Stakeholders' opinions about a tobacco policy in Lao PDR

The global epidemic of tobacco smoking is expected to impact hardest in low- and middle- income countries (LMIC). There is a lack of understanding regarding the policy environments within which tobacco control policies are being introduced particularly in LMIC. This study aims at exploring key stakeholders' beliefs about a tobacco policy in Lao PDR

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

Psychosocial Determinants of Attrition in a Longitudinal Study of Tobacco Use in Youth

To gain knowledge on psychosocial characteristics that predict the propensity of participation in longitudinal studies, attrition was analysed in a cohort of 3020 adolescents participating in the baseline survey of a longitudinal study with repeated followup focusing on adolescents' tobacco use. During the followup surveys, the proportion of responders was constantly at or above 90%. There were 941 adolescents (31.2%) who failed to participate in at least one of the six followup surveys. Boys had a fifty percent increased risk of nonparticipation compared with girls. Adolescents in families with experience of divorce, unemployment, and change of residence had a higher risk of nonparticipation. An increasing number of stressful life events during the previous year, uptake of tobacco use, number of friends, perceived performance at school, truancy, and alcohol use during the last term also independently associated with nonparticipation. Diverse psychosocial characteristics are independently associated with nonparticipation of youths in longitudinal studies

Symptoms in smokers trying to quit

AIMS: To describe the prevalence and intensity of different symptoms in relation to tobacco abstinence. To explore latent dimensions between symptoms in smokers trying to quit. DESIGN: A cross sectional study using a questionnaire to retrospectively assess symptoms over a period of 12 months. SETTING: Swedish telephone quitline, a nationwide free of charge service. PARTICIPANTS: All 741 individuals who had called the quitline and signed up for smoking cessation treatment between February 2000 to November 2001 and reported to have been smoke free for at least 24 hours during the previous 12 month period from first contact. MEASUREMENTS: Assessments were made by self-report, and abstinence was defined as "not a single puff of smoke during the last week". A factor analysis approach where individual items aggregate into factors was used to explore the relationship between the different symptoms. FINDINGS: High intensity of symptoms related to unsuccessful quitting attempts and included craving, irritability, apprehension/anxiety, difficulties concentrating, restlessness, depression/depressed mood, and insomnia. The factor loadings of all 17 symptoms resulted in three factors with factor 1, psychological being the most important. High scores on this factor relates to unsuccessful quitting attempts. Using Nicotine Replacement Therapy (NRT) for 5 weeks or longer, reduced symptoms included in factor 1. The other two factors were factor 2 physiological and factor 3 neurological. CONCLUSION: Symptoms that are psychological and/or neurological in nature are interrelated and appear to be the most significant obstacles for successful quitting attempts in a population-based setting. These symptoms may be successfully treated with NRT.NonePublishe

Lung transplantation in patients with cystic fibrosis and Mycobacterium abscessus infection

AbstractMycobacterium abscessus lung disease is difficult to treat and has been considered a strong relative contraindication to lung transplantation. We performed double lung transplantation in three cystic fibrosis patients with ongoing, and a fourth with recent treatment for Mycobacterium abscessus lung infection. Despite prolonged antibiotic courses and adjustment of immunosuppressive therapy the first three patients developed skin infection and abscesses. At follow-up after 1, 3, 5 and 7years respectively no patient had evidence of M abscessus infection and all had stable lung function. Lung transplantation in patients with M abscessus lung infection is feasible but may involve severe complications

Stopping smokeless tobacco with varenicline: randomised double blind placebo controlled trial

Objective To assess the efficacy and safety of varenicline (a licensed cigarette smoking cessation aid) in helping users of smokeless tobacco to quit

Outcome after heart-lung or lung transplantation in patients with Eisenmenger syndrome

Objective The optimal timing for transplantation is unclear in patients with Eisenmenger syndrome (ES). We investigated post-transplantation survival and transplantation-specific morbidity after heart-lung transplantation (HLTx) or lung transplantation (LTx) in a cohort of Nordic patients with ES to aid decision-making for scheduling transplantation. Methods We performed a retrospective, descriptive, population-based study of patients with ES who underwent transplantation from 1985 to 2012. Results Among 714 patients with ES in the Nordic region, 63 (9%) underwent transplantation. The median age at transplantation was 31.9 (IQR 21.1-42.3) years. Within 30 days after transplantation, seven patients (11%) died. The median survival was 12.0 (95% CI 7.6 to 16.4) years and the overall 1-year, 5-year, 10-year and 15-year survival rates were 84.1%, 69.7%, 55.8% and 40.6%, respectively. For patients alive 1 year post-transplantation, the median conditional survival was 14.8 years (95% CI 8.0 to 21.8), with 5-year, 10-year and 15-year survival rates of 83.3%, 67.2% and 50.0%, respectively. There was no difference in median survival after HLTx (n=57) and LTx (n=6) (14.9 vs 10.6 years, p=0.718). Median cardiac allograft vasculopathy, bronchiolitis obliterans syndrome and dialysis/kidney transplantation-free survival rates were 11.2 (95% CI 7.8 to 14.6), 6.9 (95% CI 2.6 to 11.1) and 11.2 (95% CI 8.8 to 13.7) years, respectively. The leading causes of death after the perioperative period were infection (36.7%), bronchiolitis obliterans syndrome (23.3%) and heart failure (13.3%). Conclusions This study shows that satisfactory post-transplantation survival, comparable with contemporary HTx and LTx data, without severe comorbidities such as cardiac allograft vasculopathy, bronchiolitis obliterans syndrome and dialysis, is achievable in patients with ES, with a conditional survival of nearly 15 years.Peer reviewe