Self-reported smoking cessation activities among Swiss primary care physicians.

ABSTRACT: BACKGROUND: Individual counselling, pharmacotherapy, and group therapy are evidence-based interventions that help patients stop smoking. Acupuncture, hypnosis, and relaxation have no demonstrated efficacy on smoking cessation, whereas self-help material may only have a small benefit. The purpose of this study is to assess physicians' current clinical practice regarding smokers motivated to stop smoking. METHODS: The survey included 3385 Swiss primary care physicians. Self-reported use of nine smoking cessation interventions was scored. One point was given for each positive answer about practicing interventions with demonstrated efficacy, i.e. nicotine replacement therapy, bupropion, counselling, group therapy, and smoking cessation specialist. No points were given for the recommendation of acupuncture, hypnosis, relaxation, and self-help material. Multivariable logistic analysis was performed to identify factors associated with a good practice score, defined as >1. RESULTS: The response rate was 55%. Respondents were predominately over the age of 40 years (88%), male (79%), and resided in urban areas (74%). Seventeen percent reported being smokers. Most of the physicians prescribed nicotine replacement therapy (84%), bupropion (65%), or provided counselling (70%). A minority of physicians recommended acupuncture (26%), hypnosis (8%), relaxation (7%), or self-help material (24%). A good practice score was obtained by 85% of respondents. Having attended a smoking cessation training program was the only significant predictor of a good practice score (odds ratio: 6.24 , 95% CI 1.95-20.04). CONCLUSION: The majority of respondents practice recommended smoking cessation interventions. However, there is room for improvement and implementing an evidence-based smoking cessation-training program could provide additional benefit.

Calcium entry blockade attenuates the acute blood pressure rise induced by cigarette smoking.

The purpose of this study was to assess whether the administration of a calcium entry blocker can prevent the acute blood pressure rise induced by cigarette smoking. Seven male habitual smokers were included. After 45 min of equilibration, they took in randomized single-blind fashion at a 1 week interval either a placebo or nifedipine, 10 mg p.o. Thirty minutes thereafter, the subjects smoked within 10 min two cigarettes containing 1.4 mg of nicotine each. In addition to heart rate and skin blood flow (laser Doppler method), blood pressure of the median left finger was monitored continuously for 100 min using a noninvasive device (Finapres). Nifedipine induced an increase in skin blood flow that was not influenced by smoking. This skin blood flow response was observed although nifedipine had by itself no effect on systemic blood pressure. The calcium antagonist markedly attenuated the blood pressure rise induced by cigarette smoking. However, it tended to accentuate the heart rate acceleration resulting from inhalation of nicotine-containing smoke.

Factor structure of early smoking experiences and associations with smoking behavior: valence or sensitivity model?

The Early Smoking Experience (ESE) questionnaire is the most widely used questionnaire to assess initial subjective experiences of cigarette smoking. However, its factor structure is not clearly defined and can be perceived from two main standpoints: valence, or positive and negative experiences, and sensitivity to nicotine. This article explores the ESE's factor structure and determines which standpoint was more relevant. It compares two groups of young Swiss men (German- and French-speaking). We examined baseline data on 3,368 tobacco users from a representative sample in the ongoing Cohort Study on Substance Use Risk Factors (C-SURF). ESE, continued tobacco use, weekly smoking and nicotine dependence were assessed. Exploratory structural equation modeling (ESEM) and structural equation modeling (SEM) were performed. ESEM clearly distinguished positive experiences from negative experiences, but negative experiences were divided in experiences related to dizziness and experiences related to irritations. SEM underlined the reinforcing effects of positive experiences, but also of experiences related to dizziness on nicotine dependence and weekly smoking. The best ESE structure for predictive accuracy of experiences on smoking behavior was a compromise between the valence and sensitivity standpoints, which showed clinical relevance.

The influence of tobacco consumption on the relationship between schizotypy and hemispheric asymmetry.

Tobacco use is positively associated with severity of symptoms along the schizophrenia spectrum. Accordingly it could be argued that neuropsychological performance, formerly thought to be modulated by schizotypy, is actually modulated by drug use or an interaction of drug use and schizotypy. We tested whether habitual cigarette smokers as compared to non-smokers would show a neuropsychological profile similar to that observed along the schizophrenia spectrum and, if so, whether smoking status or nicotine dependence would be more significant modulators of behavior than schizotypy. Because hemispheric dominance has been found to be attenuated along the schizophrenia spectrum, 40 right-handed male students (20 non-smokers) performed lateralized left- (lexical decisions) and right- (facial decision task) hemisphere dominant tasks. All individuals completed self-report measures of schizotypy and nicotine dependence. Schizotypy predicted laterality in addition to smoking status: While positive schizotypy (Unusual Experiences) was unrelated to hemispheric performance, Cognitive Disorganization predicted reduced left hemisphere dominant language functions. These latter findings suggest that Cognitive Disorganization should be regarded separately as a potentially important mediator of thought disorganization and language processing. Additionally, increasing nicotine dependence among smokers predicted a right hemisphere shift of function in both tasks that supports the role of the right hemisphere in compulsive/impulsive behavior.

Behavior of Carbonate Rocks as Concrete Aggregates, HR-15, 1962

The problem of determining the suitability of carbonate rocks as concrete aggregates is extremely complex and calls for more new data than has been available or obtainable from usual methods. Since 1955 the approach which has served as a primary basis for the project has been to gather as much new information as possible to apply to the problem. New information obtained by new and different techniques provides better understanding. This approach was decided on since, in all prior studies, a standard petrographic and petrologic approach correlated in many instances with standard engineering tests did not provide the answer in Iowa or elsewhere. One can theorize that concrete fails (excluding external causes such as traffic, foundation failure, etc.) because of stresses of internal origin. The stresses can be of a physical nature, such as frost action, or result from chemical activity such as the alkali aggregate reaction. If, as service records show, the aggregate is considered the cause of distress in concrete, it will without doubt be the manner in which an aggregate can create or contribute to stress of internal origin by physical or chemical means. Therefore the main emphasis was placed on studying physical and chemical properties of aggregates as well as the behavior of carbonate rocks in concrete environments. Although standard geologic and engineering methods were also utilized, the approach adopted required considerable effort in devising new techniques and methods. This report is intended to be a detailed summary of the research performed. Whenever possible, the work accomplished will be summarized and all pertinent data will be included. For further details, reference to the various theses and publications transmitted with this report or at previous times will be made wherever possible.

The cost effectiveness of pharmacological smoking cessation therapies in developing countries: a case study in the Seychelles

OBJECTIVE: To examine the incremental cost effectiveness of the five first line pharmacological smoking cessation therapies in the Seychelles and other developing countries. DESIGN: A Markov chain cohort simulation. SUBJECTS: Two simulated cohorts of smokers: (1) a reference cohort given physician counselling only; (2) a treatment cohort given counselling plus cessation therapy. INTERVENTION: Addition of each of the five pharmacological cessation therapies to physician provided smoking cessation counselling. MAIN OUTCOME MEASURES: Cost per life-year saved (LYS) associated with the five pharmacotherapies. Effectiveness expressed as odds ratios for quitting associated with pharmacotherapies. Costs based on the additional physician time required and retail prices of the medications. RESULTS: Based on prices for currently available generic medications on the global market, the incremental cost per LYS for a 45 year old in the Seychelles was 599 US dollars for gum and 227 dollars for bupropion. Assuming US treatment prices as a conservative estimate, the incremental cost per LYS was significantly higher, though still favourable in comparison to other common medical interventions: 3712 dollars for nicotine gum, 1982 dollars for nicotine patch, 4597 dollars for nicotine spray, 4291 dollars for nicotine inhaler, and 1324 dollars for bupropion. Cost per LYS increased significantly upon application of higher discount rates, which may be used to reflect relatively high opportunity costs for health expenditures in developing countries with highly constrained resources and high overall mortality. CONCLUSION: Pharmacological cessation therapy can be highly cost effective as compared to other common medical interventions in low mortality, middle income countries, particularly if medications can be procured at low prices.

Contribution of fine particulate matter sources to indoor exposure in bars, restaurants, and cafes

This study investigated the contribution of sources and establishment characteristics, on the exposure to fine particulate matter (PM(2.5)) in the non-smoking sections of bars, cafes, and restaurants in central Zurich. PM(2.5)-exposure was determined with a nephelometer. A random sample of hospitality establishments was investigated on all weekdays, from morning until midnight. Each visit lasted 30 min. Numbers of smokers and other sources, such as candles and cooking processes, were recorded, as were seats, open windows, and open doors. Ambient air pollution data were obtained from public authorities. Data were analysed using robust MM regression. Over 14 warm, sunny days, 102 establishments were measured. Average establishment PM(2.5) concentrations were 64.7 microg/m(3) (s.d. = 73.2 microg/m(3), 30-min maximum 452.2 microg/m(3)). PM(2.5) was significantly associated with the number of smokers, percentage of seats occupied by smokers, and outdoor PM. Each smoker increased PM(2.5) on average by 15 microg/m(3). No associations were found with other sources, open doors or open windows. Bars had more smoking guests and showed significantly higher concentrations than restaurants and cafes. Smokers were the most important PM(2.5)-source in hospitality establishments, while outdoor PM defined the baseline. Concentrations are expected to be even higher during colder, unpleasant times of the year. PRACTICAL IMPLICATIONS: Smokers and ambient air pollution are the most important sources of fine airborne particulate matter (PM(2.5)) in the non-smoking sections of bars, restaurants, and cafes. Other sources do not significantly contribute to PM(2.5)-levels, while opening doors and windows is not an efficient means of removing pollutants. First, this demonstrates the impact that even a few smokers can have in affecting particle levels. Second, it implies that creating non-smoking sections, and using natural ventilation, is not sufficient to bring PM(2.5) to levels that imply no harm for employees and non-smoking clients. [Authors]

Cómo elaborar, tutorizar y evaluar un trabajo de fin de máster

Los estudios de nivel superior en el marco de la Unión Europea se componen del Grado y del Postgrado (Másters y doctorados). Los Másters son titulaciones producto de una formación avanzada, multidisciplinar o especializada, dirigida a la consecución de logros académicos en profundidad, de especialidades profesionales o de iniciación a la investigación. Los estudios deMaster exigen la evaluación continua del proceso de aprendizaje que se concreta finalmente en el denominado Trabajo de Fin de Máster, verdadera piedra angular de la formación del estudiante. Ese trabajo final está pensado para evidenciar las competencias adquiridas a lolargo de todo el programa formativo y para demostrar el logro de los objetivos globales del aprendizaje. Es la prueba definitiva de la madurez y de la profesionalidad de una carrera hecha a conciencia...

Cómo elaborar, tutorizar y evaluar un trabajo de fin de máster

Los estudios de nivel superior en el marco de la Unión Europea se componen del Grado y del Postgrado (Másters y doctorados). Los Másters son titulaciones producto de una formación avanzada, multidisciplinar o especializada, dirigida a la consecución de logros académicos en profundidad, de especialidades profesionales o de iniciación a la investigación. Los estudios deMaster exigen la evaluación continua del proceso de aprendizaje que se concreta finalmente en el denominado Trabajo de Fin de Máster, verdadera piedra angular de la formación del estudiante. Ese trabajo final está pensado para evidenciar las competencias adquiridas a lolargo de todo el programa formativo y para demostrar el logro de los objetivos globales del aprendizaje. Es la prueba definitiva de la madurez y de la profesionalidad de una carrera hecha a conciencia...

Cómo elaborar, tutorizar y evaluar un trabajo de fin de máster

Los estudios de nivel superior en el marco de la Unión Europea se componen del Grado y del Postgrado (Másters y doctorados). Los Másters son titulaciones producto de una formación avanzada, multidisciplinar o especializada, dirigida a la consecución de logros académicos en profundidad, de especialidades profesionales o de iniciación a la investigación. Los estudios deMaster exigen la evaluación continua del proceso de aprendizaje que se concreta finalmente en el denominado Trabajo de Fin de Máster, verdadera piedra angular de la formación del estudiante. Ese trabajo final está pensado para evidenciar las competencias adquiridas a lolargo de todo el programa formativo y para demostrar el logro de los objetivos globales del aprendizaje. Es la prueba definitiva de la madurez y de la profesionalidad de una carrera hecha a conciencia...

Cómo elaborar, tutorizar y evaluar un trabajo de fin de máster

Los estudios de nivel superior en el marco de la Unión Europea se componen del Grado y del Postgrado (Másters y doctorados). Los Másters son titulaciones producto de una formación avanzada, multidisciplinar o especializada, dirigida a la consecución de logros académicos en profundidad, de especialidades profesionales o de iniciación a la investigación. Los estudios deMaster exigen la evaluación continua del proceso de aprendizaje que se concreta finalmente en el denominado Trabajo de Fin de Máster, verdadera piedra angular de la formación del estudiante. Ese trabajo final está pensado para evidenciar las competencias adquiridas a lolargo de todo el programa formativo y para demostrar el logro de los objetivos globales del aprendizaje. Es la prueba definitiva de la madurez y de la profesionalidad de una carrera hecha a conciencia...

Com elaborar, tutoritzar i avaluar um treball de fi de màster

Els estudis de nivell superior en el marc de la Unió Europea es componen del Grau i delPostgrau (Màsters i Doctorats). Els Màsters són titulacions producte d’una formació avançada, multidisciplinària o especialitzada, dirigida a la consecució d’assoliments acadèmics enprofunditat, d’especialitats professionals o d’iniciació a la recerca. Els estudis de Màster exigeixen l’avaluació continuada del procés d’aprenentatge que es concreta finalment en el denominat Treball de Fi de Màster (TFM), vertadera pedra angular de la formació de l’estudiant. Aquest treball final està pensat per evidenciar les competències adquirides al llarg de tot elprograma formatiu i demostrar l’assoliment dels objectius globals de l’aprenentatge. És la prova definitiva de la maduresa i de la professionalitat d’una carrera feta a consciència...

Com elaborar, tutoritzar i avaluar um treball de fi de màster

Els estudis de nivell superior en el marc de la Unió Europea es componen del Grau i delPostgrau (Màsters i Doctorats). Els Màsters són titulacions producte d’una formació avançada, multidisciplinària o especialitzada, dirigida a la consecució d’assoliments acadèmics enprofunditat, d’especialitats professionals o d’iniciació a la recerca. Els estudis de Màster exigeixen l’avaluació continuada del procés d’aprenentatge que es concreta finalment en el denominat Treball de Fi de Màster (TFM), vertadera pedra angular de la formació de l’estudiant. Aquest treball final està pensat per evidenciar les competències adquirides al llarg de tot elprograma formatiu i demostrar l’assoliment dels objectius globals de l’aprenentatge. És la prova definitiva de la maduresa i de la professionalitat d’una carrera feta a consciència...

Com elaborar, tutoritzar i avaluar um treball de fi de màster

Els estudis de nivell superior en el marc de la Unió Europea es componen del Grau i delPostgrau (Màsters i Doctorats). Els Màsters són titulacions producte d’una formació avançada, multidisciplinària o especialitzada, dirigida a la consecució d’assoliments acadèmics enprofunditat, d’especialitats professionals o d’iniciació a la recerca. Els estudis de Màster exigeixen l’avaluació continuada del procés d’aprenentatge que es concreta finalment en el denominat Treball de Fi de Màster (TFM), vertadera pedra angular de la formació de l’estudiant. Aquest treball final està pensat per evidenciar les competències adquirides al llarg de tot elprograma formatiu i demostrar l’assoliment dels objectius globals de l’aprenentatge. És la prova definitiva de la maduresa i de la professionalitat d’una carrera feta a consciència...

Com elaborar, tutoritzar i avaluar um treball de fi de màster

Els estudis de nivell superior en el marc de la Unió Europea es componen del Grau i delPostgrau (Màsters i Doctorats). Els Màsters són titulacions producte d’una formació avançada, multidisciplinària o especialitzada, dirigida a la consecució d’assoliments acadèmics enprofunditat, d’especialitats professionals o d’iniciació a la recerca. Els estudis de Màster exigeixen l’avaluació continuada del procés d’aprenentatge que es concreta finalment en el denominat Treball de Fi de Màster (TFM), vertadera pedra angular de la formació de l’estudiant. Aquest treball final està pensat per evidenciar les competències adquirides al llarg de tot elprograma formatiu i demostrar l’assoliment dels objectius globals de l’aprenentatge. És la prova definitiva de la maduresa i de la professionalitat d’una carrera feta a consciència...