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Smoking Cessation 1 Year Poststroke and Damage to the Insular Cortex

Background and Purpose— Hospitalization as a result of stroke provides an opportunity to stop smoking that is often not taken up. The present study analyzes sociodemographic, psychological, and lesion-related variables to identify associated factors for smoking cessation during the first year after stroke. Methods— We conducted a prospective longitudinal study with a 1-year follow-up of a cohort of 110 patients with acute stroke who were smokers at the time of diagnosis and were admitted consecutively between January 2005 and July 2007. Results— On hospital release, 69.1% had given up smoking but at 1 year, only 40% had stopped smoking. Of the 110 patients, 27 (24.5%) had an acute stroke lesion in the insular cortex, of which 19 (70.3%) were nonsmokers at 1 year. Strongly associated factors in giving up smoking were the location of the lesion in the insular cortex (OR, 5.42; 95% CI, 1.95–15.01; P=0.001) and having the intention of giving up before the stroke, comparing precontemplating patients (without intention of giving up in the near future) with contemplating and prepared patients (intention of stopping in the near future; OR, 7.29; 95% CI, 1.89–28.07; P=0.004). Conclusions— Of patients with stroke who were smokers, only 4 of 10 patients had stopped smoking 1 year after admission. Our results show that the variables best predicting smoking cessation in patients with a stroke diagnosis 1 year after hospital discharge are insular damage and the prestroke intention to stop.

Burnout and quality of life among Spanish healthcare personnel

The purpose of this study was to analyse the relationship between perceived quality of life and levels of burnout among healthcare personnel. A sample of 1095 participants (nurses, physicians, nursing assistants and orderlies) from five hospitals in the province of Girona (Spain) were studied (78% women, mean age=36.6 years, SD=8.8) using the 36-item short-form health questionnaire (SF-36) and the Maslach Burnout Inventory. The results showed that health-related quality of life reported by this sample of healthcare personnel was lower than the reference population values, especially in those SF-36 dimensions that comprise the mental component. In comparing the dimensions of the SF-36 by profession, we found that physicians had better perceived health in the dimensions of the physical component than nurses and other professionals (P< 0.01). No statistical differences were observed between profession and the dimensions of the mental component (P>0.05). Moreover, perceived health was worse among those that reported a high level on any of the components of burnout. These results should be taken account when designing a burnout prevention programme in the workplace.

The Pedestrian Behaviour of Spanish Adolescents

Adolescent pedestrians are a particularly vulnerable group of road users. This research tested the applicability of the recently developed Adolescent Road user Behaviour Questionnaire (ARBQ) amongst a sample of 2006 Spanish adolescents. Confirmatory Factor Analysis of the full scale found that the original three factors did not adequately fit the data, but an acceptable fit was obtained for the shortened 21-item version of the scale. In line with research from the UK, the present study found that males reported more unsafe road crossing behaviour and playing on the roads, but there was no gender difference for engaging in planned protective behaviour. This research also confirmed that unsafe road crossing behaviour increased with age, while dangerous playing on the road and planned protective behaviours both decreased with age. The present study also confirmed that the ARBQ is a useful tool for investigating the safety-related behaviour of adolescents on the road.

Types of polydrug use among Spanish adolescents

OBJECTIVE This study examined the types of polydrug use among Spanish adolescents. METHOD 1501 high school students (50.6% female) aged 12 to 17years old (mean age=14.03, SD=1.28), from public schools in the city of Girona (Catalonia, Spain), completed the survey. RESULTS In the previous six months 20.9% of the Spanish adolescents used alcohol, 18.8% tobacco, 10.5% cannabis and 0.7% cocaine. Specifically, 28.6% of the sample (n=429; 29% males and 28.2% females) used at least one drug and 13.9% reported polydrug use (n=208; 12.6% males and 15.1% females). The present research also found that the most critical ages for starting polydrug use were 14 and 15years old. More than one quarter (27.9%) of the adolescent polydrug users were type A (tobacco and alcohol), 67.8% were type B (cannabis together with tobacco and/or alcohol) and 3.4% were type C (cannabis together with tobacco and/or alcohol, and cocaine). CONCLUSIONS These results suggest that Spanish adolescents, particularly males, commence polydrug use at an earlier age than other European adolescents. Early preventative strategies and a multisubstance perspective are greatly needed in Spain to avoid the initiation of polydrug use or to prevent progress onto heavier drugs.

Consumo de cocaína y policonsumo de sustancias psicoactivas en jóvenes universitarios

OBJECTIVES To identify the prevalence of cocaine consumption among university students and to analyse the use of other drugs among the regular cocaine consumers. METHOD An observational, descriptive and cross-sectional study performed within the Education, Sciences and Psychology Faculties and the Nursing and Polytechnic Schools belonging to the University of Girona. The selected sample included 2139 first year university students. A self-constructed questionnaire was used to obtain the information regarding gender, age, Faculty, and the status of consume. RESULTS The participants were 47.2% males and 52.8% females, with an age range between 17 and 35 years old (median=21 years, SD=3.14). One per-cent of the participants considered themselves usual cocaine consumers. Nine out of every 10 students also use alcohol (95.2%) and cannabis (90.5%). CONCLUSIONS It has been shown that university students have health threatening habits, such as cocaine abuse. It is more common the use of other drugs among cocaine users than among non-consumers. Preventive and educational programs at the university may be required to reduce and prevent toxic substances abuse among university students.

Policonsumo de drogas y su relación con el contexto familiar y social en jóvenes universitarios

The prevalence of polydrug use continues to grow among Spanish college students. The European Observatory for Drugs and Addictions establishes three different types of polydrug use: Pattern A (consumers of alcohol and tobacco), Pattern B (consumers of cannabis plus alcohol and/or tobacco) and Pattern C (consumers of cannabis plus alcohol plus tobacco plus at least one other kind of illegal drug). The objectives are: 1) to study the frequency of substance consumption among a sample of young Spanish undergradudates studying health and sports science according to their sex; 2) to describe the patterns of polydrug use; 3) to study the relationship between the polydrug use of the participants and polydrug use within their closest environment (parents, sisters or brothers, best friend and partner). The sample was composed of 480 Spanish undergraduates (43.7% females) aged 18 to 36. The level of drug consumption of students and their closest reference persons was evaluated by means of a self-report measure. A total of 46% of the participants reported consumption of two or more substances; among them 29.4% corresponded to Pattern A, 50.7% to Pattern B and 16.7% to Pattern C, while 3.2% corresponded to other multiple consumption patterns (alcohol + cocaine; alcohol + cocaine + tobacco; alcohol + inhalants; amphetamines + hallucinogens + Spice). An important correlation was observed concerning polydrug use between participants and their closest reference persons: the more the reference person is a multiple consumer, the more the participant tends to consume. Polydrug use within the closest environment emerges as one of the key elements to be taken into account in further prevention programs.

Uso del casco en adolescentes usuarios de ciclomotores en la ciudad de Gerona, 2006.

Fundamento: Las lesiones cerebrales por traumatismos craneocerebrales son la causa mas frecuente de defuncion en colisiones de trafico con la implicacion de vehiculos de dos ruedas. A pesar de la probada eficacia del uso del casco como dispositivo de proteccion de la cabeza para atenuar las lesiones en caso de colision, algunos adolescentes y jovenes no lo utilizan. El objetivo de este trabajo es identificar las variables que mejor predicen el uso del casco entre adolescentes usuarios de ciclomotores. Metodo: Se ha realizado un estudio transversal con una muestra de 874 jovenes estudiantes de Educacion Secundaria Obligatoria durante el curso 2005-06. La poblacion objeto de estudio eran los estudiantes de tercero y cuarto curso de los 6 Institutos de Educacion Secundaria publicos de de Gerona. Participaron en el estudio los estudiantes presentes el dia de la recogida de la informacion. La participacion fue del 74,6 %. La recogida de datos se realizo mediante una encuesta de elaboracion propia. Se realizo un analisis de regresion logistica binaria. Resultados: Fueron variables predictivas del uso del casco en conductores: edad (OR=0,56), la seguridad como motivo de uso (OR=0,02), tener licencia de conduccion (OR=0,17), la influencia amigos (OR=0,23) y de los familiares (OR=0,17). En pasajeros como motivo de uso figuran la edad (OR=0,46), la influencia de amigos (OR=0,35) y la seguridad (OR=0,38). Conclusiones: Las variables que predicen el uso del casco en los usuarios de ciclomotor son: la edad, estar en posesion de la licencia para conducir ciclomotor, ponerse el casco por seguridad y el refuerzo social (amigos y familiares).

Calidad de vida relacionada con la salud y consumo de tabaco

La calidad de vida relacionada con la salud se ha descrito como un concepto multidimensional que incluye la identificacion de sintomas, el estado funcional, la percepcion de bienestar psicologico y la percepcion general de salud. En el caso de la adiccion al consumo de tabaco, la preocupacion por la salud actual o futura es uno de los motivos mas informados para dejar de fumar. En el presente estudio se analiza la relacion entre la percepcion de la calidad de vida relacionada con la salud y la etapa de cambio en el abandono del consumo de tabaco propuesta desde el modelo transteorico a fin de mejorar las estrategias de intervencion comunitaria y clinica para la cesacion tabaquica. Se ha administrado el cuestionario SF-36 a una muestra formada por 201 fumadores y exfumadores. Los datos obtenidos indican peor salud fisica percibida en las etapas de cambio mas proximas al abandono de tabaco y una peor salud mental percibida en las etapas con tabaquismo activo. Se comparan los resultados con los observados en otras poblaciones y se discuten las implicaciones a nivel de tratamiento y prevencion del tabaquismo.

Biological and Psychological Factors Associated With Smoking Abstinence Six Years Post-Stroke

Introduction Tobacco use is a public health problem causing high morbidity and mortality, including stroke. This study evaluates predictive factors of smoking cessation in the long term after stroke. Methods We followed a cohort of 110 consecutive smokers with stroke for up to 6 years. Sociodemographic variables, stroke severity, insular involvement, stage of change in smoking habit before stroke and disruption of addiction variable (smoking cessation, absence of relapses, having stopped smoking without difficulties and not having had urge) were evaluated. Results Twenty patients died during follow-up and two patients were lost leaving a final cohort of 88 patients. The prevalence of smoking cessation in the remaining population was 65.9% post-stroke, 54.9% at 3-6 months, 40.9% at 1 year and 37.5% at 6 years. Prevalence was significantly higher in patients with insular involvement during the first year of follow-up, but not at 6 years. Disruption immediately after stroke (OR = 10.1; 95% CI = 2.5 to 40.1) and intention to change before having the stroke (OR = 4.8; 95% CI = 1.0 to 23.0) were predictors of abstinence at 6 years after adjusting for age, sex and stroke severity at baseline. When tobacco abstinence at the 1 year follow-up was included in the model, this factor was the best predictor of tobacco abstinence at 1 year (OR = 10.5; 95% CI = 2.2 to 49.4). Conclusions Intention of change, having the disruption criteria, and abstinence 1 year after stroke were predictors of abstinence at 6 years. An insular lesion in the acute phase of stroke does not determine the tobacco use status at 6 years. Implications This study is the first prospective investigation with a cohort of stroke patients to examine the long-term influence of biological and psychological factors on smoking cessation. Tobacco abstinence 1 year after stroke was the strongest predictor of abstinence at 6 years of follow-up. The effect of the insular cortex lesion on tobacco cessation, which had been relevant during the first year, no longer had an influence over the longer period studied here.

Types of Polydrug Usage

Abstract The purpose of this chapter is to describe the different types of polydrug use among adolescents and adults. The examination of the natural heterogeneity in the typologies of polydrug users may be a helpful strategy to understand the etiology and problematic use. Alcohol is present among almost all types of polydrug users. Alcohol and tobacco, followed by illegal drugs (marijuana in particular), are a combination frequently used by adolescents and young adults. The majority of studies focus either on specific populations or on specific substances, or even only on indicators of polydrug use. Few studies have provided apparent evidence concerning similar types of polysubstance use. Future studies should be based on participants from the general population, clarify the concept of polydrug use, examine wider ranges of drugs, and measure polysubstance use over time. Early preventive interventions are needed, which provide a polysubstance perspective required to avoid the initiation and maintenance of polydrug use.