The Family Physician\u27s Role in Identifying and Treating Tobacco Addiction among Adolescents

Smoking and tobacco addiction are serious public health problems worldwide. New research reveals that addiction to tobacco can begin very early, with very low levels of smoking. Family physicians are in a unique position to prevent smoking initiation by youths and to diagnose and treat tobacco addiction in young smokers. In this paper we discuss the factors that prompt youths to try smoking, how quickly addiction to tobacco begins after the onset of smoking, how a family physician can determine whether a young patient is addicted, and what the physician can do to prevent adolescent patients from beginning to smoke or to assist them to quit if they already smoke

Revue systématique d’essais comparatifs randomisés d’interventions d’abandon du tabac chez les jeunes

Contexte : Bien que l’usage de la cigarette demeure courant parmi les jeunes, on en sait encore bien peu sur la façon de les aider à cesser de fumer. Seulement quelques revues systématiques d’essais comparatifs randomisés (ECR) ont évalué l’efficacité des interventions d’abandon du tabac chez les jeunes.Objectif : Résumer les connaissances sur l’efficacité des interventions visant à aider les jeunes à cesser de fumer en se basant sur des données probantes provenant d’ECR.Sélection des études et extraction des données : Nous avons retenu tous les ECR publiés qui évaluaient les interventions d’abandon du tabac ciblant les jeunes âgés de 20 ans et moins et qui rapportaient l’abstinence au tabac selon une analyse en intention de traiter. Nous avons relevé les études pertinentes provenant de huit revues de synthèse décrivant des études portant sur des interventions d’abandon du tabac publiées entre 2002 et 2006, ainsi qu’une recherche menée dans les bases de données PubMed et PsycINFO entre 2001 et novembre  2006. Nous rapportons l’abstinence au tabagisme au moment du suivi le plus prolongé. Les auteurs ont sélectionné d’un commun accord les données retenues pour cette revue.Résultats : Nous avons identifié 16 ECR auxquels ont participé 6 623 jeunes ; 11 études évaluant des interventions comportementales qui comprenaient 5 764 participants; quatre examinant des interventions pharmacologiques qui comptaient 529 participants ; et une se penchant sur l’acupuncture au laser qui comportait 330 participants. Trois interventions comportementales menées en milieu scolaire sur quatre et une intervention réalisée en milieu de soins de santé sur quatre ont fait augmenter de façon significative l’abstinence au tabac, quatre semaines à 24 mois suivant les interventions. Parmi les quatre ERC qui évaluaient les interventions pharmacologiques réalisées à l’aide soit de bupropion, de timbres ou de gommes à la nicotine, une étude, où le timbre à la nicotine a été utilisé en combinaison avec un counseling cognitivo-comportemental, a montré une hausse marquée, quoique non significative, de l’abstinence six mois après la date d’abandon.Conclusion : Il existe encore peu de preuves démontrant l’efficacité des interventions d’abandon du tabac chez les jeunes. Quatre programmes en milieu scolaire et une intervention dans un établissement de santé ont mis en évidence une certaine efficacité, tandis que pour la thérapie pharmacologique, les résultats ne sont pas encore concluants.Background: Cigarette use remains common among young people but little is known about how to help adolescent smokers quit. There are few systematic reviews of randomized controlled trials (RCTs) that evaluate the effectiveness of cessation interventions for youth.Objective: To synthesize knowledge on the effectiveness of cessation interventions targeted to youth based on evidence from RCTs.Selection of studies and data extraction: We retained all published RCTs with intention to treat analyses that evaluated cessation interventions targeted to youth aged ≤ 20 years. Relevant studies were identified from eight review articles of smoking cessation intervention studies published between 2002 and 2006, and from a search conducted in PubMed and PsycINFO databases from 2001 to November 2006. The outcome of primary interest was abstinence at the longest reported follow-up. Extraction of data was by consensus of the authors. Results: We identified 16 RCTs with a total of 6623 participants; 11 studies that included 5764 participants evaluated behavioural interventions, four with 529 participants evaluated pharmacological interventions, and one with 330 participants evaluated a laser acupuncture intervention. Three of four behavioural interventions conducted in school settings, and one of four conducted in a health care setting significantly increased abstinence four weeks to 24 months after the interventions. Of four RCTs that evaluated pharmacological interventions using either bupropion or nicotine patch or gum, one study using the nicotine patch coupled with cognitive-behavioural counselling showed a marked albeit non-significant increase in abstinence six months after quit date.Conclusion: There is still limited evidence demonstrating the efficacy of smoking cessation interventions in youth. Four school-based programs and one intervention in a health care setting have shown efficacy, while results for pharmacological therapy are inconsistent across studies.Contexto: si bien el tabaco sigue siendo de uso corriente entre los jóvenes, todavía no se sabe mucho sobre cómo ayudarlos a dejar de fumar. Solamente algunas revisiones sistemáticas de ensayos comparativos aleatorizados han evaluado la eficacia de las intervenciones dirigidas a lograr el abandono del tabaco entre los jóvenes.Objetivo: resumir los conocimientos sobre la eficacia de las intervenciones destinadas a ayudar a jóvenes a dejar de fumar sobre la base de los datos probados de los ensayos comparativos aleatorizados.Selección de estudios y extracción de datos: hemos retenido todos los ensayos comparativos aleatorizados publicados, que evalúan las intervenciones de abandono del tabaco en los jóvenes de 20 años y menos, y que informan sobre la abstinencia de tabaco, según un análisis que tiene la intención de tratar. Hemos seleccionado los trabajos pertinentes provenientes de ocho revistas de síntesis, que describen estudios referidos a intervenciones de abandono del tabaco publicados entre 2002 y 2006, así como una investigación llevada a cabo en las bases de datos PubMed et PsycINFO, realizada entre 2001 y noviembre de 2006. Informamos sobre la abstinencia del tabaquismo en el momento de seguimiento más prolongado. Los autores han seleccionado de común acuerdo los datos retenidos por esta revista.Resultados: hemos identificado dieciséis estudios comparativos aleatorizados en los que participaron 6.623 jóvenes; once estudios que evalúan las intervenciones comportamentales, con 5.764 participantes; cuatro que examinan las intervenciones farmacológicas en las que intervienen 529 participantes y uno que se centra en la acupuntura al láser, con 330 participantes. Tres intervenciones comportamentales realizadas en medio escolar de cada cuatro y una intervención realizada en el medio de la atención sanitaria de cada cuatro, aumentaron de manera significativa la abstinencia al tabaco, cuatro semanas a 24 meses después de las intervenciones. Entre los cuatro estudios comparativos aleatorizados que evaluaban las intervenciones farmacológicas, realizadas ya sea con ayuda de bupropion, de parches o de gomas de mascar a la nicotina, uno de ellos, en el que se utilizó un parche de nicotina en combinación con orientación psicológica cognitivo-comportamental, indicó un aumento marcado, aunque no significativo, de la abstinencia, seis meses después de la fecha de abandono.Conclusión: existen todavía pocas pruebas que demuestren la eficacia de las intervenciones de abandono del tabaco entre los jóvenes. Cuatro programas en medio escolar y una intervención en un establecimiento de salud evidenciaron una cierta eficacia, mientras que los resultados no son todavía concluyentes en lo que se refiere a la terapia farmacológica

What Aspect of Dependence Does the Fagerström Test for Nicotine Dependence Measure?

Although the Fagerström Test for Nicotine Dependence (FTND) and the Heaviness of Smoking Index (HSI) are widely used, there is a uncertainty regarding what is measured by these scales. We examined associations between these instruments and items assessing different aspects of dependence. Adult current smokers ( , mean age 33.3 years, 61.9% female) completed a web-based survey comprised of items related to demographics and smoking behavior plus (1) the FTND and HSI; (2) the Autonomy over Tobacco Scale (AUTOS) with subscales measuring Withdrawal, Psychological Dependence, and Cue-Induced Cravings; (3) 6 questions tapping smokers’ wanting, craving, or needing experiences in response to withdrawal and the latency to each experience during abstinence; (4) 3 items concerning how smokers prepare to cope with periods of abstinence. In regression analyses the Withdrawal subscale of the AUTOS was the strongest predictor of FTND and HSI scores, followed by taking precautions not to run out of cigarettes or smoking extra to prepare for abstinence. The FTND and its six items, including the HSI, consistently showed the strongest correlations with withdrawal, suggesting that the behaviors described by the items of the FTND are primarily indicative of a difficulty maintaining abstinence because of withdrawal symptoms

Discrete time measures versus trajectories of drinking frequency across adolescence as predictors of binge drinking in young adulthood: a longitudinal investigation

OBJECTIVES: We compared discrete time measures with trajectories of adolescent drinking frequency as predictors of sustained binge drinking in young adulthood. DESIGN: Prospective longitudinal study. SETTING: 10 high schools in Montreal, Canada. PARTICIPANTS: 1293 high-school students followed from mean (SD) age 12 (0.6) to 24 (0.7) years. PRIMARY OUTCOME MEASURES: Patterns of drinking frequency (self-reports every 3 months from ages 12 to 17) identified using group-based trajectory modelling. Sustained binge drinking was defined as binging monthly or more often at both ages 20 and 24. ANALYSES: Using logistic regression, sustained binge drinking was regressed on trajectory group membership and on four discrete time measures (frequency of drinking at age 12; frequency of drinking at age 17; age at drinking onset; age at onset of drinking monthly or more often). RESULTS: We identified seven drinking trajectories: late triers (15.2%), decreasers (9.5%), late escalators (10.4%), early slow escalators (16.5%), steady drinkers (14.4%), early rapid escalators (15.8%) and early frequent drinkers (18.2%). Sustained binge drinking was reported by 260 of 787 participants (33.0%) with complete data at both ages 20 and 24. Decreasers did not differ from late triers; all other patterns were associated with higher odds of sustained binge drinking (adjusted ORs: AORs=1.4-17.0). All discrete time measures were associated with sustained binge drinking, notably frequency at age 12 (a bit to try and drinking monthly: (AORs=2.6 (1.7; 3.9) and 2.8 (1.3; 6.1), respectively), age of drinking onset \u3c 13 years (AOR=7.6 (3.0; 24.1)), and any age of onset of drinking monthly or more often (AORs=5.1-8.2). CONCLUSION: Youth at risk of sustained binge drinking as young adults can be identified with indicators of early drinking as early as 7th grade (aged 12-13 years). Identification of easy-to-obtain indicators can facilitate screening and intervention efforts

Effect of the dietary supplement Meltdown on catecholamine secretion, markers of lipolysis, and metabolic rate in men and women: a randomized, placebo controlled, cross-over study

<p>Abstract</p> <p>Background</p> <p>We have recently reported that the dietary supplement Meltdown^®increases plasma norepinephrine (NE), epinephrine (EPI), glycerol, free fatty acids (FFA), and metabolic rate in men. However, in that investigation measurements ceased at 90 minutes post ingestion, with values for blood borne variables peaking at this time. It was the purpose of the present investigation to extend the time course of measurement to 6 hours, and to include women within the design to determine if sex differences to treatment exist.</p> <p>Methods</p> <p>Ten men (24 ± 4 yrs) and 10 women (22 ± 2 yrs) ingested Meltdown^®or a placebo, using a randomized, cross-over design with one week separating conditions. Blood samples were collected immediately before supplementation and at one hour intervals through 6 hours post ingestion. A standard meal was provided after the hour 3 collection. Samples were assayed for EPI, NE, glycerol, and FFA. Five minute breath samples were collected at each time for measurement of metabolic rate and substrate utilization. Area under the curve (AUC) was calculated. Heart rate and blood pressure were recorded at all times. Data were also analyzed using a 2 (sex) × 2 (condition) × 7 (time) repeated measures analysis of variance, with Tukey <it>post hoc </it>testing.</p> <p>Results</p> <p>No sex × condition interactions were noted for AUC for any variable (p > 0.05). Hence, AUC data are collapsed across men and women. AUC was greater for Meltdown^®compared to placebo for EPI (367 ± 58 pg·mL^-1·6 hr^-1vs. 183 ± 27 pg·mL^-1·6 hr^-1; p = 0.01), NE (2345 ± 205 pg·mL^-1·6 hr^-1vs. 1659 ± 184 pg·mL^-1·6 hr^-1; p = 0.02), glycerol (79 ± 8 μg·mL^-1·6 hr^-1vs. 59 ± 6 μg·mL^-1·6 hr^-1; p = 0.03), FFA (2.46 ± 0.64 mmol·L^-1·6 hr^-1vs. 1.57 ± 0.42 mmol·L^-1·6 hr^-1; p = 0.05), and kilocalorie expenditure (439 ± 26 kcal·6 hrs^-1vs. 380 ± 14 kcal·6 hrs^-1; p = 0.02). No effect was noted for substrate utilization (p = 0.39). Both systolic and diastolic blood pressure (p < 0.0001; 1–16 mmHg), as well as heart rate (p = 0.01; 1–9 bpm) were higher for Meltdown^®. No sex × condition × time interactions were noted for any variable (p > 0.05).</p> <p>Conclusion</p> <p>Ingestion of Meltdown^®results in an increase in catecholamine secretion, lipolysis, and metabolic rate in young men and women, with a similar response for both sexes. Meltdown^®may prove to be an effective intervention strategy for fat loss, assuming individuals are normotensive and their treatment is monitored by a qualified health care professional.</p

Mechanical Response and Decomposition of Thermally Degraded Energetic Materials: Experiments and Model Simulations

We report progress of a continuing effort to characterize and simulate the response of energetic materials (EMs), primarily HMX-based, under conditions leading to cookoff. Our experiments include mechanical-effects testing of HMX and FIMX with binder at temperatures nearing decomposition thresholds. Additional experiments have focused on decomposition of these EMs under confinement, measuring evolution of gas products and observing the effect of pressurization on the solid. Real-time measurements on HMX show abrupt changes that maybe due to sudden void collapse under increasing load. Postmortem examination shows significant internal damage to the pellets, including voids and cracks. These experiments have been used to help develop a constitutive model for pure HMX. Unconfined uniaxial compression tests were performed on HMX and LX-14 to examine the effect of binders on the deviatoric strength of EM pellets, and to assess the need of including deviatoric terms in the model. A scale-up experiment will be described that is being developed to validate the model and provide additional diagnostics

Architectures and Design Methodologies for Scalable and Sustainable Remote Laboratory Infrastructures

With the increasing demand for distance learning opportunities in the higher education sector, there isan ever-growing need for the design and deployment of remote laboratories, especially for engineering,science, and technology curricula. In order to accommodate the offering of entire degrees for distancelearning students whose curricula require remote laboratories, scalable information technology infrastructuresthat support the large scale use and deployment of these remote laboratories must exist. Thischapter provides a discussion of architectures and design methodologies using technology such as commandand control communications, Web 2.0, and cloud computing, which provide a scalable, manageable,and sustainable technological infrastructure-basis for large scale remote laboratory deployment

Risk of Heart Failure in Breast Cancer Patients After Anthracycline and Trastuzumab Treatment: A Retrospective Cohort Study

Background: Clinical trials demonstrated that women treated for breast cancer with anthracycline or trastuzumab are at increased risk for heart failure and/or cardiomyopathy (HF/CM), but the generalizability of these findings is unknown. We estimated real-world adjuvant anthracycline and trastuzumab use and their associations with incident HF/CM. Methods We conducted a population-based, retrospective cohort study of 12 500 women diagnosed with incident, invasive breast cancer from January 1, 1999 through December 31, 2007, at eight integrated Cancer Research Network health systems. Using administrative procedure and pharmacy codes, we identified anthracycline, trastuzumab, and other chemotherapy use. We identified incident HF/CM following chemotherapy initiation and assessed risk of HF/CM with time-varying chemotherapy exposures vs no chemotherapy. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment for age at diagnosis, stage, Cancer Research Network site, year of diagnosis, radiation therapy, and comorbidities. Results: Among 12 500 women (mean age &#x003D; 60 years, range &#x003D; 22–99 years), 29.6% received anthracycline alone, 0.9% received trastuzumab alone, 3.5% received anthracycline plus trastuzumab, 19.5% received other chemotherapy, and 46.5% received no chemotherapy. Anthracycline and trastuzumab recipients were younger, with fewer comorbidities than recipients of other chemotherapy or none. Compared with no chemotherapy, the risk of HF/CM was higher in patients treated with anthracycline alone (adjusted HR &#x003D; 1.40, 95% CI &#x003D; 1.11 to 1.76), although the increased risk was similar to other chemotherapy (adjusted HR &#x003D; 1.49, 95% CI &#x003D; 1.25 to 1.77); the risk was highly increased in patients treated with trastuzumab alone (adjusted HR &#x003D; 4.12, 95% CI &#x003D; 2.30 to 7.42) or anthracycline plus trastuzumab (adjusted HR &#x003D; 7.19, 95% CI &#x003D; 5.00 to 10.35). Conclusions: Anthracycline and trastuzumab were primarily used in younger, healthier women and associated with increased HF/CM risk compared with no chemotherapy. This population-based observational study complements findings from clinical trials on cancer treatment safety

Evaluating Active U: an Internet-mediated physical activity program.

Background: Engaging in regular physical activity can be challenging, particularly during the winter months. To promote physical activity at the University of Michigan during the winter months, an eight-week Internet-mediated program (Active U) was developed providing participants with an online physical activity log, goal setting, motivational emails, and optional team participation and competition. Methods: This study is a program evaluation of Active U. Approximately 47,000 faculty, staff, and graduate students were invited to participate in the online Active U intervention in the winter of 2007. Participants were assigned a physical activity goal and were asked to record each physical activity episode into the activity log for eight weeks. Statistics for program reach, effectiveness, adoption, and implementation were calculated using the Re-Aim framework. Multilevel regression analyses were used to assess the decline in rates of data entry and goal attainment during the program, to assess the likelihood of joining a team by demographic characteristics, to test the association between various predictors and the number of weeks an individual met his or her goal, and to analyze server load. Results: Overall, 7,483 individuals registered with the Active U website (≈16% of eligible), and 79% participated in the program by logging valid data at least once. Staff members, older participants, and those with a BMI < 25 were more likely to meet their weekly physical activity goals, and average rate of meeting goals was higher among participants who joined a competitive team compared to those who participated individually (IRR = 1.28, P < .001). Conclusion: Internet-mediated physical activity interventions that focus on physical activity logging and goal setting while incorporating team competition may help a significant percentage of the target population maintain their physical activity during the winter months