Determinants of smoking and cessation in older women

Background although the benefits of quitting smoking even at an advanced age have been proved, few campaigns target the older population. The goals of this study were to analyse the characteristics of older women smokers help and support those wanting to quit. Methods we assessed the determinants of smoking cessation in a prospective cohort study performed in 7,609 older women. A questionnaire about smoking habits was sent to the 486 eligible smokers. Smoking dependence and smokers' readiness to quit was assessed. Participants who had quit smoking during follow-up were asked about their previous reasons for quitting and the methods used to quit. Results 372 women of the 424 (88%) responded to our questionnaire and were included. The most common reasons for smoking were relaxation, pleasure, and habit. Major obstacles to quitting smoking were ‘no benefit to quitting at an advanced age', ‘smoking few or "light” cigarettes yields no negative health consequences', and ‘smoking does not increase osteoporotic risk'. During the 3-year follow-up period, 57 of the 372 (15%) women successfully quit smoking. Being an occasional smoker (OR=2.4) and reporting ‘quitting is not difficult' (OR=3.7) were positively associated with having recently quit smoking. Only 11% of successful cessations were reported to have received physician advice. Conclusions these data illustrate the specific smoking behaviour of older women, suggesting that cessation interventions ought to be tailored to these characteristics. Willingness to quit was associated with a low education level. The most frequent obstacles to quitting were all based on incorrect informatio

A new curriculum using active learning methods and standardized patients to train residents in smoking cessation

Physicians can play a key role in smoking cessation but often fail to advise smokers effectively, mainly because they lack counseling skills. We need effective training programs starting during residency to improve physicians' smoking cessation interventions and smokers' quit rates. To achieve this goal, we developed a curriculum using active learning methods and the stages-of-change model. A randomized trial demonstrated that this program increased the quality of physician's counseling and smokers' quit rates at 1 year. This paper describes the educational content and methods of this program. Participants learn to assess smokers' stage of change, to use counseling strategies matching the smoker's stage, and to prescribe pharmacological therapy. This 2 half-day training program includes observation of video-clips, interactive workshops, role plays, practice with standardized patients, and written material for physicians and patients. Participants reached learning objectives and appreciated the content and active methods of the progra

Opinions and Attitudes of a Sample of Swiss Physicians about Physical Activity Promotion in a Primary Care Setting

Little is known about the opinions, beliefs and behavior of Swiss physicians regarding physical activity (PA) promotion in a primary care setting. A qualitative study was performed with semistructured interviews. We purposively recruited and interviewed 16 physicians in the French speaking part of Switzerland. Their statements and ideas regarding the promotion of PA in a primary care setting were transcribed and synthesized from the tape recorded interviews. The main findings are presented in the following by thematic categories: – Screening for sedentary lifestyle and counseling practices. History regarding PA was consequently taken with new cases, but not in a systematic manner. Counseling was more likely to be delivered if other cardiovascular risk factors were present. – Counseling techniques and how to learn them. Practical education on motivational interviewing techniques and on the use of topic-specific tools was advocated. According to some interviewees, more emphasis should be put on well-being as a motivational tool, rather than on disease prevention. – Barriers to counseling. Lack of time, lack of reimbursement, lack of clear guidelines. – Interventions advocated by general practitioners for PA promotion in a primary care setting. Screening for sedentary lifestyle, booklets accompanying physician counseling, patient orientation to structured PA programs or to specially trained counselors. – Effectiveness of counseling. Most physicians described themselves as rather pessimistic in their perception of counseling effectiveness. We conclude that in order to find wider acceptance in primary care settings, the conception of PA promotion should take into account physicians’ barriers, and involve them in the development of a training curriculum

Opinions and attitudes of a sample of Swiss physicians about physical activity promotion in a primary care setting

Little is known about the opinions, beliefs and behavior of Swiss physicians regarding physical activity (PA) promotion in a primary care setting. A qualitative study was performed with semi-structured interviews. We purposively recruited and interviewed 16 physicians in the French speaking part of Switzerland. Their statements and ideas regarding the promotion of PA in a primary care setting were transcribed and synthesized from the tape recorded interviews. Les opinions, les représentations et les comportements des médecins suisses en matière de promotion de l'activité physique au cabinet médical restent largement méconnus en Suisse. Une étude qualitative a été réalisée au moyen d'entretiens semi-structurés. Nous avons intentionnellement recruté et interviewé 16 médecins en Suisse romande. Leurs opinions et attitudes concernant la promotion de l'activité physique au cabinet médical ont été transcrites et synthétisées à partir de l'enregistrement de ces entretiens

Pharmacological thromboembolic prophylaxis in a medical ward: Room for improvement

To evaluate the adequacy of pharmacological thromboembolic prevention in the medical ward of a university hospital, we performed a retrospective study in 227 consecutive inpatients. The presence of risk factors, and type, length, and dose of pharmacological prevention were documented by chart review. Only 22% of the 153 risk patients received adequate prevention, whereas 38% of the patients at low risk were given pharmacological prophylaxis. The high prevalence of over- and undertreatment is an indicator of less than optimal care. Quality of care interventions, such as the development of local guidelines, might improve the appropriateness of pharmacological thromboembolic prophylaxis in medical inpatient

Désaccoutumance au tabac. 1ère partie: Processus de désaccoutumance et bénéfices de l'arrêt

Le tabagisme est un problème clinique et de santé publique crucial en raison de sa prévalence élevée dans la population de patients ambulatoires et hospitaliers, et de ses conséquences majeures sur la mortalité, la morbidité et les coûts. Les conseils ciblés et non stigmatisant, ainsi que les traitements pharmacologiques (substituts nicotiniques et bupropion), sont efficaces pour promouvoir l'arrêt du tabac et ont un très bon rapport coût-efficacité._ La désaccoutumance au tabac est devenue une activité essentielle de la pratique clinique, en raison de l'importance épidémiologique et sociale des maladies liées au tabac d'une part, de l'apparition de méthodes et de produits permettant de faciliter la désaccoutumance à la nicotine d'autre part. Le risque de maladies lié au tabac est plus grand que la plupart des fumeurs ne l'imaginent. Le médecin praticien occupe une position privilégiée de conseiller et d'accompagnateur du processus de désaccoutumance vis-à-vis de ses patients._ L'aide à la désaccoutumance se base sur la connaissance du stade auquel se trouve le fumeur (indifférence, intention ou préparation) et sur la détermination de son degré de dépendance à la nicotine, évaluée en fonction de la consommation tabagique et du délai entre le réveil et la première cigarette de la journée. L'intervention médicale doit s'adapter à ces deux critères et amener le fumeur à progresser d'un stade de la désaccoutumance vers le suivant. _ L'intervention médicale en désaccoutumance représente l'activité la plus rentable dans le domaine de la prévention. La prise en charge des fumeurs doit tenir compte du processus de changement de comportement et de la dépendance nicotinique. L'arrêt du tabac est en effet un processus dynamique à travers 5 stades de motivation à cesser de fumer, ayant une probabilité croissante de devenir ex-fumeur. [auteurs]]]> Smoking Cessation fre oai:serval.unil.ch:BIB_DFF4297386F2 2022-08-13T01:31:17Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_DFF4297386F2 Clinical spectrum of tuberculous optic neuropathy. info:doi:10.1007/s12348-012-0079-5 info:eu-repo/semantics/altIdentifier/doi/10.1007/s12348-012-0079-5 info:eu-repo/semantics/altIdentifier/pmid/22614321 Davis, E.J. Rathinam, S.R. Okada, A.A. Tow, S.L. Petrushkin, H. Graham, E.M. Chee, S.P. Guex-Crosier, Y. Jakob, E. Tugal-Tutkun, I. Cunningham, E.T. Leavitt, J.A. Mansour, A.M. Winthrop, K.L. Hills, W.L. Smith, J.R. info:eu-repo/semantics/article article 2012 Journal of Ophthalmic Inflammation and Infection, vol. 2, pp. 183-189 info:eu-repo/semantics/altIdentifier/eissn/1869-5760 <![CDATA[PURPOSE: Tuberculous optic neuropathy may follow infection with Mycobacterium tuberculosis or administration of the bacille Calmette-Guerin. However, this condition is not well described in the ophthalmic literature. METHODS: Ophthalmologists, identified through professional electronic networks or previous publications, collected standardized clinical data relating to 62 eyes of 49 patients who they had managed with tuberculous optic neuropathy. RESULTS: Tuberculous optic neuropathy was most commonly manifested as papillitis (51.6 %), neuroretinitis (14.5 %), and optic nerve tubercle (11.3 %). Uveitis was an additional ocular morbidity in 88.7 % of eyes. In 36.7 % of patients, extraocular tuberculosis was present. The majority of patients (69.4 %) had resided in and/or traveled to an endemic area. Although initial visual acuity was 20/50 or worse in 62.9 % of 62 eyes, 76.7 % of 60 eyes followed for a median of 12 months achieved visual acuities of 20/40 or better. Visual field defects were reported for 46.8 % of eyes, but these defects recovered in 63.2 % of 19 eyes with follow-up. CONCLUSION: Visual recovery from tuberculous optic neuropathy is common, if the diagnosis is recognized and appropriate treatment is instituted. A tuberculous etiology should be considered when evaluating optic neuropathy in persons from endemic areas

Tobacco use and attitudes towards a smoke-free policy : survey in the World Health Organization in Geneva

La consommation de tabac est la première cause de mortalité dans les pays occidentaux. Plusieurs études scientifiques ont également montré l'impact du tabagisme passif sur la santé. L'Organisation mondiale de la santé (OMS) a récemment identifié le contrôle du tabagisme (actif et passif) comme l'une de ses priorités pour les prochaines décennies. Ce contrôle peut être réalisé dans le cadre d'environnements professionnels sans fumée et de l'aide aux fumeurs souhaitant arrêter de fumer. Le lieu de travail devrait donc être aménagé afin de protéger les non-fumeurs de la fumée d'autrui. Une telle stratégie permet de réduire la consommation de cigarettes et fait progresser les fumeurs dans leur désaccoutumance au tabac. En 1999, le groupe "Tobacco free initiative" de l'OMS a mandaté l'Unité de prévention, (unité commune à l'Institut universitaire de médecine sociale et préventive et à la Policlinique médicale universitaire de Lausanne) de réaliser une enquête chez les employés de l'OMS. Les objectifs de cette enquête étaient les suivants : décrire la perception des employés et leurs connaissances en termes de contrôle du tabagisme ; déterminer leur exposition au tabagisme passif; connaître leur attitude envers une organisation totalement "smoke free" ; évaluer l'intérêt des fumeurs à bénéficier d'une aide à la désaccoutumance dans le cadre de leur activité professionnelle. [P. 4]]]> Health Policy ; Health Promotion ; Smoking ; Tobacco Smoke Pollution ; World Health Organization eng https://serval.unil.ch/resource/serval:BIB_D5D9E0FEA957.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_D5D9E0FEA9577 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_D5D9E0FEA9577 info:eu-repo/semantics/submittedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_D5D9FE1D5924 2022-05-07T01:27:53Z openaire documents <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_D5D9FE1D5924 Firewalls Prevent Systemic Dissemination of Vectors Derived from Human Adenovirus Type 5 and Suppress Production of Transgene-Encoded Antigen in a Murine Model of Oral Vaccination. info:doi:10.3389/fcimb.2018.00006 info:eu-repo/semantics/altIdentifier/doi/10.3389/fcimb.2018.00006 info:eu-repo/semantics/altIdentifier/pmid/29423380 Revaud, J. Unterfinger, Y. Rol, N. Suleman, M. Shaw, J. Galea, S. Gavard, F. Lacour, S.A. Coulpier, M. Versillé, N. Havenga, M. Klonjkowski, B. Zanella, G. Biacchesi, S. Cordonnier, N. Corthésy, B. Ben Arous, J. Richardson, J.P. info:eu-repo/semantics/article article 2018 Frontiers in cellular and infection microbiology, vol. 8, pp. 6 info:eu-repo/semantics/altIdentifier/eissn/2235-2988 urn:issn:2235-2988 <![CDATA[To define the bottlenecks that restrict antigen expression after oral administration of viral-vectored vaccines, we tracked vectors derived from the human adenovirus type 5 at whole body, tissue, and cellular scales throughout the digestive tract in a murine model of oral delivery. After intragastric administration of vectors encoding firefly luciferase or a model antigen, detectable levels of transgene-encoded protein or mRNA were confined to the intestine, and restricted to delimited anatomical zones. Expression of luciferase in the form of multiple small bioluminescent foci in the distal ileum, cecum, and proximal colon suggested multiple crossing points. Many foci were unassociated with visible Peyer's patches, implying that transduced cells lay in proximity to villous rather than follicle-associated epithelium, as supported by detection of transgene-encoded antigen in villous epithelial cells. Transgene-encoded mRNA but not protein was readily detected in Peyer's patches, suggesting that post-transcriptional regulation of viral gene expression might limit expression of transgene-encoded antigen in this tissue. To characterize the pathways by which the vector crossed the intestinal epithelium and encountered sentinel cells, a fluorescent-labeled vector was administered to mice by the intragastric route or inoculated into ligated intestinal loops comprising a Peyer's patch. The vector adhered selectively to microfold cells in the follicle-associated epithelium, and, after translocation to the subepithelial dome region, was captured by phagocytes that expressed CD11c and lysozyme. In conclusion, although a large number of crossing events took place throughout the intestine within and without Peyer's patches, multiple firewalls prevented systemic dissemination of vector and suppressed production of transgene-encoded protein in Peyer's patches

Cost-effectiveness analysis of the first-line therapies for nicotine dependence

Background: Nicotine dependence is the major obstacle for smokers who want to quit. Guidelines have identified five effective first-line therapies, four nicotine replacement therapies (NRTs)—gum, patch, nasal spray and inhaler—and bupropion. Studying the extent to which these various treatments are cost-effective requires additional research. Objectives: To determine cost-effectiveness (CE) ratios of pharmacotherapies for nicotine dependence provided by general practitioners (GPs) during routine visits as an adjunct to cessation counselling. Methods: We used a Markov model to generate two cohorts of one-pack-a-day smokers: (1) the reference cohort received only cessation counselling from a GP during routine office visits; (2) the second cohort received the same counselling plus an offer to use a pharmacological treatment to help them quit smoking. The effectiveness of adjunctive therapy was expressed in terms of the resultant differential in mortality rate between the two cohorts. Data on the effectiveness of therapies came from meta-analyses, and we used odds ratio for quitting as the measure of effectiveness. The costs of pharmacotherapies were based on the cost of the additional time spent by GPs offering, prescribing and following-up treatment, and on the retail prices of the therapies. We used the third-party-payer perspective. Results are expressed as the incremental cost per life-year saved. Results: The cost per life-year saved for only counselling ranged from €385 to €622 for men and from €468 to €796 for women. The CE ratios for the five pharmacological treatments varied from €1768 to €6879 for men, and from €2146 to €8799 for women. Significant variations in CE ratios among the five treatments were primarily due to differences in retail prices. The most cost-effective treatments were bupropion and the patch, and, then, in descending order, the spray, the inhaler and, lastly, gum. Differences in CE between men and women across treatments were due to the shape of their respective mortality curve. The lowest CE ratio in men was for the 45- to 49-year-old group and for women in the 50- to 54-year-old group. Sensitivity analysis showed that changes in treatment efficacy produced effects only for less-well proven treatments (spray, inhaler, and bupropion) and revealed a strong influence of the discount rate and natural quit rate on the CE of pharmacological treatments. Conclusion: The CE of first-line treatments for nicotine dependence varied widely with age and sex and was sensitive to the assumption for the natural quit rate. Bupropion and the nicotine patch were the two most cost-effective treatment

Tabakentwöhnung. 2.Teil: Empfehlungen für die tägliche Praxis

Der praktizierende Arzt muss bei jedem Raucher abklären,wie stark er von Nikotin abhängig und wie weit er bereits motiviert ist, mit Rauchen aufzuhören. Damit kann der Arzt dann gezielt intervenieren. Bei Rauchern, die noch nicht zum Aufhören entschlossen sind, wird die Intervention beschränkt bleiben, bei Rauchern hingegen, die sich zum Aufgeben entschlossen haben oder gar aktiv darauf vorbereiten, wird sie wesentlich weiter gehen. Bei Rauchern, die sich zum Aufgeben vorbereiten, erhöht eine unterstützende medikamentöse Behandlung- ikotinersatzpräparate oder Bupropion - die Chancen für einen Langzeiterfolg signifikant. Gute Kenntnisse über die richtige Dosierung, günstige Kombinationen sowie allfällige Kontraindikationen sind für eine erfolgreiche Anwendung dieser Präparate und die Vermeidung von Rückfällen wichtig. [Autoren]]]> Smoking Cessation ; Practice Guidelines as Topic oai:serval.unil.ch:BIB_FE1DBCA82FE3 2022-05-07T01:30:49Z phdthesis urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_FE1DBCA82FE3 L-canavanine, an inhibitor of inducible nitric oxide synthase, improves venous return in endotoxemic rats Fishman, Daniel Université de Lausanne, Faculté de médecine info:eu-repo/semantics/doctoralThesis phdthesis 1996 eng https://serval.unil.ch/resource/serval:BIB_FE1DBCA82FE3.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_FE1DBCA82FE30 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_FE1DBCA82FE30 info:eu-repo/semantics/restrictedAccess Restricted: indefinite embargo Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_FE1DD5022EF7 2022-05-07T01:30:49Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_FE1DD5022EF7 Transgenic mouse models for tumors of melanocytes and retinal pigment epithelium info:doi:10.1111/j.1600-0749.1999.tb00746.x info:eu-repo/semantics/altIdentifier/doi/10.1111/j.1600-0749.1999.tb00746.x info:eu-repo/semantics/altIdentifier/pmid/10231194 Beermann, F. Hunziker, A. Foletti, A. info:eu-repo/semantics/review article 1999-04 Pigment Cell Research, vol. 12, no. 2, pp. 71-80 info:eu-repo/semantics/altIdentifier/pissn/0893-5785 <![CDATA[Cutaneous and ocular melanomas are due to malignant transformation of neural crest-derived melanocytes. The rising incidence of this tumor in humans has stimulated experiments to devise suitable mouse models. In the past years, transgenic mouse lines have been generated using different oncogenes - Ha-ras, SV40 T antigen (Tag), ret - which develop benign lesions of melanocytes, melanoma, and/or eye tumors. Pigment cell tumors in humans, although rather rare, can also develop from the retinal pigment epithelium (RPE), a cell layer of neuroectodermal origin. We, therefore, established transgenic models for this ocular tumor. Regulated by the promoter of tyrosinase-related protein-1 (TRP-1), two oncogenes, ret and SV40 Tag, were targeted to the developing RPE in transgenic mice. The TRP-1/ret transgenic mice displayed microphthalmia and benign tumors of the RPE. Expression of SV40 T antigen (TRP-1/Tag) led to malignant tumors, which were invasive and metastasized to inguinal lymph node and spleen