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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48183

RESUMO

Este mapa de evidências científicas apresenta uma síntese gráfica de revisões sistemáticas sobre a aplicação do Yoga para desfechos como dor crônica e aguda, obesidade e sobrepeso, tabagismo, saúde mental e segurança. A partir de uma ampla busca bibliográfica 37 revisões sistemáticas foram incluídas no mapa e categorizadas por tipo de intervenção e por desfechos. Os estudos avaliaram o efeito de 03 tipos de intervenção: Yoga (diversas técnicas ou não especificada), Hatha yoga e Terapias combinadas com Yoga. Principais achados: Os resultados encontrados foram favoráveis à prática de yoga para redução do Índice de Massa Corporal. A modalidade de Hatha Yoga mostrou efeitos positivos para o controle do tabagismo com relação ao desejo de fumar, abstinência, estágio de prontidão para mudanças de humor. As revisões sistemáticas apresentaram resultados favoráveis à prática de yoga em relação aos cuidados habituais, particularmente nos casos de dor lombar e cervical. Há menos evidências acerca da superioridade do Yoga em comparação a intervenções ativas. Em outras situações estudadas, como a dor associada a fibromialgia, osteoartrite, artrite reumatoide, síndromes do túnel do carpo e do intestino irritável, as evidências são menos consistentes. Pacientes diagnosticados com transtornos depressivos tiveram melhora de suas condições após o yoga relatados na maior parte das revisões, inclusive com efeitos de grande magnitude no curto prazo. Da mesma forma, foram observados efeitos positivos da Yoga na redução de sintomas de ansiedade e depressão em mulheres no período perinatal e em idosos. Resultados conflitantes foram encontrados para a prática de Yoga entre pacientes com transtornos de ansiedade. No entanto, estas evidências devem ser vistas com cautela, uma vez que a confiança nos resultados da maioria das revisões foi considerada baixa ou criticamente baixa na avaliação da qualidade metodológica.


Assuntos
Ioga/psicologia , Saúde Mental , Tabagismo/terapia , Segurança , Dor Crônica/terapia , Obesidade/terapia , Dor Aguda/terapia , Resultado do Tratamento
2.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48184

RESUMO

Este mapa de evidências científicas apresenta uma síntese gráfica de revisões sistemáticas sobre a aplicação do Yoga para desfechos como dor crônica e aguda, obesidade e sobrepeso, tabagismo, saúde mental e segurança. A partir de uma ampla busca bibliográfica 37 revisões sistemáticas foram incluídas no mapa e categorizadas por tipo de intervenção e por desfechos. Os estudos avaliaram o efeito de 03 tipos de intervenção: Yoga (diversas técnicas ou não especificada), Hatha yoga e Terapias combinadas com Yoga. Principais achados: Os resultados encontrados foram favoráveis à prática de yoga para redução do Índice de Massa Corporal. A modalidade de Hatha Yoga mostrou efeitos positivos para o controle do tabagismo com relação ao desejo de fumar, abstinência, estágio de prontidão para mudanças de humor. As revisões sistemáticas apresentaram resultados favoráveis à prática de yoga em relação aos cuidados habituais, particularmente nos casos de dor lombar e cervical. Há menos evidências acerca da superioridade do Yoga em comparação a intervenções ativas. Em outras situações estudadas, como a dor associada a fibromialgia, osteoartrite, artrite reumatoide, síndromes do túnel do carpo e do intestino irritável, as evidências são menos consistentes. Pacientes diagnosticados com transtornos depressivos tiveram melhora de suas condições após o yoga relatados na maior parte das revisões, inclusive com efeitos de grande magnitude no curto prazo. Da mesma forma, foram observados efeitos positivos da Yoga na redução de sintomas de ansiedade e depressão em mulheres no período perinatal e em idosos. Resultados conflitantes foram encontrados para a prática de Yoga entre pacientes com transtornos de ansiedade. No entanto, estas evidências devem ser vistas com cautela, uma vez que a confiança nos resultados da maioria das revisões foi considerada baixa ou criticamente baixa na avaliação da qualidade metodológica.


Assuntos
Meditação/métodos , Atenção Plena/métodos , Obesidade/terapia , Saúde Mental , Segurança , Tabagismo/terapia , Doenças Cardiovasculares/terapia , Resultado do Tratamento
3.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48185

RESUMO

Este mapa de evidências científicas apresenta uma síntese gráfica de revisões sistemáticas sobre a aplicação da acupuntura e da auriculoterapia em adultos e idosos para desfechos como dor crônica e aguda, doenças cardiovasculares, obesidade e sobrepeso, diabete mellito tipo 2, tabagismo, saúde mental, asma e segurança. A partir de uma ampla busca bibliográfica 65 revisões sistemáticas foram incluídas no mapa e categorizadas por tipo de intervenção e por desfechos. Os estudos avaliaram o efeito de 10 tipos de intervenção: Acupuntura (não especificada ou tradicional chinesa), Acupuntura placebo, Acupuntura a laser, Eletroacupuntura, Simulação de acupuntura, Auriculoterapia, Acupressão, Acupuntura com aplicação de fio catgut, Terapias combinadas com acupuntura e Farmacopuntura. Principais Achados: O tipo de intervenção mais relatado foi Acupuntura (não especificada ou tradicional chinesa), presente em 91 desfechos, seguido da Auriculoterapia, presente em 27 desfechos. A acupuntura mostrou resultados favoráveis na redução da pressão arterial, particularmente sistólica, e nos desfechos de dores crônica e aguda. A prática de acupuntura, da eletroacupuntura e auriculoterapia combinadas com cuidado usual mostraram efeito no controle da glicemia de jejum, glicemia duas horas depois de um teste de tolerância à glicose e hemoglobina glicosilada. A acupuntura, a auriculoterapia e a acupressão foram consideradas benéficas no tratamento da obesidade e sobrepeso, principalmente em reduzir gordura corporal e circunferências de cintura e quadril. Há, também, alguns benefícios da acupuntura, eletroacupuntura e auriculoterapia no tratamento de ansiedade e depressão. De maneira geral, a farmacopuntura combinada ou não a outros tratamentos, mostrou melhores resultados, em relação a seus comparadores, para desfechos de asma. Não houve diferença nos resultados entre acupuntura e auriculoterapia e seus diversos comparadores para desfechos de tabagismo. No entanto, estas evidências devem ser vistas com cautela, uma vez que a confiança nos resultados da maioria das revisões foi considerada baixa ou criticamente baixa na avaliação da qualidade metodológica.


Assuntos
Acupuntura Auricular/métodos , Dor Crônica/terapia , Asma/terapia , Obesidade/terapia , Saúde Mental , Segurança , Tabagismo/terapia , Dor Aguda/terapia , Resultado do Tratamento
4.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48186

RESUMO

Este mapa de evidências científicas apresenta uma síntese gráfica de estudos clínicos sobre a aplicação da Medicina Tradicional Chinesa para desfechos de obesidade e sobrepeso, e tabagismo. A partir de uma ampla busca bibliográfica 03 ensaios clínicos randomizados (ECR) foram incluídos no mapa e categorizados por tipo de intervenção e por desfechos. Os estudos avaliaram o efeito de 03 tipos de intervenção: Tai chi, Qigong e Terapias combinadas. Principais Achados: Os estudos foram realizados entre 2007 e 2015 nos seguintes países: Hong Kong, Estados Unidos da América e França. Não foram encontradas revisões sistemáticas sobre as intervenções. Também não foram encontrados ensaios clínicos randomizados (ECR) para os desfechos de tabagismo. Embora existam alguns resultados favoráveis à prática de tai Tai chi, é pequena a evidência de eficácia e segurança da prática de Medicina Tradicional Chinesa no tratamento da obesidade em adultos e idosos. A avaliação metodológica dos ECR mostrou alto risco de viés de alocação em um estudo, risco de viés de alocação incerto e alto risco de viés de atrito em outro estudo, e risco de viés incerto para randomização e alocação no terceiro estudo.


Assuntos
Medicina Tradicional Chinesa/métodos , Obesidade/terapia , Tai Ji/métodos , Terapias Complementares/métodos , Tabagismo/terapia
7.
JAMA ; 325(3): 280-298, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33464342

RESUMO

Importance: It has been estimated that in 2018 nearly 20% of adults in the US were currently using a tobacco product. Objective: To systematically review the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation among adults, including pregnant persons, to inform the US Preventive Services Task Force. Data Sources: PubMed, PsycInfo, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination of Health Technology Assessment; surveillance through September 25, 2020. Study Selection: Systematic reviews of tobacco cessation interventions and randomized clinical trials that evaluated the effects of electronic cigarettes (e-cigarettes) or pharmacotherapy among pregnant persons. Data Extraction and Synthesis: Independent critical appraisal and data abstraction; qualitative synthesis and random-effects meta-analyses. Main Outcomes and Measures: Health outcomes, tobacco cessation at 6 months or more, and adverse events. Results: Sixty-seven reviews addressing pharmacotherapy and behavioral interventions were included as well as 9 trials (N = 3942) addressing e-cigarettes for smoking cessation and 7 trials (N = 2285) of nicotine replacement therapy (NRT) use in pregnancy. Combined pharmacotherapy and behavioral interventions (pooled risk ratio [RR], 1.83 [95% CI, 1.68-1.98]), NRT (RR, 1.55 [95% CI, 1.49-1.61]), bupropion (RR, 1.64 [95% CI, 1.52-1.77]), varenicline (RR, 2.24 [95% CI, 2.06-2.43]), and behavioral interventions such as advice from clinicians (RR, 1.76 [95% CI, 1.58-1.96]) were all associated with increased quit rates compared with minimal support or placebo at 6 months or longer. None of the drugs were associated with serious adverse events. Five trials (n = 3117) reported inconsistent findings on the effectiveness of electronic cigarettes on smoking cessation at 6 to 12 months among smokers when compared with placebo or NRT, and none suggested higher rates of serious adverse events. Among pregnant persons, behavioral interventions were associated with greater smoking cessation during late pregnancy (RR, 1.35 [95% CI, 1.23-1.48]), compared with no intervention. Rates of validated cessation among pregnant women allocated to NRT compared with placebo were not significantly different (pooled RR, 1.11 [95% CI, 0.79-1.56], n = 2033). Conclusions and Relevance: There is strong evidence that a range of pharmacologic and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in nonpregnant adults. In pregnancy, behavioral interventions are effective for smoking cessation, but data are limited on the use of pharmacotherapy for smoking cessation. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are also limited and results are inconsistent.


Assuntos
Terapia Comportamental , Sistemas Eletrônicos de Liberação de Nicotina , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Abandono do Uso de Tabaco/métodos , Tabagismo/terapia , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Gravidez , Atenção Primária à Saúde , Abandono do Hábito de Fumar/métodos , Agentes de Cessação do Hábito de Fumar/efeitos adversos , Dispositivos para o Abandono do Uso de Tabaco/efeitos adversos , Tabagismo/tratamento farmacológico
8.
JAMA ; 325(3): 265-279, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33464343

RESUMO

Importance: Tobacco use is the leading preventable cause of disease, disability, and death in the US. In 2014, it was estimated that 480 000 deaths annually are attributed to cigarette smoking, including second hand smoke exposure. Smoking during pregnancy can increase the risk of numerous adverse pregnancy outcomes (eg, miscarriage and congenital anomalies) and complications in the offspring (including sudden infant death syndrome and impaired lung function in childhood). In 2019, an estimated 50.6 million US adults (20.8% of the adult population) used tobacco; 14.0% of the US adult population currently smoked cigarettes and 4.5% of the adult population used electronic cigarettes (e-cigarettes). Among pregnant US women who gave birth in 2016, 7.2% reported smoking cigarettes while pregnant. Objective: To update its 2015 recommendation, the USPSTF commissioned a review to evaluate the benefits and harms of primary care interventions on tobacco use cessation in adults, including pregnant persons. Population: This recommendation statement applies to adults 18 years or older, including pregnant persons. Evidence Assessment: The USPSTF concludes with high certainty that the net benefit of behavioral interventions and US Food and Drug Associated (FDA)-approved pharmacotherapy for tobacco smoking cessation, alone or combined, in nonpregnant adults who smoke is substantial. The USPSTF concludes with high certainty that the net benefit of behavioral interventions for tobacco smoking cessation on perinatal outcomes and smoking cessation in pregnant persons is substantial. The USPSTF concludes that the evidence on pharmacotherapy interventions for tobacco smoking cessation in pregnant persons is insufficient because few studies are available, and the balance of benefits and harms cannot be determined. The USPSTF concludes that the evidence on the use of e-cigarettes for tobacco smoking cessation in adults, including pregnant persons, is insufficient, and the balance of benefits and harms cannot be determined. The USPSTF has identified the lack of well-designed, randomized clinical trials on e-cigarettes that report smoking abstinence or adverse events as a critical gap in the evidence. Recommendations: The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and FDA-approved pharmacotherapy for cessation to nonpregnant adults who use tobacco. (A recommendation) The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco. (A recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant persons. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of e-cigarettes for tobacco cessation in adults, including pregnant persons. The USPSTF recommends that clinicians direct patients who use tobacco to other tobacco cessation interventions with proven effectiveness and established safety. (I statement).


Assuntos
Terapia Comportamental , Sistemas Eletrônicos de Liberação de Nicotina , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Gravidez , Atenção Primária à Saúde , Agentes de Cessação do Hábito de Fumar/efeitos adversos , Abandono do Uso de Tabaco/métodos , Dispositivos para o Abandono do Uso de Tabaco/efeitos adversos , Tabagismo/tratamento farmacológico
9.
Nutrients ; 12(12)2020 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-33334010

RESUMO

As food addiction is being more commonly recognized within the scientific community, parallels can be drawn between it and other addictive substance use disorders, including tobacco use disorder. Given that both unhealthy diets and smoking are leading risk factors for disability and death, a greater understanding of how food addiction and tobacco use disorder overlap with one another is necessary. This narrative review aimed to highlight literature that investigated prevalence, biology, psychology, and treatment options of food addiction and tobacco use disorder. Published studies up to August 2020 and written in English were included. Using a biopsychosocial lens, each disorder was assessed together and separately, as there is emerging evidence that the two disorders can develop concurrently or sequentially within individuals. Commonalities include but are not limited to the dopaminergic neurocircuitry, gut microbiota, childhood adversity, and attachment insecurity. In addition, the authors conducted a feasibility study with the purpose of examining the association between food addiction symptoms and tobacco use disorder among individuals seeking tobacco use disorder treatment. To inform future treatment approaches, more research is necessary to identify and understand the overlap between the two disorders.


Assuntos
Dependência de Alimentos/epidemiologia , Dependência de Alimentos/psicologia , Tabagismo/epidemiologia , Tabagismo/psicologia , Adulto , Adultos Sobreviventes de Eventos Adversos na Infância/psicologia , Terapia Comportamental , Encéfalo/fisiopatologia , Comorbidade , Terapia por Estimulação Elétrica , Feminino , Dependência de Alimentos/terapia , Microbioma Gastrointestinal/fisiologia , Humanos , Masculino , Apego ao Objeto , Prevalência , Fatores de Risco , Abandono do Uso de Tabaco , Tabagismo/terapia
10.
JAMA ; 324(18): 1844-1854, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33170240

RESUMO

Importance: Electronic cigarettes (e-cigarettes) for smoking cessation remain controversial. Objective: To evaluate e-cigarettes with individual counseling for smoking cessation. Design, Setting, and Participants: A randomized clinical trial enrolled adults motivated to quit smoking from November 2016 to September 2019 at 17 Canadian sites (801 individuals screened; 274 ineligible and 151 declined). Manufacturing delays resulted in early termination (376/486 participants, 77% of target). Outcomes through 24 weeks (March 2020) are reported. Interventions: Randomization to nicotine e-cigarettes (n = 128), nonnicotine e-cigarettes (n = 127), or no e-cigarettes (n = 121) for 12 weeks. All groups received individual counseling. Main Outcomes and Measures: The primary end point was point prevalence abstinence (7-day recall, biochemically validated using expired carbon monoxide) at 12 weeks, changed from 52 weeks following early termination. Participants missing data were assumed to be smoking. The 7 secondary end points, examined at multiple follow-ups, were point prevalence abstinence at other follow-ups, continuous abstinence, daily cigarette consumption change, serious adverse events, adverse events, dropouts due to adverse effects, and treatment adherence. Results: Among 376 randomized participants (mean age, 52 years; 178 women [47%]), 299 (80%) and 278 (74%) self-reported smoking status at 12 and 24 weeks, respectively. Point prevalence abstinence was significantly greater for nicotine e-cigarettes plus counseling vs counseling alone at 12 weeks (21.9% vs 9.1%; risk difference [RD], 12.8 [95% CI, 4.0 to 21.6]) but not 24 weeks (17.2% vs 9.9%; RD, 7.3 [95% CI, -1.2 to 15.7]). Point prevalence abstinence for nonnicotine e-cigarettes plus counseling was not significantly different from counseling alone at 12 weeks (17.3% vs 9.1%; RD, 8.2 [95% CI, -0.1 to 16.6]), but was significantly greater at 24 weeks (20.5% vs 9.9%; RD, 10.6 [95% CI, 1.8 to 19.4]). Adverse events were common (nicotine e-cigarette with counseling: 120 [94%]; nonnicotine e-cigarette with counseling: 118 [93%]; counseling only: 88 [73%]), with the most common being cough (64%) and dry mouth (53%). Conclusions and Relevance: Among adults motivated to quit smoking, nicotine e-cigarettes plus counseling vs counseling alone significantly increased point prevalence abstinence at 12 weeks. However, the difference was no longer significant at 24 weeks, and trial interpretation is limited by early termination and inconsistent findings for nicotine and nonnicotine e-cigarettes, suggesting further research is needed. Trial Registration: ClinicalTrials.gov Identifier: NCT02417467.


Assuntos
Aconselhamento , Sistemas Eletrônicos de Liberação de Nicotina , Abandono do Hábito de Fumar/métodos , Redução do Consumo de Tabaco/estatística & dados numéricos , Tabagismo/terapia , Adulto , Terapia Combinada , Término Precoce de Ensaios Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Dispositivos para o Abandono do Uso de Tabaco
11.
Lancet Glob Health ; 8(11): e1408-e1417, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33069301

RESUMO

BACKGROUND: Smoking cessation is important in patients with tuberculosis because it can reduce the high rates of treatment failure and mortality. We aimed to assess the effectiveness and safety of cystine as a smoking cessation aid in patients with tuberculosis in Bangladesh and Pakistan. METHODS: We did a randomised, double-blind, placebo-controlled, trial at 32 health centres in Bangladesh and Pakistan. Eligible patients were adults (aged >18 years in Bangladesh; aged >15 years in Pakistan) with pulmonary tuberculosis diagnosed in the previous 4 weeks, who smoked tobacco on a daily basis and were willing to stop smoking. Patients were randomly assigned (1:1) to receive behavioural support plus either oral cytisine (9 mg on day 0, which was gradually reduced to 1·5 mg by day 25) or placebo for 25 days. Randomisation was done using pregenerated block randomisation lists, stratified by trial sites. Investigators, clinicians, and patients were masked to treatment allocation. The primary outcome was continuous abstinence at 6 months, defined as self-report (of not having used more than five cigarettes, bidis, a water pipe, or smokeless tobacco products since the quit date), confirmed biochemically by a breath carbon monoxide reading of less than 10 parts per million. Primary and safety analysis were done in the intention-to-treat population. This trial is registered with the International Standard Randomised Clinical Trial Registry, ISRCTN43811467, and enrolment is complete. FINDINGS: Between June 6, 2017, and April 30, 2018, 2472 patients (1527 patients from Bangladesh; 945 patients from Pakistan) were enrolled and randomly assigned to receive cytisine (n=1239) or placebo (n=1233). At 6 months, 401 (32·4%) participants in the cytisine group and 366 (29·7%) participants in the placebo group had achieved continuous abstinence (risk difference 2·68%, 95% CI -0·96 to 6·33; relative risk 1·09, 95% CI 0·97 to 1·23, p=0·114). 53 (4·3%) of 1239 participants in the cytisine group and 46 (3·7%) of 1233 participants in the placebo group reported serious adverse events (94 events in the cytisine group and 90 events in the placebo group), which included 91 deaths (49 in the cytisine group and 42 in the placebo group). None of the adverse events were attributed to the study medication. INTERPRETATION: Our findings do not support the addition of cytisine to brief behavioural support for the treatment of tobacco dependence in patients with tuberculosis. FUNDING: European Union Horizon 2020 and Health Data Research UK. TRANSLATIONS: For the Bengali and Urdu translations of the abstract see Supplementary Materials section.


Assuntos
Alcaloides/uso terapêutico , Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Tuberculose/epidemiologia , Adulto , Azocinas/uso terapêutico , Bangladesh/epidemiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Psicoterapia Breve , Quinolizinas/uso terapêutico , Tabagismo/psicologia , Resultado do Tratamento
12.
PLoS One ; 15(9): e0237938, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877429

RESUMO

BACKGROUND: More smokers report using e-cigarettes to help them quit than FDA-approved pharmacotherapy. OBJECTIVE: To assess the association of e-cigarettes with future abstinence from cigarette and tobacco use. DESIGN: Cohort study of US sample, with annual follow-up. PARTICIPANTS: US adult (ages 18+) daily cigarette smokers identified at Wave 1 (W1; 2013-14) of the PATH Study, who reported a quit attempt before W2 and completed W3 (n = 2443). EXPOSURES: Use of e-cigarettes, pharmacotherapy (including nicotine replacement therapy), or no product for last quit attempt (LQA), and current daily e-cigarette use at W2. ANALYSIS: Propensity score matching (PSM) of groups using different methods to quit. OUTCOME MEASURES: 12+ months abstinence at W3 from cigarettes and from all tobacco (including e-cigarettes). 30+ days abstinence at W3 was a secondary outcome. RESULTS: Among daily smokers with an LQA, 23.5% used e-cigarettes, 19.3% used pharmacotherapy only (including NRT) and 57.2% used no product. Cigarette abstinence for 12+ months at W3 was ~10% in each group. Half of the cigarette abstainers in the e-cigarette group were using e-cigarettes at W3. Different methods to help quitting had statistically comparable 12+ month cigarette abstinence at W3 (e-cigarettes vs no product: Risk Difference (RD) = 0.01, 95% CI: -0.04 to 0.06; e-cigarettes vs pharmacotherapy: RD = 0.02, 95% CI:-0.04 to 0.09). Likewise, daily e-cigarette users at W2 did not show a cessation benefit over comparable no-e-cigarette users and this finding was robust to sensitivity analyses. Abstinence for 30+ days at W3 was also similar across products. LIMITATIONS: The frequency of e-cigarette use during the LQA was not assessed, nor was it possible to assess continuous abstinence from the LQA. CONCLUSION: Among US daily smokers who quit cigarettes in 2014-15, use of e-cigarettes in that attempt compared to approved cessation aids or no products showed similar abstinence rates 1-2 years later.


Assuntos
Fumar Cigarros/efeitos adversos , Tratamento Farmacológico/estatística & dados numéricos , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Vaping/efeitos adversos , Adolescente , Adulto , Terapia Comportamental , Fumar Cigarros/psicologia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Abandono do Hábito de Fumar/psicologia , Fatores de Tempo , Dispositivos para o Abandono do Uso de Tabaco/efeitos adversos , Tabagismo/epidemiologia , Tabagismo/etiologia , Estados Unidos/epidemiologia , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-32630743

RESUMO

Up to 95% of women who use other substances also smoke tobacco during pregnancy. Challenging psychosocial circumstances and other barriers that contribute to high levels of tobacco dependence result in few quitting successfully. This case report describes the treatment of a highly tobacco dependent 34-year-old pregnant woman with a history of recent substance use, mental illness and trauma, enrolled in the Incentives to Quit Tobacco in Pregnancy program. Heavy smoking, both during the day and overnight, was reported. An extensive history of quit attempts, as well as a strong desire to cease tobacco use during pregnancy, was also noted. Treatment utilising extensive behavioural supports, including financial incentives for carbon monoxide verified abstinence and telephone-based counselling, in combination with nicotine replacement therapy (NRT), was offered to assist cessation. Excellent uptake and adherence to all aspects of treatment saw tobacco cessation achieved and maintained for 24 weeks while on the program. NRT used at doses well above those recommended for pregnancy was required to alleviate strong withdrawal symptoms and maintain abstinence. Daily monitoring of carbon monoxide, financial incentives for continued abstinence and regular phone support were critical to maintaining motivation and preventing relapse to smoking. Post-program relapse to smoking did occur, as is common, and highlights the need for longer-term intensive support for pregnant women with complex behavioural and social problems. Given the prevalence of tobacco smoking in such populations, long-term harm reduction treatment models using extensive behavioural support in combination with NRT should be considered for inclusion in current smoking cessation guidelines.


Assuntos
Abandono do Hábito de Fumar , Tabagismo/terapia , Adulto , Feminino , Humanos , Gravidez , Dispositivos para o Abandono do Uso de Tabaco , Tabagismo/tratamento farmacológico , Tabagismo/psicologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-32668758

RESUMO

Tobacco use negatively impacts cancer treatment outcomes, yet too few providers actively support their patients in quitting. Barriers to consistently addressing tobacco use and referring to treatment include time constraints and lack of knowledge surrounding treatment options. Patient Reported Outcomes (PRO) measurement is best practice in cancer care and has potential to help address these barriers to tobacco cessation treatment. This descriptive program evaluation study reports preliminary results following implementation of a novel automated PRO tobacco use screener and referral system via the electronic health record (EHR) patient portal (MyChart) that was developed and implemented as a part of a population-based tobacco treatment program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Between 25 June 2019 and 6 April 2020, 4589 unique patients completed the screener and 164 (3.6%) unique patients screened positive for recent (past month) cigarette smoking. All patients who screened positive were automatically referred to a smoking cessation treatment program integrated within the Lurie Cancer Center, and 71 (49.7%) patients engaged in treatment, as defined by completing at least one behavioral counseling session. Preliminary results indicate that the PRO/MyChart system may improve smoker identification and increase offering of treatment and, despite the "cold call" following a positive screen, may result in a treatment engagement rate that is higher than rates of treatment engagement previously documented in oncology settings. Longer term evaluation with formal statistical testing is needed before drawing conclusions regarding effectiveness, but PRO measurement via the EHR patient portal may serve a potentially important role in a multi-component approach to reaching and engaging cancer patients in comprehensive tobacco cessation treatment.


Assuntos
Registros Eletrônicos de Saúde , Neoplasias , Medidas de Resultados Relatados pelo Paciente , Abandono do Hábito de Fumar , Tabagismo , Aconselhamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Uso de Tabaco , Tabagismo/complicações , Tabagismo/terapia
15.
Artigo em Inglês | MEDLINE | ID: mdl-32560325

RESUMO

Relapse remains a frequent and complex phenomenon that is not yet well understood. An under-researched area of study that may provide relevant information concerns the assessment of specific post-treatment variables, rather than the composite measures commonly used to predict smoking relapse. The current study sought to examine the effects of post-treatment smoking-related variables, including withdrawal symptomatology, abstinence self-efficacy, and smoking urgency in negative-affect situations and smoking relapse at the 3 month follow-up. The sample comprised 130 participants who achieved abstinence for at least 24 h through a cognitive-behavioral smoking cessation treatment. Regression analysis was conducted for both composite measures and specific subscales and items. Data showed that composite measures of tobacco withdrawal, self-efficacy, and smoking urgency in negative-affect situations were not significant predictors of smoking relapse. However, the analysis including subscales, and specific items showed that lower self-efficacy in negative-affect-related situations (OR = 1.36) and three withdrawal symptoms-irritability/frustration/anger (OR = 2.99), restlessness/impatience (OR = 1.87), and craving (OR = 2.31)-were significant predictors of relapse. These findings offer new insights into the role of different smoking-related post-treatment variables in short-term relapse. Considering and specifically targeting these variables after achieving abstinence may potentially contribute to reducing smoking relapse.


Assuntos
Terapia Cognitivo-Comportamental , Abandono do Hábito de Fumar , Síndrome de Abstinência a Substâncias , Tabagismo , Adulto , Cognição , Fissura , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Tabagismo/terapia
16.
Artigo em Inglês | MEDLINE | ID: mdl-32517176

RESUMO

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.


Assuntos
Registros Eletrônicos de Saúde , Neoplasias/complicações , Neoplasias/epidemiologia , Encaminhamento e Consulta , Abandono do Hábito de Fumar/métodos , Tabagismo/diagnóstico , Tabagismo/terapia , Humanos , Sistemas Computadorizados de Registros Médicos , Neoplasias/etiologia , Neoplasias/patologia , Uso de Tabaco , Interface Usuário-Computador
17.
Artigo em Inglês | MEDLINE | ID: mdl-32486463

RESUMO

Despite the importance of smoking cessation to cancer care treatment, historically, few cancer centers have provided treatment for tobacco dependence. To address this gap, the National Cancer Institute (NCI) launched the Cancer Center Cessation Initiative (C3i). As part of this effort, this study examined implementation outcomes in a cohort of cancer survivors (CSs) who smoked cigarettes in the first year of an ongoing process to develop and implement a robust Tobacco Treatment Service at Roswell Park Comprehensive Cancer Center. We provide a comprehensive description of the new tobacco use assessment and referral process, and of the characteristics of cancer survivors who agreed to treatment including traditional tobacco-related psychosocial and cancer treatment-related characteristics and novel characteristics such as delay discounting rates. We also examine characteristic differences among those who agreed to treatment between those who attended and those who did not attend treatment. As the new tobacco assessment was implemented, the number of referrals increased dramatically. The mean number of treatment sessions attended was 4.45 (SD = 2.98) and the six-month point prevalence intention to treat abstinence rate among those who attended was 22.7%. However, only 6.4% agreed to treatment and 4% attended at least one treatment session. A large proportion of cancer survivors who agreed to treatment were women, of older age, of lower socioeconomic status (SES), and who had high levels of depressive symptomology. The findings demonstrate that the implementation of system changes can significantly improve the identification of cancer survivors who use tobacco and are referred to tobacco use treatment. Among those who attend, treatment is effective. However, the findings also suggest that a systematic assessment of barriers to engagement is needed and that cancer survivors may benefit from additional treatment tailoring. We present plans to address these implementation challenges. Systematic electronic medical record (EMR)-sourced referral to tobacco treatment is a powerful tool for reaching cancer survivors who smoke, but more research is needed to determine how to enhance engagement and tailor treatment processes.


Assuntos
Sobreviventes de Câncer , Abandono do Hábito de Fumar , Tabagismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Uso de Tabaco , Tabagismo/terapia , Estados Unidos , Adulto Jovem
18.
Rev. chil. enferm. respir ; 36(2): 94-99, jun. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1138540

RESUMO

INTRODUCCIÓN: El tabaquismo es una de las pandemias que afecta en mayor proporción a la población mundial. Una de las medidas para controlarlo es la aplicación de consejerías de cesación tabáquica (CCT). OBJETIVO: Determinar y evaluar la técnica de CCT más empleada por profesionales de APS de Peñalolén. METODOLOGÍA: Estudio observacional de corte transversal basado en encuesta y simulación clínica en atención primaria de salud. RESULTADOS: De los 39 participantes, un 55,3% declaró utilizar la consejería breve como CCT y un 42,1% indicó no utilizar ninguna técnica específica. De los 13 profesionales que participaron de la simulación clínica, el 50% incluyó 5 o menos de un total de 7 aspectos claves durante la realización de la consejería breve. CONCLUSIONES: La estrategia de CCT más utilizada por los encuestados es la consejería breve, aunque no siempre se consideran todos los aspectos claves cuando se realiza.


INTRODUCTION: Smoking is one of the pandemics that affects the world's population in a large proportion. One of the measures to control it is the application of smoking cessation counselling (SCC). OBJECTIVE: To determine and evaluate the SCC technique most used by primary health care professionals in Peñalolén a commune of Santiago, Chile. METHODOLOGY: Cross-sectional observational study based on survey and clinical simulation in primary health care professionals. RESULTS: Of the 39 participant professionals, 55.3% declared using brief counselling as SCC and 42.1% indicated they did not use any specific technique. Of the 13 professionals who participated in the clinical simulation, 50% included 5 or less of a total of 7 key aspects during the brief counselling. CONCLUSIONS: Brief smoking cessation counselling is the most used tobacco cessation counselling strategy by the professionals surveyed. Although not all key aspects are always considered when it is done.


Assuntos
Humanos , Atenção Primária à Saúde , Abandono do Hábito de Fumar/métodos , Pessoal de Saúde , Aconselhamento/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Tabagismo/terapia , Chile , Estudos Transversais , Inquéritos e Questionários , Competência Clínica
19.
Respir Investig ; 58(5): 387-394, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32381453

RESUMO

BACKGROUND: The data on smoking cessation treatment outcomes for smokers with chronic obstructive pulmonary disease (COPD) are limited. The present study assessed the effectiveness of smoking cessation interventions at our clinic. METHODS: Data from a prospective registry of a 3-month smoking cessation program were evaluated. The primary outcome, smoking cessation, was defined as the complete abstinence from smoking between the 8-week and 12-week clinic visits. Pulmonary function and health-related quality of life using St. George's Respiratory Questionnaire (SGRQ) were assessed at baseline and at the end of the program. RESULTS: Out of the 155 COPD patients with nicotine dependence (female/male = 39/116; mean age, 67.2 ± 9.8 years; mean forced expiratory volume in 1 s (FEV1), 59.7 ± 21.1% predicted), 107 participants completed the program. Among the completers, 74 achieved smoking cessation. In the multivariate analysis, mental disorders (odds ratio [OR] 3.678, 95% confidence interval [CI]: 1.182, 11.445), higher exhaled carbon monoxide (CO) level (OR 1.080, 95% CI: 1.013, 1.151) and lower FEV1/forced vital capacity (FVC) (OR 0.958, 95% CI: 0.923, 0.995) were negatively associated with successful smoking termination. Significant changes in pulmonary function were found in quitters but not in continuous smokers (increases in FEV1 by 0.09 L/s [95% CI: 0.03, 0.15] and peak expiratory flow by 0.23 L/s [95% CI: 0.01, 0.44]). SGRQ total scores improved significantly in both quitters (-5.4 [95% CI: -8.4, -2.5]) and continuous smokers (-7.0 [95% CI: -11.6, -2.5]). CONCLUSION: In the program completers, the exhaled CO levels, FEV1/FVC ratio, and presence of mental disorders were significantly associated with program success or failure in COPD patients with nicotine dependence.


Assuntos
Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Abandono do Hábito de Fumar , Tabagismo/complicações , Tabagismo/terapia , Idoso , Monóxido de Carbono/metabolismo , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/metabolismo , Qualidade de Vida , Inquéritos e Questionários , Tabagismo/metabolismo , Tabagismo/fisiopatologia , Capacidade Vital
20.
BMC Psychol ; 8(1): 42, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32357940

RESUMO

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.


Assuntos
Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Estimulação Magnética Transcraniana , Adulto , Idoso , Comportamento Aditivo , Protocolos Clínicos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Pré-Frontal , Recidiva , Fumar/psicologia , Abandono do Hábito de Fumar/psicologia
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