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.

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.

Barriers to introduction of smoke-free workplaces in Central Europe: example of the Czech Republic.

OBJECTIVES: Smoking at the workplace has a negative impact both on employers' economic interests and employees' health. The aim of this study is to describe the current situation, mainly barriers in implementation and resources in the Czech Republic as an example of a Central European country. METHODS: We synthesised relevant review papers with our knowledge of the local situation based upon professional experience of both authors. RESULTS: Despite smoke-free laws, some EU workers are still exposed to passive smoking during working hours. The main barriers towards smoke-free workplace implementation are the lack of resources, perception of smoking as a norm, and exceptions for leading personalities and their smoking. Social support increases smoking cessation effectiveness. Low availability of local smoking cessation services is an overall problem in Central Europe. CONCLUSIONS: The working environment influences smoking habits. Smoking cessation support is cost-effective not only for the smoking employee but for employers as well. Smoking cessation resources should be available during the working day. No exceptions should be made as they serve as barriers to a smoke-free working environment.

Hospital as a smoke-free workplace.

OBJECTIVES: The primary aim of a hospital is to promote/improve and restore health, thus smoking, whether in its passive or active form, should be banned in all hospital premises for the benefit of employees and patients alike. The Global Network for Tobacco Free Healthcare Services (GNTH) is an international non-profit association formed in 1999. The GNTH's mission is to implement tobacco-free policies to create a healthy workplace and patients' environment; help physicians, nurses, and other healthcare workers to stop smoking; and educate all caregivers about tobacco dependence treatment and support them in providing smoking cessation interventions. METHODS: Implementation standards and a system of their self-audit for all participating hospitals were developed by the GNTH. We describe both the international and Czech networks, recommended methods for programme implementation and results of self-audit questionnaires completed by Czech participating hospitals. RESULTS: Worldwide, there are 19 national networks with 1,672 members including 56 gold forum members. To date, the largest network has been formed in France (670 members), followed by Spain (580) and Taiwan (209). After the first Czech institution (Prague-based General University Hospital) joined GNTH in 2010, the Czech Republic established its national network in 2017 currently comprising 10 members, of this number 1 gold, 3 silver and 6 bronze national certification level members. The main barriers to better outcomes in the Czech Republic include smoking on outdoor hospital grounds, lack of pharmacotherapy reimbursement and time, and inadequate staff education in the field of tobacco dependence treatment. CONCLUSIONS: The Global Network's mission is to advocate, recruit and enable healthcare services and professionals to implement and sustain effective tobacco management and cessation policies in accordance with the WHO Framework Convention on Tobacco Control (FCTC). A systematic approach supports the quality of care and treatment outcomes for patients as well as healthy workplace conditions for the staff.

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.

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.

[Cigarette manufacturers and their corrective statement]. / Výrobci cigaret a jejich opravné prohlásení - corrective statement.

Half a century of lying, an eighteen-year litigation, and an eleven-year disagreement with few words - to sum up a media campaign forced on cigarette manufacturers in the US at the turn of 2017/2018. In the given media, in the given extent and at the given frequency, they are forced to publish an apology for public lying with an impact on human health and lives.

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.

Use of Fludarabine for the Treatment of Indolent Lymphoma with Chylothorax.

BACKGROUND: Although chylothorax is rare in patients with malignant lymphoma, it has been reported in cases with mediastinal lymphadenopathy, a bulky retroperitoneal mass, or thoracic ducts blocked by lymphocytes in chronic lymphocytic leukemia (CLL). The clinical picture is not specific. Patients become more immunocompromised and malnourished after repeated evacuations. Chylothorax is usually diagnosed when the triglyceride level is > 1.24 mmol/l and the cholesterol level is < 5.18 mmol/ l in the effusion. Chemotherapy or radiotherapy of the associated malignant tumors has been used as the first-line treatment of malignant chylothorax. The responses of chylothorax after 3-8 chemotherapy courses have been described. A few cases of indolent lymphoma associated with chylothorax that were treated with fludarabine-based chemotherapies with various outcomes have been published. Total parenteral nutrition or a low-fat diet combined with ingestion of medium-chain triglycerides can accelerate remission of chylothorax. OBSERVATION: This study presents two cases with chylothorax associated with a bulky abdominal mass in relapsed CLL and newly diagnosed follicular lymphoma, respectively. No further evacuations were required after one and three courses of fludarabine plus cyclophosphamide with/without rituximab in the patients with CLL and follicular lymphoma, respectively. Chylothorax disappeared after five courses, and a partial or complete response of malignant lymphoma was achieved. The response lasted for 30 months in the patient with CLL and has persisted throughout maintenance therapy with rituximab in the patient with follicular lymphoma. CONCLUSION: Limited experience indicates that fludarabine-based regimes can result in rapid regression of chylothorax, in addition to treating indolent lymphoma, which prevents patients becoming more malnourished and immunocompromised. Key words: lymphoma - fludarabine - chylothorax The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 2. 2. 2018 Accepted: 20. 5. 2018.

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.

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.

Brand Awareness and Access to Cigarettes among Children 8-12 Years Old in the Czech Republic.

OBJECTIVE: The aim of the study is to assess smoking behaviour, knowledge of cigarette brands and access to cigarettes among children 8-12 years old in the Czech Republic. METHOD: Between 2009 and 2012, a cross sectional survey was conducted among 4,439 children aged 8-12 years attending 51 primary schools in Prague and Central Bohemia, Czech Republic. Data including age, gender, ever smoking, parental and sibling smoking, knowledge of cigarette brands, sources of cigarettes, and smoking frequency were collected. RESULTS: Fifty nine percent of all children could name one or more cigarette brands, 62.8% of boys and 55.3% of girls (p<0.01). The most well-known brands were Marlboro and the local brand Petra. Marlboro was better known among boys, while Petra was more known among girls. Children whose parents smoke showed higher brand awareness than children with non-smoking parents, 72.5% and 45.6%, respectively (p<0.001), and 76.4% of children reported one or more possible sources where to obtain cigarettes. Nearly one quarter (23.3%) of children had ever tried cigarettes, water pipe, cigars, or marijuana. Nearly half of all children (43.1%) reported that they had obtained their first cigarette from a relative or at home, and the second most frequent source were their peers (22.8%). Only 3.9% of children reported that they had purchased their first cigarettes. Relatives were the main source of cigarettes among children that reported smoking more than once. CONCLUSIONS: The high level of cigarette brand awareness and ever smoking provide evidence that tobacco control policies in the Czech Republic do not adequately protect children. Tougher legislation and effective strategies in accordance with the WHO Framework Convention on Tobacco Control are therefore required to better protect children from harmful effects of smoking and the influence of tobacco industry in the Czech Republic.

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.

Impact of Online Education on Nurses' Delivery of Smoking Cessation Interventions With Implications for Evidence-Based Practice.

BACKGROUND: Tobacco use is the leading cause of preventable disease and death in Europe and worldwide. Nurses, if properly educated, can contribute to decreasing the burden of tobacco use in the region by helping smokers quit smoking. AIMS: To assess: (a) the feasibility of an online program to educate nurses in Czech Republic and Poland on evidence-based smoking cessation interventions for patients and (b) self-reported changes in practices related to consistently (usually or always) providing smoking cessation interventions to smokers, before and 3 months after participation in the program. METHODS: A prospective single-group pre-post design. RESULTS: A total of 280 nurses from Czech Republic and 156 from Poland completed baseline and follow-up surveys. At 3 months, nurses were significantly more likely to provide smoking cessation interventions to patients who smoke and refer patients for cessation services (p < .01). Nurses significantly improved their views about the importance of nursing involvement in tobacco control. IMPLICATIONS FOR PRACTICE: Education about tobacco control can make a difference in clinical practice, but ongoing support is needed to maintain these changes. Health system changes can also facilitate the expectation that delivering evidence-based smoking cessation interventions should be routine nursing care. LINKING EVIDENCE TO ACTION: Educating nurses on cessation interventions and tobacco control is pivotal to decrease tobacco-related disparities, disease, and death. Online methods provide an accessible way to reach a large number of nurses.

Current and past smoking patterns in a Central European urban population: a cross-sectional study in a high-burden country.

BACKGROUND: Many studies have examined the socioeconomic variations in smoking and quitting rates across the European region; however, data from Central and East European countries, where the tobacco burden is especially high, are sparse. This study aimed to assess the patterns in current and past smoking prevalence based on cross-sectional data from a Central European urban population sample. METHODS: Data from 2160 respondents aged 25-64 years in Brno, Czech Republic were collected in 2013-2014 using the Czech post-MONICA survey questionnaire to assess the prevalence of cardiovascular risk factors, including smoking status. The age- and sex-stratified randomized sample was drawn using health insurance registries. Descriptive statistics and quit ratios were calculated, and chi-square and multivariate logistic analyses conducted to examine relationships between current and past smoking and demographic (age, gender, marital status) and socioeconomic variables (education, income, occupation). RESULTS: The prevalence of current and past smoking was 23.6 and 31.3 % among men and 20.5 and 23.2 % among women, respectively. Education reliably predicted smoking and quitting rates in both genders. Among men, being unemployed was associated with greater odds of smoking (OR 3.6; 1.6-8.1) and lower likelihood of quitting (OR 0.2: 0.1-0.6); the likelihood of quitting also increased with age (OR 1.8; 1.2-2.8). Among women, marital status (being married) decreased the odds of current smoking (OR 0.6; 0.4-0.9) and increased the odds of quitting (OR 2.2; 1.2-3.9). Quit ratios were the lowest in the youngest age group (25-34 years) where quitting was more strongly associated with middle income (OR 2.7; 95 % CI 1.2-5.9) than with higher education (OR 2.9; 95 % CI 0.9-8.2). CONCLUSIONS: Interventions to increase cessation rates and reduce smoking prevalence need to be gender-specific and carefully tailored to the needs of the disadvantaged groups of the population, especially the less well-off young adults. Future studies should examine the equity impact of the tobacco control policies and be inclusive of the Central and East European countries.

Nurses' Attitudes toward Intervening with Smokers: Their Knowledge, Opinion and E-Learning Impact.

BACKGROUND: Numbering about 90,000, nurses represent the largest group of health care providers in the Czech Republic. Therefore, nurses can make a significant impact in the treatment of tobacco dependence, particularly in applying brief interventions to smokers. METHODS: During 2014, 279 nurses from the Czech Republic participated in an e-learning education programme consisting of two Webcasts with additional web-based resources about smoking cessation in relation to health and treatment options in daily clinical practice, particularly regarding brief intervention methods. Before viewing the e-learning programme, and three months after viewing it, the nurses completed a questionnaire documenting their interventions with smokers and their knowledge, attitudes and opinions regarding nurses' roles in smoking cessation. RESULTS: The responses in all of the following categories significantly improved: usually/always asking patients about smoking from 58% to 69% (OR 1.62, CI=1.14-2.29, p=0.007); recommendations to stop smoking from 56% to 66% (OR 1.46, CI=1.03-2.06, p=0.03); assessing willingness to quit from 49% to 63% (OR 1.72, CI=1.23-2.42, p=0.002); assisting with cessation from 21% to 33% (OR 1.85, CI=1.26-2.71, p=0.002); and recommending a smoke-free home from 39% to 58% (OR 2.16, CI=1.54-3.04, p<0.001). The increase in arranging follow-up from 7% to 10% did not constitute a statistically significant improvement, however, this finding is understandable in relation to the status of nurses in the Czech Republic. However, nurses' confidence in helping smokers to quit smoking, their senses of responsibility and determining the appropriateness of these interventions remains inadequate. CONCLUSION: The nurses' brief intervention skills improved significantly after the completion of the e-learning programme, even though reservations remain among this group. The systematic education of nurses aimed at smoking cessation intervention and analyzing their motivation for treatment may contribute to improved nursing care, and thus lead to a reduction of smoking prevalence in the general population.

Smoking Prevalence and Its Clinical Correlations in Patients with Narcolepsy-cataplexy.

Narcolepsy-cataplexy (NC) is a chronic neurological disease with suggested autoimmune etiopathogenesis. Nicotine stimulates central nervous system and smoking increases the risk of autoimmune diseases. Assessment of smoking habits and its correlation to clinical parameters among 87 adult NC patients (38 male, 49 female) included night polysomnography and multiple sleep latency test. In our sample, 43.7% NC patients were regular smokers, and 19.5% former smokers compared to 22.2%, and 12.6%, respectively, in the general population. Patients started to smoke in the mean age of 20.0 (SD ±6.0) years. 72.2% of NC smokers started to smoke before the onset of NC and the mean of the delay between smoking onset and NC onset was 9.1 (±5.8) years. We found a direct correlation between smoking duration and the number of awakenings, duration of N1 sleep, REM sleep latency, and apnoea/hypopnoea index (AHI), and, on the contrary, indirect correlation between smoking duration and N3 sleep duration, showing that smoking duration consistently correlates with sleep macrostructure. Smoking is highly prevalent in NC and has relationship with clinical features of NC.