Sex differences in negative affective response during nicotine withdrawal

This study examined physiological indicants of the neurobiological mediators of negative affect during acute nicotine withdrawal. Eighty subjects (41 male) were assigned to one of four groups (24-h deprived or nondeprived dependent smokers, occasional smokers, and nonsmokers) and participated in an instructed fear conditioning paradigm involving cued administration of electric shock. Negative affective response was measured with fear-potentiated startle during cues that signaled electric shock and during the postcue offset recovery period. Salivary cortisol and self-report measures were also collected. Fear-potentiated startle results indicated that affective recovery postcue offset was delayed in nicotine-deprived women. Nicotine-deprived women also displayed elevated cortisol levels throughout the fear conditioning procedure.     

Effect of young maternal age and skeletal growth on placental growth and development

Objectives

Teenagers are susceptible to delivering small-for-gestational-age infants. Previous studies implicate continued skeletal growth as a contributory factor, and impaired placental development was the primary cause of fetal growth restriction in growing adolescent sheep. The aims of this study were to examine the impact of young maternal age and growth on placental development.

Study design

Placentas were collected from 31 teenagers, of which 12 were growing and 17 non-growing based on knee height measurements. An adult control group (n = 12) was included.

Main outcome measures

Placental weight and morphometric measurements of villous, syncytiotrophoblast, fibrin and vessel areas, as well as indices of proliferation and apoptosis, were analysed in relation to maternal growth and age.

Results

Growing teenagers had a higher birthweight:placental weight ratio than non-growing teenagers (p < 0.05). Villous area, syncytial area, fibrin content, vascularisation and cell turnover did not differ between growing and non-growing teenagers. There were no differences in placental weight or morphometry between adult and teenage pregnancies. Maternal smoking, a potential confounding factor, did not exert a major influence on the placental parameters examined, except for a stimulatory effect on placental proliferation (p < 0.05) and syncytial knot formation (p < 0.05).

Conclusions

We were unable to detect any major differences in placental size or composition between growing and non-growing teenagers. Birthweight:placental weight ratio was higher in growing compared to non-growing teenagers. This suggests that maternal growth may affect placental function rather than development, and is consistent with our recent observations that maternal growth was not detrimental to fetal growth.     

Nicotine withdrawal and stress‐induced changes in pain sensitivity: A cross‐sectional investigation between abstinent smokers and nonsmokers

Chronic smoking has been linked with alterations in endogenous pain regulation. These alterations may be pronounced when individuals quit smoking because nicotine withdrawal produces a variety of psychological and physiological symptoms. Smokers interested in quitting (n = 98) and nonsmokers (n = 37) completed a laboratory session including cold pressor test (CPT) and heat thermal pain. Smokers set a quit date and completed the session after 48 h of abstinence. Participants completed the pain assessments once after rest and once after stress. Cardiovascular and nicotine withdrawal measures were collected. Smokers showed blunted cardiovascular responses to stress relative to nonsmokers. Only nonsmokers had greater pain tolerance to CPT after stress than after rest. Lower systolic blood pressure was related to lower pain tolerance. These findings suggest that smoking withdrawal is associated with blunted stress response and increased pain sensitivity.     

The influence of vascular risk factors on cognitive decline in patients with Alzheimer's Disease

Introduction

The influence of vascular risk factors (VRFs) on the rate of cognitive decline in patients with established dementia is unclear. This study aims to examine the association between VRFs and the rate of cognitive decline in patients with Alzheimer's disease (AD).

Methods

Data were obtained from patients visiting a memory clinic between 2004 and 2012. VRFs were determined at baseline and included hypertension, hypercholesterolemia, diabetes mellitus, overweight and smoking. Continuous values of blood pressure, total cholesterol, glucose level and body mass index were also obtained. Mini-Mental State Exam (MMSE) scores were obtained at baseline and during follow-up visits. The association between VRFs and the annual change in MMSE scores was analysed with a multivariable linear mixed model adjusted for age, sex and the aforementioned VRFs.

Results

From 174 patients (mean age 78.3 years), with a follow-up time up to 5.8 years (mean 1.1 year), in total 447 MMSE scores were obtained. The multivariable analyses showed an association between age as well as systolic blood pressure and a decline in annual rates of change in MMSE scores of −0.05 (95% confidence interval (CI): −0.09 to 0.00) and −0.01 (CI: −0.03 to 0.00), respectively. For all other VRFs, including sex, patients did not show a significant difference.

Conclusion

This study did not find an association between preventable vascular risk factors and cognitive decline in patients with AD, except for systolic blood pressure. As the association between systolic blood pressure and decline in MMSE was small, clinical relevance may be limited.     

Daily assessment of arterial distensibility in a pediatric population before and after smoking cessation

OBJECTIVES:

Cigarette smoking is an important modifiable cardiovascular risk factor associated with increased stiffness of the large arteries in adulthood. This study aimed to 1) evaluate arterial distensibility and echocardiographic measures in adolescent smokers before and after participation in a successful smoking cessation program and to 2) compare the findings obtained with data from a control population of healthy non-smokers.

METHODS:

A total of 31 young smoking subjects (58.1% male; range: 11-18 years old; mean: 16.5±1.4 years old; mean tobacco consumption: 2.6±0.6 years) were examined before commencing and after taking part for at least 1 year in a smoking cessation program (mean: 1.4±0.3 years). Arterial stiffness was measured using the previously validated QKd_100-60 method. Twenty-four-hour ambulatory blood pressure monitoring and transthoracic echocardiography were also performed.

RESULTS:

(Smokers before abuse cessation vs. smokers after abuse cessation) systolic blood pressure: p<0.004; diastolic blood pressure: p<0.02; mean blood pressure: p<0.01; QKd_100-60 value: 183±5 vs. 196±3 msec, p<0.009; p = ns for all echocardiographic parameters. (Smokers after abuse cessation vs. controls) systolic blood pressure: p<0.01; diastolic blood pressure: p<0.03; mean blood pressure: p<0.02; QKd_100-60 value: 196±3 vs. 203±2 msec, p<0.04; p<0.02, p<0.01, and p<0.05 for the interventricular septum, posterior wall, and left ventricular mass, respectively.

CONCLUSIONS:

Despite successful participation in a smoking cessation program, arterial distensibility improved but did not normalize. This finding underlines the presence of the harmful effect of arterial rigidity in these individuals, despite their having quit smoking and their young ages, thus resulting in the subsequent need for a lengthy follow-up period.     

Patient–provider communication and perspectives on smoking cessation and relapse in the oncology setting

Objective

To fill a gap in research by examining cancer patient–provider communication regarding tobacco use and patients’ perspectives regarding their experiences with smoking cessation and relapse.

Methods

In-depth interviews were conducted with 20 lung and head and neck cancer patients and 11 health care providers.

Results

Qualitative analyses revealed that cancer patients express high levels of motivation to quit smoking; however, patients do not ask providers for assistance with quitting and maintaining abstinence and relapsed patients are reluctant to disclose smoking behavior due to stigma and guilt. Health care providers vary in the advice and type of assistance they supply, and their awareness and sensitivity to relapsed patients’ feelings. Whereas providers emphasized long-term risks of continued smoking in their interactions with patients and recommendations for intervention content, patients expressed a preference for a balance between risks and benefits.

Conclusion

Findings underscore the need for increased awareness, emphasis, and communication about the immediate risks of continued smoking and the benefits of continued abstinence specifically for cancer patients.

Practice implications

Our findings demonstrate the potential to affect cancer outcomes by improved training in conducting smoking cessation and relapse-prevention interventions. Additional training could be given to health care providers to increase adherence to clinical practice guidelines (5 A's), to learn ways to enhance patients’ motivation to maintain abstinence, and to deliver smoking messages in a non-threatening manner.     

被动吸烟对致敏大鼠气道5-脂氧合酶及其mRNA表达的影响

目的 通过研究吸烟对致敏大鼠气道5-脂氧合酶及其mRNA表达的影响,探讨吸烟对支气管哮喘(简称哮喘)气道炎症的影响,从而为临床上治疗吸烟哮喘提出实验依据.方法 雄性Wistar 大鼠30只,随机分为对照组、致敏组和吸烟致敏组.每组10只.后两组应用卵白蛋白致敏并长期(8周)吸人激发,制备哮喘模型;在激发第3周开始,将吸烟致敏组大鼠置于自制熏箱内进行被动吸烟.采用免疫组织化学及原位杂交法检测各组大鼠气道5-脂氧合酶蛋白及其mRNA的表达.结果 ①吸烟致敏组气道5-脂氧合酶蛋白的表达(32.58±2.78)明显高于致敏组(21.65±2.12)和对照组(15.38±1.68),差异有统计学意义(P值均＜0.01);致敏组高于对照组,差异有统计学意义(P＜0.01);②吸烟致敏组气道5-脂氧合酶mRNA的表达(34.68±2.90)高于致敏组(23.55±2.28)和对照组(15.78±1.72),差异有统计学意义(P值均＜0.01);致敏组高于对照组,差异有统计学意义(P＜0.01).结论 吸烟可使致敏大鼠气道5-脂氧合酶及其mRNA表达增多,加重气道炎症.     

What mediates the effect of confrontational counselling on smoking cessation in smokers with COPD?

Objective

Within the framework of a randomized, active treatment controlled trial, we used a mediation analysis to understand the mechanisms by which an intervention that uses confrontation with spirometry for smoking cessation achieves its effects.

Methods

Participants were 228 smokers from the general population with previously undetected chronic obstructive pulmonary disease (COPD), who were detected with airflow limitation by means of spirometry. They received two equally intensive behavioural treatments by a respiratory nurse combined with nortriptyline for smoking cessation: confrontational counselling with spirometry versus conventional health education and promotion (excluding confrontation with spirometry and COPD).

Results

Cotinine validated abstinence rates from smoking at 5 weeks after the target quit date were 43.1% in the confrontational counselling group versus 31.3% in the control group (OR = 1.67, 95%CI = 0.97–2.87). The effect of confrontational counselling on abstinence was independently mediated by the expectation of getting a serious smoking related disease in the future (OR = 1.76, 95%CI = 1.03–3.00), self-exempting beliefs (OR = 0.42, 95%CI = 0.21–0.84), and self-efficacy (OR = 1.38, 95%CI = 1.11–1.73).

Conclusion

We conclude that confrontational counselling increases risk perceptions and self-efficacy, and decreases self-exempting beliefs (risk denial) in smokers with previously undetected COPD. These changes in mediators are associated with a higher likelihood of smoking cessation.

Practice implications

Apart from the intensity, the content of smoking cessation counselling may be an important factor of success. A confrontational counselling approach as we applied may have the potential to alter smoking-related cognitions in such a way that smokers are more successful in quitting. Nurses can be trained to deliver this treatment.     

The effects of the acupuncture treatment for smoking cessation in high school student smokers

The use of alternative medicine for smoking cessation have been increasing steadily in recent years. A series of clinical group studies was performed to clarify the effect, outcome and success rate of an acupuncture treatment for smoking cessation. This study was conducted for four weeks using 238 smoking students at 2 high schools. The subjects were separated into two groups: 159 students were treated with acupuncture on the anti-smoking acupoints of the ear, which is known to be effective for cessation of smoking (case group), and 79 students were treated at other sites of the ear (control group). The acupuncture treatment was alternately administered at each side of the ears on a weekly basis for 4 weeks. The smoking cessation success was only 1 case (0.6%) in the case group and none in the control group after 4 weeks. The change in the taste of tobacco and the intensity of the desire to smoke were not significantly different between the case and control groups, but the case group showed a tendency of reduction in the taste of tobacco and the intensity of the desire to smoke. In addition, the reduction in cigarette consumption was not significant, but the tendency of reduction in the study group was significant. It is believed that the site of auricular acupuncture for smoking cessation is not important. However, there was a significant tendency in terms of the reduction in cigarette consumption, the taste of tobacco and the intensity of the desire to smoke in the case group, indicating that auricular acupuncture in smoking cessation has some effect.