Smoking and prognosis in women with breast cancer

The hypothesis was that smokers might have more aggressive types of breast cancer because of either delayed diagnosis or higher grade and hence have a worse prognosis. A cohort of breast cancer patients completed a lifestyle questionnaire at the time of diagnosis, including whether they were current smokers, ex-smokers or lifelong non-smokers. Ex-smokers were asked when they had stopped. The participants were 166 women with stage I/II invasive breast cancer diagnosed between October 1984 and March 1987. Participants were divided into three groups: current smokers, ex-smokers and non-smokers. Survival curves were produced by using Cox proportional hazards analysis, with outcome variables for overall and breast cancer-specific survival together with distant relapse-free survival. Smoking was the third most important predictor of distant relapse-free, breast cancer-specific and overall survival after stage and age at diagnosis. These results suggest that smokers are not only more likely to die of other diseases, but also have a higher mortality from breast cancer, compared with those with the disease who have never smoked. The best prognosis, however, was found in those who had given up smoking.     

Nurses'' Tobacco-Related Knowledge, Attitudes, and Practice in Four Major Cities in China

PURPOSE: To (a) identify Chinese nurses' tobacco-related knowledge, attitude, and practice (KAP), including perception of competency in smoking-cessation interventions; (b) identify barriers and facilitators to smoking cessation interventions to patients; and (c) assess the learning needs and smoking status of nurses. Design: A cross-sectional survey was conducted in four major cities (Beijing, Shanghai, Guangzhou, and Chongqing) in China from November to December 2003. METHODS: 2,888 registered nurses working in hospitals affiliated with five university schools of nursing in these cities were invited to complete a questionnaire. An instrument used to assess tobacco-related KAP in Hong Kong was translated into Chinese and pilot tested to ensure reliability and validity. FINDINGS: 2,179 questionnaires were returned and after exclusion of the grossly incomplete questionnaires, 1,690 were included in the present analysis. Only 2% of participants were current and 1% were former smokers; most had not received training for smoking-cessation interventions as part of their nursing education program. Two-thirds recognized smoking as a leading cause of preventable death and that smoking cessation was the most cost effective intervention, but only a third routinely assisted patients' quit attempts. Nurses who received training reported greater competence in providing smoking-cessation intervention, and more frequent practice of cessation interventions. CONCLUSIONS: Chinese nurses had some knowledge about the health effects of tobacco use, but seldom practiced smoking-cessation interventions. Those who had prior training had greater competence and more practice. Including tobacco control, especially smoking cessation, in nursing curricula in China has the potential to save millions of lives.     

Reversal theory states and cigarette availability predict lapses during smoking cessation among adolescents

Although 67% of adolescent smokers say they want to quit, only 7% are able to do so. The purpose of this study was to use metamotivational states as described in reversal theory to predict whether adolescents who are trying to quit smoking will lapse (smoke a cigarette) or will resist smoking in highly tempting situations. Reversal theory holds that individuals switch between telic (serious-minded) and paratelic (playful) metamotivational states. Questionnaires and semistructured interviews were administered to 62 adolescents ages 14-19 who had participated in a smoking cessation program. Interviews were coded according to the Metamotivational State Interview and Coding Schedule, and the resulting data were analyzed using logistic regression analysis. Adolescents in the paratelic metamotivational state (OR = 15.34; 95% CI: 5.3, 43.6) or with cigarettes readily available (OR = 4.6; 95% CI: 1.6, 13.2) were more likely to lapse than were adolescents in the telic state or who required effort to obtain cigarettes. The variables telic/paratelic state and cigarette availability accurately predicted the outcome of highly tempting situations 80% of the time. Using reversal theory constructs to develop state-specific strategies shows promise as an additional tool for those in this age group coping with the temptation to smoke.     

Does physical exercise in addition to a multicomponent smoking cessation program increase abstinence rate and suppress weight gain? An intervention study

Does physical exercise in addition to a multicomponent smoking cessation program increase abstinence rate and suppress weight gain? An intervention study Tobacco use is considered the single most preventable cause of premature morbidity and mortality. Smoking cessation programs aim at two interrelated purposes, to help people to give up smoking and to prevent relapse. A multicomponent intervention consisting of nicotine replacement therapy, health education, behaviour modification therapy and counselling is widely recommended in the health care literature. Smoking cessation studies from a nursing perspective are few. The purpose of this quasi‐experimental study was to compare outcomes of two nurse‐managed 1‐year group smoking cessation interventions. Intervention 1 (n=34) was provided at a health care centre and consisted of nicotine replacement therapy, health education, behavioural modification and individual and group counselling. In intervention 2 (n=33), provided in a health club, physical exercise was added to the intervention provided in 1. Participants were self‐referred with equal numbers in both interventions. A nonsignificant difference in lapse free abstinence time (LFAT) at 1 year was demonstrated between intervention 1 (20.6%, n=7) and intervention 2 (39.4%, n=13) (p=0.16, odds ratio=2.5). The difference in weight gain between intervention groups was also nonsignificant. Within intervention comparison between abstinent participants and smokers showed that abstinent participants had gained significantly more weight than smokers in intervention 2 (p=0.001), but in intervention 1 the difference was nonsignificant (p=0.2). The small sample size in the study detracts from the significance of the findings. However, a trend is observed showing that physical exercise increases the abstinence rate of participants. The conclusion is drawn that a multicomponent smoking cessation program that includes physical exercise might be an effective intervention, but further studies with a larger sample size are needed.     

Smoking Habits of Emergency Department Patients: An Opportunity for Disease Prevention

Objective: To determine smoking habits, levels of addiction, readiness to quit, and access to primary care among ED patients.
Methods: A questionnaire was administered prospectively to all non-critical adult patients who presented to one university hospital ED during 23 randomly selected four-hour time blocks; 336 (89%) of 376 eligible patients responded. Self-reported smoking was validated by carbon monoxide breath testing in a pilot sample of 49 patients.
Results: The study patients were mostly young (mean age = 35 ± 15 years), female (59%), white (62%), and high school-educated (73%). Of the 336 ED patients, 41% were current smokers (95% CI = 0.36–0.46); 42% of these were "moderately" to "very highly" dependent on nicotine (Fagerstrom Test for Nicotine Dependence > 4). Of those who smoked, 68% stated they wanted to quit, and 49% wanted to quit within the month. Fifty-six percent of all those who smoked stated that they had never been told to quit smoking by any physician. Thirty-five percent of the ED sample (118 patients) relied upon EDs for most or all of their routine, primary health care; 55% (95% CI = 0.46–0.64) of these patients were current smokers.
Conclusions: The prevalence rates of smoking and nicotine addiction among ED patients are high. Almost half of ED smokers are ready to quit, but most state they have never been told by a physician to do so. Finally, a large proportion of ED smokers receive their primary care in EDs. Therefore, the ED may be an underused setting for smoking cessation intervention.     

Smoking Status Among Women in Households With Young Children

purpose . To identify sociodemographic and health-related correlates of smoking status among women in households with young children.
design . A secondary analysis of the 1992 California Behavioral Risk Factor Surveillance System public-use data tape
participants . Women (N = 520) in households with very young children (≤ 5 years of age)
main outcome measures . Current smoking status
results . Approximately 18% were current smokers; more than 40% smoked more than 10 cigarettes each day. A majority of smokers indicated a high level of nicotine addiction, but had plans to quit. Smoking prevalence varied by sociodemographic variables with higher rates for unmarried, less than college educated, and unemployed participants. Health status also was related to smoking, with higher rates among those with poor health and those limited in activities.
conclusions . Smoking is one way of coping with the stressors of daily life, including those associated with caring for young children. Special cessation efforts may be needed for the unemployed, the unmarried woman, and for those in poor health.     

Effect of nicotine replacement and quitting smoking on circulating adhesion molecule profiles (sICAM-1, sCD44v5, sCD44v6)

BACKGROUND: Soluble ICAM-1 (sICAM-1; sCD54), sCD44v5 and sCD44v6 are circulating adhesion molecules, with immunomodulatory potential, that have been frequently attributed diagnostic, prognostic and aetiological significance in a number of inflammatory and malignant diseases. We have previously shown that systemic concentrations of these molecules are increased significantly in tobacco smokers, but reduce to within normal levels at 12 months following successful quitting. MATERIALS AND METHODS: We have been able to extend these observations by measuring levels before and 4, 8, 22 and 52 weeks after smoking cessation in subjects receiving high-dose nicotine replacement therapy (25 mg of nicotine; n = 34) or placebo patches (n = 34) for 26 weeks. Smoking cessation was confirmed by regular measurement of expired-air CO levels and by plasma cotinine analysis. RESULTS: Plasma sICAM-1, sCD44v5 and sCD44v6 concentrations all declined rapidly within 4 weeks of smoking cessation (P < 0.001 for all declines). Additionally, no differences were observed between those using nicotine replacement and those who were not for sICAM-1, sCD44v5, or sCD44v6. CONCLUSIONS: The recovery in smoking-associated adhesion molecule profiles represents an almost immediate beneficial effect of smoking cessation. Nicotine replacement therapy is an effective aid to quitting and does not affect these recoveries. The elevated levels of these important risk factors in smokers (sICAM-1, sCD44v5 and sCD44v6) are linked to noxious element(s) in tobacco smoke other than nicotine or nicotine metabolites.     

Interaction among smoking status,single nucleotide polymorphisms and markers of systemic inflammation in healthy individuals

Cigarette smoke contains toxic and carcinogenic substances that contribute to the development of cancer and various diseases. Genetic variation might be important, because not all smokers develop smoking‐related disease. The current study addressed the possible interactions among selected single nucleotide polymorphisms (SNPs) in genes related to systemic inflammation, smoking status, the levels of circulating immune response cells and plasma biomarkers of systemic inflammation. Sixty‐four healthy blood donors were recruited, 31 of whom were current smokers and 33 were never‐users of tobacco products, references. Compared to references, the smokers showed significantly increased levels of circulating total white blood cells, lymphocytes, monocytes, neutrophils, basophils and C‐reactive protein (CRP). Smokers also more frequently exhibited circulating cell phenotypes that are associated with an immunocompromised state: CD8^dim cells in the lymphocyte group, CD13⁺ CD11⁺, CD13⁺ CD14⁺, CD13⁺ CD56⁺ cells in the monocyte group and CD13⁺ CD11⁺, CD13⁺ CD56⁺ cells in the neutrophil group. We observed an interaction among SNPs, smoking status and some of the studied biomarkers. The average plasma CRP level was significantly higher among the smokers, with the highest level found among those with the CRP rs1800947 CC genotype. Additionally, an increased CD8⁺ GZB⁺ cells in the CD8^dim group were found among smokers with the GZB rs8192917 AA genotype. Thus, smoking appears to be associated with systemic inflammation and increased levels of circulating immunosuppressive cells. The extent of these effects was associated with SNPs among the smokers. This observation may contribute to a better understanding of the genetic susceptibility of smoking‐related disease and the variations observed in clinical outcomes.     

Thermography and laser-Doppler flowmetry for monitoring changes in finger skin blood flow upon cigarette smoking

Summary. Haemodynamic changes after smoking two 1·1 mg nicotine cigarettes were monitored in 24 smokers on two different occasions. Smoking caused an increase in heart rate and arterial blood pressure, whereas finger temperature as measured by thermography and finger skin blood flow as measured by laser-Doppler flowmetry (LDF) decreased. Lowest values were seen within 15 min by LDF, and after 30 min by thermography. Changes in the two methods correlated closely, however, when maximum responses during a 45-min period after smoking were compared. The wider distribution of LDF values would seem to be due to the small measuring volume which is susceptible to differences in vascular anatomy and reactivity. In both methods, responses showed a high degree of reproducibility.     

舒血宁注射液(雪乐通)治疗急性脑梗死的临床评价

【目的】评价舒血宁注射液治疗急性脑梗死的临床疗效。【方法】选择 180例急性脑梗死病人 ,随机分为治疗组 90例及对照组 90例 ,治疗组采用常规内科治疗和舒血宁注射液静点 ,对照组仅给予常规内科治疗。【结果】治疗组及对照组的有效率分别为 87.6 %和 76 .8% ,两组组内治疗前后及治疗后两组间的神经功能缺损积分值比较 ,差异均有显著性 (P <0 .0 5 ) ,治疗组的血脂、血流变明显低于对照组 (P <0 .0 5 )。【结论】舒血宁注射液不仅治疗急性脑梗死的疗效显著 ,而且可显著降低血脂及血流变。