High risk strategy in smoking cessation is feasible on a population-based level. The Inter99 study

INTRODUCTION: A high risk strategy is one of more strategies in public health. Smoking remains the most important contributor to the burden of disease in developed countries. METHODS: A population-based multi-factorial intervention study, Inter99 (1999-2006), Copenhagen, Denmark, using a high risk strategy. All 2408 daily smokers were repeatedly offered individual face-to-face lifestyle counselling. Smokers in the high-intensity group were offered participation in smoking cessation groups. We measured point abstinence at 1, 3 and 5-year follow-up and compared with a control group, using adjusted intention-to treat analyses. RESULTS: Compared with the control group it was twice as likely to be self-reported abstinent at 5-year follow-up in the high-intensity intervention group (OR: 2.19; 95%CI: 1.7-2.8; p<0.001). The effect of the intervention was significant, even when comparing validated abstinence in the intervention groups with self-reported abstinence in the control group (OR: 1.38; 95%CI: 1.1-1.8; p=0.014). Male gender, vocational training, higher age at onset of smoking, high knowledge of harm of smoking and lower tobacco consumption predicted abstinence. CONCLUSION: A high risk strategy showed a significant effect on smoking in the long term. Proactive recruitment, face-to-face setting, repeated offer of assistance to quit and a multi-factorial approach may explain the success of the intervention.     

Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review

A review of the literature revealed high comorbidity of chronic obstructive pulmonary disease (COPD) and states of anxiety and depression, indicative of excess, psychiatric morbidity in COPD. The existing studies point to a prevalence of clinical significant symptoms of depression and anxiety amounting to around 50%. The prevalence of panic disorder and major depression in COPD patients is correspondingly markedly increased compared to the general population. Pathogenetic mechanisms remain unclear but both psychological and organic factors seem to play a role. The clinical and social implications are severe and the concurrent psychiatric disorders may lead to increased morbidity and impaired quality of life. Furthermore, the risk of missing the proper diagnosis and treatment of a concurrent psychiatric complication is evident when COPD patients are treated in medical clinics. Until now only few intervention studies have been conducted, but results suggest that treatment of concurrent psychiatric disorder leads to improvement in the physical as well as the psychological state of the patient. Panic anxiety as well as generalized anxiety in COPD patients is most safely treated with newer antidepressants. Depression is treated with antidepressants according to usual clinical guidelines. There is a need for further intervention studies to determine the overall effect of antidepressants in the treatment of anxiety and depression in this group of patients.     

The association between active and passive smoking and frequent pain in a general population

Background: It is controversial whether the association between back pain, and other types of chronic pain, and smoking is causal or not. Aim: To examine the relationship between frequent pain and smoking, and between frequent pain and exposure to environmental tobacco smoke (ETS) in smokers and non‐smokers. Methods: A randomised population‐based study, Inter99 (1999–2006), Denmark. Subjects in the intervention groups (N=6784; participation rate=52.5%) completed self‐report questionnaires. Cross‐sectional data from baseline were analysed in adjusted logistic regression analyses to investigate the relationship between active and passive smoking and frequent pain in the back, abdomen, joints and head. Results: Daily smokers reported significantly more frequent pain in every of the six locations, and in several, minimum three, locations (OR=1.98 (95%CI=1.6–2.4)) than never smokers. We found a dose–response relationship between frequent pain and intensity of both active and passive smoking (test‐for‐trend p<0.001). Those exposed to 5h or more of ETS reported significantly more frequent pain than those almost never exposed to ETS (non‐smokers: OR=1.46 (95%CI=1.2–1.8), and smokers: OR=2.04(95%CI=1.4–3.0)). Also, an earlier smoking debut and an increasing number of pack‐years increased the probability of frequent pain in daily smokers (test‐for‐trend p<0.05). Conclusion: We found significant association, dose–response and reversibility between active smoking and frequent pain in all six locations. Furthermore, we found that increasing intensity of ETS increased the probability of frequent pain in non‐smokers, which has not been shown before. In conclusion, several findings in this study indicate a causal link between tobacco smoke and pain, which is supported by recent prospective studies.     

Acceptance of the smoking cessation intervention in a large population-based study: the Inter99 study

AIMS: Potential exists for improving the impact of quit-smoking programmes, by recruiting smokers in early motivational stages, by using active recruitment strategies, and by offering professional assistance to quit. METHODS: This was a randomized population-based intervention study, in Copenhagen, Denmark. A total of 2,408 daily smokers in all motivational stages were included. All participants completed a questionnaire, and underwent a health examination and a lifestyle consultation. Smokers in the high-intensity intervention were offered assistance to quit smoking in smoking cessation groups. RESULTS: Before the lifestyle consultation only 11% of the smokers stated that they planned to quit within one month. After the lifestyle consultation 27% accepted smoking cessation in groups and an additional 12% planned to quit without assistance. Of the smokers who accepted smoking cessation groups 23% had not been planning to quit before the lifestyle consultation. Being a woman, having high tobacco consumption, having a long smoking history, having tried to quit within the previous year, and having a higher motivation to quit predicted participation in smoking cessation groups. CONCLUSIONS: It was possible to recruit a large number of smokers in early motivational stages by using active recruitment strategies and by offering assistance to quit. Lifestyle consultations markedly increased the number of smokers willing to try to quit. Smokers preferred assistance to quit in a smoking cessation group to quitting on their own; therefore, it is important to improve recruitment strategies for smoking cessation programmes.     

Genetic determinants of serum vitamin B12 and their relation to body mass index

Lower serum vitamin B12 levels have been related to adverse metabolic health profiles, including adiposity. We used a Mendelian randomization design to test whether this relation might be causal. We included two Danish population-based studies (n_total = 9311). Linear regression was used to test for associations between (1) serum vitamin B12 levels and body mass index (BMI), (2) genetic variants and serum vitamin B12 levels, and (3) genetic variants and BMI. The effect of a genetically determined decrease in serum vitamin B12 on BMI was estimated by instrumental variable regression. Decreased serum vitamin B12 associated with increased BMI (P < 1 × 10^?4). A genetic risk score based on eight vitamin B12 associated variants associated strongly with serum vitamin B12 (P < 2 × 10^?43), but not with BMI (P = 0.91). Instrumental variable regression showed that a 20% decrease in serum vitamin B12 was associated with a 0.09 kg/m² (95% CI 0.05; 0.13) increase in BMI (P = 3 × 10^?5), whereas a genetically induced 20% decrease in serum vitamin B12 had no effect on BMI [?0.03 (95% CI ?0.22; 0.16) kg/m²] (P = 0.74). Nevertheless, the strongest serum vitamin B12 variant, FUT2 rs602662, which was excluded from the B12 genetic risk score due to potential pleiotropic effects, showed a per allele effect of 0.15 kg/m² (95% CI 0.01; 0.32) on BMI (P = 0.03). This association was accentuated including two German cohorts (n_total = 5050), with a combined effect of 0.19 kg/m² (95% CI 0.08; 0.30) (P = 4 × 10^?4). We found no support for a causal role of decreased serum vitamin B12 levels in obesity. However, our study suggests that FUT2, through its regulation of the cross-talk between gut microbes and the human host, might explain a part of the observational association between serum vitamin B12 and BMI.     

Are emotional symptoms and depression among young people with parental alcohol problems modified by socioeconomic position?

The aim was to test the hypothesis that parental alcohol problems and low socioeconomic position would be associated with higher odds ratio of emotional symptoms and depression as compared to high socioeconomic position and parental alcohol problems. Data came from Danish National Youth Study 2014, a web-based national survey with 75,853 high school and vocational school students participating, merged with register-data on family socioeconomic position. Multi-level logistic regression models (nesting participants within schools) were used to assess the association between perceived parental alcohol problems and frequent emotional symptoms and depression and effect modification by financial strains in the family, family income, or parental educational level. All analyses were adjusted for age, sex, education, immigration status, and cohabitation with parents. Young people with parental alcohol problems had higher odds ratio of experiencing frequent emotional symptoms (OR = 1.56 [1.46–1.66]) and depression (OR = 2.07 [1.88–2.28]), compared to young people without parental alcohol problems. There was no effect modification between severity of parental alcohol problems and the measures of socioeconomic position on the odds ratio of frequent emotional symptoms and depression. This study found that young people with parental alcohol problems in all social strata had higher odds ratios of frequent emotional symptoms and depression compared to young people without parental alcohol problems; the more severely they had been affected by parent’s alcohol problems, the higher the odds ratios of frequent emotional symptoms and depression.

     

Weight concerns and smoking in a general population: the Inter99 study

OBJECTIVE: No previous studies have explored weight concerns in relation to smoking habits, or investigated how weight concerns affect smoking cessation in a general population. METHOD: Inter99 is a population-based lifestyle interventional study, conducted in 1999-2001 in Copenhagen, Denmark, comprising 30-60 year old men and women. All daily smokers (N=2408) were offered help to quit. The baseline investigation (N=6784) was used for analysing associations of smoking status with weight concerns (cross-sectional design). To analyse how weight concerns affected smoking cessation we included the 1387 daily smokers attending 1-year follow-up; 221 of these were verified quitters (longitudinal design). RESULTS: Daily smoking men and women had a significantly lower body mass index than never smokers (men: 3%, women 5%) but reported to be significantly less concerned of their weight (men: OR=0.64, 95%CI=0.4-0.9), women: 0.78(0.6-1.0)). Ex-smoking normal weight women were significantly more likely to be frequently concerned of their weight than never smoking normal weight women (OR=2.06, 95CI%=1.6-2.7). Fifty-two percent of the women and 32% of the men with a previous quit attempt reported that weight gain was a reason for relapse. Neither weight concerns nor eating patterns were predictive of point abstinence at 1-year follow-up. CONCLUSION: Smokers are believed to be very concerned of their weight but in this population-based study, daily smokers more frequently ate what they wanted, had a lower BMI and were significantly less concerned of their weight than never smokers. Weight concerns and eating patterns did not predict abstinence at 1-year follow-up. It seems that weight gain and weight concerns are independent factors.     

Further evidence that mutations in INS can be a rare cause of Maturity-Onset Diabetes of the Young (MODY)

Background

Interleukin (IL)-1β is a potent proinflammatory cytokine markedly overexpressed in the brains of patients with Alzheimer's disease (AD), and also involved in development of atherosclerosis and coronary artery disease. Caspase-1 (CASP1), formerly called IL-1β converting enzyme (ICE), mediates the cleavage of the inactive precursor of IL-1β into the biologically active form. CASP1 genetic variation (G+7/in6A, rs501192) has been associated with susceptibility to myocardial infarction and cardiovascular death risk. We examined the contribution of this gene to the susceptibility for AD.

Methods

We examined genetic variations of CASP1 by genotyping haplotype tagging SNPs (htSNPs) (rs501192, rs556205 and rs530537) in a group of 628 Spanish AD cases and 722 controls.

Results

There were no differences in the genotypic, allelic or haplotypic distributions between cases and controls in the overall analysis or after stratification by age, gender or APOE ε4 allele.

Conclusion

Our negative findings in the Spanish population argue against the hypothesis that CASP1 genetic variations are causally related to AD risk.