An international review of tobacco smoking in the medical profession: 1974–2004

Background\ud Tobacco smoking by physicians represents a contentious issue in public health, and regardless of what country it originates from, the need for accurate, historical data is paramount. As such, this article provides an international comparison of all modern literature describing the tobacco smoking habits of contemporary physicians.\ud \ud Methods\ud A keyword search of appropriate MeSH terms was initially undertaken to identify relevant material, after which the reference lists of manuscripts were also examined to locate further publications.\ud \ud Results\ud A total of 81 English-language studies published in the past 30 years met the inclusion criteria. Two distinct trends were evident. Firstly, most developed countries have shown a steady decline in physicians' smoking rates during recent years. On the other hand, physicians in some developed countries and newly-developing regions still appear to be smoking at high rates. The lowest smoking prevalence rates were consistently documented in the United States, Australia and the United Kingdom. Comparison with other health professionals suggests that fewer physicians smoke when compared to nurses, and sometimes less often than dentists.\ud \ud Conclusion\ud Overall, this review suggests that while physicians' smoking habits appear to vary from region to region, they are not uniformly low when viewed from an international perspective. It is important that smoking in the medical profession declines in future years, so that physicians can remain at the forefront of anti-smoking programs and lead the way as public health exemplars in the 21st century

SMOKING-HABITS IN MEDICAL-STUDENTS AND PHYSICIANS IN GRONINGEN, THE NETHERLANDS

Smoking habits and attitudes towards smoking of medical students (n = 725), house officers (n = 126) and consultants (n = 236) of the University Hospital of Groningen were studied, in 1989 by means of a World Health Organization (WHO) questionnaire. Overall response rate was 84%. Twenty seven percent of the medical students are current smokers, 28% of the house officers and 34% of the consultants. There is a remarkable difference among medical specialists i.e: smoking prevalence is highest among psychiatrists and lowest among paediatricians. The prevalence of smoking in medical students and house officers is lower than in the Dutch population. Smoking habits of the consultants are similar to those of the general population. About 75% of the doctors reported having no experience with smoking cessation programmes. Doctors report a need for more skills and knowledge on smoking cessation programmes

Inaccuracy of portable peak flow meters:correction is not needed

This study examined whether correction of peak expiratory flow (PEF) values for the inaccuracy of the meter would affect asthma management in 102 children (7-14 y old). PEF was recorded with a mini Wright meter twice daily for 2 weeks. As expected, measured PEF overestimated PEF level and asthma control in these children on many diary days. The actual numerical differences between measured and corrected PEF on these days were very small(>5% in only five patients, maximum 10%). It is unlikely that such small changes in PEF justify changes in asthma management, even if these changes cause PEF levels to cross arbitrary borders between various levels of asthma control used in self-management plans. The clinical importance of the inaccuracy of portable PEF meters is negligible

REMISSION OF CHILDHOOD ASTHMA AFTER LONG-TERM TREATMENT WITH AN INHALED CORTICOSTEROID (BUDESONIDE) - CAN IT BE ACHIEVED

This study was undertaken in order to determine whether long-term treatment with inhaled corticosteroid can induce a remission in childhood asthma, and to decide when stabilization of airway responsiveness occurred. We therefore carried out, an extended follow-up of 28-36 months in one of two groups of children who participated in a long-term intervention study. This former study had shown that long-term (median follow-up 22 months) treatment with inhaled corticosteroid plus beta(2)-agonist improves symptoms, airway calibre and airway responsiveness in children with asthma, compared with beta(2)-agonist alone. On treatment with inhaled corticosteroid plus beta(2)-agonist, airway calibre did not further improve after 4 months, whereas the provocative dose of histamine which causes a 20% fall in forced expiratory volume in one second (PD20) histamine showed gradual improvement without reaching an apparent plateau. Remission was defined as being symptom free during any 8 month period. Of the 58 children originally randomized to receive 0.2 mg salbutamol, plus 0.2 mg budesonide, Lid, five children withdrew: three due to lack of motivation, one for psychological reasons, and one due to a deterioration of asthma One patient was hospitalized because of an asthma exacerbation. Airway calibre showed no improvement after 4 months up to 36 months. Mean PD,histamine stabilized after 20 months at 2.1 doubling doses above baseline, but at a subnormal level of 80 mu g. Symptoms improved during the first 18 months, and may have been improving further, but slowly, during the period between 18 and 36 months. Thirty five patients (60%) achieved a period of remission at some time during the 28-36 months of treatment, However, 23 (66%) of these had a relapse. We conclude that long-term treatment with inhaled corticosteroid improves clinical signs, airway calibre and airway responsiveness, although in most patients only up to a subnormal level Only a minority of the patients achieve a long-lasting remission