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。     

吸烟对肺结核的疗效影响

目的探究吸烟对于肺结核疗效的影响和二者之间的剂量与反应的关系。方法选取近段时间某医院住院并完成了2个月的强化的疗程的肺结核患者共有261例,依据他们治疗之前的吸烟量的情况,并观察他们经过了2个月强化性抗结核的治疗后他们的痰菌的阴转的概率。结果患者们经过了2个月的强化治疗后,其中202例病患出现痰菌阴转。但是性别、年龄等和病灶范围等等因素对于痰菌的阴转并没有明显的影响;但在吸烟的患者中,治疗前如果每天吸烟的平均值有所增加,那么他的痰菌阴转率就会明显下降,因此在一定程度上可以认为,每天吸烟的平均值与痰菌阴转率之间有一定的关系,也可以说是剂量与反应之间存在明显的关系。结论吸烟对于肺结核的疗效具有较大的影响,在临床实践中,应该多加重视。     

吸烟人群戒烟意愿与戒烟尝试现况调查

目的了解郑州市吸烟人群戒烟意愿和戒烟尝试的现状。方法应用流行病学现况调查方法,采用多阶段与规模成正比的容量比例抽样方法获得调查对象,在调查员的帮助下,吸烟人群自填问卷的方式调查。结果本次调查的394名吸烟者中,有戒烟意愿的人数为173人,占44．8％;有过戒烟尝试的人数为159,占40．5％。不同人口学特征的吸烟人群的戒烟尝试和戒烟意愿无明显不同;单因素分析发现：家中有吸烟限制（X^2=13．084,P=0．001）、工作单位有限制吸烟规定（X^2=29．904,P=0．000）、单位室内张贴禁烟标识（X^2=22．407,P9=0．000）均会促使吸烟者产生戒烟意愿,而工作单位有限制吸烟规定（X^2=13．214,P=0．001）、单位室内张贴禁烟标识（X^2=18．958,P=0．000）、个人压力过大（X^2=13．511,P=0．000）的吸烟者有更多的尝试戒烟。结论通过家人督促,家中限制吸烟、单位限制吸烟、张贴禁烟标识等方式,可以很好地提高郑州市吸烟者戒烟意愿和戒烟尝试的产生,亦可鼓励吸烟者多次尝试戒烟,以提高戒烟率。     

吸烟、戒烟与血压关系的研究进展

高血压是一种以体循环动脉血压增高为主要表现的全身性疾病,其中原发性高血压占95%以上。在高血压常见的危险因素中,吸烟是较受关注的因素之一。本文就吸烟与高血压的关系进行综述,并探讨戒烟对血压的影响。     

我院住院吸烟患者240例戒烟问卷调查分析

目的 总结240例我院住院吸烟患者的人口学特征及其入院前吸烟习惯等,为戒烟工作提供依据.方法 采用统一问卷,用自我填表的形式对240例在我院住院治疗的吸烟患者进行问卷调查.收集个人资料及健康状况,人院前吸烟的相关行为、曾经戒烟的态度和方法等资科.以SPSS软件统计分析各参数构成比.结果 戒烟者的平均年龄为54.8岁,绝大多数(95％)为男性,多数(79％)是已婚.吸烟开始的平均年龄为21岁,在发病后51％的人完全停止吸烟,伴有医生诊断过证明患有慢性疾病的有60％,大多数人是靠意志力自行减少吸烟量来达到戒烟目的.曾向医生或护士寻求建议和帮助的仅占2％.结论 进一步对50岁男性吸烟者人群加强吸烟有害健康的宣传是做好戒烟工作的重点.     

某县肺结核患者吸烟与疗效分析

目的分析肺结核患者疗效与吸烟因素提高治愈率。方法采用询问调查的方式和统计分析2005年至2012年全县肺结核患者疗效与吸烟因素。结果本县8年间登记活动性肺结核910例(胸膜炎除外),登记率为445/10万,新涂阳登记率为227/10万,男女之比3.25∶1,肺结核患病率低于全国第五次流调全省水平,涂阳患病率高于全国第五次流调全省水平;吸烟与不吸烟在症状、体征改善,病灶吸收、空洞闭合方面存在显著差异,P<0.001;涂阳患者痰菌阴转不存在差异;治疗转归不存在差异。结论吸烟影响病灶吸收、症状改善、空洞闭合,对治疗效果有一定影响。     

吸烟、戒烟对睡眠呼吸暂停低通气综合征影响的临床研究

目的 探讨吸烟、戒烟与阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea hypopnea syndrom,OSAHS）的关系和影响.方法 将100例OSAHS患者根据是否吸烟分为：吸烟组和不吸烟组.选取呼吸暂停低通气指数（apnea hypopnea index,AHI）、平均血氧饱和度 SaO2 mean（%）等数据作为评价病情变化的依据,同时监测患者吸烟的烟龄、吸烟量的多少,进行统计学处理和相关分析.对吸烟组患者进行戒烟干预,并对比分析成功戒烟者3个月前后AHI、SaO2 mean（%）的变化.结果 吸烟组AHI显著高于不吸烟组,吸烟组患者平均血氧饱和度低于不吸烟组患者,吸烟量和烟龄是影响分析结果的主要因素.吸烟组患者戒烟后AHI和SaO2 mean（%）有明显改善（P＜0.01）;戒烟联合系统连续的睡眠时经鼻CPAP治疗,病情改善更为明显.结论 OSAHS吸烟组患者的睡眠呼吸障碍程度均比非吸烟组严重,戒烟对改善OSAHS病情有积极的作用.     

吸烟对结核患者诊疗及药品不良反应的影响

目的:研究吸烟与不吸烟对结核患者治愈率及药品不良反应(ADR)发生率的影响,为吸烟肺结核患者制订有效的预防和处理措施提供依据。方法:将我院2010年6月-2013年6月期间住院治疗肺结核患者189例,分为吸烟组(122例)与非吸烟组(67例),比较两组患者的治愈率、咳嗽及ADR发生情况。结果:男性患者治愈率非吸烟组患者为77.78%,吸烟组为66.96%,两组比较,差异有统计学意义(χ2=6.13,P<0.01);女性患者治愈率非吸烟组为83.67%,吸烟组为60.00%,两组比较差异有统计学意义(χ2=5.63,P<0.01);咳嗽的发生率吸烟组为92.62%,非吸烟组为74.63%,两组比较差异有统计学意义(χ2=11.81,P<0.01);患者的ADR主要为肝肾功能异常、食欲不振、白细胞减少等,吸烟组ADR发生率高于非吸烟组,两组比较差异有统计学意义(χ2=12.15,P<0.01)。结论:吸烟会降低肺结核患者的治愈率,升高患者咳嗽及ADR发生率。     

某团戒烟的主要做法和体会

吸烟是危害人类健康的一大公害。吸烟问题在部队这个特殊的环境中也比较普遍。为了认真贯彻《全军除害灭病规划》，在部队开展系统化健康教育，改变不良卫生习惯，促进健康行为的养成，沈阳军区某团从1994年3月开始在全团范围开展群体“控烟、戒烟”活动。     

Influence of fluoxetine on positive and negative affect in a clinic-based smoking cessation trial

Rationale Fluoxetine improves affect in clinical syndromes such as depression and premenstrual dysphoric disorder. Little is known about fluoxetines influence on mood changes after quitting smoking, which often resemble sub-clinical depression.Objectives The present study, a re-analysis of previously published data (Niaura et al. 2002), examined fluoxetines effect on changes in negative and positive affect following quitting smoking.Methods Adult smokers (n=175) without clinically significant depression were randomized on a double-blind basis to receive fluoxetine hydrochloride (30 or 60 mg daily) or placebo for 10 weeks in combination with cognitive-behavioral therapy (CBT) for smoking cessation. We postulated that fluoxetine would beneficially influence post-cessation changes in positive and negative affect.Results Mood change across treatment was analyzed using mixed linear modeling controlling for initial level of nicotine dependence, plasma fluoxetine metabolites, and change in cotinine (a nicotine metabolite) at each visit. Relative to placebo, those on 60 mg fluoxetine experienced an elevation in positive affect that increased across time [t(526)=2.50, P=0.01], and a reduction in negative affect that returned to baseline across time [t(524)=2.26, P=0.02]. There were no differences between 30 mg and placebo on changes in positive or negative affect.Conclusions Results indicate that 60 mg of fluoxetine improves both positive and negative mood states after quitting smoking and that diminished positive affect may be an overlooked affective response to smoking cessation.     

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.     

Effects of partner smoking status and gender on long term abstinence rates of patients receiving smoking cessation treatment

AIMS: To assess the effect of partner smoking status on the success of a cessation program. DESIGN: Prospective cohort. SETTING: Smoking Cessation Unit in Hospital of Bellvitge (Hospitalet de Llobregat, Barcelona). PARTICIPANTS: A total of 1516 smokers of 10 or more cigarettes who started a smoking cessation program between January 1995 and December 2001 were included. MEASUREMENTS: All patients gave information about smoking history and smoking partner status. Abstinence was determined by carbon monoxide exhaled. FINDINGS: Significant differences were found in the abstinence rates at 12 months by smoking partner status: abstinence was achieved by 28.3% of patients with smoking partner, and by 46.5% of patients without smoking partner (p<0.001). Subjects whose partner was smoking at the beginning of the program appear to be more likely to relapse than subjects without smoking partners (p<0.001) and this is more pronounced in women than in men. However no significant gender differences were found in any group of smoking partner status. CONCLUSIONS: Having a smoking partner is a determinant of relapse 1 year after the beginning of the cessation program. Interacting not just with the smoker, but also with his or her partner, could neutralize interpersonal influences making smokers more accessible to behavioural and pharmacological techniques.     

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.     

Transdermal nicotine in smoking cessation

Summary A systematic search of the literature was made to identify relevant reports of clinical trials of transdermal nicotine, followed by detailed statistical analysis of the results to calculate a pooled estimate of the rate of smoking cessation. Both a fixed effect and a random effects model were used to calculate pooled estimates.The pooled odds ratio (OR) for short-term smoking cessation in favour of the transdermal patches was OR=3.10. Using a random effects model, the risk difference (RD) in favour of the transdermal patches was RD=0.25. The corresponding values for long-term cessation were OR=2.26 and RD=0.11. Skin irritation was a common adverse effect with incidence rates ranging up to about 70%.Nicotine transdermal patches were effective in promoting smoking cessation both in the short-term, with assessments at 3 to 10 weeks, and in the long-term, with assessment at 24 to 52 weeks. Long-term abstinence rates in subjects treated with nicotine patches for a few weeks remained higher than in subjects treated with placebo patches. Adverse effects were usually minor and transient, although subjects with a sensitive skin may find the applications intolerable. Further studies are required to confirm the value of nicotine patches in promoting smoking cessation in the absence of professional medical support and in general medical practices in the community.     

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.     

Endocrine and metabolic effects of smoking cessation

ABSTRACT

Background: Cardiovascular, pulmonary, and oncological hazards of tobacco smoking have been well studied. Smoking may also have multiple effects on endocrine and metabolic systems affecting pituitary, thyroid, and adrenal glands; testicular and ovarian function; as well as energy balance; lipid, and glucose metabolism; and insulin resistance. Less is known about hormonal and metabolic effects that patients may experience while quitting smoking.

Scope: The objective of this article is to review systematically data on the endocrine and metabolic effects of smoking cessation. Articles based upon clinical trials, randomised controlled trials, and meta-analyses were obtained via a MEDLINE search (articles published between 1?August 1998 and 31?July 2008, inclusive; English language; human subjects; including abstracts) using key search terms relating to smoking cessation and endocrine or metabolic parameters. Additional studies were identified from the bibliographies of reviewed literature. Studies related to the search criteria were reviewed, 199 papers were identified, and 57 pertinent to this review were included.

Findings: Limited data are available on the short- and long-term effects of smoking cessation on hypothalamic– and thyroid–pituitary–adrenal axes, sex hormones, energy homeostasis, and lipid and glucose metabolism. Initial data indicate that smoking cessation is associated with decreased cortisol levels and in the short-term, smoking cessation does not correct the diminished adrenocortical responses to stress caused by chronic smoking. Cessation reverses smoking's effects on thyroid disorders and may reduce the risk of osteoporosis. Finally, smoking cessation increases transiently food intake and sustained weight gain and is associated with increases in high-density lipoprotein cholesterol levels that occur rapidly on cessation.

Conclusion: Further research may provide insight into post-cessation endocrine changes that may be caused by alterations to central and peripheral systems. Such research may increase the understanding of underlying biological mechanisms that lead to symptoms and clinical features of smoking cessation.     

Clinical phenotypes related to smoking cessation

Introduction

The aim of the current study is the identification of clinical phenotypes of patients visiting a specialized smoking cessation center and the determination of smoking cessation rate for each phenotype, 1 year after the initial evaluation.

Methods

Seven hundred eighty-three smokers who visited the outpatient clinic were included in the study. Demographic data, smoking habits, tobacco dependence and comorbidities were recorded. Smoking cessation rates and carbon monoxide levels were determined 1 year after the initial evaluation.

Results

Τhe overall smoking cessation rate 1 year after the initial evaluation was 32.3%. Four distinct phenotypes were identified. The first one included mainly young women with low tobacco dependence and allergic profile. The second and the third ones included mainly men with high tobacco dependence, without comorbidities, treated with varenicline and bupropione SR, respectively. The fourth one included mainly older men with high tobacco dependence and smoking related comorbidities. Smoking cessation rates for each phenotype were 33.8, 39.4, 23.3, and 24.6%, respectively.

Conclusion

Patients visiting a specialized smoking cessation center can be categorized in different phenotypes. Phenotyping may lead to a more personalized approach concerning smoking cessation.     

Predictors of the participation of smoking parents in a proactive telephone-based smoking cessation program

OBJECTIVE: The objective of this study is to identify the predictors of participation by smoking parents in a proactive telephone-based smoking cessation program. METHODS: The smoking parents of young children from a birth cohort were interviewed and invited to take part in a telephone-based smoking cessation program. The characteristics of the parents and the predictors of participation were analyzed by chi-square test and by logistic regression. RESULTS: A total of 952 (82.9%) out of the 1149 smoking parents who were interviewed agreed to participate in the smoking cessation program. The analysis showed that the predictors of participation in a pro-active smoking cessation program are being from a middle-income household, being currently employed, having recently had a medical consultation or been hospitalized, being at the stage of contemplating a change in behavior, and perceiving the importance of quitting smoking. CONCLUSIONS: Recruitment approaches should be refined according to the identified factors to target those who might decline an invitation to participate in a smoking cessation program.