Smoking cessation guidelines: evidence-based recommendations of the French Health Products Safety Agency

2005 ◽  
Vol 20 (5-6) ◽  
pp. 431-441 ◽  
Author(s):  
B. Le Foll ◽  
P. Melihan-Cheinin ◽  
G. Rostoker ◽  
G. Lagrue ◽  
Keyword(s):  
Cognitive Therapy ◽  
Nicotine Dependence ◽  
Pharmacological Treatment ◽  
Smoking Status ◽  
Single Agent ◽  
Smoking Behavior ◽  
Developed Countries ◽  
Evidence Based ◽  
Health Products

AbstractTobacco use is the leading preventable cause of death in developed countries. Millions of smokers are willing to stop, but few of them are able to do so. Clinicians should only use approaches that have demonstrated their efficacy in helping patients to stop smoking. This article summarizes the evidence-based major findings and clinical recommendations for the treatment of tobacco dependence of the French Health Products Safety Agency (AFSSAPS). Clinicians should enquire about the smoking status of each patient and provide information about health consequence of smoking and effective treatments available. These treatments include counseling (mainly individual or social support and behavioral and cognitive therapy) and pharmacological treatment with either nicotine replacement therapy (NRT) or bupropion LP. Pharmacological treatments should be used only for proven nicotine dependence, as assessed by the Fagerstrom test for Nicotine Dependence. The choice of pharmacologic treatment depends of the patient's preference and history and of the presence of contra-indications. The clinician should start with a single agent, but these treatments may be used in combination. Smoking behavior is a chronic problem that requires long-term management and follow-up. Access to intensive treatment combining pharmacological treatment and extensive behavioral and cognitive therapy should be available for highly dependent patients.

Standard Evidence-Based Pharmacological Treatment for OCD

2017 ◽  
Author(s):  
Jemma E Reid ◽  
Samar Reghunandanan ◽  
Ann Roberts ◽  
Naomi A Fineberg
Keyword(s):  
Quality Of Life ◽  
Pharmacological Treatment ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Evidence Based ◽  
Health Related Quality ◽  
Pharmacological Treatments ◽  
Related Quality ◽  
Health Related

This chapter reviews standard pharmacological treatments for OCD and the evidence supporting them. Selective serotonin reuptake inhibitors (SSRIs) remain the pharmacological treatment of choice and are associated with improved health-related quality of life. Improvements are usually sustained over time as long as treatment is continued. Discontinuation is associated with relapse and loss of quality of life, implying that treatment should continue long-term. A substantial minority of patients who fail to respond to SSRIs may benefit from dose elevation, switch to clomipramine, or adjunctive antipsychotic, though long-term trials validating the effectiveness and tolerability of these strategies are relatively lacking.

Cigarette Smoking from Adolescence to Adulthood

2018 ◽  
Author(s):  
Laurie Chassin ◽  
Clark C. Presson ◽  
Jonathan T. Macy ◽  
Steven J. Sherman
Keyword(s):  
Cigarette Smoking ◽  
Intergenerational Transmission ◽  
Tobacco Use ◽  
Smoking Status ◽  
Smoking Behavior ◽  
Historical Change ◽  
Societal Change ◽  
Developmental Approach ◽  
Smoking Onset

In this chapter, findings from a long-term, cohort-sequential, multigenerational study of cigarette smoking are used to illustrate the importance of a developmental approach for (1) understanding trajectories of smoking behavior (in relation to other forms of tobacco use) and the conditions and challenges of the developmental periods that show transitions in smoking status (particularly adolescent smoking onset and challenges for parents with adolescent children), (2) understanding heterogeneity in these trajectories because differing trajectories may have different etiological underpinnings as well as different implications for the intergenerational transmission of smoking, (3) recognizing that development unfolds within the larger context of societal and historical change and that societal change can influence outcomes, and (4) considering development within a family systems and multigenerational context.

scholarly journals Assessment of changes in nicotine dependence, motivation, and symptoms of anxiety and depression among smokers in the initial process of smoking reduction or cessation: a short-term follow-up study

2013 ◽  
Vol 35 (3) ◽  
pp. 212-220 ◽  
Author(s):  
Luciana Rizzieri Figueiró ◽  
Cassandra Borges Bortolon ◽  
Mariana Canellas Benchaya ◽  
Nadia Krubskaya Bisch ◽  
Maristela Ferigolo ◽  
...  
Keyword(s):  
Nicotine Dependence ◽  
Tobacco Use ◽  
Smoking Behavior ◽  
Anxiety And Depression ◽  
Smoking Reduction ◽  
Porto Alegre ◽  
Quit Attempt ◽  
Important Challenge

Introduction: The first days of a quit attempt represent an important challenge to long-term abstinence, especially because of the changes that take place over this period. Objective: To examine whether smokers who have recently changed their smoking behavior show changes in the intensity of nicotine dependence, motivational stage, or symptoms of anxiety and depression relative to smokers without recent changes in smoking behavior. Methods: Smokers attending a support group for smoking cessation in Porto Alegre, southern Brazil, were invited to participate. The program consisted of four weekly sessions. Smokers answered questionnaires covering intensity of nicotine dependence, stage of motivation, and symptoms of anxiety and depression at baseline and in the fourth week. Urine was collected at both time points, tested for cotinine concentration, and used to determine the final status of smokers. Results: Of the 54 smokers included in the study, 20 (37%) stopped smoking or decreased tobacco use. Both smokers who stopped or reduced tobacco use and those who did not change their behavior presented a decrease in nicotine dependence scores (p = 0.001). Conversely, only the smokers who changed behavior presented an increase in scores in the maintenance stage (p < 0.001). Conclusion: When modifying tobacco use, smokers face a difficult process, marked by several changes. A better understanding of these changes and their implications for treatment are discussed.

scholarly journals EpiSmokEr: A robust classifier to determine smoking status from DNA methylation data

2018 ◽  
Author(s):  
Sailalitha Bollepalli ◽  
Tellervo Korhonen ◽  
Jaakko Kaprio ◽  
Miina Ollikainen ◽  
Simon Anders
Keyword(s):  
Dna Methylation ◽  
Smoking Status ◽  
Smoking Behavior ◽  
R Package ◽  
Future Studies ◽  
Recent Exposure ◽  
Optimal Classification ◽  
Never Smokers

AbstractSelf-reported smoking status is prone to misclassification due to under-reporting, while biomarkers like cotinine can only measure recent exposure. Smoking strongly influences DNA methylation, with current, former and never smokers exhibiting different methylation profiles. Recently, two approaches were proposed to calculate scores based on smoking-responsive DNA methylation loci, to serve as reliable indicators of long-term exposure and potential biomarkers to estimate smoking behavior. However, these two methodologies need significant improvements to make them globally applicable to all populations and to achieve an optimal classification of individuals with unknown smoking habits. To advance the practical applicability of the smoking-associated methylation signals, we used machine learning methodology to train a classifier for smoking status prediction. We show the prediction performance of our classifier on three independent whole-blood test datasets demonstrating its robustness and global applicability. Furthermore, we show the cross-tissue functionality of our classifier in tissues other than blood. Additionally, we provide the community with an R package, EpiSmokEr, facilitating implementation of our classifier to predict smoking status in future studies.

Perceived Versus Actual Sedation Practices in Adult Intensive Care Unit Patients Receiving Mechanical Ventilation

2012 ◽  
Vol 46 (10) ◽  
pp. 1331-1339 ◽  
Author(s):  
Kimberly Varney Gill ◽  
Stacy A Voils ◽  
Gregory A Chenault ◽  
Gretchen M Brophy
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Single Agent ◽  
Treatment Algorithm ◽  
Research Management ◽  
Evidence Based ◽  
Short Term ◽  
Treatment Algorithms ◽  
Daily Interruption

Background: With drug shortages, newer sedative medications, and updates in research, management of sedation and delirium in patients receiving mechanical ventilation continues to evolve. Objective: To compare perceived and actual sedation practices for adults receiving mechanical ventilation in intensive care units (ICUs). Methods: This was a multicenter, 2-part study conducted in adult ICUs in US hospitals, It included a sedation practice survey completed by ICU pharmacists and an observational study evaluating actual sedation practices over a 24-hour period. Results: Surveys were completed for 85 ICUs; observational data for 496 patients were collected. Preferred sedatives from the survey data were propofol (short-term); propofol, midazolam, or lorazepam (intermediate); and lorazepam (long-term). Propofol was the most commonly used agent overall during the observational period (primarily for short-term and intermediate-length sedation); midazolam was the most commonly used for long-term sedation. Fentanyl was the preferred analgesic, and Haloperidol and quetiapine were the preferred antipsychotics. Sedation treatment algorithms were used in only 50% of observed ICUs. Use of daily interruption of sedation was perceived to be 66% but was only observed in 36% of patients. Monitoring for delirium was reported among 25% of those surveyed but was observed in only 10% of patients. Targeted sedation goals were most frequently achieved when a treatment algorithm was used or when an opiate infusion was the single agent used for sedative management Conclusions: These data suggest differences in perceived and actual sedation practice in the US, as well as underutilization of evidence-based interventions. Most notable was the limited use of sedation treatment algorithms, daily interruption of sedation, and monitoring for delirium. Individual sedation and delirium protocols should be evaluated and updated based on evidence-based recommendations.

scholarly journals Changes in Smoking Behaviors following Exposure to Health Shocks in China

2018 ◽  
Vol 15 (12) ◽  
pp. 2905 ◽  
Author(s):  
Qing Wang ◽  
John Rizzo ◽  
Hai Fang
Keyword(s):  
Smoking Status ◽  
Smoking Behavior ◽  
Health Shocks ◽  
Long Term Effects ◽  
Short Term ◽  
Heavy Smoking ◽  
Random Effects Models ◽  
Smoking Behaviors ◽  
Spousal Health

Background: Evidence suggests that following major individual health shocks, smokers change their smoking behaviors. However, little is known about the association between spousal health shocks and smoking. This study examined the contemporaneous and long-term effects of individual and spousal health shocks on males’ smoking behaviors in China. Methods: This study employed a nation-wide data base from the 1991–2011 China Health and Nutrition Study. Random effects models were estimated to ascertain the impacts of health shocks on males’ smoking behavior. Smoking behaviors were measured by smoking status, smoking consumption and smoking cessation. Results: In the short term, respondents who incurred health shocks decreased their likelihood of smoking by 10%. In addition, health shocks decreased the likelihood of heavy smoking versus the combined moderate and light categories by 41.6%, and increased their likelihood of quitting by 85.3% for ever smokers. Spousal health shocks had no significant effects on individual smoking behaviors. The long-term effects were similar to the short term impacts. Conclusions: People changed their smoking behaviors in response to their own health experiences but not those of their spouses. Antismoking messages about the health effects on others are unlikely to influence individual smoking behaviors, unless individuals believed that they are personally vulnerable to smoking-related diseases.

Pretreatment characteristics and early indicators of long-term efficacy of cetuximab in patients with recurrent/metastatic squamous cell carcinoma of the head and neck (rmSCCHN).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17015-e17015
Author(s):  
Ulrich Keilholz ◽  
Maren Knoedler ◽  
Ines Redlich ◽  
Thomas Christoph Gauler
Keyword(s):  
Standard Dose ◽  
Performance Status ◽  
Single Agent ◽  
Smoking Behavior ◽  
Treatment Discontinuation ◽  
Treatment Protocols ◽  
Primary Tumor Site ◽  
Short Term Exposure ◽  
Early Indicators

e17015 Background: Cetuximab has established activity in rmSCCHN as a single agent as well as in conjunction with chemotherapy. Combination treatment protocols lead to significant toxicity. It would be of interest to identify pretreatment characteristics and early indicators of long-term cetuximab efficac. Methods: rmSCCHN patients were analysed, who participated in trials of chemotherapy plus cetuximab, followed by cetuximab maintenance. Patients were stratified into two groups of long term exposure (LTE) and short term exposure (STE) of cetuximab using 6 months as cut-off. Factors considered for analysis included age, sex, performance status, smoking behavior, primary tumor site, time from primary to treatment for rm-disease, number of chemotherapy cycles received, response, toxicity, and reason for treatment discontinuation. Results: In 2 institutions, 61 patients were enrolled in 5 clinical trials between 2008 and 2011. Cetuximab was administered in standard dose and schedule until disease progression or unacceptable toxicity. 27 patients received cetuximab <6 mo (STE, median 1.5 mo) and 34 >6 mo (LTE, median 9 mo). Patients with LTE as compared to STE only differed in 2 characteristics: oral/oropharyngeal primary (56% vs. 41%) and median chemotherapy cycles received (6 vs. 2). Comparing LTE to STE, treatment discontinuation during the chemotherapy phase was due to toxicity in 14 vs. 37% or death in 4 vs. 15%. Median OS in LTE vs. STE was 18 vs. 4 mo. Conclusions: LTE was associated with a huge improvement of OS. Toxicity of chemotherapy was a relevant factor for early discontinuation of combination treatments, limiting the overall efficacy of cetuximab. Results may be improved by further intensification of the already implemented proactive toxicity management, but also by development of less toxic chemotherapy schedules.

scholarly journals Nurturing Family Environments for Children: Compassion-Focused Parenting as a Form of Parenting Intervention

2019 ◽  
Vol 10 (1) ◽  
pp. 3 ◽  
Author(s):  
James N. Kirby
Keyword(s):  
Social Learning Theory ◽  
Developed Countries ◽  
Parenting Programs ◽  
Evidence Based ◽  
Social Emotional ◽  
New Approach ◽  
Motivational Systems ◽  
Externalizing Behaviour ◽  
Developing And Developed Countries

The style of parenting a child receives has profound long-term impacts on that child’s life. Yet, the rates of child maltreatment globally are high (in both developing and developed countries), indicating that many children around the world are being raised in toxic environments. Evidence-based parenting programs (EBPPs) have been demonstrated to have positive impacts on improving parenting style, whilst reducing childhood social, emotional and behavioural problems. EBPPs originated out of a need to address externalizing behaviour problems and to address conduct problems, and compliance became a key target of these parenting models. Thus, many EBPPs were developed in an era where operant and social learning theory-based approaches to parenting were most prominent and these parenting models still prevail today. This paper has one major aim—to demonstrate how the next generation of EBPPs need to be grounded in evolved caring motivational systems and affiliative emotion processing, which requires an understanding of the evolved processes involved in parent-offspring caring. This new approach to parenting is called, ‘compassion-focused parenting’, and this new approach to parenting will be described.

Treatment for Tobacco Dependence for Rural, Lower-Income Smokers: Outcomes, Predictors, and Measurement Considerations

2009 ◽  
Vol 23 (5) ◽  
pp. 328-338 ◽  
Author(s):  
Christine E. Sheffer ◽  
Maxine Stitzer ◽  
Thomas J. Payne ◽  
Bradford W. Applegate ◽  
David Bourne ◽  
...  
Keyword(s):  
Smoking Status ◽  
Behavioral Therapy ◽  
Tobacco Dependence ◽  
Evidence Based ◽  
Long Term Outcomes ◽  
Lower Socioeconomic Status ◽  
Intention To Treat ◽  
Lower Socioeconomic ◽  
Treat Analysis

Purpose. Outcomes from a statewide program that delivered evidence-based, intensive treatment for tobacco dependence to a rural population of lower socioeconomic status (SES) were evaluated. Factors that predicted success and measurement considerations were examined. Design and Analyses. Data were collected at intake, at all treatment sessions, and at 3- and 12-months posttreatment. Abstinence rates were calculated using complete-case analysis and intention-to-treat analysis, and they were estimated for all participants. Logistic regression was used to evaluate the predictive significance of demographic and clinical factors. Setting. Twenty health care sites across Arkansas. Participants. A total of 2,350 predominantly rural, lower SES, Arkansas residents. Intervention. Evidence-based, six-session, multi-component cognitive-behavioral therapy with relapse prevention. Results. The estimated percent abstinent was 26.47% at 3-months and 21.73% at 12-months posttreatment; 51.02%) of patients completed treatment and demonstrated markedly higher quit rates. Although numerous factors predicted outcomes at different points, self-efficacy and dependence levels at intake were robust predictors across time and methods of calculating outcomes. Sex, partner smoking status, and educational level were significant predictors of long-term abstinence. Conclusions. This study demonstrates that intensive, evidence-based treatment for tobacco dependence can be successfully delivered in a statewide program and can yield long-term outcomes that approximate those seen in more controlled settings. Overall sample estimates may be more appropriate for the assessment of outcomes in this context.

The Association between Depressive Symptoms and Cigarette Smoking in An Urban Primary Care Sample

2000 ◽  
Vol 30 (1) ◽  
pp. 15-26 ◽  
Author(s):  
Charlotte Brown ◽  
Pamela A. F. Madden ◽  
Deena R. Palenchar ◽  
Lisa Cooper-Patrick
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Cigarette Smoking ◽  
Nicotine Dependence ◽  
Primary Care Physicians ◽  
Employment Status ◽  
Smoking Status ◽  
Smoking Behavior ◽  
Depression Scale ◽  
Population Based

Objective: To examine the relationship between cigarette smoking and depressive symptoms in an urban primary care sample. Methods: Eligible participants were 526 patients aged eighteen to sixty-four presenting in the waiting rooms of two university affiliated internal medicine clinics. Participants were asked to complete a brief interview which ascertained current depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D), demographic information, and smoking status using a modified version of the Fagerstrom Test for Nicotine Dependence (FTND). Results: Smoking status differed significantly by age, gender, education, and employment status. Mean level of depressive severity also differed by smoking status. Current smokers with nicotine dependence symptoms had significantly higher CES-D scores than those who had never smoked, ex-smokers, and non-dependent smokers. Logistic regression analyses indicated that gender, employment status, age, and smoking status were significantly associated with CES-D scores ≥16. Exploratory analyses suggested that among smokers with a symptom of nicotine dependence, significantly more women than men had clinically significant levels of depressive symptoms. Conclusions: The association between smoking behavior and depressive symptoms in the present study is consistent with that reported in population-based and psychiatric samples. Symptoms of nicotine dependence were significantly associated with clinical levels of depressive symptoms. Primary care physicians may wish to inquire about depressive symptoms among smokers, because these symptoms may interfere with patients' efforts to quit.

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