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1.
Artículo en Inglés | MEDLINE | ID: mdl-32517176

RESUMEN

Continued tobacco use after cancer diagnosis is detrimental to treatment and survivorship. The current reach of evidence-based tobacco treatments in cancer patients is low. As a part of the National Cancer Institute Cancer Center Cessation Initiative, the Mayo Clinic Cancer Center designed an electronic health record (EHR, Epic©)-based process to automatically refer ambulatory oncology patients to tobacco use treatment, regardless of intent to cease tobacco use("opt out"). The referral and patient scheduling, accomplished through a best practice advisory (BPA) directed to staff who room patients, does not require a co-signature from clinicians. This process was piloted for a six-week period starting in July of 2019 at the Division of Medical Oncology, Mayo Clinic, Rochester, MN. All oncology patients who were tobacco users were referred for tobacco treatment by the rooming staff (n = 210). Of these, 150 (71%) had a tobacco treatment appointment scheduled, and 25 (17%) completed their appointment. We conclude that an EHR-based "opt-out" approach to refer patients to tobacco dependence treatment that does not require active involvement by clinicians is feasible within the oncology clinical practice. Further work is needed to increase the proportion of scheduled patients who attend their appointments.


Asunto(s)
Registros Electrónicos de Salud , Neoplasias/complicaciones , Neoplasias/epidemiología , Derivación y Consulta , Cese del Hábito de Fumar/métodos , Tabaquismo/diagnóstico , Tabaquismo/terapia , Humanos , Sistemas de Registros Médicos Computarizados , Neoplasias/etiología , Neoplasias/patología , Uso de Tabaco , Interfaz Usuario-Computador
2.
BMC Psychol ; 8(1): 42, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32357940

RESUMEN

BACKGROUND: Despite the considerable success of comprehensive tobacco control efforts, tobacco use remains one of the greatest preventable causes of death and disease today. Over half of all smokers in the US make quit attempts every year, but over 90% relapse within 12 months, choosing the immediate reinforcement of smoking over the long-term benefits of quitting. Conceptual and empirical evidence supports continued investigation of high frequency repetitive transcranial magnetic stimulation (rTMS) of the left dorsolateral prefrontal cortex in reducing relapse and decreasing cigarette consumption. While this evidence is compelling, an optimal dosing strategy must be determined before a long-term efficacy trial can be conducted. The goal of this study is to determine a dosing strategy for 20 Hz rTMS that will produce the best long-term abstinence outcomes with the fewest undesirable effects. METHODS: This is a fully crossed, double-blinded, sham-controlled, 3x2x2 randomized factorial study. The three factors are duration (stimulation days: 8, 12, and 16); intensity (900 or 1800 pulses per day); and sham control. Participants (n = 258) will consist of adults (18-65) who are motivated to quit smoking cigarettes and who will be followed for 6 months post-quit. Outcomes include latency to relapse, point prevalence abstinence rates, delay discounting rates, cognitive-behavioral skills acquisition, and multiple measures of potential undesirable effects that impact participant compliance. DISCUSSION: This study integrates existing theoretical concepts and methodologies from neuropsychology, behavioral economics, brain stimulation, clinical psychology, and the evidence-based treatment of tobacco dependence in the development of a promising and innovative approach to treat tobacco dependence. This study will establish an optimal dosing regimen for efficacy testing. Findings are expected to have a significant influence on advancing this approach as well as informing future research on clinical approaches that combine rTMS with other evidence-based treatments for tobacco dependence and perhaps other addictions. TRIAL REGISTRATION: Clinical Trials NCT03865472 (retrospectively registered). The first participant was fully enrolled on November 26, 2018. Registration was posted on March 7, 2019.


Asunto(s)
Cese del Hábito de Fumar/métodos , Tabaquismo/terapia , Estimulación Magnética Transcraneal , Adulto , Anciano , Conducta Adictiva , Protocolos Clínicos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Corteza Prefrontal , Recurrencia , Fumar/psicología , Cese del Hábito de Fumar/psicología
3.
Monaldi Arch Chest Dis ; 90(1)2020 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-32253889

RESUMEN

We aimed to evaluate the effects of stage-matched repeated individual behavioural counselling (RIBCS) on the basis of the transtheoretical model (TTM) as an intervention to reduce and stop smoking. This study was conducted over a period of one year where all smokers presenting to a chest clinic in a tertiary centre were enrolled, each was classified on the basis of stage of readiness to change and underwent repeated counselling for a period of six months and each session was preceded and succeeded with filling of Fagerstorm test for nicotine dependence. Over the period of a year, 207 patients participated in this study, the mean age was 50.74±14.74 years; mean duration of tobacco use was 29.43±14.72 years; 64.3% were illiterate, 11.6% primary education, 14.1% were matric and while 10.1% were graduate. About 73% of smokers reported high level of nicotine dependence (FTND score >5/10). In the present study mean dependence score was 6.0±1.96; 44 (21.3%) were in pre-contemplation stage, 93 (44.9%) were in contemplation, 57 (27.5%) were in preparation and 13 (6.3%) were in action. The point prevalence excellence rate in follow up-I was 15%, follow up-II was 35.3% and follow up-III was 61.9% which was statistically significant. When we took both abstinence and reduction in smoking behaviour as one, p-value was <0.05. The point prevalence of abstinence rate (questionnaire validated) 1 month to 6 months was almost 4 times. Our intervention (RIBCS) succeeded in increasing the abstinence rates during the study period among smokers with a lower motivation to quit (pre-contemplators and contemplators) as well as those ready to quit (preparators). This is significant because of most existing smoking-cessation interventions target only motivated smokers, with few having a positive effect in smokers with a lower motivation to quit.


Asunto(s)
Terapia Conductista/métodos , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Fumar/terapia , Tabaquismo/terapia , Adolescente , Adulto , Anciano , Consejo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Motivación , Estudios Prospectivos , Fumar/efectos adversos , Fumar/psicología , Encuestas y Cuestionarios , Tabaquismo/complicaciones , Tabaquismo/diagnóstico , Tabaquismo/psicología , Adulto Joven
4.
Rev. chil. enferm. respir ; 36(1): 33-40, mar. 2020. tab, graf
Artículo en Español | LILACS | ID: biblio-1115460

RESUMEN

El tabaquismo es considerado una de las principales causas de morbilidad y mortalidad en la población general. En Chile la prevalencia de tabaquismo alcanza el 36,7% en hombres y 28,5% en mujeres. En este contexto, diversas estrategias farmacológicas y no farmacológicas han sido propuestas para promover la cesación de su consumo, así como para contrarrestar las comorbilidades asociadas al tabaquismo prolongado. Entre ellas, el ejercicio físico ha sido tradicionalmente considerado, por su impacto en la promoción de la cesación del hábito tabáquico, así como también por sus efectos en la reducción de las manifestaciones clínicas del síndrome de abstinencia post cesación. No obstante, estudios realizados en modelos animales durante los últimos 10 años han proporcionado datos contundentes para sustentar la hipótesis de que la práctica regular de ejercicio físico sería también efectiva para prevenir o modular el estrés oxidativo y la respuesta inflamatoria inducida por el tabaco, previniendo el deterioro orgánico de los sistemas fisiológicos expuestos. Esta revisión tiene por objetivo discutir la evidencia publicada respecto a los efectos biológicos inducidos por ejercicio físico y su impacto en la reversión de los mecanismos fisiopatológicos que subyacen a las comorbilidades asociadas al hábito tabáquico, focalizando el análisis en los mecanismos de estrés oxidativo y respuesta inflamatoria del sistema respiratorio y cardiovascular.


Smoking is considered one of the main causes of morbidity and mortality in the general population. In Chile, the prevalence of smoking reaches 36.7% in men and 28.5% in women. In this context, several pharmacological and non-pharmacological strategies have been proposed to promote the cessation of their use, as well as to counteract the comorbidities associated with prolonged smoking. Among them, physical exercise has been traditionally considered, due to its impact on the promotion of cessation of smoking, as well as its effects in reducing the clinical manifestations of withdrawal syndrome. However, studies conducted in animal models during the last 10 years have provided strong data to support the hypothesis that regular practice of physical exercise would also be effective in preventing or modulating oxidative stress and the inflammatory response induced by tobacco, preventing the organic deterioration of exposed physiological systems. The objective of this review is to discuss the published evidence regarding the biological effects induced by physical exercise and its impact on the reversion of the pathophysiological mechanisms underlying the comorbidities associated with smoking, focusing the analysis on the mechanisms of oxidative stress and inflammatory response of the respiratory and cardiovascular system.


Asunto(s)
Humanos , Terapia por Ejercicio , Fumar Tabaco/terapia , Tabaquismo/fisiopatología , Tabaquismo/terapia , Ejercicio Físico/fisiología , Estrés Oxidativo/fisiología , Fumar Tabaco/fisiopatología , Inflamación
5.
J Acquir Immune Defic Syndr ; 83(4): 405-414, 2020 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-31904707

RESUMEN

BACKGROUND: Tobacco use has emerged as the leading killer of persons living with HIV (PLWH) in the United States. Little is known about the efficacy of tobacco treatment strategies in PLWH. DESIGN: Randomized controlled trial comparing Positively Smoke Free (PSF), an intensive group therapy intervention targeting HIV-infected smokers, to brief advice to quit. All participants were offered a 12-week supply of nicotine patches. METHODS: A cohort of 450 PLWH smokers, recruited from HIV-care centers in the Bronx, New York, and Washington, DC, were randomized 1:1 into the PSF or brief advice to quit conditions. PSF is an 8-session program tailored to address the needs and concerns of HIV-infected smokers and delivered by a trained smoking cessation counselor and PLWH ex-smoker peer pair. The primary outcome was biochemically confirmed, 7-day point-prevalence abstinence at 6 months. RESULTS: In the intention to treat analysis, PSF condition subjects had nearly double the quit rate of controls, 13% vs. 6.6% [odds ratio = 2.10 (95% confidence interval = 1.10 to 4.14), P = 0.04], at 3 months, but no significant difference in abstinence was observed at 6 months. PSF participants exhibited lower nicotine dependence and higher self-efficacy to resist smoking temptations at both 3 and 6 months compared with controls. Lower educational attainment, current cocaine use, past use of nicotine patches, and higher distress tolerance were significant predictors of continued smoking at 6 months. CONCLUSIONS: These findings suggest a role for group therapy among tobacco treatments for PLWH smokers, but strategies to augment the durability of early effects are needed.


Asunto(s)
Fumar Cigarrillos/terapia , Infecciones por VIH/complicaciones , Psicoterapia de Grupo , Tabaquismo/terapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad
6.
BMC Public Health ; 19(1): 1700, 2019 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-31852536

RESUMEN

BACKGROUND: The rate of tobacco use among people with mental illness is nearly twice that of the general population. Psychotropic medications for tobacco cessation are relatively expensive for most Kenyans. Behavioral counseling and group therapy are effective lower cost strategies to promote tobacco cessation, yet have not been studied in Kenya among individuals with concomitant mental illness. METHODS/DESIGN: One hundred tobacco users with mental illness who were part of an outpatient mental health program in Nairobi, Kenya were recruited and allocated into intervention and control groups of the study (50 users in intervention group and 50 users in control group). Participants allocated to the intervention group were invited to participate in 1 of 5 tobacco cessation groups. The intervention group received the 5As (Ask, Advise, Assess, Assist and Arrange) and tobacco cessation group behavioral intervention, which included strategies to manage cravings and withdrawal, stress and anxiety, and coping with depression due to withdrawal; assertiveness training and anger management; reasons to quit, benefits of quitting and different ways of quitting. Individuals allocated to the control group received usual care. The primary outcome was tobacco cessation at 24 weeks, measured through cotinine strips. Secondary outcomes included number of quit attempts and health-related quality of life. DISCUSSION: This study will provide evidence to evaluate the efficacy and safety of a tobacco cessation group behavioral intervention among individuals with mental illness in Kenya, and to inform national and regional practice and policy. TRIAL REGISTRATION: Trial registration number: NCT04013724. Name of registry: ClinicalTrials.gov. URL of registry: https://register.clinicaltrials.gov Date of registration: 9 July 2019 (retrospectively registered). Date of enrolment of the first participant to the trial: 5th September 2017. Protocol version: 2.0.


Asunto(s)
Terapia Conductista/métodos , Análisis Costo-Beneficio/estadística & datos numéricos , Consejo/métodos , Calidad de Vida/psicología , Cese del Hábito de Fumar/métodos , Cese del Uso de Tabaco/psicología , Tabaquismo/terapia , Adulto , Anciano , Anciano de 80 o más Años , Terapia Conductista/economía , Consejo/economía , Femenino , Humanos , Kenia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Cese del Hábito de Fumar/economía , Cese del Uso de Tabaco/estadística & datos numéricos
9.
Nicotine Tob Res ; 21(Suppl 1): S133-S144, 2019 12 23.
Artículo en Inglés | MEDLINE | ID: mdl-31867659

RESUMEN

BACKGROUND: The US Food and Drug Administration (FDA) is considering reducing nicotine levels in cigarettes to "minimally or non-addictive levels." However, important research gaps remain, and the FDA must determine when the available research is sufficient to support moving forward. METHODS: The authors conducted a systematic review of research articles in PubMed relating to nicotine reduction. Building on a review of risk assessment best practices, the authors also developed a risk assessment framework for tobacco regulation and used it to guide a gap analysis of nicotine reduction research. RESULTS: The final sample consisted of 78 articles. The majority examined either nicotine dependence on very low nicotine cigarettes (VLNCs) or markers of potential health effects of using VLNCs. One-third of the identified articles reported results from four large randomized controlled trials (RCTs). While these studies report promising results and suggest that a nicotine reduction rule would be a powerful tool to reduce cigarette smoking, our gap analysis suggests that there is a need for studies that better reflect the use and availability of a wide range of tobacco/nicotine products and the potential for dual- or multi-product use. CONCLUSION: The current body of research on nicotine reduction is weighted towards RCTs, which is appropriate for a policy that has not yet been implemented anywhere in the world. The FDA must consider a wide range of factors that may impact a product standard's public health impact, including those difficult to assess in RCTs, such as a nicotine reduction rule's impact on smoking initiation and relapse. IMPLICATIONS: This systematic review presents a gap analysis based on a risk assessment framework to help identify remaining research priorities to inform FDA's potential product standard to reduce nicotine levels in cigarettes. Quickly addressing those gaps would support the FDA's effort to develop a nicotine reduction product standard that will be effective and withstand legal challenges.


Asunto(s)
Nicotina , Cese del Hábito de Fumar/métodos , Fumar/terapia , Humanos , Productos de Tabaco , Tabaquismo/terapia
10.
Pediatr Clin North Am ; 66(6): 1053-1062, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31679596

RESUMEN

Rates of certain tobacco products have decreased over the past decade, but nicotine use disorder is still prevalent among adolescents. New trends in tobacco use, such as in the use of electronic cigarettes, are creating alarm. This article reviews nicotine addiction and measurement in adolescents, along with potential health risks and comorbidities. Various psychosocial and pharmacologic interventions are reviewed along with novel interventions that show promise for reducing tobacco use in this vulnerable population.


Asunto(s)
Conducta del Adolescente/psicología , Estimulantes Ganglionares/efectos adversos , Nicotina/efectos adversos , Trastornos Relacionados con Sustancias , Vapeo , Adolescente , Humanos , América del Norte/epidemiología , Psicología del Adolescente , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/etiología , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , Tabaquismo/epidemiología , Tabaquismo/etiología , Tabaquismo/psicología , Tabaquismo/terapia , Vapeo/epidemiología , Vapeo/psicología , Vapeo/terapia
11.
Artículo en Inglés | MEDLINE | ID: mdl-31614952

RESUMEN

Background: Smoking is among the most preventable causes of death globally. Tobacco cessation can lessen the number of potential deaths. The China Tobacco Cessation Guidelines encourage medical staff to perform the 5As (Ask, Advise, Assess, Assist, Arrange) when delivering tobacco dependence treatments to patients. Nursing students will develop to be nurses in the future and they have to finish 9 months of clinical practicum study in the last year at hospitals or care centers. However, the frequency of behaviors used to help smokers quit among Chinese nursing internship students is unclear. This study analyzed the rate of nurse interns' performance of the 5As and which demographic characteristics, perceptions of smoking and knowledge predicted higher performance of the 5As. Methods: The cluster sampling method was used to select 13 teaching hospitals among 29. All nursing intern students were expected to finish the questionnaire about their 5As behaviors to help patients quit smoking. Their 5As performances were scored from one to five with 5 being the best and scores were summed. A multivariate linear mixed-effect model was employed to test the differences between their 5As. Results: Participating in the survey were 1358 interns (62.4% response rate). The average scores were as follows-Ask-3.15, Advise-2.75, Assess-2.67, Assist-2.58 and Arrange-2.42. A total of 56.3% students perceived that medical staff should perform the 5As routinely to help patients quit smoking. On the other hand, 52.1% viewed clinical preceptors as role models of the 5As. School education regarding tobacco control, smoking dependence treatment, self-efficacy and positive intentions were predictors of higher performance of the 5As (p < 0.001). Conclusions: Nursing internship students seldom administered tobacco dependence treatments to patients. It is essential to improve the corresponding education, skills and self-efficacy of the 5As. Meanwhile, clinical preceptors should procure more training in the responsibilities and skills related to tobacco cessation. In this way, clinical preceptors can be role models of the 5As and impart positive influences on interns.


Asunto(s)
Internado y Residencia , Fumadores/psicología , Cese del Hábito de Fumar/métodos , Estudiantes de Enfermería , Tabaquismo/terapia , Adulto , China , Estudios Transversales , Femenino , Humanos , Capacitación en Servicio , Masculino , Autoeficacia , Fumar , Encuestas y Cuestionarios , Fumar Tabaco
12.
Rev. esp. patol. torac ; 31(3): 174-178, oct. 2019. graf, tab
Artículo en Español | IBECS | ID: ibc-187172

RESUMEN

Introducción: desde la aparición de la terapia antiretroviral la supervivencia de los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) ha aumentado considerablemente tomando importancia la aparición de otras patologías crónicas en estos pacientes como puede ser la enfermedad pulmonar obstructiva crónica (EPOC). Nuestro objetivo fue conocer la incidencia de EPOC en una cohorte de pacientes VIH derivados en un programa de detección de hipertensión pulmonar (HTP). Material y Métodos: análisis post-hoc, de un prospectivo, pseudo-experimental de pacientes con infección del VIH a los que se les preguntaba por disnea y en caso afirmativo eran derivados a consultas de neumología para despistaje de HTP. Resultado: desde 2014 hasta 2016, reclutamos un total de 32 pacientes, con un predominio de varones (75%). La disnea según la mMRC (Medical Reserach Council) fue grado 1, 2 y 3 en el 37,5%, 43,8% y 18,8%, respectivamente. La prevalencia de tabaquismo fue del 87,1% (intervalo de confianza [IC] 95%: 71- 96,4%), y 18 pacientes fueron catalogados de EPOC (62%; IC95%: 42,2 - 79,3%). Conclusión: la incidencia de EPOC en nuestra serie fue muy superior a la de la población general. Es necesario plantear estrategias de búsqueda activa de EPOC en estos pacientes para un diagnóstico y tratamiento precoz


Introduction: Since the advent of antiretroviral therapy, the survival of patients infected with the human immunodeficiency virus (HIV) has considerably increased, with the occurrence of other chronic diseases such as chronic obstructive pulmonary disease (COPD) gaining importance in these patients. Our objective was to find out the incidence of COPD in a cohort of HIV patients that were referred to a program to detect pulmonary hypertension (PH). Materials and Methods: Post hoc analysis of a prospective, quasi-experimental study on HIV-infected patients who were asked whether they had dyspnea. If this was the case, they were referred to a pulmonologist for PH screening. Results: From 2014 to 2016, we recruited a total of 32 patients, with a predominance of male recruits (75%). According to the mMRC (Modified Medical Research Council) Dyspnea Scale, 37.5%, 43.8% and 18.8% were classified as Grade 1, 2 and 3, respectively. The prevalence of smoking was 87.1% (95% confidence interval [CI]: 71 - 96.4%), and 18 patients were classified with COPD (62%; 95% CI: 42.2 - 79.3%). Conclusion: The incidence of COPD in our sample was much higher than that of the general population. It is necessary to plan active search strategies for COPD in these patients for early diagnosis and treatment


Asunto(s)
Humanos , Masculino , Adulto , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Infecciones por VIH/complicaciones , Estudios de Cohortes , Tabaquismo/epidemiología , VIH , Hipertensión Pulmonar/diagnóstico , Estudios Prospectivos , Disnea/etiología , Intervalos de Confianza , Tabaquismo/prevención & control , Tabaquismo/terapia
13.
Addict Sci Clin Pract ; 14(1): 29, 2019 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-31474229

RESUMEN

Tobacco use is a chronic relapsing disease, and remains the leading cause of preventable death in much of the world. Increasingly, tobacco use, chiefly cigarette smoking, is being framed as a chronic disease, with periods of use and periods of abstinence. An implicit component of this conceptualization is that treatment-both counseling and pharmacotherapy-may be needed at various intervals for extended periods of time, perhaps over an individual's lifetime. This would mirror the treatment of other chronic conditions, such as diabetes, hypertension, or hyperlipidemia. Yet, clinical trials of tobacco dependence treatment still generally model outcome measures in terms of cessation, abstinence, or quitting, measured at discrete time points. This reinforces the notion that smoking, or tobacco dependence, is a dichotomous condition, and that one is either "cured," or not. Although the goal of treating tobacco dependence is to ensure long-term abstinence (i.e. "quitting"), this model is discordant with clinical reality, in which of periods of tobacco use are interspersed with periods of abstinence. Hence, the goal of treatment is to lengthen the duration of the latter, while shortening the duration of the former. In the clinical arena, this dichotomous model of tobacco use is reflected in electronic health records, where smoking is generally categorized as current, former, or never. We propose that clinicians move away from the dichotomous categorization of tobacco use, and adopt methods used to categorize the status of other chronic conditions. Specifically, biomarkers such as carbon monoxide, cotinine, and anabasine, measured at regular intervals, can provide clinicians with much clearer, clinically relevant and actionable assessments of current tobacco use by their patients. This can be done without making reference to dichotomous states such as current or former use of tobacco. In psychological terms, one can frame tobacco use in terms of states, attributes in specific situations at discrete moments in time, rather than the more durable traits.


Asunto(s)
Cese del Hábito de Fumar/métodos , Fumar Tabaco/terapia , Tabaquismo/terapia , Biomarcadores , Enfermedad Crónica , Humanos , Planificación de Atención al Paciente
14.
Adv Mind Body Med ; 33(2): 12-17, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31476134

RESUMEN

Objective: The purpose of this study was to examine whether the Life-Change Stop Smoking Program (tobacco dependence treatment program with Stress Management/Mindfulness Training) was more effective in achieving 6 mo of smoking abstinence among a high-risk group, such as US veterans at the Loma Linda Veterans Affairs (VA) Medical Center, compared with the VA's conventional stop smoking program. The effects of participants' initial stress level and depression risk on achieving abstinence were also assessed. Methods: Through examination of medical records and confirmation of exhaled air carbon monoxide level, abstinence status from smoking was determined at the 6-mo follow-up of the Life-Change Stop Smoking program (study group) participants and the Break the Chains program (comparison group, age and gender matched) participants. The 6-mo abstinence rates of the study group and comparison group were analzyed. Results: The statistically significant level of difference (χ2 [P < .001], regression [P = .0000]) in 6-mo abstinence rates between groups was observed. Conclusion: The stop smoking program with Stress Management/Mindfulness Training was effective (64.6% in study group, 40.1% in comparison group, P < .001) in achieving 6 mo of smoking abstinence for the high-risk group.


Asunto(s)
Atención Plena , Cese del Hábito de Fumar , Tabaquismo , Veteranos , Humanos , Fumar , Cese del Hábito de Fumar/métodos , Tabaquismo/terapia , Veteranos/psicología
15.
Psychiatry Res ; 281: 112562, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31521838

RESUMEN

We performed a systematic review of the studies employing repetitive transcranial magnetic stimulation (rTMS) in subjects with smoking addiction. High-frequency (HF) rTMS over the prefrontal cortex (PFC), in particular the left dorsolateral PFC (DLPFC), might represent a save and innovative treatment tool for tobacco consumption and craving in nicotine-dependent otherwise healthy people. rTMS can be effective for this indication also in patients with schizophrenia, but the results are conflicting and sufficient evidence from large-scale trials is still lacking. Promising results have been obtained using particular techniques for brain stimulation, such as deep rTMS and theta burst stimulation. Multiple-target HF rTMS can also have a potential in smoking cessation. fMRI and EEG recordings have proven to be useful for objectively assessing the treatment effects. TMS is likely to be most effective when paired with an evidence-based self-help intervention, cognitive-behavioral interventions and nicotine replacement therapy. However, the most recent studies employed different protocols and yielded heterogeneous results, which should be replicated in further controlled studies with larger sample sizes and rigorous standards of randomization. To date, no recommendation other than that a possible efficacy of HF-rTMS of the left DLPFC can be made for alternative rTMS procedures in nicotine craving and consumption.


Asunto(s)
Ansia/fisiología , Cese del Hábito de Fumar/métodos , Tabaquismo/psicología , Tabaquismo/terapia , Estimulación Magnética Transcraneal/métodos , Adulto , Electroencefalografía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Corteza Prefrontal/diagnóstico por imagen , Corteza Prefrontal/fisiopatología
16.
Artículo en Inglés | MEDLINE | ID: mdl-31557913

RESUMEN

Physicians play a key role in combating tobacco use. This study aims to evaluate the knowledge, attitude, and behaviors toward smoking cessation and vaping cessation interventions among physicians in Poland; to identify factors shaping physicians' behaviors toward smoking and vaping cessation interventions; and to assess differences in the tobacco cessation interventions recommended for cigarette smokers and users of electronic cigarettes (e-cigarettes). A questionnaire-based survey was conducted in 2018 among physicians attending mandatory public health training courses delivered at the School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland. The questionnaire included 25 questions related to tobacco product use and smoking cessation interventions. Data were obtained from 423 physicians (64.3% female; mean age 32.0 ± 5.8 years) with response rate of 84.6%. Current cigarette smoking was declared by 7.8% of participants; 1.9% of participants were e-cigarette users and 1.9% used heated tobacco. Smoking cessation interventions were offered more often to patients who smoked cigarettes than those who used e-cigarettes (p < 0.001). Physicians' behaviors toward smoking cessation and vaping cessation interventions were associated with (p < 0.05) physicians' smoking status and self-declared knowledge about smoking cessation methods. Among physicians in Poland, discussion of smoking cessation was not common behavior and limited mainly to identification of smoking status.


Asunto(s)
Actitud del Personal de Salud , Fumar Cigarrillos , Pautas de la Práctica en Medicina , Cese del Hábito de Fumar/métodos , Vapeo , Adulto , Femenino , Humanos , Masculino , Médicos , Polonia , Fumadores , Encuestas y Cuestionarios , Tabaquismo/terapia
17.
PLoS One ; 14(9): e0222813, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31557211

RESUMEN

OBJECTIVES: A lack of physician training is a major obstacle for effective tobacco dependence treatment. This study assessed the feasibility of an active learning training program and its effects on smoking cessation counselling skills of medical residents in Armenia, an Eastern European country with high smoking prevalence. STUDY DESIGN: The study used a pre-post assessment of smoking cessation counselling activities and a course evaluation survey to assess the feasibility of the intervention in a different environment. METHODS: We adapted an active learning training model developed in Switzerland. Residents were trained in Yerevan, Armenia, using video-taped counselling sessions, role plays, standardized patients (actors), group discussions and immediate feedback. The training evaluation was done using a semi-structured anonymous questionnaire. The study assessed the physicians' self-reported smoking cessation counselling activities before and 6 months after the training. A non-parametric Mann-Whitney test was used to assess pre-post differences in physicians' counselling skills measured on ordinal scale. RESULTS: Of the 37 residents trained, 75% were female, 89% aged 20-29 years and 83% were never-smokers. Twenty-eight trainees (76%) returned the course evaluation survey and 32 (86%) answered a questionnaire on skills self-assessment at 6 months follow-up. The majority agreed the course was successful in achieving its learning objectives (64%-96%) and increased their confidence in assisting their patients to quit (74%). After 6 months, the physicians were more likely than at baseline to adhere to evidence-based counselling strategies, including assessing the smoking status and dependence and matching the advice to the patient motivation. The training did not, however, improve the prescription of tobacco dependence medications. CONCLUSIONS: Six months after the training, several self-reported smoking cessation counselling activities had significantly improved compared to baseline. This training model is acceptable for medical residents in Yerevan, Armenia and offers a promising approach in addressing the lack of physician counselling skills in similar settings and populations.


Asunto(s)
Consejo/educación , Educación Médica Continua/organización & administración , Médicos/estadística & datos numéricos , Cese del Hábito de Fumar/métodos , Tabaquismo/terapia , Adulto , Armenia , Consejo/estadística & datos numéricos , Educación Médica Continua/métodos , Educación Médica Continua/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Educacionales , Simulación de Paciente , Aprendizaje Basado en Problemas/métodos , Aprendizaje Basado en Problemas/organización & administración , Aprendizaje Basado en Problemas/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Fumadores/psicología , Encuestas y Cuestionarios/estadística & datos numéricos , Tabaquismo/diagnóstico , Adulto Joven
19.
Artículo en Inglés | MEDLINE | ID: mdl-31450707

RESUMEN

Stress is robustly associated with tobacco smoking and relapse. African Americans experience greater difficulty quitting compared to whites, yet no studies have examined race differences in physiological stress biomarkers during a quit attempt. This pilot study compared cortisol levels among treatment-seeking African American and white smokers, and relapse rates. Adult smokers (N = 115; n = 72 African American, n = 43 White) received eight sessions of group cognitive behavioral therapy plus transdermal nicotine patches. Assessments included demographics, salivary cortisol (collected at session 1, the end-of-therapy [EOT], and one-month post-therapy), and carbon monoxide-verified smoking relapse. Overall, cortisol levels declined over the course of the day at baseline, the EOT, and the one-month follow-up. African Americans exhibited lower cortisol levels compared to Whites at baseline and the EOT, but not at the one-month follow-up. In addition, African American smokers exhibited flatter slopes compared to Whites at each time point. Relapse rates were greater among African Americans at the EOT and one-month follow-up. The attenuated cortisol pattern observed in African Americans may indicate hypothalamic-pituitary-adrenal axis (HPA) exhaustion and aid our understanding of tobacco-related disparities. There is a need to focus on stress mechanisms and specific intervention approaches in order to eliminate racial/ethnic differences.


Asunto(s)
Fumadores/psicología , Cese del Hábito de Fumar , Estrés Fisiológico , Fumar Tabaco , Tabaquismo , Adulto , Terapia Cognitivo-Conductual , Grupos de Población Continentales , Grupos Étnicos , Femenino , Humanos , Hidrocortisona/sangre , Masculino , Persona de Mediana Edad , Recurrencia , Cese del Hábito de Fumar/etnología , Cese del Hábito de Fumar/psicología , Fumar Tabaco/sangre , Fumar Tabaco/etnología , Fumar Tabaco/psicología , Fumar Tabaco/terapia , Dispositivos para Dejar de Fumar Tabaco , Tabaquismo/sangre , Tabaquismo/etnología , Tabaquismo/psicología , Tabaquismo/terapia
20.
BMC Biotechnol ; 19(1): 56, 2019 08 02.
Artículo en Inglés | MEDLINE | ID: mdl-31375100

RESUMEN

BACKGROUND: Smoking and tobacco use continue to be the largest preventable causes of death globally. A novel therapeutic approach has recently been proposed: administration of an enzyme that degrades nicotine, the main addictive component of tobacco, minimizing brain exposure and reducing its reinforcing effects. Pre-clinical proof of concept has been previously established through dosing the amine oxidase NicA2 from Pseudomonas putida in rat nicotine self-administration models of addiction. RESULTS: This paper describes efforts towards optimizing NicA2 for potential therapeutic use: enhancing potency, improving its pharmacokinetic profile, and attenuating immunogenicity. Libraries randomizing residues located in all 22 active site positions of NicA2 were screened. 58 single mutations with 2- to 19-fold enhanced catalytic activity compared to wt at 10 µM nicotine were identified. A novel nicotine biosensor assay allowed efficient screening of the many primary hits for activity at nicotine concentrations typically found in smokers. 10 mutants with improved activity in rat serum at or below 250 nM were identified. These catalytic improvements translated to increased potency in vivo in the form of further lowering of nicotine blood levels and nicotine accumulation in the brains of Sprague-Dawley rats. Examination of the X-ray crystal structure suggests that these mutants may accelerate the rate limiting re-oxidation of the flavin adenine dinucleotide cofactor by enhancing molecular oxygen's access. PEGylation of NicA2 led to prolonged serum half-life and lowered immunogenicity observed in a human HLA DR4 transgenic mouse model, without impacting nicotine degrading activity. CONCLUSIONS: Systematic mutational analysis of the active site of the nicotine-degrading enzyme NicA2 has yielded 10 variants that increase the catalytic activity and its effects on nicotine distribution in vivo at nicotine plasma concentrations found in smokers. In addition, PEGylation substantially increases circulating half-life and reduces the enzyme's immunogenic potential. Taken together, these results provide a viable path towards generation of a drug candidate suitable for human therapeutic use in treating nicotine addiction.


Asunto(s)
Monoaminooxidasa/metabolismo , Nicotina/metabolismo , Tabaquismo/metabolismo , Animales , Proteínas Bacterianas/administración & dosificación , Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Dominio Catalítico/genética , Humanos , Ratones , Modelos Moleculares , Monoaminooxidasa/química , Monoaminooxidasa/genética , Mutación , Nicotina/química , Unión Proteica , Dominios Proteicos , Pseudomonas putida/enzimología , Pseudomonas putida/genética , Ratas Sprague-Dawley , Tabaquismo/enzimología , Tabaquismo/terapia
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