Carlos A. Jiménez Ruiz

Spanish Productivity in Smoking Research Relative to World and European Union Productivity From 1999 Through 2003, Analyzed With the Science Citation Index

Objective To analyze Spanish scientific productivity from 1999 through 2003 in the area of smoking research, in comparison with world and European Union research, based on data in the Science Citation Index (SCI). Material and methods This bibliometric study was carried out by searching the title field of the Science Citation Index Expanded. Descriptive statistics with 95% confidence intervals (CI) were compiled. Results Two-hundred ninety-two documents on smoking by Spanish authors were located. The most productive subspecialties were the group comprised of public health, education and health economics with 57 articles, and areas of the respiratory system, experimental research, and internal medicine with 36 articles each. The journals that published the largest number of articles located were Medicina Clinica, with 35 articles (12%) and Archivos de Bronconeumologia with 20 (6.8%). International collaboration was undertaken with institutions in the United States of America and other European Union countries. The mean (SD) number of citations received was 5.12 (8.6) (range, 59-0). Spain contributed 8.34% of the SCI-indexed smoking research overall and 12.85% of SCI-indexed smoking research from the European Union. Conclusions Smoking research is developing appropriately in Spain and has high impact, even though output is modest. Factors associated with increased citation are international collaboration, language (being written in English), and having a non-Spanish first author.

Characteristics of COPD Smokers and Effectiveness and Safety of Smoking Cessation Medications

INTRODUCTION Smoking is the main cause of chronic obstructive pulmonary disease (COPD), and smoking cessation is the only treatment shown to be effective in arresting the progression of COPD. Different epidemiological and population-based studies have shown smokers with COPD to have specific smoking characteristics that differentiate them from the rest of smokers and which complicate smoking cessation. The main objective of this study is to analyze the effectiveness and safety of drug treatments for smoking cessation in smokers with severe or very severe COPD. METHODS Smokers with severe or very severe COPD (Global Initiative for Chronic Obstructive Lung Disease stages III and IV) received treatment for smoking cessation. The treatment program consisted of a combination of behavioral therapy and drug treatment. Patients were followed up at 1, 2, 4, 6, 8, 10, 12, 18, and 24 weeks after the quit date. RESULTS Four hundred seventy-two patients were seen, 65% were male, and their mean age was 58.3 (9.8). They smoked an average of 29.7 (13.4) cigarettes/day, and their mean Fagerström test for nicotine dependence score was 7.4 (2.1). Continuous abstinence rate from 9 to 24 weeks (CAR 9-24) was 48.5%. According to type of treatment used, CAR 9-24 for nicotine replacement therapy (NRT), bupropion, and varenicline were 38.2%, 55.6%, and 58.3%, respectively. Varenicline was more effective than nicotine patches: 61% versus 44.1% (odds ratio: 1.98; 95% CI: 1.25-3.12; p = .003). NRT was the treatment producing the fewest adverse effects. The onset of psychiatric symptoms due to medication was rare and evenly distributed across groups. CONCLUSIONS This study shows that smokers with severe or very severe COPD are predominantly males with a high degree of physical dependence upon nicotine. CAR 9-24 was 48.5%. Varenicline and bupropion yielded higher abstinence rates than NRT. Varenicline was more effective than nicotine patches: all types of treatments were safe.

Resultados asistenciales de una unidad especializada en tabaquismo

BACKGROUND AND OBJECTIVE To present the short, medium and long-term results of a stop-smoking clinic after 5 years of experience. The clinic was designed following the SEPAR Recommendations. PATIENTS AND METHODS Two types of clinic protocols have been applied: individual and group. Both included the offer of a combination of psychological intervention and pharmacological treatment. The programme included 10 visits over 12 months. The pharmacological treatment consisted of: nicotine replacement therapy (NRT) or bupropion or varenicline or a combination. The psychological intervention consisted of: self-monitoring, copying skills, cognitive-behavioural therapy and social intra-treatment support. The treatment was always offered for free. RESULTS A total of 3920 patients were seen in the clinic. These patients made 21,418 clinic visits. The analysis was performed on the 1850 smokers who attended the clinic consecutively. Their mean age was 47.83 (+/-11.03) and the mean fagerström test for nicotine dependence (FTND)-score was 6.56 (+/-2.41). 55.9% patients received NRT, 22.8% bupropion, 18.9% varenicline and 2.4% did not receive any pharmacological treatment. Continuous abstinence rates at 6 and 12 months follow up were 58.5% and 54.9%, respectively. These abstinence rates at 36 and 57 months follow up were 42% and 35%, respectively. The cost in medication for each patient was 118 euros and the cost in medication for a successful abstainer at 6, 12, 36, and 57 months of follow up were 202, 215, 281 and 338 euros, respectively. CONCLUSIONS A stop-smoking clinic that is designed according to SEPAR Recommendations is effective and has a good cost/effective ratio.

Tratamiento sustitutivo con nicotina durante el embarazo

El consumo de tabaco durante el embarazo es la principal causa de morbimortalidad obstetrica. A pesar de ello, el 20% de las mujeres norteamericanas fuman cuando estan embarazadas, cifra que llega a ser de hasta el 30-35% en nuestro pais. El tratamiento del tabaquismo en la mujer embarazada debe ser la primera y principal medida terapeutica que los profesionales sanitarios deben adoptar cuando prestan asistencia sanitaria a la embarazada. Todos los expertos recomiendan la utilizacion del tratamiento sustitutivo con nicotina en los casos en que hayan fracasado tratamientos mas conservadores. A lo largo de este articulo se abordan las indicaciones y contraindicaciones del tratamiento sustitutivo con nicotina durante el embarazo, asi como aspectos relativos a su seguridad de uso.

World-wide collaboration among medical specialties in smoking research: production, collaboration, visibility and influence

The aim of this study was to analyse the network of scientific collaboration generated by the co-authorship of articles on smoking among different specialties on a world-wide level through the Science Citation Index (SCI) in the period 1999–2003. Material and methods: We selected collaboration articles on smoking research among different specialties listed in the SCI (1999–2003). The underlying network of collaboration among specialties was analysed, comparing production, visibility and centrality. Results: Forty-nine different specialties were identified, of which 47 (96%) had produced articles in collaboration (461 articles). The most productive specialty was Psychiatry–Psychology. The specialties that produced more studies in collaboration with others were Respiratory Medicine and Internal Medicine. Respiratory Medicine, however, was the specialty that received the greatest number of citations. Conclusions: Psychiatry–Psychology was the most productive specialty, while Internal Medicine and Respiratory Medicine produced more articles in collaboration. Respiratory Medicine was the specialty that received the greatest number of citations. Copyright , Beech Tree Publishing.

Nicotine Replacement Therapy During Pregnancy

In spite of the fact that smoking is the main cause of obstetric morbidity and mortality, 20% of North American women smoke during pregnancy. In Spain, this figure is as high as 30% to 35%. Treating smoking addiction in these patients should be the first and most important therapeutic measure undertaken by health professionals responsible for the care of pregnant women. All experts recommend the use of nicotine replacement therapy when more conservative treatments have failed. This article reviews the indications and contraindications for nicotine replacement therapy during pregnancy as well as other issues relating to the safety of this type of treatment.

Consenso sobre la atención sanitaria del tabaquismo en España

The Consensus on Health Assistance for Smoking Cessation in Spain, is a document reviewing the treatment evidence, as well as policy needs in relation to smoking cessation in Spain. It has been developed by technical representatives of public health administrations, at a national and autonomous level, together with representatives of the scientific societies and professional bodies which are members of the Spanish coalition on smoking prevention National Committee on Tobacco Prevention (CNPT). After approval of a new national tobacco control law 28/2005, several tobacco control policies are being developed, especially by the autonomous governments, including treatment policies. Within this framework, and as part of the requirements of the law, all parties have considered the need to review effectiveness, experimentally validated tobacco dependence treatments and practices. An initial draft written by an expert committee was presented to all parties and discussed at three meetings over a period of a year and a half. The initial draft did review primary and secondary scientific literature from 1987 to 2007 on efficacy and effectiveness of different smoking cessation interventions, including: medical advice and brief smoking cessation interventions; pharmacological aids for treating nicotine dependence; behavioral interventions; specialized intensive treatment; community interventions; and treatment for groups with special needs. Considering the available evidence; current treatment needs; policy gaps; and the criteria of risk, accessibility, efficiency, sustainability and equity; the consensus document recommends the minimal requirements which should be taken into account when developing a policy on smoking cessation in Spain.

Redes de colaboración científica internacional en tabaquismo: análisis de coautorías mediante el Science Citation Index durante el periodo 1999-2003

OBJECTIVE The aim of this study was to analyze patterns of scientific collaboration and the visibility generated by coauthorship of articles on smoking among different countries on a world-wide basis through the Science Citation Index-Expanded (SCI-expanded) from 1999 to 2003. MATERIAL AND METHODS We selected articles on smoking resulting from collaboration among different countries in the SCI-Expanded (1999-2003). The underlying networks of collaboration among countries were analyzed by comparing production (number of articles published), visibility (number of citations received) and centrality (node degree, intermediation and proximity). RESULTS A total of 3,484 articles were obtained, in which 5,008 institutions from 79 countries participated. The most productive country was the United Kingdom, with Germany and France in the second and third places. The United Kingdom also published the largest number of articles with inter-institutional collaboration (570 articles), with the USA and Germany in second and third places. The USA published the largest number of articles with international collaboration with the United Kingdom and France in the second and third places. All countries received a greater number of citations for articles resulting from international and inter-institutional collaboration than for those performed without collaboration. Networks of collaboration were completely connected through a single component and the annual increase in size of these inter-country networks was due to new countries joining the periphery of the network. CONCLUSIONS We found a positive correlation between international and inter-institutional collaboration and the number of citations received by articles on smoking research. The number of citations per year remained constant throughout the 5-year study period.

Deshabituación tabáquica. Valor del resultado en la fase de acción sobre el resultado en la fase de consolidación

Objetivo La escasez de estudios a largo plazo dificulta la valoracion de la abstinencia mantenida en el tiempo de los fumadores que consiguen dejar de fumar. El objetivo de nuestro estudio ha sido determinar en que medida los resultados obtenidos tras la intervencion para dejar de fumar se consolidan en el tiempo, al cabo de 5 anos. Pacientes y metodos Se ha realizado un estudio longitudinal y prospectivo sobre 502 fumadores, cuasi experimental, al considerar el grado de dependencia nicotinica como criterio para la asignacion del tratamiento: intervencion minima sistematizada en los fumadores con dependencia baja o que aun no se encontraban en fase de preparacion, y tratamiento sustitutivo con nicotina en aquellos con dependencia moderada-alta y/o alto consumo de cigarrillos. Resultados De los 267 pacientes que completaron el seguimiento a los 5 anos, el 29,6% dejo de fumar y se mantuvo abstinente al ano de seguimiento, y el 18,0% a los 5 anos. De los que consiguieron dejar de fumar a los 2 meses de la intervencion el 47,4% consolido su abstinencia al cabo de los 5 anos de seguimiento, y de los que no lo consiguieron seguia fumando el 88,1%. Conclusiones LOS resultados observados en la fase de accion pueden considerarse un elemento de ayuda para reorientar la actitud terapeutica, y quiza el planteamiento de controles programados en el tiempo ayude a consolidar la abstinencia tabaquica conseguida durante la intervencion.

Abstinencia puntual y continuada con el tratamiento farmacológico del tabaquismo en la práctica clínica

BACKGROUND AND OBJECTIVE: The objective of the study was to evaluate the effectiveness of the pharmacological treatment of tobacco dependence according to the criteria established by SEPAR.ATIENTS AND METHOD: Longitudinal, prospective and multicentre study. We included smokers aged more than 18 years who attended 5 smokers clinics and received nicotine replacement therapy (NRT), bupropion or both. The punctual and continuous abstinence was studied at the 15, 30, 60, 90 and 180 days with each one of the proposed treatments. Effective results were defined as the intention to treat. RESULTS: There were 904 smokers, 476 males and 428 females, mean age 42.51 (10.09). Of the 904 individuals who started the treatment, 820, 776, 687, 719 and 679 were present at the follow-up sessions at 15, 30, 60, 90 and 180 days, respectively. The punctual global abstinence at 15 and 180 days was 65.6% and 43.1%, while the continuous one was 57.4% and 38.8% at two and six months, respectively. Significant differences were not observed with regard to the punctual or continuous abstinence among patients treated with NRT, bupropion or both.ONCLUSIONS: The pharmacological treatment of tobacco dependence used individually according to the recommendations of the clinical guidelines allows to obtain good results with regard to the momentous and continuous abstinence. The effectiveness of the different first line treatments is similar in all the phases of the therapeutic process.