatment of dependence are relevant to clinicians of all disciplines. Clinicians should provide a brief intervention about tobacco use with smokers at each clinical contact (success rate of 5-10 %). Intensive treatment (success rate >30%) should be available to those who need it. Brief intervention is not yet standard clinical practice. Our aim was to assess clinical practice guidelines (CPG) of selected medical professional societies to determine whether or not tobacco dependence treatment recommendations were included. METHODS: Between October and December 2013, we conducted a keyword search of CPG for 20 medical professional societies in the Czech Republic. We searched for the keywords "smoking", "tobacco" and "nicotine addiction" in 91 CPG documents, which were freely available on the websites of selected professional societies. We focused specifically on CPG relating to cardiovascular and respiratory diseases as well as cancer. We excluded any CPG focused on acute conditions, diagnostics only, laboratory methods, or administration. RESULTS: There was no mention of smoking in 27.7% (26/94) of CPG documents. Only 16% (15/94) of CPG documents listed smoking as a risk factor. 42.5% (40/94) mentioned smoking related phrases (e.g. "smoking ban"). Only 13.8% (13/94) of CPG included a section on tobacco dependence, referenced tobacco dependence treatment guidelines or mentioned specialized treatment centres where smokers can be referred. CONCLUSION: Nearly one third of CPG related to cardiovascular and respiratory diseases as well as cancer made no mention of smoking. Despite the clinical significance of smoking, the majority of CPG did not adequately address tobacco dependence and its treatment.

[Centers for tobacco-dependent in the Czech Republic in 2016]. / Centra pro závislé na tabáku v CR v roce 2016.

This article sums up the evaluation of the intensive specialized treatment of tobacco dependence in the Czech Republic according to international guidelines and the ratified Framework Convention on Tobacco Control of the World Health Organization. 36 centers (100 %) were evaluated in 2016 and compared with the same survey from 2012.Most of the centers (24 of 36) are based at pulmonary clinics, opening hours for the smokers are on average 7 hours/week (0.5-40.0, SD ± 9, median 4). Average number of new patients is 55/year per center (2-449, SD ± 77.26, median 32). Follow-up period is 12 months in 27 centers, 6-12 months in 2 centers, 6 months in 4 centers, and 3 months in 4 centers. The average number of visits per year is 5 (2-11, SD ± 2.03, median 4.5). The baseline visit takes on average 67 minutes (66.81 in the range of 25180 minutes, SD ± 32.24, median 60), follow-up visits 24 minutes (23.86 minutes in the range of 12-45, SD ± 7.7, median 20). Nicotine replacement therapy is indicated in most centers (33), varenicline in all of them except of one, and bupropion in 16 centers. Lack of personal and time possibilities is considered the most frequent barriers of broader activity.In the future, working conditions should be more supported in those centers so that this needed, effective and highly cost-effective treatment could be more available to smokers.

Weight Concerns Associated With Delay in Quit Date But Not Treatment Outcomes: A Czech Republic Experience.

BACKGROUND: Weight concerns are prevalent in smokers and may reduce the success rate of quitting. This concept has been primarily studied on US populations and it is unknown how weight concerns may differ cross-culturally. This study examined the role of weight concern in European smokers wishing to stop smoking. METHODS: A sample of 593 smokers (299 men and 294 women, mean age 38 years) utilizing the Centre for Tobacco-Dependent in Prague, Czech Republic, between 2010 and 2013 were studied. Weight concerns were assessed at baseline prior to treatment by evidence-based stop smoking methods. Abstinence was evaluated at 12 months post baseline. RESULTS: Approximately 34% of all patients (204/593) were classified as weight concerned (by indicating on the Weight Concern Scale that they would return to smoking after any weight gain) at the time they sought treatment. Among all men, 19.4% (58/299) were weight concerned and among all women, 49.7% (146/294) were weight concerned. Among females, weight-concerned smokers were of similar weight, but younger (p < .001), and had been smoking cigarettes for fewer years (p = .002) compared with those without weight concerns, whereas the male weight-concerned smokers were significantly (p = .030) heavier than those without weight concerns. Although the presence of weight concern was associated with a delay in setting a quit date (log-rank test p = .019), it was not associated with abstinence at one year. CONCLUSION: The quit success rate of weight-concerned smokers in Czech Republic did not differ from those without weight concern when utilizing an individualized smoking cessation treatment program. Individually tailored tobacco dependence treatment could help to prevent weight concern from affecting successful quitting. IMPLICATIONS: This study adds the new cross-cultural aspect of post-cessation weight concern. Weight concern has been studied primarily on US populations and our sample consists of European sample of smokers. Additionally, we have found that the presence of weight concern lead to delay in setting a quit date, but the success rate of those weight concerned did not differ from those without weight concern. Thus, it is possible, that this individualized evidence-based tobacco treatment program was able to prevent weight concern impact towards successful quitting.

Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up.

BACKGROUND: Smoking is more prevalent among people with depression. Depression may make cessation more difficult and cessation may affect depression symptoms. PURPOSE: The aims of this study were to assess the associations between (1) baseline depression and 1-year smoking abstinence and (2) abstinence and change in depression. METHODS: Observational study using data collected routinely in a smoking cessation clinic in the Czech Republic from 2008 to 2014. Aim 1: N = 3775 patients; 14.3% reported mild and 15.4% moderate/severe baseline depression levels measured using Beck's Depression Inventory (BDI-II). Logistic regressions assessed if depression level predicted 1-year biochemically verified abstinence while adjusting for patient and treatment characteristics. Aim 2: N = 835 patients abstinent at 1 year; change in depression was analysed using Chi-square statistics, t test and mixed method analyses of variance. RESULTS: Rate of abstinence was lower for patients with mild (32.5%, OR = 0.68; 95% CI: 0.54 to 0.87, p = 0.002) and moderate/severe depression (25.8%; OR = 0.57, 95% CI: 0.45 to 0.74, p < 0.001) compared with patients without depression (40.5%). Across abstinent patients, the majority with baseline depression reported lower depression levels at follow-up. Overall mean (SD) BDI-II scores improved from 9.2 (8.6) to 5.3 (6.1); t(834) = 14.6, p < 0.001. There were significant main effects of time (F(1832) = 880.8, p < 0.001, partial η2 = 0.51) and baseline depression level (F(2832) = 666.4, p < 0.001, partial η2 = 0.62) on follow-up depression and a significant depression * time interaction (F(2832) = 296.5, p < 0.001, partial η2 = 0.42). CONCLUSIONS: In this effective smoking cessation clinic, depression at the start of treatment predicted reduced smoking abstinence 1 year later. Patients abstinent from smoking experienced considerable improvement in depression.

[Tobacco dependence treatment guidelines]. / Doporucení pro lécbu závislosti na tabáku.

Tobacco dependence causes every sixth death in the Czech Republic and is associated with diseases of the whole body. Treatment of tobacco dependence should be a standard part of clinical care to the extent of time available--from brief intervention at each clinical contact with patients up to intensive treatment. It includes psycho-socio-behavioural support and pharmacotherapy. It should apply to all professions in clinical medicine--as recommended by WHO mainly doctors, nurses, pharmacists and dentists, and should be covered within health care systems. Economically, it is one of the most cost-effective interventions in medicine. In our population over 15 years about 30% smokes (about 2.2 million people), diagnosis F17 relates to approximately 1.75 million people (about 80% of smokers).

[Centres for Tobacco-Dependent in the Czech Republic in 2012: overview and economy]. / Centra pro závislé na tabáku v Ceské republice v roce 2012: prehled, ekonomika.

BACKGROUND: Since 2005, in the Czech Republic the Centres for Tobacco-Dependent are being established at hospitals. METHODS: Evaluation of the activity of these 37 centres in 2012, economic analysis of treatment costs and assessment of the cost of life year gained (LYG). RESULTS: Most of the centres (26 of 37) are based at pulmonary clinics with opening hours for smokers: on average 7 hours/week. Treatment codes 25501 and 25503 are used at 28 centres. Entry visit usually takes on average 61 minutes, follow-up visits 22 minutes. Nicotine replacement therapy and varenicline are indicated in all centres, but only 14 centres use bupropion. Virtually all centres use links to other clinical disciplines, about 10.5 % of patients are sent to other departments. The most common barriers for wider activity are insufficient salaries and staffing. In 2012, the Centre for Tobacco-Dependent at the 3rd Medical Department, 1st Faculty of Medicine, Charles University in Prague and the General University Hospital treated 430 patients for the price of 3792 CZK per treated patient ( 150 Euro), respectively, with 38 % success rate for the price of 10,003 CZK per abstinent patient ( 400 Euro), or for 1,334 CZK per LYG ( 50 Euro/LYG). CONCLUSION: In the future it would be good to improve working conditions in centres and to take advantage of their potential for the indispensable, effective and highly cost-effective treatment.