Antigona Trofor

Gaps in Guidelines for the Management of Diabetes in Low- and Middle-Income Versus High-Income Countries—A Systematic Review

OBJECTIVE The extent to which diabetes (DM) practice guidelines, often based on evidence from high-income countries (HIC), can be implemented to improve outcomes in low- and middle-income countries (LMIC) is a critical challenge. We carried out a systematic review to compare type 2 DM guidelines in individual LMIC versus HIC over the past decade to identify aspects that could be improved to facilitate implementation. RESEARCH DESIGN AND METHODS Eligible guidelines were sought from online databases and websites of diabetes associations and ministries of health. Type 2 DM guidelines published between 2006 and 2016 with accessible full publications were included. Each of the 54 eligible guidelines was assessed for compliance with the Institute of Medicine (IOM) standards, coverage of the cardiovascular quadrangle (epidemiologic surveillance, prevention, acute care, and rehabilitation), translatability, and its target audiences. RESULTS Most LMIC guidelines were inadequate in terms of applicability, clarity, and dissemination plan as well as socioeconomic and ethical-legal contextualization. LMIC guidelines targeted mainly health care providers, with only a few including patients (7%), payers (11%), and policy makers (18%) as their target audiences. Compared with HIC guidelines, the spectrum of DM clinical care addressed by LMIC guidelines was narrow. Most guidelines from the LMIC complied with less than half of the IOM standards, with 12% of the LMIC guidelines satisfying at least four IOM criteria as opposed to 60% of the HIC guidelines (P < 0.001). CONCLUSIONS A new approach to the contextualization, content development, and delivery of LMIC guidelines is needed to improve outcomes.

Depression, anxiety and panic disorders in chronic obstructive pulmonary disease patients: correlations with tobacco use, disease severity and quality of life

BackgroundThe objective of this study is to assess anxiety, depression and panic disorders among patients diagnosed with COPD and to investigate their correlation with disease severity, quality of life as well as tobacco use.MethodsAn observational study was performed between January and September 2014 among 60 patients diagnosed with COPD. COPD staging according to GOLD criteria, while anxiety and depression were assessed using Hospital Anxiety and Depression Scale and panic attacks were evaluated based on ICD 10 criteria.ResultsAlmost 40% of the sample were smokers, the medium packs-years was 34.3 and the medium Fagerstrom score was 7.5. Overall, mean Modified Medical Research Council Dyspnea Scale (mMRC) was 2.86, mean COPD Assessment Test (CAT) score was 21.75 and study participants had 1.93 COPD exacerbations/year. Mean distribution of anxiety and depression symptoms scores among COPD subjects was 10.65 ± 3.5 and 9.93 ± 3.8, respectively. Smokers and ex-smokers had similar scores with regard to anxiety, depression or the presence of panic attacks. The results of the bivariate correlations indicated associations between anxiety, depression, panic attacks and disease severity, as well as poor quality of life of patients with COPD, regardless of their current tobacco use status.ConclusionsIn conclusion, the results of this study indicate that anxiety, depression and panic attacks were constant characteristics among COPD patients- regardless of their current tobacco use.

Opinions and practices regarding electronic cigarette use among Romanian high school students

OBJECTIVE The study assessed awareness, opinions, practices regarding electronic cigarettes (e-cigarettes) and factors associated with their use among Romanian high school students. METHODS A cross-sectional study was conducted in 2013 in two major Romanian cities, distributing anonymous questionnaires to 342 high school students aged 16-18. RESULTS 52.3% of the smokers, 29.2% of the ex-smokers and 7% of the never-smokers had tried e-cigarettes at least once in their life; 7.8% of the smokers and 4.6% of the ex-smokers had used e-cigarettes in the last month. Among smokers, e-cigarette use was associated with lower participation in school health education regarding e-cigarettes and with having parents using e-cigarettes.. Among ex-smokers and never-smokers, e-cigarette use was associated with intention to use e-cigarettes in the next year and with having friends who use e-cigarettes. CONCLUSION Health education programmes and regulatory interventions addressing e-cigarettes are needed in Romania. More research is necessary on how to develop effective public health messages.

Impact of the Tobacco Treatment Guidelines for High RiskGroups (TOB.g): A pilot study among physicians specializing inCVD, Diabetes and COPD

INTRODUCTION The 2017 Tobacco Cessation Guidelines for High-risk Groups (TOB-G) is a comprehensive document on best practices for smoking cessation in clinical practice. The purpose of this pilot study was to assess physician satisfaction and changes in tobacco-related knowledge, self-efficacy and attitudes following exposure to training in the TOB-G guidelines for patients with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), or diabetes. METHODS A pre-post pilot study was conducted. All participating physicians received an electronic or printed copy of the TOB-G guidelines for patients with CVD, COPD or diabetes. Physicians were also exposed to a one-day training focused on the key clinical practice recommendations from the TOB.g guidelines. Outcome measurement occurred via survey before, immediately following and 6 months after exposure to the training. RESULTS Fifty physicians participated in the TOB.g training session. High rates of participant satisfaction were documented (exceeded expectations 47.7%; met expectations to a great extent 52.3%). Significant increases in physician knowledge and self-efficacy were documented immediately following and 6 months after exposure to the guideline training session. Exposure to the training was associated with positive changes in some but not all tobacco-related treatment attitudes, however these were no longer significant at the 6-month follow-up. Lower knowledge, confidence and unfavourable attitudes were documented for aspects of treatment related to pharmacotherapy. CONCLUSIONS Positive changes in previously reported barriers to the delivery of tobacco treatment among physicians were documented following exposure to the TOB.g guidelines and training for patients with CVD, COPD or diabetes.

Characteristics and correlates of electronic cigarette productattributes and undesirable events during e-cigarette use in sixcountries of the EUREST-PLUS ITC Europe Surveys

INTRODUCTION This study assessed characteristics and correlates associated with e-cigarette product attributes and identified correlates of experiencing undesirable events during e-cigarette use among adult smokers across six European Union (EU) Members States (MS) prior to the implementation of the Tobacco Products Directive (TPD) in 2016. METHODS We conducted a cross-sectional survey with a nationally representative sample of adult cigarette smokers from six EU MS (Germany, Greece, Hungary, Poland, Romania, Spain) reporting e-cigarette use; randomly selected through a multistage cluster sampling design from June to September 2016. Stepwise logistic regressions were used to identify factors associated with use of flavors, noticing health warnings, mixing e-liquids, experiencing ‘dry puff’, e-liquid leaking during use and e-liquid spilling during refill. RESULTS Current daily or weekly prevalence of e-cigarette use among this sample of adult smokers was 7.5%. The most common attributes of e-cigarettes used included those that are flavored, contain nicotine, and are of tank style. Noticing health warnings on e-cigarette packaging and leaflets, respectively, was low (10.2% and 28%, respectively). Use of e-liquid refill nozzle caps, described as easy for a child to open, was associated with spilling during refill (OR=6.73; 95% CI: 2.02–22.37). Participants who adjusted occasionally or regularly the power (voltage) or temperature of their e-cigarette had greater odds of ever experiencing a ‘dry puff’ (OR=6.01; 95% CI: 2.68–13.46). Mixing different e-liquids was associated with leaking during use (OR=7.78; 95% CI: 2.45–24.73) and spilling during refill (OR=8.54; 95% CI: 2.29–31.88). CONCLUSIONS Ongoing evaluation of factors associated with e-cigarette attributes and of the correlates of experiencing e-cigarette undesirable events during use, related to product design, is crucial to monitoring the impact of the implementing Acts of the EU TPD.

Tobacco Treatment Guideline for High Risk Groups: A pilotstudy in patients with Chronic Obstructive PulmonaryDisease

INTRODUCTION Smoking cessation is a key clinical intervention for reducing progressive lung destruction and lung function deterioration in patients with Chronic Obstructive Pulmonary Disease (COPD). Specialised Tobacco Cessation Guidelines for High-risk Groups (TOB-G) were developed and published in 2017 that present evidence-based recommendations to support smoking cessation in COPD patients. The purpose of this pilot study was to examine the real world effectiveness of the TOB-G guideline recommendations among a sample of COPD patients. METHODS A pilot study was conducted among a sample of COPD patients who smoke and were interested in quitting. Participants were recruited from inpatient and outpatient hospital admissions between October and December 2016 in Iasi, Romania. The intervention program was designed based on the recommendations of the TOB-G guidelines for COPD patients. Patients received a total of four contacts: at baseline, 1, 2, and 6 months. The primary outcome measure was biochemically validated point prevalence smoking abstinence measured at 6 months. RESULTS Fifty patients (74% male; age mean±SD = 60.2±7.8) with diagnosed COPD took part in the pilot study. Self-reported rates of point prevalence smoking abstinence were 30.6%, 44.9% and 64.6% at the 1-, 2-, and 6-month follow-up, respectively. Carbon monoxide testing was completed with 51.6% of the sample at 6 months. The biochemically verified abstinent rate was 33.3% at the 6-month follow-up. CONCLUSIONS This pilot testing of the TOB-G Clinical Practice Guidelines for COPD patients was associated with high rates of patient smoking abstinence, which are of clinical importance. Further research is needed to evaluate the guidelines large-scale effectiveness in clinical practice.

Study protocol of EUREST-PLUS - European Regulatory Science on Tobacco: Policy Implementation to Reduce Lung Disease

Efforts to mitigate the devastation of tobacco-attributable morbidity and mortality in the European Union (EU) are founded on its newly adopted Tobacco Products Directive (TPD) along with the first-ever health treaty, the WHO Framework Convention on Tobacco Control (FCTC). The aim of this Horizon 2020 Project entitled European Regulatory Science on Tobacco: Policy Implementation to Reduce Lung Disease (EURESTPLUS) is to monitor and evaluate the impact of the implementation of the TPD across the EU, within the context of WHO FCTC ratification. To address this aim, EUREST-PLUS consists of four objectives: 1) To create a cohort study of 6000 adult smokers in six EU MS (Germany, Greece, Hungary, Poland, Romania, Spain) within a pre-TID vs post-TPD implementation study design; 2) To conduct secondary dataset analyses of the Special Eurobarometer on Tobacco Survey (SETS); 3) To document changes in e-cigarette product parameters (technical design, labelling/packaging and chemical composition) pre-TID vs post-TPD; and 4) To enhance innovative joint research collaborations on chronic non-communicable diseases. Through this methodological approach, EUREST-PLUS is designed to generate strong inferences about the effectiveness of tobacco control policies, as well as to elucidate the mechanisms and factors by which policy implementation translates to population impact. Findings from EUREST-PLUS have potential global implications for the implementation of innovative tobacco control policies and its impact on the prevention of lung diseases.

Smoking cessation for free: First long-term outcomes in three Romanian centres

Introduction: The reimbursed smoking cessation (SC) national program in Romania, covering three months pharmacotherapy and counselling, is routinely evaluating only end of treatment (EOT) abstinence. Aim: To assess abstinence rate, 12 months after quit date, by a long term telephone follow-up (LTFU) intervention and to evaluate participants9 compliance to LTFU, in a first such attempt in our centres. To correlate smoking characteristics with EOT and LTFU abstinence. Methods: A standard Romanian SC guideline telephone interview about smoking status, abstinence duration and willingness to be delivered relapse prevention counseling, was conducted in 832 subjects in the SC centers of Iasi, Cluj and Tg. Mures. Statistic analysis was used to find useful correlations for clinical practice. Results: Overal EOT abstinence was 53.4%, with significantly increased varenicline abstinence in women (r=-0,113, p=0,001) and in severely addicted smokers (r=0.23, p≤0,001). LTFU abstainers smoking profile at enrollement showed average 27.2±16.3SD packs-years and high dependence scores in 53.4%. LTFU smoking status showed 327 (39.3%) smokers, 155 (18.6%) abstinent and 350 (42.1%) unrated patients. A maximum abstinence duration of 154 days±180.1SD was reported even among the 327 still smokers. The reimbursed program had a positive impact at 12 months, as in LTFU 61.5% of smokers and 97.2% of no-smokers were willing to receive relapse prevention counseling. Conclusions: Providing smoking cessation for free had a positive long term effect on program participants, even if there was no intermediary contact between EOT and LTFU.

The problem of low rate-smokers: Smoking pattern and cessation outcomes

Introduction: Low-rate smokers, defined as no more than 5 cigarettes per day (CPD) or 1 – 5 CPD smokers are often a challenge to smoking cessation practitioners. Aim: To determine smoking cessation outcomes in low-rate smokers treated in our centre, in relation with pattern of smoking in this particular category of patients. Material and methods: Low-rate smokers included in a tobacco dependence 3 months pharmacological and counselling treatment program were evaluated for age, gender, smoking history, nicotine dependence score and co-morbidities. Abstinence rate was determined at 3 months end of treatment (3-EOT) and in 6 months follow-up (6 -FU) . Results: We analyzed 180 subjects, age average 35. 6 yrs, in majority women (70%), with various co-morbidities (psychiatric - 11 %, COPD- 5%, cardio-vascular – 4.2% ). At a CPD consumption ≤ 5, paradoxically, we found a moderate-severe degree of nicotine dependence in majority of subjects ( only in 30.5% the nicotine dependence Fagerstrom score was Conclusions: Even if low-rate smokers, quitting may be difficult in this category of patients, due to a particular smoking pattern and frequent moderate-severe nicotine dependence, resulting in lower than expected abstinence rates.