Associations between Practitioner Personality and Client Quit Rates in Smoking Cessation Behavioural Support Interventions

Introduction: There is wide variation in the success rates of practitioners employed to help smokers to stop, even once a range of potential confounding factors has been taken into account. Aim: This paper examined whether personality characteristics of practitioners might play a role success rates. Methods: Data from 1,958 stop-smoking treatment episodes in two stop-smoking services (SSS) involving 19 stop-smoking practitioners were used in the analysis. The outcome measure was clients’ biochemically verified quit status 4 weeks after the target quit date. The five dimensions of personality, as assessed by the Ten-Item Personality Inventory, were included as predictor variables: openness, conscientiousness, agreeableness, extraversion, and neuroticism. A range of client and other practitioner characteristics were used as covariates. A sensitivity analysis was conducted to determine if managers' ratings of practitioner personality were also associated with clients’ quit status. \ud Results: Multi-level random intercept models indicated that clients of practitioners with a higher extraversion score had greater odds of being abstinent at four weeks (self-assessed: OR = 1.10, 95% CI = 1.01–1.19; manager-assessed: OR = 1.32, 95% CI = 1.21–1.44). Conclusions: More extraverted stop smoking practitioners appear to have greater success in advising their clients to quit smoking. Findings need to be confirmed in larger practitioner populations, other SSS, and in different smoking cessation contexts. If confirmed, specific training may be needed to assist more introverted stop smoking practitioners

Performance of English stop smoking services in first 10 years: analysis of service monitoring data

Objectives: To analyse the performance of the English Stop Smoking Services from 2001/02 to 2010/11. Design: Analysis of national service monitoring data. Setting: England. Participants: Smokers recorded as having been treated by English stop smoking services between April 2001 and March 2011. Main outcome measures: Annual figures for the number of quit dates set (throughput), the percentage of these that led to biochemically verified abstinence after four weeks (four week quit rate), and the “impact” in terms of the number of four week quitters beyond those who it is estimated would have stopped with only a prescription for smoking cessation treatment; characteristics of smokers being treated, medication used, and mode of delivery (for example, one to one, group based); variability across local services in throughput, four week quit rates, and impact for 2010/11. Results: Throughput rose from 227 335 in 2001/02 to 787 527 (8% of all smokers) in 2010/11. The percentage of four week quitters declined slightly from 35% to 34%. Impact rose from 22 933 four week quitters created in 2001/02 to 72 411 in 2010/11 (corresponding to an estimated 21 723 12 month quitters). The services were successful in reaching disadvantaged smokers; 54% (n=425 684) were in receipt of free prescriptions in 2010/11. Substantial variation existed across local services in throughput, success rates, and impact. Conclusions: The English stop smoking services have had an increasing impact in helping smokers to stop in their first 10 years of operation and have successfully reached disadvantaged groups. However, performance across local services has varied considerably

Developing a clinical trial unit to advance research in an academic institution

AbstractResearch, clinical care, and education are the three cornerstones of academic health centers in the United States. The research climate has always been riddled with ebbs and flows, depending on funding availability. During a time of reduced funding, the number and scope of research studies have been reduced, and in some instances, a field of study has been eliminated. Recent reductions in the research funding landscape have led institutions to explore new ways to continue supporting research. Mayo Clinic in Rochester, MN has developed a clinical trial unit within the Department of Medicine, which provides shared resources for many researchers and serves as a solution for training and mentoring new investigators and study teams. By building on existing infrastructure and providing supplemental resources to existing research, the Department of Medicine clinical trial unit has evolved into an effective mechanism for conducting research. This article discusses the creation of a central unit to provide research support in clinical trials and presents the advantages, disadvantages, and required building blocks for such a unit

Experience and expectations of patients on weight loss: The Learning Health System Network Experience

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152010/1/osp4364_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152010/2/osp4364.pd

Racial differences in smoking abstinence rates in a multicenter, randomized, open-label trial in the United States

Background: This study evaluates differences in smoking abstinence between white and minority smokers using pharmaceutical aids. Methods: This is an analysis of data from a multi-center, randomized, clinical trial conducted in the United States. Of the 1,684 subjects randomized to one of three medications (nicotine inhaler, bupropion, or a combination of both), 60% were women and 10% were minority races. Results: Factors associated with a decreased likelihood of smoking at 12 weeks were older age (OR = 0.971, p\u3c 0.0001), being married (OR = 0.678, p= 0.0029), using bupropion SR (OR = 0.480, p∈\u3c∈0.0001), and using combination therapy (OR = 0.328, p∈\u3c∈0.0001). Factors associated with an increased likelihood of smoking were higher tobacco dependence scores (OR = 1.244, p \u3c 0.0001), prior quit attempts (OR = 1.812, p=0.004), and being a minority (OR = 1.849, p=0.0083). Compared to white smokers, minority smokers were significantly older at time of study entry (46 vs. 42 years, p\u3c 0.0001), less likely to be married (35% vs. 59%, p\u3c 0.0001), older at smoking initiation (21 vs. 19 years of age, p\u3c 0.0001), and had a lower abstinence rate (16% vs. 26%, p=0.0065). Conclusion: Regardless of the treatment used, minority smokers in the US have lower smoking abstinence after treatment for tobacco dependence. Future research should focus on the improvement in treatment strategies for minority smokers

Enhanced Hydrologic Connectivity and Solute Dynamics Following Wildfire and Drought in a Contaminated Temperate Peatland Catchment

Intact peatlands provide hydrological ecosystem services, such as regulating water regimes and immobilizing pollutants within catchments. Climate change impacts including drought and wildfire may impair their functioning, potentially impacting ecosystem service delivery. Here we investigate stream water quality changes following the combined impacts of a summer drought and wildfire in a peat‐dominated catchment in the UK during 2018. The study catchment stores legacy pollutants (i.e., metals) due to past industrial activity, thus making it particularly susceptible to pollutant release during wildfires. We quantified changes in water chemistry during five storm events over a 9‐month period following the wildfire. Concentration‐discharge (C‐Q) relationships for nine solutes were analyzed to explore changes in activation and connectivity of solute source zones. Hysteresis and flushing indices of C‐Q responses further described solute dynamics during storm events. We found that most nutrient and base cation concentrations in the stream discharge were highest in the immediate post‐fire storm events and decreased during subsequent autumn and spring storms. Metal concentrations increased during autumn and spring storms, indicating delayed mobilization from within‐peat or distal headwater sources. Our findings suggest that seasonal re‐wetting and hydrologic connectivity following disturbance influenced solute source zone activation and transport in the study catchment. Water quality responses associated with wildfire and drought were primarily observed in the months following the wildfire, suggesting mobilization of pollutants peaks shortly after fire. Our results contribute to a critical understanding of the future of water quality risks in temperate peatland catchments subject to disturbances exacerbated by climate change

Enhanced Hydrologic Connectivity and Solute Dynamics Following Wildfire and Drought in a Contaminated Temperate Peatland Catchment

Intact peatlands provide hydrological ecosystem services, such as regulating water regimes and immobilizing pollutants within catchments. Climate change impacts including drought and wildfire may impair their functioning, potentially impacting ecosystem service delivery. Here we investigate stream water quality changes following the combined impacts of a summer drought and wildfire in a peat‐dominated catchment in the UK during 2018. The study catchment stores legacy pollutants (i.e., metals) due to past industrial activity, thus making it particularly susceptible to pollutant release during wildfires. We quantified changes in water chemistry during five storm events over a 9‐month period following the wildfire. Concentration‐discharge (C‐Q) relationships for nine solutes were analyzed to explore changes in activation and connectivity of solute source zones. Hysteresis and flushing indices of C‐Q responses further described solute dynamics during storm events. We found that most nutrient and base cation concentrations in the stream discharge were highest in the immediate post‐fire storm events and decreased during subsequent autumn and spring storms. Metal concentrations increased during autumn and spring storms, indicating delayed mobilization from within‐peat or distal headwater sources. Our findings suggest that seasonal re‐wetting and hydrologic connectivity following disturbance influenced solute source zone activation and transport in the study catchment. Water quality responses associated with wildfire and drought were primarily observed in the months following the wildfire, suggesting mobilization of pollutants peaks shortly after fire. Our results contribute to a critical understanding of the future of water quality risks in temperate peatland catchments subject to disturbances exacerbated by climate change

Association between respiratory tract diseases and secondhand smoke exposure among never smoking flight attendants: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>Little is known about long-term adverse health consequences experienced by flight attendants exposed to secondhand smoke (SHS) during the time smoking was allowed on airplanes. We undertook this study to evaluate the association between accumulated flight time in smoky airplane cabins and respiratory tract diseases in a cohort of never smoking flight attendants.</p> <p>Methods</p> <p>We conducted a mailed survey in a cohort of flight attendants. Of 15,000 mailed questionnaires, 2053 (14%) were completed and returned. We excluded respondents with a personal history of smoking (n = 748) and non smokers with a history of respiratory tract diseases before the age of 18 years (n = 298). The remaining 1007 respondents form the study sample.</p> <p>Results</p> <p>The overall study sample was predominantly white (86%) and female (89%), with a mean age of 54 years. Overall, 69.7% of the respondents were diagnosed with at least one respiratory tract disease. Among these respondents, 43.4% reported a diagnosis of sinusitis, 40.3% allergies, 30.8% bronchitis, 23.2% middle ear infections, 13.6% asthma, 13.4% hay fever, 12.5% pneumonia, and 2.0% chronic obstructive pulmonary disease. More hours in a smoky cabin were observed to be significantly associated with sinusitis (OR = 1.21; p = 0.024), middle ear infections (OR = 1.30; p = 0.006), and asthma (OR = 1.26; p = 0.042).</p> <p>Conclusion</p> <p>We observed a significant association between hours of smoky cabin exposure and self-reported reported sinusitis, middle ear infections, and asthma. Our findings suggest a dose-response between duration of SHS exposure and diseases of the respiratory tract. Our findings add additional evidence to the growing body of knowledge supporting the need for widespread implementation of clean indoor air policies to decrease the risk of adverse health consequences experienced by never smokers exposed to SHS.</p

Psychotherapy as a treatment modality for psychiatric disorders: Perceptions of general public of Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Psychiatric disorders affect about 450 million individuals worldwide. A number of treatment modalities such as psychotropic medications, psychotherapy and electroconvulsive therapy can be used to treat these disorders. Attitudes of general public play a pivotal role in effective utilization of mental health services. We explored the perceptions of general public of Karachi, Pakistan regarding psychotherapy.</p> <p>Methods</p> <p>A cross-sectional study was conducted in Karachi, Pakistan during July-August, 2008. A three-step sampling strategy and a structured questionnaire were employed to survey knowledge and perceptions of adult general public about psychotherapy. Descriptive statistics were used for baseline characteristics. Logistic regression models were used to investigate any significant associations between baseline characteristics of the participants and their perceptions.</p> <p>Results</p> <p>The study sample comprised of 985 individuals (536 males; 531 financially independent) with an average age of 36.7 years (SD 13.54 years) and 12.5 years (SD 3.09 years) of education were included. Majority (59.4%; n = 585) claimed to be aware of psychotherapy as a treatment option for psychiatric disorders but 47.5% of these (n = 278/585) failed to identify its correct definition. Concerns voiced by the participants about psychotherapy included stigma (48.7%) and breech in confidentiality (39.5%); 60.7% opined it cost effective and 86.5% favored its use as an adjuvant modality. A preference for psychotherapy as the treatment strategy for psychiatric disorders was demonstrated by 46.6% (n = 459/985). Younger, more educated, financially independent and female participants were more likely to prefer psychotherapy as were those who deemed it cost effective.</p> <p>Conclusion</p> <p>Positive attitudes regarding the acceptability, clinical utility and cost-effectiveness of psychotherapy were observed in a sample representative of general public of Karachi, Pakistan. These findings highlight its potential utility for devising pragmatic mental health strategies in the face of limited resources.</p

Time to discontinuation of atypical versus typical antipsychotics in the naturalistic treatment of schizophrenia

BACKGROUND: There is an ongoing debate over whether atypical antipsychotics are more effective than typical antipsychotics in the treatment of schizophrenia. This naturalistic study compares atypical and typical antipsychotics on time to all-cause medication discontinuation, a recognized index of medication effectiveness in the treatment of schizophrenia. METHODS: We used data from a large, 3-year, observational, non-randomized, multisite study of schizophrenia, conducted in the U.S. between 7/1997 and 9/2003. Patients who were initiated on oral atypical antipsychotics (clozapine, olanzapine, risperidone, quetiapine, or ziprasidone) or oral typical antipsychotics (low, medium, or high potency) were compared on time to all-cause medication discontinuation for 1 year following initiation. Treatment group comparisons were based on treatment episodes using 3 statistical approaches (Kaplan-Meier survival analysis, Cox Proportional Hazards regression model, and propensity score-adjusted bootstrap resampling methods). To further assess the robustness of the findings, sensitivity analyses were performed, including the use of (a) only 1 medication episode for each patient, the one with which the patient was treated first, and (b) all medication episodes, including those simultaneously initiated on more than 1 antipsychotic. RESULTS: Mean time to all-cause medication discontinuation was longer on atypical (N = 1132, 256.3 days) compared to typical antipsychotics (N = 534, 197.2 days; p < .01), and longer on atypicals compared to typicals of high potency (N = 320, 187.5 days; p < .01), medium potency (N = 140, 213.5 days; p < .01), and low potency (N = 74, 208.7 days; p < .01). Among the atypicals, only clozapine, olanzapine, and risperidone had significantly longer time to all-cause medication discontinuation compared to typicals, regardless of potency level, and compared to haloperidol with prophylactic anticholinergic treatment. When compared to perphenazine, a medium-potency typical antipsychotic, only clozapine and olanzapine had a consistently and significantly longer time to all-cause medication discontinuation. Results were confirmed by sensitivity analyses. CONCLUSION: In the usual care of schizophrenia patients, time to medication discontinuation for any cause appears significantly longer for atypical than typical antipsychotics regardless of the typical antipsychotic potency level. Findings were primarily driven by clozapine and olanzapine, and to a lesser extent by risperidone. Furthermore, only clozapine and olanzapine therapy showed consistently and significantly longer treatment duration compared to perphenazine, a medium-potency typical antipsychotic