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Tobacco use, exposure to secondhand smoke, and smoking cessation counselling among medical students from the University of Medicine and Pharmacy from Târgu-Mureș – baseline data of the first Smok

Zoltán Preg, Edith Simona Ianoși, Enikő Nemes-Nagy, Mihály Imre László, Zita Fazakas, Márta Germán-Salló, Dalma Bálint-Szentendrey, Zoltán Ábrám, Péter Balázs, Kristie L. Foley, Pál István Kikeli
Tobacco use, exposure to secondhand smoke, and smoking cessation counselling among medical students from the University of Medicine and Pharmacy from Târgu-Mureș – baseline data of the first Smoke-Free Medical University Project
The University of Medicine and Pharmacy from Târgu-Mureș launched the first smoke-free medical university effort in Romania in 2014. A baseline evaluation was conducted to inform the smoke-free policy and implementation strategy.
Aims. To assess medical students' prevalence of smoking, attitudes towards smoking regulation policies, and the level of knowledge about current smoking cessation counselling methods.
Methods. Baseline, cross-sectional data were collected in March 2014. We adopted the Global Health Professions Students Survey items and added questions related to the smoke-free policy and implementation strategy. The target population was the total number of medical students of all years (2197) of which 1897 participated (86.3%). We used the IBM-SPSS version 22 program for descriptive statistical evaluation.
Results. The prevalence of current cigarette smoking was 33.7% (30.5% female, 40.5% male). The current use of other tobacco products was 15.1% (10.2% female, 25.5% male). Every fifth current smoker (21%) declared that he or she smoked cigarettes inside university buildings during the past year. Only 15.3% of the medical students declared they had received any formal training in smoking cessation approaches to help patients quit smoking. Only 26.6% reported that they've ever heard of using pharmacotherapy in tobacco cessation programs.
Conclusions. Smoking prevalence is high in medical students attending the University of Medicine and Pharmacy from Târgu-Mureș. Despite existing smoke-free regulations at all state-owned universities, more than one-fifth of smoker students reported smoking inside university buildings. The enforcement of existing smoke-free policies is needed to ensure the successful implementation and to reduce exposure to second-hand smoke. Additionally, there is an imperative need to increase medical students' knowledge about the current clinical approach of a smoking patient.
Keywords: smoking, medical students, attitudes, second-hand smoke exposure, training

Obstructive sleep apnea – a new tobacco-related disease?

Mihaela Trenchea, Agripina Rașcu, Maria Șuță, Oana-Cristina Arghir
Obstructive sleep apnea – a new tobacco-related disease?
Introduction. Smoking and obstructive sleep apnea syndrome (OSA) have in common hypoxia and premature aging, both having a growing prevalence. Smoking is a risk factor for OSA onset, increases OSA severity, amplifies comorbidities, and causes a vicious circle, increasing morbidity and mortality. The aim of our research was to assess the impact of smoking on OSA.
Materials and methods. A 42-month transversal study of OSA prevalence and comorbidities (cardiovascular, metabolic, COPD and asthma) was performed among 326 adults, with sleep breathing complaints, based on clinical and paraclinical data, including Body Mass Index (BMI), Epworth and Tobacco Smoke-Exposure (TSE) questionnaires and overnight cardio-respiratory polygraphy. Apnea-hypopnea index (AHI) of ≥5 obstructive events/hour of sleep was the main criteria for OSA diagnosis.
Results. 228 of 326 adults, with age ≥50 years old (67%), male gender (73%), and TSE (65.64%) were diagnosed with sleep disorder breathing (SDB). The high mean value of AHI (33.01) was influenced by the decade of age (p=0.005). Oxygen desaturation index (ODI) by hour of sleep correlated with TSE and OSA associated diseases (p<0.05), BMI, obesity and AHI (p<0.01). The prevalence of OSA was increased among SDB patients (89.47%) and smokers (64.48%). OSA was two times more frequent in smokers versus other SDB (p<0.0000003), especially in heavy smokers (p=0.045). Severe OSA related smoking was revealed by high mean values of AHI (p=0.032) and ODI (p=0.017), being 2.2 times more frequent in heavy and moderate smokers (p<0.007). Heart disease, COPD and asthma associated to OSA were significantly influenced by TSE (p<0.03). The means of AHI and ODI are significantly increased in smokers with OSA and without COPD (n=50) versus nonsmokers (n=100) for F=32.417; p=0.000; respectively F=29.417; p=0.000, with no influence of BMI (F=3.786; p<0.06). In conclusion, OSA occurence, prevalence and severity are related to smoking.
Keywords: COPD, OSA, AHI

Serum level of GDF-15 in obstructive sleep apnea syndrome

Laura-Georgiana Moise, Daciana-Silvia Marta, Ioan-Ștefan Clapon, Elena Moldoveanu
Serum level of GDF-15 in obstructive sleep apnea syndrome
Background. Growth differentiation factor-15 (GDF-15) is a stress-induced cytokine in (hypoxia, oxidative stress) that has emerged as a novel biomarker of cardiac remodeling used to assess the evolution and prognostic of metabolic and cardiovascular diseases. Obstructive sleep apnea (OSAS) patients are well known to be associated with several cardiometabolic comorbidities. We hypothesized that there is an association between sleep parameters and GDF-15 level.
Aim. To investigate the relationship between serum GDF-15 level and OSAS severity.
Methods. We enrolled 81 subjects who underwent overnight cardiorespiratory sleep study because of clinical suspicion for obstructive sleep apnea. The patients were classified according to disease severity using the apnea-hypopnea index (AHI): non-OSAS group (AHI<5; n=28), mild-moderate OSAS (AHI: 5-29.9; n=23) and severe OSAS (AHI≥30; n=30). All patients underwent detailed history and physical examination, laboratory tests and respiratory polygraphy. The correlation between clinical and paraclinical parameters was assessed.
Results. Serum level of GDF-15 was significantly higher in OSAS group than those in non-OSAS group (p<0.05) and increased with OSAS severity. There was a significant positive association between GDF-15 level and AHI (r2=0.34, p=0.02) and oxygen desaturation index [ODI (r2=0.37, p=0.01)]. The GDF-15 level was associated with ODI, independent of age and BMI (p<0.05). In severe OSAS group we found positive correlation between GDF-15 level and total cholesterol (r2=0.57, p=0.02), lowest oxygen saturation (r2=0.64, p=0.009), average oxygen level (r2=0.53, p=0.03) and AHI (r2=0.71, p=0.003) and a negative correlation with HDL (r2=-0.57, p=0.02).
Conclusions. Our findings revealed that GDF-15 levels increased with OSAS severity and correlated with ODI and lowest oxygen saturation.
Keywords: GDF-15, obstructive sleep apnea, oxygen desaturation index, oxidative stress