Quitline in smoking cessation : a cost-effectiveness analysis

OBJECTIVES: The cost-effectiveness of the Swedish quitline, a nation-wide, free of charge service, is assessed. METHODS: The study was based on data of a sample of 1131 callers enrolled from February 1, 2000 to November 30, 2001. Outcome was measured as cost per quitter and cost per year of life saved. Cost per quitter was based on a calculation of the total cost of the quitline divided by the number of individuals who reported abstinence after 12 months. The cost per life year saved (LYS) was calculated by the use of data from the literature on average life expectancy for smokers versus quitters, the total cost of the quitline, and the cost of pharmacological treatment. RESULTS: The number of smokers who used the quitline and reported abstinence after 1 year was 354 (31 percent). The accumulated number of life years saved in the study population was 2400. The cost per quitter was 1052-1360 USD, and the cost per life year saved was 311-401 USD. A sensitivity analysis showed that, for outcomes down to an abstinence rate of 20 percent, the cost per LYS rose modestly, from 311 to 482 USD. Discounting the cost per LYS showed the cost to be 135 USD for 3 percent and 283 USD for 5 percent. CONCLUSIONS: The Swedish quitline is a cost-effective public health intervention compared with other smoking cessation interventions.Swedish Government through The National Institute of Public HealthThe Swedish Cancer SocietyThe Swedish Heart-Lung FoundationThe National Corporation of Swedish PharmaciesPublishe

Treating tobacco addiction. Praxis and barriers amongst Icelandic general practitioners

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: To assess praxis and identify the most common barriers for engaging in tobacco prevention in general practice in the Nordic countries. Material and methods: All 167 practicing general practitioners in Iceland received a questionnaire at home assessing praxis and barriers for systematic involvement in tobacco prevention. Results: The over all response rate was 77%. Few general practitioners asked patients if they smoked if the patient had no smoking related symptoms. Few supported patients who wanted to stop smoking. However, a big majority agreed that tobacco prevention was a part of their job. The main reasons for not engaging in tobacco prevention was lack of time and the feeling that the time spent may not be worth the effort since few patients quit. A big majority stated that they would prefer to reefer smokers to smoking cessation specialist. Conclusions: Smoking cessation expertise needs to be more accessible to Icelandic patients and doctors.Tilgangur: Að kanna meðferðarvenjur heilsugæslulækna við meðhöndlun á tóbaksfíkn og greina helstu þröskulda (hindranir) sem standa í vegi fyrir því að heilsugæslulæknar á Íslandi sinni tóbaksvörnum. Efniviður og aðferðir: Spurningalisti var sendur heim til allra 167 starfandi heilsugæslulækna á Íslandi vorið 1999. Spurt var um tóbaksvarnastarf, hindranir fyrir að sinna tóbaksvörnum og eigin tóbaksneyslu heilsugæslulækna. Niðurstöður: Svarshlutfall var 77%. Af þeim sem svöruðu reyktu 7% daglega og 14% af og til. Fáir heilsugæslulæknar höfðu það sem reglu að spyrja sjúklinga sín hvort þeir reyktu ef þeir höfðu engin einkenni sem líklegt er að rekja megi til reykinga. Fáir buðu sjúklingum sínum upp á stuðning við að hætta að reykja. Flestir töldu tóbaksvarnir þó vera innan síns verksviðs. Aðalástæðan fyrir að sinna ekki tóbaksvörnum var tímaskortur og sú tilfinning að fáir hætti að reykja þrátt fyrir stuðning. Mikill meirihluti taldi æskilegt að geta vísað reykingamönnum til sérfræðinga í reykbindindi. Ályktanir: Auka þarf aðgengi sjúklinga og heilsugæslulækna að sérfræðingum í reykbindindi

Disseminating evidence from health technology assessment : the case of tobacco prevention

OBJECTIVES: The aims of the present study were to investigate the awareness among dentists and dental hygienists of evidence-based reports and guidelines on tobacco cessation activities and the impact these publications had on clinical practice. METHODS: A questionnaire was mailed to dental hygienists and dentists in Stockholm County, Sweden, and the results were compared with a previous investigation. RESULTS: Among the respondents, awareness of a popular science version of a systematic review on smoking and its effect on oral health was reported by 90 percent of the hygienists and 66 percent of the dentists. The information was used in clinical work by 34 percent of the dentists and 54 percent of the hygienists. Reported changes in patterns of practice were more frequent recommendations to use nicotine replacement therapy and a more widespread use of setting quit dates. Approximately one quarter of the dental professionals reported that they had increased tobacco cessation consultation because of the results from the reports. CONCLUSIONS: Changes in patterns of practice were observed after dissemination of evidence-based information on tobacco cessation. Methods that were proven to be effective in the evidence-based report such as discussing quit dates and recommending nicotine replacement therapy were more commonly used after the publication of the report. Short, popular versions of extensive systematic reviews seem to be useful for implementing evidence-based knowledge and changing clinical practice.NonePublishe

Comparison of a high and a low intensity smoking cessation intervention in a dentistry setting in Sweden – a randomized trial

<p>Abstract</p> <p>Background</p> <p>Tobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases. Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting. The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting.</p> <p>Methods</p> <p>300 smokers attending dental or general health care were randomly assigned to two arms and referred to the local dental clinic for smoking cessation support. One arm received support with low intensity treatment (LIT), whereas the other group was assigned to high intensity treatment (HIT) support. The main outcome measures included self-reported point prevalence and continuous abstinence (≥ 183 days) at the 12-month follow-up.</p> <p>Results</p> <p>Follow-up questionnaires were returned from 86% of the participants. People in the HIT-arm were twice as likely to report continuous abstinence compared with the LIT-arm (18% vs. 9%, p = 0.02). There was a difference (not significant) between the arms in point prevalence abstinence in favour of the HIT-protocol (23% vs. 16%). However, point prevalence cessation rates in the LIT-arm reporting additional support were relatively high (23%) compared with available data assessing abstinence in smokers trying to quit without professional support.</p> <p>Conclusion</p> <p>Screening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden. The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option, but should be integrated with other forms of available support in the community. The more extensive and expensive HIT-protocol should be offered to those who are unable to quit with the LIT approach in combination with other support.</p> <p>Trial Registration</p> <p>Trial registration number: NCT00670514</p

COPA syndrome in an Icelandic family caused by a recurrent missense mutation in COPA

Background: Rare missense mutations in the gene encoding coatomer subunit alpha (COPA) have recently been shown to cause autoimmune interstitial lung, joint and kidney disease, also known as COPA syndrome, under a dominant mode of inheritance. Case presentation: Here we describe an Icelandic family with three affected individuals over two generations with a rare clinical presentation of lung and joint disease and a histological diagnosis of follicular bronchiolitis. We performed whole-genome sequencing (WGS) of the three affected as well as three unaffected members of the family, and searched for rare genotypes associated with disease using 30,067 sequenced Icelanders as a reference population. We assessed all coding and splicing variants, prioritizing variants in genes known to cause interstitial lung disease. We detected a heterozygous missense mutation, p.Glu241Lys, in the COPA gene, private to the affected family members. The mutation occurred de novo in the paternal germline of the index case and was absent from 30,067 Icelandic genomes and 141,353 individuals from the genome Aggregation Database (gnomAD). The mutation occurs within the conserved and functionally important WD40 domain of the COPA protein. Conclusions: This is the second report of the p.Glu241Lys mutation in COPA, indicating the recurrent nature of the mutation. The mutation was reported to co-segregate with COPA syndrome in a large family from the USA with five affected members, and classified as pathogenic. The two separate occurrences of the p.Glu241Lys mutation in cases and its absence from a large number of sequenced genomes confirms its role in the pathogenesis of the COPA syndrome. Keywords: COPA syndrome, Lung disease, Arthritis, Immune dysregulation, Case reportPeer Reviewe

exual function and its importance for the well-being of elderly men. The ethical dilemma of sub¬sidizing treatment for waning erection stiffness

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenRistruflanir valda mörgum körlum miklu hugarangri, jafnvel þó þeir séu komnir að áttræðu og hættir að hafa samfarir (1). Ristruflanir tengjast auknum aldri (1) en eru einnig oft afleiðing sjúkdóma eða meðferða við þeim (2-4). Dæmi um sjúkdóma sem tengjast ristruflunum eru sykursýki og hjarta- og æðasjúkdómar (2,4). Dæmi um sjúkdómsmeðferð sem hefur þessar afleiðingar í för með sér er skurðaðgerð við krabbameini í blöðruhálskirtli, en gera má ráð fyrir að 60-70% sjúklinganna verði getulausir (sjá skilgreiningu að neðan) í kjölfar aðgerðarinnar (3). Lyf sem tengd hafa verið ristruflunum eru meðal annars þvagræsilyf, histamín-2 blokkarar og segavarnarlyf af kúmaríngerð (2,4). Lyf sem vinna gegn minnkandi limstífni eru ekki niðurgreidd hér á landi. Umræðan um það hvort greiða eigi niður slík lyf eða ekki er skammt á veg komin enda stutt síðan lyfin komu á markað. í þessari grein verður fyrst rætt um hugtakið getuleysi sem er grundvallarhugtak í umræðunni. Gerð verður grein fyrir nýlegum sænskum rannsóknum á kynlífsatferli eldri karla og áhrifum ristruflana á andlega vellíðan. Að lokum verða rædd rök sem liggja til grundvallar þeirri kröfu að lyf sem auka limstífni eigi, í vis sum tilfellum, að greiða niður af samfélaginu

Tóbaksvarnir

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Í nýlegri samantekt tímaritsins The Economist kemur fram að tóbak drap u.þ.b. 80 miljónir á öldinni sem leið en 37 miljónir féllu í öllum stríðum aldarinnar samanlagt. Þetta er sláandi samanburður, ekki síst þegar tillit er tekið til þess að reykingar urðu ekki vemlega útbreiddar fyrr en um miðja öldina. Ef ekkert verður að gert er áætlað að u.þ.b. 450 miljónir falli í tóbaksvalinn á næstu 50 árum

Prostate cancer treatment and quality of life : a three level epidemiological approach

Prostate Cancer Treatment and Quality of Life - a Three Level Epidemiological Approach The decision whether or not to treat localized prostate cancer with curative intent is influenced by the expected beneficial and harmful effects in terms of patient survival and quality of life. In this thesis symptoms specifically related to prostate cancer treatment are investigated, including urinary and bowel symptoms and waning sexual functions. The prevalence of these symptoms and the extent to which they distress the men were assessed. Finally, the relationship between distress owing to these symptoms and psychological, physical and overall well-being was analyzed. Applying epidemiological methods, a total of 842 men were analyzed in seven studies. In four of the studies, 342 prostate cancer patients were compared to a reference group of 314 age matched men without prostate cancer and patients subjected to different treatment protocols were compared to each other and to patients not subjected to any initial treatment. Urinary and bowel symptoms were more prevalent in the prostate cancer group than in the age-matched reference group but few men, with or without prostate cancer, reported severe symptoms. A small minority of patients (4%) reported high levels of distress owing to urinary or bowel symptoms and their feeling of well-being was impaired. The prevalence of impaired sexualfunction was much higher in the prostate cancer group than in the reference group. The majority of men with the disease that had experienced waning sexual function stated that this distressed them and distress owing to waning sexual function was more common than distress owing to urinary and bowel symptoms. Prostate cancer patients reporting moderate or high distress owing to waning sexual function (52%) reported an impaired feeling of well-being compared with other patients. Men treated for their prostate cancer were more likely to report waning sexual function compared with patients reporting no treatment. External beam radiation therapy was less likely than radical prostatectomy to be related to waning sexual function after treatment. The willingness to trade off an intact sexual capacity for the possibility of a prolonged life expectancy varied considerably among the men. This emphasizes the need to adapt treatment decisions to each individual, not only based on medical variables but also on the patient's emotional values and religious and ethical positions. It is possible that the question "How should localized prostate cancer be treated?" may newer be answered. We can only collect valid information about the basis for the trade-off and learn to communicate the data to the patient in a fruitful way. Key words: Prostate cancer, urinary symptoms, bowel symptoms, sexual function, distress, well-being, quality of life, trade-off. ISBN 91-628-2518-

Tóbaksvarnir

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Í nýlegri samantekt tímaritsins The Economist kemur fram að tóbak drap u.þ.b. 80 miljónir á öldinni sem leið en 37 miljónir féllu í öllum stríðum aldarinnar samanlagt. Þetta er sláandi samanburður, ekki síst þegar tillit er tekið til þess að reykingar urðu ekki vemlega útbreiddar fyrr en um miðja öldina. Ef ekkert verður að gert er áætlað að u.þ.b. 450 miljónir falli í tóbaksvalinn á næstu 50 árum