Problems of smoking cessation
Smoke Free Policies in Europe - An Overview
Abstract
Florence Berteletti KempEuropean Respiratory Society
Florence Berteletti Kemp
European Respiratory Society
Contact: Florence Berteletti Kemp, florence.berteletti@ersnet.org,
ABSTRACT
This article is an overview of the current status of implementation of smoke free legislation in Europe and particularly in Romania. It
overviews mostly how these laws are put to work. Comments are made on the scientific evidence of the harm induced by second-hand
smoking, well known cause of lung cancer, cardiac disease, low birth weight and chronic respiratory diseases like bronchitis and asthma,
especially in children.
In the countries where the smoke free legislation was successfully implemented (Ireland, Italy, Scotland) there is evidence of reduced
prevalence of the smoking induced diseases, especially acute coronary attacks.
The article emphasizes on the major role of healthcare professionals in reducing the smoking level, but also on the involvement of
politicians, especially the newly elected Romanians in the European political organisms.
Keywords: smoke free laws, second-hand smoking, implementation
Smoking cessation – a „must have“ in medical curricula. HERMES project – a supportive initiative
Abstract
Antigona Trofor, Traian MihaescuClinica Pneumologica Iasi, Universitatea de Medicina si Farmacie „Gr.T.Popa Antigona Trofor, Traian Mihaescu
Clinica Pneumologica Iasi, Universitatea de Medicina si Farmacie „Gr.T.Popa" Iasi
Contact: Antigona Trofor, atrofor@yahoo.com,
ABSTRACT
Respiratory Medicine is a complex domain of activity, moreover has enlarged its content in last decades by numerous areas of expertise,
among which also smoking cessation, a field aiming to assist individuals to quit or prevent tobacco use. Introducing routinely this preoccupation
in Romanian doctors' work is supposed to legitimate nicotine dependence as a disease, as already classified by world medical organizations. In agreement with HERMES project, an European Respiratory Society initiative to harmonize education in respiratory medicine across Europe, we recommend smoking cessation to be mandatory in Romanian medical curricula. Thus, students will earn theoretical, practical and behavioral skills to approach health effects of tobacco use, treatment and approach of smokers. Yet, considering real life situation in our country, for actual generations of practitioners we suggest intensive training in two modules: a basic one to cover lack of elementary
knowledge during previous years and an advanced module for specialists. To future generations, a continuous, more coherent approach is to be settled, aiming to create brief advice expertise during medical university years of study. When graduating, future doctors willing to become smoking cessation experts will be provided postgraduate training to achieve this degree.
Hopefully, within next two generations, many Romanian doctors will become capable to routinely deliver smoking cessation interventions, at European standards.
Keywords: smoking cessation, nicotine dependence, curricula, counselling.
Media advocacy in anti-tobacco campaign in the Republic of Moldova
Abstract
Victoria TataruMedia advocacy in anti-tobacco campaign in the Republic of Moldova Victoria Tataru
Centrul de Informare, Instruire si Analiza Sociala „CAPTES" Chisinau, Republica Moldova
Contact: Victoria Tataru, Chisinau, captes@ong.md, victataru@yahoo.com
ABSTRACT
This paper makes obvious the role of mass media in supporting the effort of an organisation/ group of citizens to achieve changes of a social nature (requires, first of all, changes of public policies) and its promotion at the level of decision-makers, as well as public opinion.
The main purpose of this paper is to study the phenomenon of media advocacy, identify its social potential to project and evaluate media engagement in the national anti-tobacco campaign of 2007.
The anti-tobacco campaign carried out in 2007 had as an aim the public awareness on changing the tobacco control policies in Moldova. Media advocacy activities have been focused towards improving journalists' knowledge in the field of tobacco control and encouraging them (through media products carried out) to influence the Parliament's members to ratify documents agains smoking.
Results: the increase by two-three times and, for some media means even by ten times, of the number of anti-tobacco references (articles, radio and TV broadcastings) as compared to 2006. Media advocacy had a significant contribution to the unfolding of political and
social events in this field (approval of FCTC; approval of a new Law on tobacco and tobacco products, stipulating „restrictions and afferent provisions to the consumption of tobacco products and the harmful effects on health")
Key words: media, advocacy, anti-tobacco laws
Practical implementation of varenicline as an aid to smoking cessation in clinical practice
Abstract
Serena TonstadPractical implementation of varenicline as an aid to smoking cessation in clinical practice Serena Tonstad
Loma Linda School of Public Health (LLU-SPH) Norway.
Contact: Serena Tonstad, stonstad@llu.edu
ABSTRACT
Varenicline is a non-nicotinic medication developed as an aid for people who are trying to stop smoking and is the third class of drug, after nicotine replacement therapy and bupropion, to be approved for smoking cessation. Varenicline can be prescribed as a treatment for patients who have never tried medication for smoking cessation as well as for those in whom other treatments have not been successful. Practical suggestions are made for implementing smoking cessation with varenicline.
Key words: varenicline, smoking cessation, non-nicotinic aids
Expecting the antinicotine vaccine
Abstract
Cristian DidilescuExpecting the antinicotine vaccine Cristian Didilescu
Institutul de Pneumologie „Marius Nasta" Bucuresti
Contact: C. Didilescu, didilescu@yahoo.com,
ABSTRACT
The last decade is marked by a number of studies regarding the conception of an antinicotine vaccin. There are research studies waiting to be done (Switzerland, USA, Sweden). The principle is represented by the fact that nicotine has a small molecule which can cross the blood-brain barrier resulting psychic effects and dependence. Vaccination against nicotine produces in the blood an amount of antibodies that stop the nicotine effects and generates the feeling of pleasure when the person tries to smoke again.
The research studies are advanced and the specialists are hoping to introduce the vaccine against nicotine on the market at the beginning of 2010.
Key words: antinicotinic vaccine, smoking cessation, antibodies, nicotine
Information group – a solution to increase the efficacity of specialized intervention for smoking ce
Abstract
Magdalena Ciobanu1, Catalina Panaitescu2, Aura Popescu3, Agripina Rascu4, Marinela Raileanu1, Miruna Todor1, Ana Maria Trailescu5, Bogdana Bursuc1, Catalina Constantin1, Florentina Lica1Information group – a solution to increase the efficacity of specialized intervention for smoking cessation Magdalena Ciobanu1, Catalina Panaitescu2, Aura Popescu3, Agripina Rascu4, Marinela Raileanu1, Miruna Todor1, Ana Maria Trailescu5, Bogdana Bursuc1, Catalina Constantin1, Florentina Lica1
1Institutul de Pneumologie „Marius Nasta" Bucuresti
2Policlinica „Sf. Mina" Bucuresti
3Institutul de Cardiologie „C.C. Iliescu" Bucuresti
4Spitalul Colentina Bucuresti, sectia Boli Profesionale
5Spitalul „Victor Babes" Bucuresti
Contact: Magda Ciobanu, magda_ciobanu@yahoo.com,
ABSTRACT
Since 2007, in Romania, the Ministry of Health implements the national programme for tobacco control which contains also a sub-programme for sustaining smoking cessation through free treatment and counselling. Because the specialised intervention lasts too long (often more than 60 minutes) and the requests for support increased with a high
rate, we had to identify methods to increase the efficacity of the intervention and, thus, the efficiency. According to this new situation, since January 2008, all the smokers asking for support to the Center for Smoking Cessation from the National Institute of Pneumology „Marius Nasta" had to participate to an „information group" prior to visit to the doctor or/ and psychologist for specialized help. The aim of this group is to offer the common information needed by all smokers and does not have any elements of group therapy. During 1st january 2008 - 31st December 2009, 829 smokers asked for help in Bucharest centers, from which 585 addressed to the physicians and 288 to the psychologists, a percentage being referred to both specialists. The smokers who are going directly to the specialist tend to choose only one specialist (67,8% doctor and 24% psychologist); only 8,1% are going to both specialists. In the meantime, those smokers who are participating to the information group, are using the servicies of both counsellors: 30,8% comparing with 28,2% only to doctor and 9,4% only to psychologist.
Comparing with the smokers who went directly to the doctor, the smokers who underwent the group of information had an increased succes rate at 3 months after quiting with 27,8%. Also, the percentage of „lost" persons decreased with 51%. Participation to the information group increases the likelihood of attendance to both specialists by 2,8 times. The common approach of the smoker increased the abstinence rate independently of the participation to the information group: 44% increase for smokers who participated to the information group, and 67,3% for persons that directly addressed to the physician.
In conclusion, organising an information group will increase the double approach of the smoker (by physician and psychologist) which, in turn, will increase the success rate and the efficiency of the medical act.
Key words: „Stop smoking" Programme, information group, smoking cessation counceling
Smoking as a predictor for loosing control of treated bronchial asthma
Abstract
Stefan Mihaicuta, Sorin Ursoniu, Diana Dumitriu, Stefan Frent, Ovidiu Fira-Mladinescu, Voicu TudoracheSmoking as a predictor for loosing control of treated bronchial asthma Stefan Mihaicuta, Sorin Ursoniu, Diana Dumitriu, Stefan Frent, Ovidiu Fira-Mladinescu, Voicu Tudorache
UMF „V. Babes" Timisoara, V. Babes Hospital
Contact: Stefan Mihaicuta, mihaicuta@yahoo.com
ABSTRACT
Aim. Analysis of the factors involved in uncontrolled bronchial asthma (BA).
Material and method. Between October 2007 and November 2008 we evaluated 584 consecutive patients, known and treated for BA, and collected general data, medical history, disease onset, spirometry, treatment duration, treatment, asthma control test (ACT). The association of variables was analyzed by calculating the odds ratio (OR) together with confidence intervals (CI) in a univariate analysis. The significant independent variables were utilized to create models of multivariate logistical analysis in order to identify the most important predictors. Results. 584 patients, 162 males (27,74%), 422 females (72,26%), medium age 45,38 ± 17,48 years (4-85), 14% smokers,
ACT <19 (36,2%), 20-24 (48,8%), 25 (15%), 43,1% exacerbations, 4 predictors for uncontrolled BA: exacerbations OR 4,11, CI 3,30-7,48, p <0,001, professional exposure OR 2,29, CI 1,23-4,26, p =0,009, altered lung function on spirometry OR =1,18, CI 1,02-1,36, p=0,021 (obstruction OR 3,78 CI 1,76-7,78, p =0,0001), duration of disease months) OR=1,02, CI 1,00-1,03, p=0,021, smoking OR 0,57, CI 0,26-0,71, p=0,012.
Conclusions. More than 1/3 (36, 2%) of treated asthmatic patients had uncontrolled asthma. Smoking is not among the predictors for lack of control.
Key words: asthma, control, predictor, smoking
Prevalenta fumatului la pacientii coronarieni din studiul EuroAspire III România
Abstract
Laura Craciun, Adina Avram, Stela Iurciuc, Cristian Sarau, Claudiu Avram, Madalina Caprariu, Gabrjela Gojka, Dan Gaita, Silvia MancasSmoking prevalence in coronary patients from EuroAspire III Romania Laura Craciun, Adina Avram, Stela Iurciuc, Cristian Sarau, Claudiu Avram,
Madalina Caprariu, Gabrjela Gojka, Dan Gaita, Silvia Mancas
Department of Medical Polyclinic and Medical Emergencies, Victor Babes University of Medicine and Pharmacy, Timisoara, Department of Internal Medicine, Municipal Hospital Timisoara, Romania
Contact: Laura Craciun, ldavid@cardiologie.ro
ABSTRACT
Objective: Evaluating smoking incidence, the compliance to smoking cessation recommendation and benefits of quitting smoking in coronary patients included in EuroAspire III Romania survey. Materials and methods: We evaluated the acute cardiovascular events (MACE) incidence in 530 consecutive coronary patients (≥18 years and < 80 years at the time of identification) with first or recurrent clinical diagnosis or treatments for coronary heart disease, retrospectively identified from diagnostic registers or hospital discharge lists. The coronary events for hospital admission were: elective or emergency coronary artery by-pass graft (CABG), elective or emergency percutaneous transluminal coronary angioplasty (PTCA), acute myocardial infarction (AMI) and unstable angina (UA). The starting date for identification was not less than 6 months and not more than 3 years prior to the expected date of interview. Patients were divided in three groups according to their condition of smoker (smoking at interview moment), ex-smoker (quitting smoking prior to interview moment) and no smoker (never smoking). Results: Smoking incidence before hospital admission for coronary event was 68.3% and 10% after hospital discharge. Prior the coronary event, percentage of male smokers (77.15%) predominated by female smokers (42.64%) - p<0.05, OR=4.54. Male smokers (67.25%) were more compliant to smoking cessation recommendation compared to females (32.35%) - p=0.04, OR= 2.16; there was no significant difference between the two sexes concerning smoking incidence at interview moment (p>0.05). Patients who continued smoking after hospital discharged presented an increased frequency of MACE compared to non smokers (p=0.043, OR= 1.98). Also, patients who continued smoking till hospitalization for coronary event, presented a higher risk compared to non smokers concerning re-intervention by PTCA (p=0.017, OR =4.28) and AMI incidence (p=0.01, OR =4.89). The MACE incidence was higher in active smokers versus passive smokers, but there was no significant differences between the two groups (p>0.05). Conclusion: Majority of coronary patients renounced smoking after their first experience with cardiovascular events, a small part continued smoking. Patients who continued smoking after the acute event had higher incidence of MACE compared to non-smokers or exsmokers (p<0.05). Also, MACE incidence was higher in active smokers versus passive but the difference was not significant between the two groups (p>0.05).
Key words: coronary heart disease, smoking, acute cardiovascular event.
MoreDe ce fumeaza doctorii?
Abstract
Milena Adina Man , Cosmina Bondor, Monica Pop ,Ruxandra Râjnoveanu1, Dana Alexandrescu, Gabriela RusuWhy do doctors smoke? Milena Adina Man , Cosmina Bondor, Monica Pop ,Ruxandra Râjnoveanu1, Dana Alexandrescu, Gabriela Rusu
UMF Cluj Iuliu Hatieganu, UMF Brasov, Clinica de Pneumologie Leon Daniello Cluj, Romania
Contact: Milena Man, manmilenaadina@yahoo.com
ABSTRACT
Smoking prevalence is decreasing in developed countries in the last decades. Nevertheless, there is a constant increase of morbidity and mortality of the smoking related diseases (COPD, asthma, respiratory infections, cardiac diseases, cancer). Then why do doctors smoke? Because they experimented in adolescence and college and the addiction developed fast, while information about smoking risks arrived too late. Five hundred questionnaires were distributed to 100 doctors and 400 students between March-April 2009; 50% were returned from the doctors and 90.5% from the students. We analyzed comparative the smoking status (60% non-smoking doctors and 56.9% non-smoking students. Mean age was 25.05 for doctors and 24.2 for smoking students. Mean starting age was 17.13 years, 17.78 respectively. They were asked about major components of cigarettes, main diseases induced by smoking, the effects of nicotine addiction, known laws and projects, the need for introducing in the university curricula of anti-smoking modules. 20% of the doctors and 14.5% of the students had a smoking-related disease. 52% of doctors and 57% of students supported forbidding smoking in public spaces, 13.7% of doctors and 88.9% of students supported the increase of cigarettes price, and only 48% of doctors and 47% of students suggested the need of help for smoking cessation. We noticed there are flaws in knowledge of extra pulmonary diseases in students as well as doctors. Most respondents had lacking, nonsystematic information and 96% of doctors and only 69.6% of students consider useful tabaccology lectures. For stopping epidemic morbidity and mortality due to smoking related diseases, there is need for involving all those working in health programmes. For this, the medicine schools should do better in preparing specialists. We also consider it is time that all medical specialties should consider smoking cessation a priority, while the pneumologists should sustain a systematic and routine activity against smoking.
Key words: questionnaire, smoking cessation, doctors, students
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