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1.
Elisheva R. Danan Anne M. Joseph Scott E. Sherman Diana J. Burgess Siamak Noorbaloochi Barbara Clothier Sandra J. Japuntich Brent C. Taylor Steven S. Fu 《Journal of general internal medicine》2016,31(8):878-887
Background
Current guidelines advise providers to assess smokers’ readiness to quit, then offer cessation therapies to smokers planning to quit and motivational interventions to smokers not planning to quit.Objectives
We examined the relationship between baseline stage of change (SOC), treatment utilization, and smoking cessation to determine whether the effect of a proactive smoking cessation intervention was dependent on smokers’ level of motivation to quit.Design
Secondary analysis of a multicenter randomized controlled trial.Participants
A total of 3006 current smokers, aged 18–80 years, at four Veterans Affairs (VA) medical centers.Interventions: Proactive care included proactive outreach (mailed invitation followed by telephone outreach), offer of smoking cessation services (telephone or face-to-face), and access to pharmacotherapy. Usual care participants had access to VA smoking cessation services and state telephone quitlines.Main Measures
Baseline SOC measured with Readiness to Quit Ladder, and 6-month prolonged abstinence self-reported at 1 year.Key Results
At baseline, 35.8 % of smokers were in preparation, 38.2 % in contemplation, and 26.0 % in precontemplation. The overall interaction between SOC and treatment arm was not statistically significant (Limitations
Mostly male participants limits generalizability. Randomization was not stratified by SOC.Conclusions
Proactive care increased treatment uptake compared to usual care across all SOC. Proactive care increased smoking cessation among smokers in preparation and contemplation but not in precontemplation. Proactively offering cessation therapies to smokers at all SOC will increase treatment utilization and population-level smoking cessation.2.
Leung Y Kaplan GG Rioux KP Hubbard J Kamhawi S Stasiak L Cohen RD Devlin SM Panaccione R Hanauer SB Rubin DT 《Digestive diseases and sciences》2012,57(4):1026-1032
Background
Patients with Crohn’s disease (CD) who smoke have a more complicated disease course.Aims
Our primary objective was to assess smoking related variables that were associated with smoking cessation versus continued smoking in patients with CD.Methods
A multi-center study identified CD patients who were seen at the University of Chicago and University of Calgary IBD clinics. Patients were categorized into three subgroups: lifetime non-smokers, current smokers, or ex-smokers. Participants completed questionnaires assessing their cigarette smoking behavior. Current smokers were prospectively followed for 6?months to assess smoking status and attempts to quit. Logistic regression analysis was performed to identify factors associated with smoking cessation.Results
Three hundred patients were enrolled with 148 identifying themselves as lifetime non-smokers, 70 as current smokers, and 82 as ex-smokers. Patients who reported their first cigarette within 5?min of waking were more likely to be current smokers (OR?=?21; 95% CI 3.94–107.3) as compared to patients who waited greater than 60?min. Current smokers were more likely to have one or more household members who smoked compared to ex-smokers (P?0.05). Nearly half (49%) of the current smokers were in the precontemplation stage of change (i.e. no intention to quit smoking). At the 6-month follow-up, only 11% reported they quit smoking.Conclusions
Patients who report a short time to first cigarette in the morning may have more difficulty in smoking cessation. Current smokers were more likely to have another smoker in the household compared to ex-smokers. Current smokers had low levels of motivation to quit smoking and consequently with no intervention, very few quit 6?months after the baseline assessment. 相似文献3.
Assessment of factors associated with smoking cessation at diagnosis or during follow‐up of Crohn's disease
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Eun Mi Song Gwang‐Un Kim Myeongsook Seo Sung Wook Hwang Sang Hyoung Park Eunja Kwon Ho‐Su Lee Dong‐Hoon Yang Kyung‐Jo Kim Byong Duk Ye Jeong‐Sik Byeon Seung‐Jae Myung Suk‐Kyun Yang 《Journal of gastroenterology and hepatology》2018,33(1):180-186
Background and Aim
Smoking cessation is known to improve the course of Crohn's disease (CD). However, the factors associated with smoking cessation after CD diagnosis have not been well established.Methods
Clinical characteristics and change in smoking status were evaluated in 445 current smokers at the time of CD diagnosis. Patients were classified into three subgroups based on their final smoking status and time of smoking cessation: non‐quitters, quitters at diagnosis, and quitters during follow‐up.Results
The overall smoking cessation rate was 55.7% (248 of 445 patients). The diagnosis of CD was the main reason for quitting (41.5%, 103 of 248 patients). Smoking cessation at the time of CD diagnosis was associated with intestinal resection within 3 months from CD diagnosis (odds ratio [OR] 2.355, 95% confidence interval [CI] 1.348–4.116, P = 0.003), light smoking (OR 2.041, 95% CI 1.157–3.602, P = 0.014), and initiation of smoking before 18 years of age (OR 0.570, 95% CI 0.327–0.994, P = 0.047). Light smoking (OR 1.762, 95% CI 1.019–3.144, P = 0.043) and initiation of smoking before 18 years (OR 0.588, 95% CI 0.381–0.908, P = 0.017) were also associated with overall smoking cessation.Conclusion
Quitters after CD diagnosis, including quitters at diagnosis and quitters during follow‐up, had features distinct from those of non‐quitters. Given the motivation at CD diagnosis, a detailed history of smoking habits should be taken and all current smokers should be encouraged to quit smoking at the time of CD diagnosis. 相似文献4.
Background
The pathogenesis of HIV/hepatitis C virus (HCV) coinfection is poorly understood. We examined markers of oxidative stress, plasma antioxidants and liver disease in HIV/HCV‐coinfected and HIV‐monoinfected adults.Methods
Demographics, medical history, and proof of infection with HIV, hepatitis A virus (HAV), hepatitis B virus (HBV) and HCV were obtained. HIV viral load, CD4 cell count, complete blood count (CBC), complete metabolic panel, lipid profile, and plasma concentrations of zinc, selenium, and vitamins A and E were determined. Malondialdehyde (MDA) and glutathione peroxidase concentrations were obtained as measures of oxidative stress. Aminotransferase to platelet ratio index (APRI) and fibrosis index (FIB‐4) markers were calculated.Results
Significant differences were found between HIV/HCV‐coinfected and HIV‐monoinfected participants in levels of alanine aminotransferase (ALT) (mean±standard deviation: 51.4±50.6 vs. 31.9±43.1 U/L, respectively; P=0.014), aspartate aminotransferase (AST) (56.2±40.9 vs. 34.4±30.2 U/L; P<0.001), APRI (0.52±0.37 vs. 0.255±0.145; P=0.0001), FIB‐4 (1.64±.0.91 vs. 1.03±0.11; P=0.0015) and plasma albumin (3.74±0.65 vs. 3.94±0.52 g/dL; P=0.038). There were no significant differences in CD4 cell count, HIV viral load or antiretroviral therapy (ART) between groups. Mean MDA was significantly higher (1.897±0.835 vs. 1.344± 0.223 nmol/mL, respectively; P=0.006) and plasma antioxidant concentrations were significantly lower [vitamin A, 39.5 ± 14.1 vs. 52.4±16.2 μg/dL, respectively (P=0.0004); vitamin E, 8.29±2.1 vs. 9.89±4.5 μg/mL (P=0.043); zinc, 0.61±0.14 vs. 0.67±0.15 mg/L (P=0.016)] in the HIV/HCV‐coinfected participants than in the HIV‐monoinfected participants, and these differences remained significant after adjusting for age, gender, CD4 cell count, HIV viral load, injecting drug use and race. There were no significant differences in glutathione peroxidase concentration, selenium concentration, body mass index (BMI), alcohol use or tobacco use between groups. Glutathione peroxidase concentration significantly increased as liver disease advanced, as measured by APRI (β=0.00118; P=0.0082) and FIB‐4 (β=0.0029; P=0.0177). Vitamin A concentration significantly decreased (β=?0.00581; P=0.0417) as APRI increased.Conclusion
HIV/HCV coinfection is associated with increased oxidative stress and decreased plasma antioxidant concentrations compared with HIV monoinfection. Research is needed to determine whether antioxidant supplementation delays liver disease in HIV/HCV coinfection.5.
Objectives
Antiretroviral therapy (ART) in HIV‐infected patients is associated with increased cardiovascular risk. Circulating markers of endothelial dysfunction may be used to study early atherogenesis. The aim of our study was to investigate changes in such markers during initiation of ART.Methods
In 115 HIV‐positive treatment‐naïve patients, plasma lipids, E‐selectin, soluble intercellular adhesion molecule 1 (sICAM‐1), soluble vascular cell adhesion molecule 1 (sVCAM‐1), tissue‐type plasminogen activator inhibitor 1 (tPAI‐1) and high‐sensitivity C‐reactive protein (hsCRP) were measured before and after 2 and 14 months of ART. A control group of 30 healthy subjects was included. Values are mean±standard error of the mean.Results
Prior to treatment, HIV‐infected patients had elevated levels of sICAM‐1 (296±24 vs. 144±12 ng/mL), tPAI‐1 (18 473±1399 vs. 5490±576 pg/mL) and hsCRP (28 060±5530 vs. 6665±2063 ng/mL) compared with controls (P<0.001). In contrast, sVCAM‐1 and E‐selectin did not differ between the groups. Initiation of ART resulted in significantly lower levels of E‐selectin (15.1±0.8; P<0.01), sICAM‐1 (248±12 ng/mL; P<0.05), sVCAM‐1 (766±33 ng/mL; P<0.001) and hsCRP (14 708±2358 ng/mL; P<0.001) after 2 months, which remained reduced at 14 months. tPAI‐1 was not influenced by initiation of ART.Conclusions
Markers of endothelial dysfunction were elevated in treatment‐naïve HIV‐infected patients and were related to HIV RNA viral load. Initiation of ART reduced the levels of the majority of these markers. The positive effect of ART initiation was dependent on the duration of HIV infection prior to treatment. 相似文献6.
Louise Balfour William D. Cameron Daniella Sandre Andrew Pipe Curtis Cooper 《AIDS care》2017,29(1):24-31
Cardiovascular disease (CVD) rates among people living with HIV/AIDS (PHAs) are high. Rates of cigarette smoking, a leading contributor to CVD among PHAs, are 40–70% (2–3 times higher than the general population). Furthermore, PHAs have high rates of depression (40–60%), a risk factor for smoking cessation relapse. The current pilot study examined the effectiveness of a specifically tailored 5-session smoking cessation counselling programme for PHAs, which addressed depression, in combination with Nicotine Replacement Therapy (NRT) in a cohort of PHA smokers (n?=?50). At 6-month follow-up, 28% of participants demonstrated biochemically verified abstinence from smoking. This result compares favourably to other quit-smoking intervention studies, particularly given the high percentage of HIV+ smokers with depression. At study baseline, 52% of HIV+ smokers scored above the clinical cut-off for depression on the Centre for Epidemiological Studies – Depression (CES-D) scale. HIV+ smokers with depression at study baseline demonstrated quantitatively lower depression at 6-month follow-up with a large effect size (d?=?1), though it did not reach statistical significance (p?=?.058). Furthermore, those with depression were no more likely to relapse than those without depression (p?=?.33), suggesting that our counselling programme adequately addressed this significant barrier to smoking cessation among PHAs. Our pilot study indicates the importance of tailored programmes to help PHAs quit smoking, the significance of addressing depressive symptoms, and the need for tailored counselling programmes to enhance quit rates among PHAs. 相似文献
7.
Sonia M. Grandi Kristian B. Filion André Gervais Lawrence Joseph Jennifer O'Loughlin Gilles Paradis Stéphane Rinfret Louise Pilote François R. Grondin Sohrab Lutchmedial Mark J. Eisenberg 《The American journal of medicine》2014
Background
Current guidelines recommend smoking cessation and weight management for secondary prevention in patients post-myocardial infarction. However, little is known about the effects of smoking cessation on weight change post-myocardial infarction.Methods
We examined patterns of weight change and its effects on blood pressure and glycemic control using data from a randomized trial investigating the effect of bupropion on smoking cessation in patients post-myocardial infarction. Weight change was compared among 3 groups of patients: those who were completely abstinent (n = 92), those who smoked intermittently (n = 49), and those who smoked persistently (n = 38) during the 12-month follow-up. Analyses were restricted to patients who attended all follow-up visits.Results
The median weight at baseline was 77.1 kg (interquartile range [IQR], 66.0, 87.5), and 64.3% of patients were overweight/obese (body mass index ≥25.0 kg/m2). The median weight gain at 12 months was 4.0 kg (IQR, 0-7.0), with more than one third gaining >5 kg. The proportion of patients who were overweight/obese increased by approximately 10%, and 23.2% of patients moved up a body mass index category. Abstainers gained a median of 4.8 kg (IQR, 1.0, 8.6), intermittent smokers gained a median of 2.0 kg (IQR, −2.0, 5.0), and persistent smokers gained a median of 3.0 kg (IQR, −0.8, 6.0). Weight gain was associated with an increase in blood pressure and requirements for hypoglycemic medications at 12 months.Conclusions
The majority of patients attempting to quit smoking gain weight 12 months post-myocardial infarction, with abstainers gaining more weight than those who return to smoking. Weight gain was associated with an increased prevalence of hypertension and diabetes. 相似文献8.
Nete M. Villebro Tom Pedersen Ann M. Møller Hanne Tønnesen 《The clinical respiratory journal》2008,2(3):175-182
Introduction: Preoperative smoking intervention programmes reduce post‐operative complications in smokers. Little is known about the long‐term effect upon smoking cessation. Aim: To discover long‐term quit rates and the reasons behind successful cessation. Materials and Methods: 101 one of 120 smokers, randomised to smoking intervention or no intervention before hip and knee surgery, completed questionnaires concerning smoking after 1 year. We selected representative men and women for focus group interviews. Results: Significantly more patients from the intervention group abstained from smoking for 1 year post‐operatively [13 in 60 patients (22%) vs 2 in 60 (3%), P < 0.01]. Sex (male), low nicotine dependency, non‐smoking spouse and preoperative smoking intervention were related to smoking cessation. All patients gave the same reasons for smoking cessation: improved health and saving money. Follow‐up for 5 years showed 17% of the controls and 8% in the intervention group (P = 0.42) had died. Conclusion: The intervention group had a significantly higher quit rate 1 year after a preoperative smoking cessation programme. Please cite this paper as: Villebro NM, Pedersen T, Møller AM and Tønnesen H. Long‐term effects of a preoperative smoking cessation programme. The Clinical Respiratory Journal 2008; 2: 175–182. 相似文献
9.
Background: Many Australian hospitals have recently introduced smoke‐free policies. Aim: The aim of this study was to determine the smoking habits of hospital inpatients and to investigate the scope for an inpatient smoking cessation programme. Methods: A cross‐sectional survey of adult inpatients of a tertiary‐referral hospital who were smoking just before admission. The questionnaire contained items on general demographics, views on quitting, past quit attempts and validated scales – Fagerström test of nicotine dependence, Biener's contemplation ladder and Velicer's smoking decisional balance. Results: Participants' (n= 125) median age was 53 years and had smoked for 35.0 ± 17.2 years. The majority were male (n= 84; 67.2%) and 45 (36.3%) lived with someone who smoked. Participants self‐reported 4.5 ± 7.3 past attempts to quit. Only 61 (49.6%) said that their health professionals ever discussed options to assist quitting. Forty‐nine (39.2%) reported accessing smoking areas during their hospital stay. Participants scored 4.5 ± 2.5 on the Fagerström test. Forty‐two (33.8%) ranked themselves very high (9 or 10) on the contemplation ladder. The mean difference between the Velicer's subscales –‘cons’ (α= 0.81) and ‘pros’ (α= 0.80) was 3.2 ± 10.6 in favour of quitting. Fifty‐four (43.9%) participants were interested in starting smoking cessation therapy during their hospital stay. Nicotine patches (31; 25.4%) were the preferred dosage forms to assist quitting followed by oral tablets (23; 18.9%) and chewing gum (20; 16.4%). Conclusions: Our findings could guide the design of inpatient smoking cessation interventions. Greater efforts from health professionals are essential for informing people about smoking cessation options, promoting their uptake, potentially resulting in higher quit rates. 相似文献
10.
BACKGROUND
Community health center (CHC) patients have high rates of smoking. Insurance coverage for smoking cessation assistance, such as that mandated by the Affordable Care Act, may aid in smoking cessation in this vulnerable population.OBJECTIVE
We aimed to determine if uninsured CHC patients who gain Medicaid coverage experience greater primary care utilization, receive more cessation medication orders, and achieve higher quit rates, compared to continuously uninsured smokers.DESIGN
Longitudinal observational cohort study using electronic health record data from a network of Oregon CHCs linked to Oregon Medicaid enrollment data.PATIENTS
Cohort of patients who smoke and who gained Medicaid coverage in 2008–2011 after ≥ 6 months of being uninsured and with ≥ 1 smoking assessment in the 24-month follow-up period from the baseline smoking status date. This group was propensity score matched to a cohort of continuously uninsured CHC patients who smoke (n?=?4140 matched pairs; 8280 patients).INTERVENTION
Gaining Medicaid after being uninsured for ≥ 6 months.MAIN MEASURES
‘Quit’ smoking status (baseline smoking status was ‘current every day’ or ‘some day’ and status change to ‘former smoker’ at a subsequent visit), smoking cessation medication order, and ≥ 6 documented visits (yes/no variables) at ≥ 1 smoking status assessment within the 24-month follow-up period.KEY RESULTS
The newly insured had 40 % increased odds of quitting smoking (aOR?=?1.40, 95 % CI:1.24, 1.58), nearly triple the odds of having a medication ordered (aOR?=?2.94, 95 % CI:2.61, 3.32), and over twice the odds of having ≥ 6 follow-up visits (aOR?=?2.12, 95 % CI:1.94, 2.32) compared to their uninsured counterparts.CONCLUSIONS
Newly insured patients had increased odds of quit smoking status over 24 months of follow-up than those who remained uninsured. Providing insurance coverage to vulnerable populations may have a significant impact on smoking cessation.11.
Tsz Ho Kwan Ngai Sze Wong Kenny Chi Wai Chan Owen Tak Yin Tsang Man Po Lee Grace Chung Yan Lui Denise Pui Chung Chan Wing Cheong Yam Shui Shan Lee 《Lancet》2017
Background
Improved understanding of network structure—one of the driving forces of HIV transmission—could facilitate the design of interventions. We aimed to assess the structure of HIV transmission networks and their relationship to newly diagnosed cases in Hong Kong, where sexual transmission between men prevails.Methods
We used HIV gag-pol sequences collected over a 20-year period from all major HIV services in Hong Kong to construct transmission networks. We identified network clusters and decomposed them by modularity if one contained more than half of the connected nodes. We analysed network size, average degree, and epidemiological metrics, and examined sequences of newly diagnosed cases in a cross-sectional study to assess growth of identified clusters.Findings
A total of 2352 archived HIV sequences collected in 1994–2013 were retrieved, alongside HIV sequences from 81 cases diagnosed between Aug 4, 2016, and Jan 17, 2017. The transmission network with a density of 1·58% contained 1801 (74%) nodes that were linked to at least one other node. Network degree followed a power law distribution (correlation 0·988). There were 72 dyads and 64 clusters with at least three nodes. The largest connected component contained more than half of the connected nodes (1282 [71%]) and thus was decomposed into 20 clusters. Of 83 clusters included in the analysis, 10 were linked to 37 (46%) new cases. The sizes of incident clusters were significantly larger (p<0·001, median 15 [IQR 11-81] vs 4 [IQR 3-8]) with a higher mean degree (p<0·001, 10·86 [IQR 4·35–22·64] vs 2·80 [IQR 2·00–4·64]). Clusters with newly diagnosed patients had higher transmission speeds (p<0·001, median 0·97 [IQR 0·72–4·77] persons per year [ppy] vs 0·24 [IQR 0·17–0·44] ppy). Clusters with new cases in 2016 had a higher 3-year cluster incidence in 2013 (p<0·001, 0·33 [IQR 0·33–4·17]) and wider age difference between nodes (40·50 years [IQR 24·75–50·25]) than those without new cases in 2016 (3-year cluster incidence 0·00 [IQR 0·00–0·33]; age difference 17·00 years [IQR 10·00–28·5]).Interpretation
Hong Kong's HIV transmission was a preferential attachment process as inferred from the power law degree distribution elicited. The HIV epidemic has grown from existing clusters with large size, degree, and transmission speed. Disassortative age mixing could have predisposed younger individuals to transmission risk from older patients.Funding
Research Grants Council of Hong Kong (14103315), AIDS Trust Fund (MSS 229 R, 243 R). 相似文献12.
Background
Among HIV‐infected patients, hepatitis C virus (HCV) coinfection is associated with lower cholesterol levels, but it remains unclear how it affects cardiovascular outcomes.Methods
We performed logistic regression to evaluate acute myocardial infarction (AMI) and cerebrovascular disease (CVD) events by HCV status among HIV‐infected US veterans in the highly active antiretroviral therapy (HAART) era (1996–2004). We then performed survival analyses to evaluate incident AMI and CVD, exploring antiretroviral therapy (ART) as a time‐dependent variable.Results
A total of 19 424 HIV‐infected patients [31.6% of whom were HCV‐coinfected (HIV/HCV)] contributed 76 376 patient‐years of follow‐up. HCV coinfection was associated with lower rates of hypercholesterolaemia (18.0% in HIV/HCV vs. 30.7% in HIV‐only patients; P<0.001), but higher rates of hypertension (43.8%vs. 35.6%; P<0.0001), type 2 diabetes mellitus (16.2%vs. 11.1%; P<0.0001) and smoking (36.7%vs. 24.7%; P=0.009). Rates of AMI and CVD were significantly higher among HIV/HCV than HIV‐only patients: 4.19 vs. 3.36 events/1000 patient‐years, respectively (P<0.001), for AMI; and 12.47 vs. 11.12 events/1000 patient‐years, respectively (P<0.001), for CVD. When analyses were controlled for diabetes mellitus, hypertension, age and duration of ART, hazard ratios (HRs) among those with HIV/HCV (vs. HIV only) were 1.25 [95% confidence interval (CI) 0.98–1.61; P=0.072] for AMI and 1.20 (CI 1.04–1.38; P=0.013) for CVD. Hypertension (HR 2.05; P<0.001), greater age (HR 1.79; P<0.001) and longer duration (cumulative years) of antiretroviral use (HR 1.12; P=0.0411) were also associated with increased risk of AMI in the adjusted model.Conclusions
In the HAART era, HCV coinfection was associated with a significantly increased risk of CVD and a trend towards an increased risk of AMI among HIV‐infected patients. 相似文献13.
Reconceptualizing motivation for smoking cessation among people with rheumatoid arthritis as incentives and facilitators
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Megan E. Gath Lisa K. Stamp Pip Aimer Simon Stebbings Gareth J. Treharne 《Musculoskeletal care》2018,16(1):139-146
Objectives
Smokers with rheumatoid arthritis (RA) may have different motivations for, and barriers to, quitting. Understanding the motivations of smokers and ex‐smokers with RA will help in the design and implementation of targeted smoking cessation interventions for people with RA that are not based solely on extrapolation from the general population or populations with other chronic illnesses.Methods
Twenty‐nine smokers and 10 recent ex‐smokers with RA participated in semi‐structured interviews via telephone 18 months after being offered a smoking cessation intervention in Aotearoa/New Zealand. The sample consisted of 27 women and 12 men (age range 32–78 years), of whom 14 had received the intervention, 14 had been in the control group and 11 had declined participation in the trial.Results
Thematic analysis led to the formulation of four “incentives” to quit and five “facilitators” of quitting for people with RA. Desiring improvements to health (overall and specific to arthritis), social relationships and avoiding costs were incentives to quit. Coping with stress without smoking, commitment, mental preparedness, willpower and interventions were facilitators of quitting.Conclusions
Becoming aware of the effects of smoking on arthritis provides an important motivation to quit smoking that may counter RA‐specific barriers to smoking cessation. Further research is needed to test whether similar incentives and facilitators of smoking cessation exist in other chronic illnesses, and how to develop interventions to address these motivational processes. 相似文献14.
The safety,effectiveness and cost‐effectiveness of cytisine in achieving six‐month continuous smoking abstinence in tuberculosis patients—protocol for a double‐blind,placebo‐controlled randomized trial
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Omara Dogar Deepa Barua Melanie Boeckmann Helen Elsey Razia Fatima Rhian Gabe Rumana Huque Ada Keding Amina Khan Daniel Kotz Eva Kralikova James N. Newell Iveta Nohavova Steve Parrott Anne Readshaw Lottie Renwick Aziz Sheikh Kamran Siddiqi 《Addiction (Abingdon, England)》2018,113(9):1716-1726
Background and aims
Tuberculosis (TB) patients who quit smoking have much better disease outcomes than those who continue to smoke. In general populations, behavioural support combined with pharmacotherapy is the most effective strategy in helping people to quit. However, there is no evidence for the effectiveness of this strategy in TB patients who smoke. We will assess the safety, effectiveness and cost‐effectiveness of cytisine—a low‐cost plant‐derived nicotine substitute—for smoking cessation in TB patients compared with placebo, over and above brief behavioural support.Design
Two‐arm, parallel, double‐blind, placebo‐controlled, multi‐centre (30 sites in Bangladesh and Pakistan), individually randomized trial.Setting
TB treatment centres integrated into public health care systems in Bangladesh and Pakistan.Participants
Newly diagnosed (in the last 4 weeks) adult pulmonary TB patients who are daily smokers (with or without dual smokeless tobacco use) and are interested in quitting (n = 2388).Measurements
The primary outcome measure is biochemically verified continuous abstinence from smoking at 6 months post‐randomization, assessed using Russell Standard criteria. The secondary outcome measures include continuous abstinence at 12 months, lapses and relapses; clinical TB outcomes; nicotine dependency and withdrawal; and adverse events.Comments
This is the first smoking cessation trial of cytisine in low‐ and middle‐income countries evaluating both cessation and TB outcomes. If found effective, cytisine could become the most affordable cessation intervention to help TB patients who smoke. 相似文献15.
David Goldberg MD Kathleen M. Weber BSN Jennifer Orsi MPH Nancy A. Hessol MSPH Gypsyamber D’Souza PhD D. Heather Watts MD Rebecca Schwartz PhD Chenglong Liu MD Marshall Glesby MD Pamela Burian PA-C Mardge H. Cohen MD 《Journal of general internal medicine》2010,25(1):39-44
BACKGROUND
Cigarette smoking is an important risk factor for adverse health events in HIV-infected populations. While recent US population-wide surveys report annual sustained smoking cessation rates of 3.4–8.5%, prospective data are lacking on cessation rates for HIV-infected smokers.OBJECTIVE
To determine the sustained tobacco cessation rate and predictors of cessation among women with or at risk for HIV infection.DESIGN
Prospective cohort study.PARTICIPANTS
A total of 747 women (537 HIV-infected and 210 HIV-uninfected) who reported smoking at enrollment (1994–1995) in the Women’s Interagency HIV Study (WIHS) and remained in follow-up after 10 years. The participants were mostly minority (61% non-Hispanic Blacks and 22% Hispanics) and low income (68% with reported annual incomes of less than or equal to $12,000).MEASUREMENTS AND MAIN RESULTS
The primary outcome was defined as greater than 12 months continuous cessation at year 10. Multivariate logistic regression was used to identify independent baseline predictors of subsequent tobacco cessation. A total of 121 (16%) women reported tobacco cessation at year 10 (annual sustained cessation rate of 1.8%, 95% CI 1.6–2.1%). Annual sustained cessation rates were 1.8% among both HIV-positive and HIV-negative women (p = 0.82). In multivariate analysis, the odds of tobacco cessation were significantly higher in women with more years of education (p trend = 0.02) and of Hispanic origin (OR = 1.87, 95% CI = 1.4–2.9) compared to Black women. Cessation was significantly lower in current or former illicit drug users (OR = 0.42 95% CI = 0.24–0.74 and OR = 0.65, 95% CI = 0.49–0.86, respectively, p trend = 0.03) and women reporting a higher number of cigarettes per day at baseline (p trend < 0.001).CONCLUSIONS
HIV-infected and at-risk women in this cohort have lower smoking cessation rates than the general population. Given the high prevalence of smoking, the high risk of adverse health events from smoking, and low rates of cessation, it is imperative that we increase efforts and overcome barriers to help these women quit smoking.KEY WORDS: smoking cessation, HIV/AIDS, clinical epidemiology, vulnerable populations 相似文献16.
Elizabeth E. Lloyd-Richardson Cassandra A. Stanton George D. Papandonatos William G. Shadel Michael Stein Karen Tashima Timothy Flanigan Kathleen Morrow Charles Neighbors & Raymond Niaura 《Addiction (Abingdon, England)》2009,104(11):1891-1900
Aims To test the efficacy of two smoking cessation interventions in a HIV positive (HIV+) sample: standard care (SC) treatment plus nicotine replacement therapy (NRT) versus more intensive motivationally enhanced (ME) treatment plus NRT. Design Randomized controlled trial. Setting HIV+ smoker referrals from eight immunology clinics in the northeastern United States. Participants A total of 444 participants enrolled in the study (mean age = 42.07 years; 63.28% male; 51.80% European American; mean cigarettes/day = 18.27). Interventions SC participants received two brief sessions with a health educator. Those setting a quit date received self‐help quitting materials and NRT. ME participants received four sessions of motivational counseling and a quit‐day counseling call. All ME intervention materials were tailored to the needs of HIV+ individuals. Measurements Biochemically verified 7‐day abstinence rates at 2‐month, 4‐month and 6‐month follow‐ups. Findings Intent‐to‐treat (ITT) abstinence rates at 2‐month, 4‐month and 6‐month follow‐ups were 12%, 9% and 9%, respectively, in the ME condition, and 13%, 10% and 10%, respectively, in the SC condition, indicating no between‐group differences. Among 412 participants with treatment utilization data, 6‐month ITT abstinence rates were associated positively with low nicotine dependence (P = 0.02), high motivation to quit (P = 0.04) and Hispanic American race/ethnicity (P = 0.02). Adjusting for these variables, each additional NRT contact improved the odds of smoking abstinence by a third (odds ratio = 1.32, 95% confidence interval = 0.99–1.75). Conclusions Motivationally enhanced treatment plus NRT did not improve cessation rates over and above standard care treatment plus NRT in this HIV+ sample of smokers. Providers offering brief support and encouraging use of nicotine replacement may be able to help HIV+ patients to quit smoking. 相似文献
17.
Rates of sustained virological response 12 weeks after the scheduled end of direct‐acting antiviral (DAA)‐based hepatitis C virus (HCV) therapy from the National German HCV registry: does HIV coinfection impair the response to DAA combination therapy?
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J Bischoff S Mauss C Cordes T Lutz S Scholten A Moll H Jäger M Cornberg MP Manns A Baumgarten JK Rockstroh 《HIV medicine》2018,19(4):299-307
Objectives
The European Association for the Study of the Liver (EASL) treatment recommendations for hepatitis C no longer discriminate between HIV/hepatitis C virus (HCV)‐coinfected and HCV‐monoinfected patients. However, recent data from Spain are questioning these recommendations on the basis of the findings of higher relapse rates and lower cure rates in HIV/HCV‐infected subjects. The aim of our study was to compare HCV cure rates in monoinfected and coinfected patients from Germany.Methods
Data acquired from the Deutsches Hepatitis C‐Registry were analysed. A total of 5657 HCV‐monoinfected subjects and 488 HIV/HCV‐coinfected patients were included in the study. Rates of sustained virological response 12 weeks after the scheduled end of therapy (SVR12) were collected in both subgroups and in cirrhotic and noncirrhotic patients.Results
HIV/HCV‐coinfected patients were more frequently male (84.6% vs. 56.4%, respectively; P < 0.001) and younger than HCV‐monoinfected subjects (46.5 ± 9 vs. 53.8 ± 12.5 years, respectively; P < 0.001). The CD4 blood cell count was > 350 cells/μL in 63.1% of HIV‐positive subjects and 88.7% were on antiretroviral therapy. SVR12 rates were 90.3% (5111 of 5657) in our HCV‐monoinfected cohort and 91.2% (445 of 488) in our coinfected patients. Liver cirrhosis was confirmed in 1667 of 5657 (29.5%) monoinfected patients and 84 of 488 (17.2%; P < 0.001) coinfected patients. SVR12 rates did not differ between HCV‐monoinfected and HIV/HCV‐coinfected patients with liver cirrhosis (87.8% vs. 89.3%, respectively; P = 0.864). A treatment duration of 8 weeks did not reduce the percentage of patients with SVR12 in either subgroup (93.7% in both groups).Conclusions
We found high SVR12 rates in monoinfected as well as coinfected individuals. No differences were detected between the two subgroups regardless of whether there was accompanying liver cirrhosis or a shortened treatment duration.18.
19.
C Laurent A Bourgeois E Mpoudi-Ngolé C Kouanfack L Ciaffi N Nkoué R Mougnutou A Calmy S Koulla-Shiro J Ducos E Delaporte 《HIV medicine》2010,11(1):85-89
Objectives
To investigate the presence of hepatitis B virus (HBV) DNA and hepatitis C virus (HCV) RNA in HIV‐infected patients initiating antiretroviral therapy in Cameroon.Methods
Baseline blood samples from 169 patients were tested retrospectively for hepatitis B surface antigens (HBsAg), anti‐hepatitis B core (anti‐HBc), anti‐HCV and – if HBsAg or anti‐HCV result was positive or indeterminate – for HBV DNA or HCV RNA, respectively, using the Cobas Ampliprep/Cobas TaqMan quantitative assay (Roche Diagnostics GmbH, Mannheim, Germany).Results
HBV DNA was detected in 14 of the 18 patients with positive or indeterminate HBsAg results [8.3% of the total study population, 95% confidence interval (CI) 4.6–13.5]. The median HBV viral load was 2.47 × 107 IU/mL [interquartile range (IQR) 3680–1.59 × 108; range 270 to >2.2 × 108]. Twenty‐one patients (12.4%, 95% CI 7.9–18.4) were found with HCV RNA (all with positive HCV serology). The median HCV viral load was 928 000 IU/mL (IQR 178 400–2.06 × 106; range 640–5.5 × 106). No patient was co‐infected with HBV and HCV. In multivariate analysis, HCV co‐infection was associated with greater age [≥45 years vs. <45 years, odds ratio (OR) 11.89, 95% CI 3.49–40.55, P<0.001] and abnormal serum alanine aminotransferase level [≥1.25 × upper limit of normal (ULN) vs. <1.25 × ULN, OR 7.81, 95% CI 1.54–39.66, P=0.01]; HBV co‐infection was associated with abnormal serum aspartate aminotransferase level (OR 4.33, 95% CI 1.32–14.17, P=0.02).Conclusions
These high rates of active HBV and HCV co‐infections in HIV‐positive Cameroonian patients requiring antiretroviral therapy underline the need to promote: (i) screening for HBV and HCV before treatment initiation; (ii) accessibility to tenofovir (especially in HBV‐endemic African countries); and (iii) accessibility to treatment for HBV and HCV infections. 相似文献20.
Diong C Raboud J Li M Cooper C;Ontario HIV Treatment Network Cohort Study Team 《HIV medicine》2011,12(7):403-411