Interactive voice response telephony to promote smoking cessation in patients with heart disease: a pilot study

OBJECTIVE: A pilot study was conducted to determine the feasibility and potential efficacy of an interactive voice response (IVR) follow-up system for smokers recently hospitalized with coronary heart disease (CHD). METHODS: Ninety-nine smokers hospitalized with CHD completed a baseline questionnaire, were provided with bedside counseling, and offered nicotine replacement therapy. They were randomly assigned to a usual care (UC) or an IVR group. The IVR group received automated telephone follow-up calls 3, 14 and 30 days after discharge inquiring about their smoking status and confidence in remaining smoke-free. When deemed necessary, they were offered additional counseling. Smoking status was determined 52 weeks after hospital discharge. RESULTS: The 52-week point prevalence abstinence rate in the IVR group was 46.0% compared to 34.7% in the UC group (OR=1.60, 95% CI: 0.71-3.60; P=.25). After adjustment for education, age, reason for hospitalization, length of hospitalization, and quit attempts in the past year, the odds of quitting in the IVR group compared to the UC group were 2.34 (95% CI: 0.92-5.92; P=.07). CONCLUSIONS: IVR is a promising technology for following CHD patients attempting to quit smoking following discharge from hospital, however, a larger trial is required to confirm its efficacy. PRACTICE IMPLICATIONS: IVR may enhance the timely provision of follow-up counseling for smoking cessation in patients with CHD.     

A pilot double-blind study of sodium-magnesium EDTA in peripheral vascular disease

Ten male patients with peripheral vascular disease, Type 2 (LaFontaine), were randomly assigned in a double-blind study to receive either Na2 ethylene diamine tetra acetic acid (EDTA) plus MgSO4, B complex, and vitamin C, or a placebo of MgSO4, B complex, and vitamin C in Ringer's lactate solution. A total of 20 intravenous infusions were planned for administration to each patient. Clinical and laboratory (noninvasive) tests showed dramatic improvements after 10 infusions in some patients, and thus was broken the code indicating who was receiving EDTA and who was receiving placebo. The group that improved had been receiving EDTA; there was no change in the placebo group. The trial was then completed in a single-blind fashion. Patients originally assigned to receive placebo then received 10 EDTA infusions, while the group originally assigned to EDTA received 20 EDTA infusions. The group that had formerly received placebo showed improvements comparable to those seen in the first EDTA group after 10 treatments.     

A pilot study on mindfulness based stress reduction for smokers

Background  

Mindfulness means paying attention in the present moment, non-judgmentally, without commentary or decision-making. We report results of a pilot study designed to test the feasibility of using Mindfulness Based Stress Reduction (MBSR) (with minor modifications) as a smoking intervention.     

African-American teen smokers: issues to consider for cessation treatment

Previous reports have indicated ethnic differences in both tobacco-related morbidity and treatment outcome for smoking cessation among adults. We assessed smoking-related characteristics in African-American and non-African American teenagers applying to a cessation trial. 115 teens (15.9 +/- 1.8 years, 68% females, 27% African-American) responded via telephone to media ads. Self-reported sociodemographic, medical and smoking-related data were obtained to determine pre-eligibility for a full intake screen prior to trial participation. Compared to non-African American, African American teen applicants were older (16.4 +/- 1.7 years versus 15.6 +/- 1.6; p = 0.015), had lower Fagerström Test for Nicotine Dependence (FTND) scores (5.3 +/- 2.3 versus 6.1 +/- 1.8; p = 0.018, ANOVA controlling for age) and smoked fewer cigarettes on the weekend (27 +/- 16 versus 38 +/- 17; p = 0.001). African American teens reported similar duration of smoking (3.3 +/- 1.4 versus 3.1 +/- 1.5 years) and time elapsed between first cigarette ever smoked and daily smoking (0.7 +/- 0.9 versus 0.6 +/- 0.7 years). African American and non-African American teens had similar motivation to quit scores and frequency of reported health problems (e.g., asthma, psychiatric conditions). These data suggest that cessation treatment programs designed for African American youth should include lower Fagerstrom-defined levels, and possibly other criteria for tobacco dependence. These observations also highlight the importance of ethnocultural issues in treatment research programs.     

Screening for Parkinson's disease with response time batteries: A pilot study

Background  

Although significant response time deficits (both reaction time and movement time) have been identified in numerous studies of patients with Parkinson's disease (PD), few attempts have been made to evaluate the use of these measures in screening for PD.     

Thinking with images or thinking with language: a pilot EEG probability mapping study.

This pilot EEG mapping study was designed to explore thinking processes using complex mental imagery and thought processes. EEG was recorded with 19 electrodes (10/20 system against averaged ear lobe signals) while volunteers (n = 42) performed two separate tasks: visualization of an abstract concept and interpretation of a painting. Average spectral parameters such as amplitude, local and interhemispheric coherences were computed for five frequency bands (theta, alpha, beta 1, 2 and 3). Results indicate that the frontal regions are strongly involved during these tasks as evidenced by coherence changes. Changes are also present in temporal, parietal and occipital regions and are discussed in relation to information processing with the frontal regions considering the different cognitive functions required by the tasks.     

Uptake of smoking cessation aids by smokers with a mental illness

Psychiatric inpatient settings represent an opportunity to initiate the provision of tobacco cessation care to smokers with a mental illness. This study describes the use of evidence-based smoking cessation aids proactively and universally offered to a population of psychiatric inpatients upon discharge, and explores factors associated with their uptake. Data derived from the conduct of a randomised controlled trial were analysed in terms of the proportion of participants (N = 378) that utilised cessation aids including project delivered telephone smoking cessation counselling and nicotine replacement therapy (NRT), and Quitline support. Factors associated with uptake of cessation aids were explored using multivariable logistic regression analyses. A large proportion of smokers utilised project delivered cessation counselling calls (89 %) and NRT (79 %), while 11 % used the Quitline. The majority accepted more than seven project delivered telephone cessation counselling calls (52 %), and reported NRT use during more than half of their accepted calls (70 %). Older age, higher nicotine dependence, irregular smoking and seeing oneself as a non-smoker were associated with uptake of behavioural cessation aids. Higher nicotine dependence was similarly associated with use of pharmacological aids, as was NRT use whilst an inpatient. Most smokers with a mental illness took up a proactive offer of aids to support their stopping smoking. Consideration by service providers of factors associated with uptake may increase further the proportion of such smokers who use evidence-based cessation aids and consequently quit smoking successfully.     

Patient education for children with interstitial lung diseases and their caregivers: A pilot study

ObjectivePatient education in children with rare chronic diseases like children’s interstitial lung disease (chILD) remains a challenge.AimsTo develop and evaluate a component-based educational program for individual counselling and to improve patients’ and caregivers’ self-efficacy and treatment satisfaction. Furthermore, to create chILD-specific educational material and assess physicians’ satisfaction with the intervention as well as patients’ health-related quality of life (HrQoL).MethodsThe study was conducted in two German centers for pediatric pulmonology, as a single-group intervention with pre-post-follow-up design.ResultsParticipants (N = 107, age: M = 7.67, SD = 5.90) showed significant improvement of self-efficacy (self-report: t = 2.89, p < 0.01; proxy-report: t = 3.03, p < 0.01), and satisfaction (patients: t = 3.56, p = 0.001; parents t = 6.38, p < 0.001) with the medical consultations. There were no pre-post differences in HrQoL. Participants were highly satisfied with the material and the physicians with the program.ConclusionsThe chILD education-program is a promising strategy to improve patients’ and their parents’ self-efficacy and treatment-satisfaction. Specific effects of the intervention need to be determined in a randomized controlled trial.Practice implicationHealthcare providers managing pediatric patients with chILD, may choose to use a patient education-program specifically tailored to the needs of chILD patients and their families, such as the program described here, which is the first of its kind.     

A review of smoking cessation interventions for smokers aged 50 and older

Objectives

Cigarette smoking poses substantial health risks at any age, but is particularly dangerous for older smokers, who are already at heightened risk for various health conditions. Studies suggest that older smokers are motivated to quit and succeed, but few of these have been randomized controlled trials. There is a need to systematically evaluate the research on effective interventions in older smokers.

Methods

We followed PRISMA guidelines in the development of this systematic review, which included randomized controlled trials of cessation interventions with smokers aged 50 or older.

Results

We found 740 unique titles matching specified search criteria; 13 met final eligibility criteria. Nearly all the cessation treatments combined counseling with other strategies. Eight studies provided smoking cessation medications. None of the studies used newer forms of technology such as web- or text-based interventions. Nine of the 13 studies reported a significant intervention effect at one or more time points, with three studies reporting sustained treatment effects at 12 mos or longer. In general, more intensive interventions and those with combined approaches including medications and follow-up counseling achieved the best outcomes.

Conclusion

The quit rates from these studies and the relative effectiveness of different intervention approaches are consistent with the general smoking cessation literature. However, in most studies, treatment effects were of short duration, and absolute quit rates were low, leaving the vast majority of older smokers at high risk for smoking-related health conditions. This systematic review suggests a need for additional research to design and test future interventions specifically tailored for older smokers.     

Access to social services for undiagnosed rare disease patients in France: A pilot study

Although the challenge of access to care for undiagnosed rare disease patients is well documented in the literature, little is known about lack of diagnosis preventing access to social services. Yet this has serious consequences for patients and their families because disability associated with rare disease requires frequent and costly multi-disciplinary support.The aim of this research is to explore, in the French context, access to social assistance for rare disease patients. We investigate the link between diagnosis and access to social services to identify potential barriers and unmet needs for patients.Our study is based on a self-administered online questionnaire, adressed to parents or legal representatives of a child under ten years old with a rare disease and development disorders. The survey has been carried out between November 2019 and the end of January 2020 and includes 103 respondents.While our data does not show any differences in the possibility of obtaining a social benefit depending on the diagnosis status, there are differences in the length of time they are granted and in the satisfaction of families with the assistance obtained. Families with an undiagnosed child obtained social assistance for a shorter period on average. They were also more likely to be dissatisfied with the amount of benefit they received. The results of this pilot study need to be confirmed by further extended studies.     

A follow-up study of vascular disease in growth-hormone-deficient dwarfs with diabetes

Thirty-one growth-hormone-deficient dwarfs were re-examined after a period of 10 to 12 years. These subjects had initially shown glucose intolerance, insulinopenia and hyperlipidemia comparable to those of diabetic patients matched for age and sex, but vascular complications were not present in dwarfs. After 10 years glucose tolerance became progessively more abnormal in dwarfs than could be accounted for by expected deterioration with age, and hyperglycemia after mixed meals remained greater than in control subjects. Serum lipid and serum lipoprotein concentrations were abnormal in over one third of the dwarfs. Despite the metabolic similarity to the diabetic patients, clinical complications of diabetes were absent in dwarfs: retinopathy did not occur, and the prevalence of hypertension and arteriosclerosis was considerably lower in dwarfs than in the diabetic subjects in both study periods. The follow-up data support the hypothesis that growth hormone has at least a supportive role in the pathogenesis of vascular disease in the diabetic state.     

Evaluation of an integrated yoga program in patients with inflammatory bowel disease: A pilot study

BackgroundThe effects of integrated yoga programs on mental health outcomes in inflammatory bowel disease (IBD) have not been well explored. To explore the acceptability, implementation and effectiveness of an integrated eight-week yoga program plus aromatherapy massage in patients with IBD.MethodsNine participants with documented IBD were recruited from a gastroenterology clinic in Calgary, Alberta, Canada to participate in an integrated yoga program weekly for eight weeks with outcomes assessed at baseline and week 8. Primary outcomes were assessed using Theory of Planned Behaviour as a guiding theory to identify salient beliefs from qualitative analysis of a semi-structured interview, survey items measuring the strength of beliefs and a daily log was used to capture adherence and adverse events. Secondary outcomes were collected using validated survey tools examining anxiety, depression, stress, sleep quality, and physical and mental quality of life.ResultsAttitude, subjective norm and perceived behavioral control beliefs pertinent to the yoga intervention and daily practice were identified. Participants reported feeling the intervention was very helpful; however, felt guilt about not completing daily practices which decreased confidence and intention to continue with the practice. An average of 55.6% of in-person sessions were attended and decreased over time. Participants practiced on average of 5.4 days per week. Depression and mental health scores improved at week 8 from baseline.ConclusionsWe were able to identify key salient beliefs of IBD patients in regard to an integrated yoga plus aromatherapy massage intervention. This intervention appears to be acceptable and further research should explore its potential to improve mental and physical health outcomes including IBD symptoms.     

Adenosine receptors in COPD and asymptomatic smokers: effects of smoking cessation

Our group has shown that 1-year smoking cessation persisted or increased airway inflammation in chronic obstructive pulmonary disease (COPD). We compared adenosine and adenosine receptor (AR) expression in COPD and asymptomatic smokers (AS) before and after 1-year smoking cessation. Sputum cytospins and bronchial biopsies of (ex)smoking COPD patients and AS were studied for A₁R, A_2AR, A_2BR, and A₃R expression. Adenosine and inflammatory mediators were measured in sputum supernatants. At baseline, COPD patients had lower levels of adenosine and higher levels of vascular endothelial growth factor in sputum than AS. Smoking cessation induced significantly different effects in COPD than in AS, i.e. an increase in percentages of A₃R expressing neutrophils and A₁R expressing macrophages in COPD as increase in adenosine and monocyte chemoattractant protein-1 levels in sputum. Adenosine-related effector mechanisms may contribute to the persistence and progression of airway inflammation in COPD following 1-year smoking cessation.     

Online advertising to reach and recruit latino smokers to an internet cessation program: impact and costs

Background

Tobacco cessation among Latinos is a public health priority in the United States, particularly given the relatively high growth of this population segment. Although a substantial percentage of American Latinos use the Internet, they have not engaged in Web-based cessation programs as readily as other racial/ethnic subgroups. A lack of culturally specific advertising efforts may partly explain this disparity.

Objective

Phase I of this study focused on the development of four Spanish-language online banner advertisements to promote a free Spanish-language smoking cessation website (es.BecomeAnEX.org). Phase II examined the relative effectiveness of the four banner ads in reaching and recruiting Latino smokers to the cessation website.

Methods

In Phase I, 200 Spanish-speaking Latino smokers completed an online survey to indicate their preference for Spanish-language banner ads that incorporated either the cultural value of family (familismo) or fatalism (fatalismo). Ads included variations on message framing (gain vs loss) and depth of cultural targeting (surface vs deep). In Phase II, a Latin square design evaluated the effectiveness of the four preferred ads from Phase I. Ads were systematically rotated across four popular Latino websites (MySpace Latino, MSN Latino, MiGente, and Yahoo! en Español) over four months from August to November 2009. Tracking software recorded ad clicks and registrants on the cessation website. Negative binomial regression and general linear modeling examined the main and interacting effects of message framing and depth of cultural targeting for four outcomes: number of clicks, click-through rate, number of registrants, and cost per registrant.

Results

In Phase I, smokers preferred the four ads featuring familismo. In Phase II, 24,829,007 impressions were placed, yielding 24,822 clicks, an overall click-through rate of 0.10%, and 500 registrants (2.77% conversion rate). Advertising costs totaled US $104,669.49, resulting in an overall cost per click of US $4.22 and cost per registrant of US $209.34. Website placement predicted all four outcomes (all P values < .01). Yahoo! en Español yielded the highest click-through rate (0.167%) and number of registrants (n = 267). The message framing and cultural targeting interaction was not significant. Contrary to hypotheses, loss-framed ads yielded a higher click-through rate than gain-framed ads (point estimate = 1.08, 95% CI 1.03 1.14, P = 0.004), and surface-targeted ads outperformed deep-targeted ads for clicks (point estimate = 1.20, 95% CI 1.13 1.28, P < .001), click-through rate (point estimate = 1.22, 95% CI 1.16 1.29, P < .001), and number of registrants (point estimate = 2.73, 95% CI 2.14 3.48, P < .001).

Conclusions

Online advertising can be an effective and cost-efficient strategy to reach and engage Spanish-speaking Latino smokers in an evidence-based Internet cessation program. Cultural targeting and smoking-relevant images may be important factors for banner ad design. Online advertising holds potential for Web-based cessation program implementation and research.     

107例戒烟就诊者的疗效相关因素分析

对107例戒烟者资料的分析结果表明,与戒烟成功有关的因素包括:男性、戒前自我预测能戒掉、健康状况较差、良好的家庭支持监督系统、原戒烟时间较长、服用可乐宁药物;而戒断症状较严重,艾森克个性问卷 N 分较高者戒烟较困难。本文还对这些因素对结果的影响途径进行了简单的讨论。     

Biomarker feedback intervention for smoking cessation among Alaska Native pregnant women: Randomized pilot study

Objective

There is some evidence for biomarker feedback when combined with cessation counseling for reducing smoking in pregnancy. This randomized controlled pilot study evaluated feasibility and potential efficacy of a social-cognitive theory (SCT)-based biomarker feedback intervention among pregnant Alaska Native (AN) smokers.

Geometrical accuracy and fusion of multimodal vascular images: a phantom study

The aim of this work was to compare the geometrical accuracy of x-ray angiography, magnetic resonance imaging (MRI), x-ray computed tomography (XCT), and ultrasound imaging (B-mode and IVUS, or intravascular ultrasound) for measuring the lumen diameters of blood vessels. An image fusion method was also developed to improve these measurements. The images were acquired from a phantom that mimic vessels of known diameters. After acquisition, the multimodal images were coregistered by manual alignment of fiducial markers, and then by maximization of mutual information. The fusion method was performed by means of a fuzzy logic modeling approach followed by a combination process based on a possibilistic theory. The results showed (i) the better geometrical accuracy of XCT and IVUS compared to the other modalities, and (ii) the better accuracy and smaller variability of fused images compared to single modalities, with respect to most diameters investigated. For XCT, the error varied from 0.4% to 5.4%, depending on the vessel diameter that ranged from 0.93 to 6.24 mm. For IVUS, the error ranged from -0.3% to 1.7% but the smallest vessel (0.93 mm) could not be investigated because of the probe size. Compared to others fusion schemes, the XCT-MRI fused images provided the best results for both accuracy (from -1.6% to 0.2% for the three largest vessels) and robustness (mean relative error of 1.9%). To conclude, this work underlined both the usefulness of the multimodality vascular phantom as a validation tool and the utility of image fusion in the vascular context.