Non-conventional therapies for analgesia

Purpose: Third molar surgery is a quite common procedure. Some patients experience pain associated with this situation. The aim of this article aims to discuss non-conventional therapies for the management of postoperative pain associated with third molar surgery. Methods: An extensive literature search was conducted with the keywords “third molar” + “pain” and all articles that excluded already established drugs as analgesics, anti-inflammatories, or therapies such as laser therapy and ozone therapy whereas non-conventional drugs and therapies were retained. Results: The article rated bromelain, honey, hyaluronic acid, nicotine patches, Kinesio tape, TENS, anticonvulsants, curcumin, and melatonin. Some therapies are efficient and safe, while others have not shown promising results. Conclusions: Bromelain and Kinesio tape are considered the most effective non-conventional therapies for controlling postoperative pain, and even with few studies on them, they are therapies with promising results.

Progressive nicotine poisoning by multiple transdermal nicotine patches

The pharmacokinetic properties of transdermal nicotine patches (TNPs) are different from those of other routes of nicotine administration; further, acute nicotine poisoning by TNPs may present with different clinical features. In the present report, we describe the case of a 23-year-old woman who was admitted to emergency department (ED) at Jeju National University Hospital with loss of consciousness. Five hours before the ED visit, she used multiple TNPs to attempt suicide. Initially, nausea and vomiting occurred, and the symptoms worsened over time. We immediately removed the TNPs, and the application sites were gently washed with sterile water. The patient’s level of consciousness gradually improved, and she fully recovered an altered mental status 5 hours later. Her initial urinary cotinine level was 324 ng/mL. Physicians should be aware that acute nicotine poisoning by TNPs can cause various toxic symptoms.

Offering nicotine patches to all households in a community with high smoking rates: Pilot test of a population-based approach to promote tobacco cessation

BackgroundThe objective of this project is to determine the effectiveness of targeting a community with a high smoking rate with the distribution of free-of-charge nicotine patches in order to promote tobacco cessation. Methods/DesignOne small community with an elevated smoking rate (compared to national and provincial averages) has been identified. All households in the community will be sent a letter offering one smoker (18 years or older; 10 or more cigarettes per day) in the household a free-of-charge mailed five-week supply of nicotine patches (up to a total of 800 five-week kits will be available for distribution). Participants receiving nicotine patches will be asked to complete a six-month follow-up survey assessing tobacco cessation defined as 30-day point prevalence abstinence. In addition, attempts will be made to employ ongoing national population surveys containing cigarette smoking variables to compare changes in smoking prevalence in the target community to other communities with similar characteristics. DiscussionWe will examine whether the concentrated distribution of mailed nicotine patches will result in a measurable reduction in smoking rates in the target community. If demonstrated, this would provide support for the targeted population-level distribution of an effective individual-level public health intervention. Clinical Trials registrationNCT04534231

Targeting mailed nicotine patch distribution interventions to rural regions of Canada: protocol for a randomized controlled trial

Background Quitting smoking is the most effective way of reducing the risk of cancer among smokers. One way of helping people stop smoking is to provide them with free Nicotine Replacement Therapy (NRT), such as when NRT is sent to people by postal mail as part of a mass distribution initiative. Our previous research indicated that there may be a substantial impact on increasing quit rates of a mailed NRT intervention in rural areas. The current research seeks to confirm this finding and to understand the social determinants of health driving these anticipated large effects. Methods/design Telephone numbers will be randomly selected from across rural regions of Canada in order to recruit adult smokers interested in completing a smoking survey and willing to be interviewed again in 6 months. The survey will ask participants about their smoking history, demographic characteristics, and a hypothetical question: would they be interested in receiving nicotine patches if they were provided to them free of charge? Half of the smokers interested in receiving nicotine patches will be selected by chance and offered the NRT package. The other half of smokers will not be offered the nicotine patches. In addition, the municipality where each participant lives will be identified and, once the relevant general population data becomes available, attempts will be made to link participant data to relevant municipal characteristics (e.g., smoking rates, availability of health services). Characteristics of the participants and the municipalities in which they live will be used to explain why the nicotine patch intervention may have a larger impact in some rural regions compared to others. Discussion The findings from the proposed RCT are timely and of high relevance as the distribution of nicotine patches has substantial potential to combat the public health problem of cigarette related cancer, other diseases, and premature death from tobacco use. Targeting such tobacco cessation initiatives to rural regions may substantially increase the impact of this intervention, helping to optimize the use of limited prevention resources while aiming to save the maximum number of lives. Clinical trials registration ClinicalTrials.govNCT04606797, October, 27, 2020.

Free, easy and effective: how young adults used 8 weeks of mailed nicotine patches and to what effect

IntroductionResearch shows the mass distribution of free nicotine replacement therapy (NRT) is a high-impact, population-level strategy for smoking cessation; but underrepresentation of younger, and/or lighter, smokers challenges generalisability of findings to young adult smokers.AimsThis naturalistic study examined how and with what effect young adult smokers used free nicotine patches provided through a mass mailout programme.MethodsIn total, 5,025 eligible 18–29 year-old smokers who accessed an online ordering platform received self-help materials and an 8-week course of patches matched to their consumption level (<10 cigarettes per day (cpd); ≥10 cpd). No other behavioural support occurred. Whether participants used patches correctly and achieved 30-day continuous abstinence at 6-month follow-up were assessed.ResultsAmong 694 participants with complete data: 89% used some patches; 8% used the patches correctly for 8 weeks; 31.0% (95% confidence interval (CI) = 27.6, 34.7) achieved abstinence. Adjusted logistic regression analysis showed the highest odds of abstinence was associated with the correct use of patches (odds ratio = 2.8, 95% CI = 1.5, 5.1).ConclusionsMass distribution of free patches may be an effective public health measure for supporting younger, lighter smokers to attempt cessation, reduce consumption, or achieve abstinence. Emphasising why and how to use NRT for the entire treatment course may enhance outcomes.

Lessons Learned from a Text Messaging Intervention for Young Smokers Experiencing Homelessness (Preprint)

BACKGROUND Smoking rates are significantly higher among youth experiencing homelessness (YEH) than in the general population. Despite a willingness to quit, YEH have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. YEH generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. OBJECTIVE This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI), as an adjunct to group-based cessation counseling and provision of nicotine patches, to help YEH quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. METHODS YEH smokers who were interested in quitting (n = 77) were recruited from drop-in centers serving YEH in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches; with n = 40 randomly assigned to receive six weeks of text messages to provide additional support for their quit attempt. Participants were sent the text messages to their own phone, rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow up survey data, as well as backend data from the messaging platform, to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. RESULTS Participants had widespread (smart)phone ownership – only 14% were ineligible for study participation because they either did not have a phone that could receive text messages or did not want to receive messages. Participants experienced interruptions in their phone use but reported being able to receive the majority of messages. These survey results were corroborated by backend data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Participants reported enjoying the group counseling session that preceded the TMI, and suggested to include more such group elements into the intervention. CONCLUSIONS The TMI was well accepted and feasible to support smoking cessation among YEH. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages, and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support YEH, a population urgently in need of effective smoking cessation interventions. CLINICALTRIAL We report on implementation lessons, i.e. do not make use of the randomized controlled trial aspect of the underlying parent study that is registered with the ClinicalTrials.gov Identifier: NCT03874585

The Preliminary Efficacy and Feasibility of Group-Based Smoking Cessation Treatment Program for Incarcerated Smokers

Group-based tobacco dependence treatment has been known to help smokers to quit in general adult populations, but the feasibility and efficacy of this type of smoking cessation treatment in correctional settings remain uncertain. A 6-week group-based smoking cessation treatment with nicotine replacement therapy (NRT) in the form of nicotine patches was implemented in seven male prison facilities, in the Northeast, among smokers who were born biologically as male. Exhaled breath carbon monoxide (CO) levels were collected from participants at each session to confirm smoking status. Participants were evaluated at the 1-month post-group treatment follow-up to determine abstinence. Those who were lost to follow-up were recorded as continued smoking and not using NRT nicotine patches. The goal of the study was to explore the feasibility and preliminary efficacy of conducting a smoking cessation treatment program for incarcerated smokers. A total of 350 inmates were screened, 177 inmates were enrolled across the prison sites for the 6-week program, and 102 inmates completed the program. A majority of those enrolled reported that they began smoking when they were between 15 and 19 years of age (44.9%) and were smoking on average for 26 years. Less than half (21.3%) reported ever using electronic cigarettes at baseline and in Session 1,116 individuals who attended reported a median CO level of 18.0 parts per million (ppm). At a 1-month follow-up, 43 individuals reported a median CO level of 5.00 ppm. The study demonstrated preliminary efficacy and feasibility of group-based smoking cessation treatment with NRT nicotine patches in incarcerated smokers.

4066 In Teenagers Who Smoke Cigarettes Are Nicotine Patches as Compared to Placebo Effective to Decrease the Number of Cigarettes Smoked? – A Systematic Review

OBJECTIVES/GOALS: The aim was to examine whether nicotine patch was more effective in encouraging abstinence from cigarettes smoking compared to placebo. METHODS/STUDY POPULATION: Randomized controlled trials involving the general teenage age group smokers who were current smokers-“smoked less than 100 cigarettes over their lifetime and smoked at the time of the interview. Databases were searched for relevant studies reported in English that employed a randomized design published since 2000. Two authors extracted data and assessed quality. The primary outcomes and prioritization were continuous abstinence at 3, 6 and 12-month follow-up or more for the number of patients who responded to treatment, defined as a reduction/abstinence. Heterogeneity between studies did not preclude combined analyses of the data. RESULTS/ANTICIPATED RESULTS: 4 of 266 publications were included. Four studies reported positive effects on smoking cessation at end of treatment: (1) nicotine patches improved continuous abstinence at 6 weeks – 9 weeks months; (2) nicotine patch improved continuous abstinence at 3 to 6 months; (3) nicotine patches improved continuous abstinence 6 and 12 months; (4) nicotine patches improved continuous abstinence at 6 months – 12 and 24 months (5). All studies showed, continuous abstinence at follow up differed in percentage between groups both at 6 weeks through 24 months, with NRT (Nicotine patch) intervention groups achieving higher rates in most of the studies compared to placebo intervention group. Conclusions: NRT intervention methods seem to increase smoking abstinence in those treated for smoking cessation. Further and larger sample size studies are required to make stronger the base of evidence. DISCUSSION/SIGNIFICANCE OF IMPACT: Four randomized controlled trials investigating the effectiveness of smoking cessation interventions, for teenagers who smoke cigarettes were identified for inclusion in this review. Four of the studies reported significant effects on smoking cessation, providing evidence of effectiveness of NRT (nicotine patch), behavioral support and combinations of the two, although not all trials intervention treatments found an effect. The four studies reported important intervention effects at both the short and long follow-ups required: 6 weeks up to the 24 months, thereby, providing stronger evidence to support the effectiveness of NRT intervention on smoking cessation. All studies showed some evidence of improved smoking abstinence outcomes. The four studies had in common that the smoking cessation interventions provided a combination of intent to treat prevention, and of all the clinical trials none of them suggested a negative effect of smoking cessation treatment on substance use outcomes using NRT. However, the studies used reliable methods and reported their cases properly, but the small number of studies reviewed for the systematic review makes the conclusion about the effectiveness of these interventions uncertain. The papers visibly stated how the trials protected against bias, as indicated by the Yes (low risk). No (high risk) and U as “unclear risk.” All four studies conducted a random sequence generation of participants enrolled into the study sample.

Evaluating the determinants of COVID-19 mortality: A cross-country study

As the COVID-19 pandemic has spread to the entire world, a race to understand the virus and to find an effective and safe vaccine or treatment has triggered interest in the factors contributing to mortality. For instance, some studies have suggested that the BCG vaccine could protect from COVID-19 and nicotine patches could be therapeutic against the virus. This study makes use of data for about 140 countries to evaluate the determinants of COVID-19 mortality. It finds that a country's share of spending on health care (as a measure of a country's effectiveness in tracking, recording, and reporting COVID-19 deaths) is positively associated with COVID-19 deaths. It also finds that the share of people above 65 years of age, obesity, and urbanization are all positively associated with COVID-19 mortality. There is no evidence that BCG vaccination, smoking prevalence, and PM25 pollution have any link to COVID-19 mortality. These estimation results are robust to alternative specifications and after controlling for confounding factors and excluding outliers. Policymakers should allocate resources towards the protection of the elderly and those suffering from underlying conditions such as obesity. They should also exercise caution about administering nicotine patches or the BCG vaccine to fight COVID-19 without the backing of concrete scientific evidence.