VII Scandinavian Copd Research Symposium, Holmenkollen, Oslo 18th-19th November 2016

Peer reviewe

Systematic review of the evidence relating FEV1 decline to giving up smoking

<p>Abstract</p> <p>Background</p> <p>The rate of forced expiratory volume in 1 second (FEV₁) decline ("beta") is a marker of chronic obstructive pulmonary disease risk. The reduction in beta after quitting smoking is an upper limit for the reduction achievable from switching to novel nicotine delivery products. We review available evidence to estimate this reduction and quantify the relationship of smoking to beta.</p> <p>Methods</p> <p>Studies were identified, in healthy individuals or patients with respiratory disease, that provided data on beta over at least 2 years of follow-up, separately for those who gave up smoking and other smoking groups. Publications to June 2010 were considered. Independent beta estimates were derived for four main smoking groups: never smokers, ex-smokers (before baseline), quitters (during follow-up) and continuing smokers. Unweighted and inverse variance-weighted regression analyses compared betas in the smoking groups, and in continuing smokers by amount smoked, and estimated whether beta or beta differences between smoking groups varied by age, sex and other factors.</p> <p>Results</p> <p>Forty-seven studies had relevant data, 28 for both sexes and 19 for males. Sixteen studies started before 1970. Mean follow-up was 11 years. On the basis of weighted analysis of 303 betas for the four smoking groups, never smokers had a beta 10.8 mL/yr (95% confidence interval (CI), 8.9 to 12.8) less than continuing smokers. Betas for ex-smokers were 12.4 mL/yr (95% CI, 10.1 to 14.7) less than for continuing smokers, and for quitters, 8.5 mL/yr (95% CI, 5.6 to 11.4) less. These betas were similar to that for never smokers. In continuing smokers, beta increased 0.33 mL/yr per cigarette/day. Beta differences between continuing smokers and those who gave up were greater in patients with respiratory disease or with reduced baseline lung function, but were not clearly related to age or sex.</p> <p>Conclusion</p> <p>The available data have numerous limitations, but clearly show that continuing smokers have a beta that is dose-related and over 10 mL/yr greater than in never smokers, ex-smokers or quitters. The greater decline in those with respiratory disease or reduced lung function is consistent with some smokers having a more rapid rate of FEV₁decline. These results help in designing studies comparing continuing smokers of conventional cigarettes and switchers to novel products.</p

Insuliinihoitoisten diabeetikoiden omahoito

Abstract The goals in diabetes care are good metabolic control, minimisation of complications due to diabetes and a good quality of life. In order to achieve these goals, it is important that persons with diabetes adhere to self-care. Internationally, there are numerous studies available about adherence to self-care among adults with diabetes, but in Finland there are hardly any, especially in nursing science. The purpose of this study was to examine adherence to self-care and also how metabolic control, social support and health locus of control beliefs are related to patient adherence. The data were gathered by questionnaires from 213 working-aged adults with insulin-treated diabetes from the Oulu Health Center or the Central Hospital of Lapland. The response rate was 76%. In order to verify the reliability and the validity of the instruments, we used correlation coefficients, factor analysis and item-total analysis. Internal consistency was checked by Cronbach's alfa. Cross-tabulations with the chi-square test of independence, correlations, One- and Two-Way ANOVA and covariate analysis were used for data analysis. Our multivariate statistical methods consisted of logistic and multiple linear regression analysis and cluster analysis. The subjects who were adherent to self-care had better metabolic control than those who neglected self-care. A fifth of the respondents were neglecting their self-care. The others undertook flexible, regimen-adherent or self-planned self-care. Poor metabolic control, smoking and living alone explained neglect of self-care. If the diabetic got support from her/his family and friends, living alone was not a predictor of neglect of self-care. Those who were adherent to self-care perceived themselves as getting more support from their family and friends than the group who neglected self-care. Those who had poor metabolic control perceived themselves as getting peer support from other persons with diabetes. Those who were adherent to self-care were responsible internals who believed both in their own action and in health care team action. Those who mainly believed in health care team action (powerful other externals) were more adherent to self-care than those with an internal or chance external health locus of control. We got evidence about the importance of adherence to self-care, and its relationship with metabolic control, social support anf HLOC beliefs. The results can be used when developing the individual patient education of persons with diabetes