不同干预措施与因素对戒烟效果的影响

目的分析可能影响戒烟效果的因素,为戒烟患者提供更有效更科学的干预措施。方法以问卷形式记录门诊戒烟患者的基本资料,并给予药物等综合干预措施,随后对就诊的戒烟患者分时间段定期随防48周,汇总并分析可能影响戒烟效果的因素。结果首诊满12,24,48周可随访患者的总体成功戒烟率分别为35.9%,33.3%和31.0%;在满12和24周时使用伐尼克兰比未使用药物的戒烟成功率高（P＜0.01）,但在48周时差异无统计学意义;有戒烟经历的患者在满12和24周时的戒烟成功率显著高于无戒烟经历的患者（P＜0.01）,未发现其他因素影响戒烟成功率;在所有的患者中,12周戒烟效果与24和48周的戒烟效果高度一致（P＜0.01）。结论曾有过戒烟经历的患者可能更容易戒烟成功;前12周为戒烟能否成功的关键时期,使用伐尼克兰则可能有助于成功戒烟。     

艾滋病患者抑郁状况及其影响因素的述评

抑郁是人类最常见的心理疾患。由于艾滋患者群总体上有很高的抑郁症状,且较一般人群发生率高、程度严重,对他们的生活质量、心理健康产生了很大影响。国外此方面的研究较早较深入,而国内研究很少。因此,为提高艾滋病患者心理健康水平及生活质量,国内此方面的研究已迫在眉睫。本文对艾滋病患者的抑郁状况及其影响因素进行了综合分析评述。     

戒烟药物研究进展

烟草依赖为一种慢性尼古丁成瘾性疾病.尼古丁强化效应是吸烟者戒烟失败的主要原因.吸烟者成功戒烟往往需戒烟药物的辅助治疗,常用戒烟药物有一线戒烟药物(如尼古丁替代、安非他酮及伐尼克兰)和二线戒烟药物(如可乐定和去甲替林等),以及其他戒烟药物.     

前列腺癌患者社会支持和抑郁状况调查及相关性分析

目的了解前列腺癌患者的社会支持状况及其与抑郁程度的相关性,为更好地了解这一特殊人群的需求并给予社会支持提供理论参考。方法收集患者的基本资料,采用社会支持评定量表(social support rating scale,SSRS)及抑郁自评量表(self-rating depression scale,SDS),对65例前列腺癌患者进行问卷调查。结果 65例的社会支持得分(39.17±6.11)与常模(34.56±3.73)的差异有统计学意义(P<0.05)。患者SDS平均分(41.14±11.54)与常模(33.46±8.55)的差异亦有统计学意义(P<0.05)。在65例中根据其SDS量表得分划分为非抑郁组及抑郁组,非抑郁组的客观支持(11.28±1.99)及主观支持(20.43±5.14)与抑郁组的客观支持(9.97±2.19)及主观支持(16.53±4.47)相比的差异有统计学意义(P<0.05),而对社会支持的利用度的差异无统计学意义(P>0.05)。结论前列腺癌患者所获得的社会支持多于正常人群,并且存在较严重的抑郁情绪;抑郁程度较重者所获得的主观支持、客观支持较少。     

慢性肾炎患者抑郁症状对其社会支持状况的影响

目的：评价慢性肾炎患者的抑郁程度,探讨抑郁症状对社会支持状况的影响。方法：2008年3-12月对200例慢性肾炎患者进行词查,采用问卷调查的方式,由专职护士在统一指导语下使用抑郁自评量表（self-ratlng depressive scale,SRDS）和社会支持评定量表（social support rating scale,SSRS）。结果：200例中无抑郁倾向147例（73．5％）、可能抑郁倾向32例（16．0％）、明显抑郁倾向21例（10．5％）。3组抑郁倾向的患者中,明显抑郁倾向组患者的社会支持总分（32．67±6．87）分、客观支持（7．12±1．58）分、主观支持（19．12±5．78）分,支持利用度（6．23±1．13）分均显著低于无抑郁倾向组和可能抑郁倾向组,P〈0．05。结论：慢性肾炎患者存在一定程度的抑郁症状,抑郁倾向严重影响患者的社会支持状况。     

产后抑郁者的人格和社会支持影响因素分析

目的研究产后抑郁者的人格特征、社会支持影响因素以及两者的相关关系。方法对237例产妇评定爱丁堡产后抑郁量表(EPDS)、艾森克人格问卷(EPQ)、社会支持评定量表(SSRS)。结果产后抑郁组与正常组EPQ各维度得分差异有统计学意义(P＜0．01);产后抑郁组的社会支持总分及其分量表得分均显著低于正常组(P＜0．01);社会支持与人格特征之间存在显著相关;抑郁产妇的主观支持情况受其认知模式的影响。结论内倾型、神经质女性易发生产后抑郁;产后抑郁的女性社会支持情况较正常女性差;在提高产妇的社会支持的同时,要注意改变产妇尤其是抑郁产妇的认知模式。     

社会支持因素与肝胆肿瘤患者术后抑郁的相关性分析

抑郁症是一种常见的可由各种原因引起的心境障碍,以显著而持久的心情低落为主要临床特征,重症患者可出现自杀念头和行为,严重影响患者的生活质量[1]。肝胆肿瘤患者术后多数存在抑郁状态,文献报道该抑郁状态与社会支持因素密切相关[2]。社会支持因素是基于社会网络机构之上的以自身为中心的各种社会关系对个体的主客观所产生的影响力[3]。本研究通过对肝胆肿瘤患者术后抑郁发生情况及社会支持因素进     

肝硬化患者抑郁状况分析

我院运用医院焦虑抑郁量表对肝硬化患者的焦虑和抑郁状况实行评估．采取心理治疗措施，减轻其焦虑和抑郁，现报道如下。     

沈阳市2008年中国戒烟竞赛大众参赛者情况分析

目的：了解沈阳市参加戒烟竞赛的大众参赛者情况,探讨适宜的组织动员方法。方法：对符合竞赛要求的参赛者的基本情况和烟草使用状况进行统计分析。结果：以军人、农民及在校学生的参赛人数最少,其他劳动者、办事人员、单位负责人、离退休人员的参赛人数相对较多。结论：加大重点行业人群的宣传力度,开展有效的宣传和教育,并积极探索适宜、有效的戒烟方法,为戒烟提供尽可能多的技术支持。     

Correlates of expected positive and negative support for smoking cessation among a sample of chronically ill veterans

Objective

To examine demographic, relationship, and smoking history factors related to expected positive and negative support for quitting smoking among chronically ill veterans.

Methods

Data for this report comes from baseline data from a randomized controlled trial of a support-based smoking cessation intervention for veterans with chronic diseases (cancer, cardiovascular disease, hypertension, diabetes, and chronic obstructive pulmonary disease). We used separate multiple linear regression models to analyze relationships between positive and negative support and variables selected for model entry.

Results

Veterans in our sample expected high positive and negative support for quitting. Veterans who were married/living as married, had some college education, were female, or named a female support person expected higher levels of positive support. Veterans who named a female or a nonsmoker as a support person expected higher levels of negative support. Males and non-Caucasians also reported higher levels of expected negative support.

Conclusions

Individual differences that influence perceptions of expected support are likely to influence intervention participation and engagement. Thus, understanding factors associated with expected positive and negative support is necessary to optimize future implementation of support-based cessation interventions through better treatment matching.     

Overcoming recruitment challenges of web-based interventions for tobacco use: The case of web-based acceptance and commitment therapy for smoking cessation

Web-based behavioral interventions for substance use are being developed at a rapid pace, yet there is a dearth of information regarding the most effective methods for recruiting participants into web-based intervention trials. In this paper, we describe our successful recruitment of participants into a pilot trial of web-based Acceptance and Commitment Therapy (ACT) for smoking cessation and compare traditional and web-based methods of recruitment in terms of their effects on baseline participant characteristics, association with study retention and treatment outcome, yield, and cost-effectiveness. Over a 10-week period starting June 15, 2010, we recruited 222 smokers for a web-based smoking cessation study using a variety of recruitment methods. The largest portion of randomized participants were recruited through Google AdWords (36%), followed by medical Internet media (23%), standard media (14%), word of mouth (12%), broadcast emails (11%), and social media (6%). Recruitment source was not related to baseline participant characteristics, 3-month data retention, or 30-day point prevalence smoking abstinence at the 3-month outcome assessment. Cost per randomized participant ranged from $5.27/participant for word of mouth to $172.76/participant for social media, with a mean cost of $42.48/participant. Our diversified approach to recruitment, including both traditional and web-based methods, enabled timely enrollment of participants into the study. Because there was no evidence of a substantive difference in baseline characteristics, retention, or outcomes based on recruitment channel, the yield and cost-effectiveness of recruitment methods may be the more critical considerations in developing a feasible recruitment plan for a web-based smoking cessation intervention study.     

Treatment seeking for smoking cessation among young adults

Young adult smokers (18–24 year olds) do not seek treatment for smoking cessation as often as older smokers. Two commonly hypothesized reasons for this are that younger smokers are not aware of treatments or cannot afford them. The State of Vermont provides free smoking cessation treatment, and most young smokers are aware of this; thus, we tested whether young adult smokers from Vermont would still underutilize treatment via a secondary analysis of the population-based 2005 VT Adult Tobacco Survey. Young adult smokers from Vermont were less likely to have used medication (24% vs. 58%; relative risk = 0.42) or psychosocial (28% vs. 53%; relative risk = 0.54) treatment than middle-aged smokers (25–44 year olds). We conclude that reasons other than awareness and cost cause young adult smokers to not seek treatment.     

Changes in urinary catecholamine excretion after smoking cessation

Excretion levels of norepinephrine, epinephrine, and dopamine were assessed in 17 habitual cigarette smokers while smoking and periodically during 30 days of abstinence to determine whether a pattern of transient change existed, suggestive of sympathetic nervous system (SNS) involvement in tobacco withdrawal. Excretion of all three catecholamines declined 1 day after abstinence but did not return to precessation levels during the rest of the follow-up period. The results suggest that postcessation declines in excretion may be permanent changes caused by loss of tobacco's agonist effects, rather than transient withdrawal phenomena resulting from SNS adaptation to the stimulatory effects of tobacco.     

慢性心衰患者吸烟及戒烟依从性影响因素的临床研究

目的临床研究慢性心衰患者吸烟及戒烟依从性的影响因素。方法选取我院有吸烟史的慢性心衰患者200例,本研究采用问卷方式进行调查,研究所用量表综合了Fager-strom尼古丁依赖性评分表及2006年中国国际戒烟竞赛随访调查表的内容,并结合慢性心衰患者情况进行调整。结果对慢性心衰患者吸烟及戒烟依从性影响因素进行分析研究,可明显提高戒烟率,文化程度高,依从性相对较好,已戒烟者占80％;文化程度低,依从性相对较差,戒烟者只有20％,家庭成员支持戒烟的比例,戒烟者为85％,高于家庭成员不支持戒烟的比例55％。讨论戒烟是慢性心衰患者最有力的干预方法之一,帮助患者戒烟成为慢性心衰诊治工作不可缺少的部分。烟草依赖是一种慢性成瘾性疾病,具有高复发的特点,自行戒烟率低,必须将烟草依赖作为一种慢性病对待,予以评估并反复干预。     

General and smoking cessation related weight concerns in veterans

This study sought to assess general and cessation related weight concerns in Veterans presenting for QuitSmart, a tobacco cessation program used extensively in the Veteran Affairs system. Assessed were prevalence rates of cessation related weight concerns, the weight at which concerned Veterans would relapse to smoking, characteristics of weight concerned Veterans, and the impact of weight concerns on cessation at the program's end and at the 1-month follow-up. Sixty-seven Veterans participated. Of those, 63 were eligible for cessation analyses. Results suggested that 26.9% were concerned about post-cessation weight gain, the mean and median weights tolerated before relapse were in the 10-12 lb range, and weight concerned Veterans were more likely younger with more general weight concerns. At both time points, Veterans with general weight concerns were much more likely to quit smoking than those without such concerns. At neither time point, were post-cessation weight concerns significantly associated with quit status, though specific concerns remained in predictive models and trends suggested those with cessation related weight concerns were less likely to quit smoking than those without such concerns. Results suggest a significant prevalence rate of general and cessation related weight concerns in Veterans attempting to quit smoking, greater success in doing so if weight concerns are general in nature, and the need to continue to assess these relationships and develop effective cessation treatments for this population.     

Management of smoking cessation in patients with psychiatric disorders

ABSTRACT

Background: There is a close relationship between tobacco smoking and psychiatric disorders, and a higher proportion of individuals with mental health conditions smoke compared with the general population. Due to the increased smoking prevalence in this population, patients with psychiatric conditions are at greater risk of smoking-related morbidity and mortality and experience detrimental effects on their quality of life. However, while the majority of individuals with a history of mental health conditions appreciate that smoking is detrimental to their health, they are less likely to quit smoking and have a lower success rate during quit attempts compared with the general population.

Scope: Peer-reviewed articles were identified from PubMed using the inclusive date-range of 1990 – October 2008 and the search terms; depression, mental health, psychiatric disorders, schizophrenia, and smoking cessation. Articles were selected from the search results to provide a general overview of some of the main issues for smokers with psychiatric disorders in general and specifically, those with schizophrenia and depression. The evidence from smoking cessation trials within these populations was also reviewed.

Findings: Nicotine has some positive effects on symptoms of psychiatric disorders and it has been proposed that patients with mental health conditions may smoke as a form of self-medication. Further, several studies have shown that some symptoms of psychiatric disorders may be exacerbated by nicotine withdrawal. Therefore, attempts to quit smoking pose additional problems to patients with mental health problems.

Conclusion: Traditional programmes for smoking cessation may not always be suitable for psychiatric patients due to their neuropsychological profile. Preliminary evidence suggests that more flexible, open-ended, combination approaches of pharmacotherapy and counselling may be more successful. In addition, identification and treatment of nicotine addiction remains very low in patients with mental health conditions and far more needs to be done to raise the awareness and ability of psychiatrists to diagnose and treat patients with nicotine problems.     

戒烟和吸烟对门诊初治培阳肺结核患者的影响

目的：探讨吸烟和戒烟对门诊初治培阳肺结核患者治疗结果的影响。方法102例门诊吸烟初治培阳肺结核患者分为吸烟组和戒烟组,吸烟组根据吸烟指数再分为两个亚组（第1组,200年支≤吸烟指数〈800年支,28例;第2组,吸烟指数≥800年支,26例）,对两组患者的2个月末痰菌培养的痰菌阴转率对比分析。结果吸烟组2个月末痰菌培养阴转率（87.0%）,明显低于戒烟组（95.8%）,两组相比差异具有统计学意义（P〈0.05）。吸烟指数≥800年支组痰培养阴转率（80.7%）明显低于吸烟指数200年支≤吸烟指数〈800年支组（92.8%）,两组相比差异具有统计学意义（P〈0.05）。结论吸烟是使门诊初治培阳肺结核患者2个月痰菌培阳性率增高的重要因素,并影响化疗效果。提倡戒烟是减少肺结核传染源、保护易感人群的简单而有效的方法。     

An algorithm for choosing among smoking cessation treatments

Currently, there are nine validated medications, four validated psychosocial strategies, and three validated ways to deliver psychosocial treatments for smoking cessation. This article presents an algorithm based on a literature review and the author's clinical experience. The algorithm integrates the recommendations of the major guidelines and meta-analyses and provides rationales for its treatment decisions. The algorithm suggests a brief assessment followed by use of one to two medications and counseling in most smokers. Because all treatments appear equally effective and have few adverse events, the algorithm suggests clinicians inform smokers of the pros and cons of the different treatments, and recommend use of one or more of each. If a smoker fails to quit, the algorithm suggests an assessment of why relapse occurred and then a more intense treatment, a new treatment, or both.     

Cigarette smoking cessation services in outpatient substance abuse treatment programs in the United States

OBJECTIVE: The objective of this study was to estimate the prevalence and determinants of cigarette smoking cessation treatment in U.S. outpatient substance abuse treatment (OSAT) units. METHODS: Program directors and clinical supervisors from a national sample of 550 OSAT units in the United States were surveyed in 2004-2005. Supervisors reported the availability of cigarette smoking assessment, and individual or group counseling and pharmacotherapy for smoking cessation. This analysis examines whether institutional and resource factors influence the delivery of these services. RESULTS: Of OSAT programs in the United States, 41% offer smoking cessation counseling or pharmacotherapy, 38% offer individual/group counseling, and 17% provide quit-smoking medication. In multivariate models, hospital affiliation, service breadth, the priority given to physical health, the availability of medication to treat addictive problems, assessment of cigarette smoking, and a greater perception of the proportion of patients who smoke were associated with the delivery of smoking cessation services. Program size and medical staffing also influenced the availability of quit-smoking medication. CONCLUSIONS: Of U.S. OSAT programs, two in five offer behavioral treatment for smoking cessation, but fewer than one in five provide access to pharmacotherapy. Substance abuse treatment programs that are medically oriented, provide more comprehensive services, and recognize the burden of tobacco smoking among their patients are more likely to deliver evidence-based smoking cessation services.