Presentation by Hayden McRobbie, M.B., Ch.B., Ph.D., Auckland University of Technology, New Zealand, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
Psiquiatria y adicciones. socidrogalcohol 2015 finalAntoni Gual
Formación en adicciones de los médicos residentes en psiquiatría en el conjunto de la Unión Europea. Ponencia presentada en Logroño el 13 de marzo del 2015, en el marco de las 42º Jornadas Nacionales de Socidrogalcohol
Breakout 4.2 Optimise not maximise for better value COPD and asthma care - No...NHS Improvement
Breakout 4.2 Optimise not maximise for better value COPD and asthma care - Noel Baxter
Co-lead NHS London Respiratory Team
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
Psiquiatria y adicciones. socidrogalcohol 2015 finalAntoni Gual
Formación en adicciones de los médicos residentes en psiquiatría en el conjunto de la Unión Europea. Ponencia presentada en Logroño el 13 de marzo del 2015, en el marco de las 42º Jornadas Nacionales de Socidrogalcohol
Breakout 4.2 Optimise not maximise for better value COPD and asthma care - No...NHS Improvement
Breakout 4.2 Optimise not maximise for better value COPD and asthma care - Noel Baxter
Co-lead NHS London Respiratory Team
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
The presentation by Dr.M.S.Chandragupta, Chief Dental Surgeon, Dr. Gupta's Dental Specialities Centre, deals with Tobacco Cessation Methodologies.
Tobacco is the number one killer in the world and kills around 9 lakh people annually in India alone. The victims succumb to tobacco in the most productive years of their life. To curb this issue the World Health Organization has brought out a public health legal treaty called ‘Frame Work Convention on Tobacco Control (FCTC)’ which more than 176 countries have signed and ratified the same. India has signed in the year 2005 and initiated measures to bring down the demand and supply of tobacco in India as mandated by the FCTC. India has the second highest number of tobacco users in the world, at an alarming number of 274 million users (GATS Report, 2010) and it is high time we act together to make India Tobacco Free for a healthier and wealthier tomorrow
5 A’s of smoking cessation guidelines, Nicotine replacement therapy (NRT), Bupropion, Varenicline, Tips to quit smoking and Complementary Health Approaches for Smoking Cessation are discussed in this presentation.
Smoking cessation by
Dr. Fazle Rabbi Mohammed
MBBS, MD (Chest)
7 of the worst diseases smoking causes
Lung Cancer: more people die of lung cancer than any other type of cancer
COPD: it is the third leading cause of death worldwide
Heart disease: can cause many heart diseases & heart disease is the number one cause of death in US population
Stroke: triggered by smoking & it is the fourth leading cause of death in US
Asthma: smoking cause exacerbation of asthma
Over 10 other types of cancer, including Colon, Cervix, Liver, Stomach, Pancreatic cancer.
Diabetes Mellitus
Associate Consultant,Department of Respiratory Medicine
Square Hospitals Ltd
Nicotine Replacement Therapy (NRT) can help with the withdrawal symptoms in patients who find it difficult to quit tobacco. It is available in the form of - gums, patches, sprays, inhalers or lozenges.
The presentation by Dr.M.S.Chandragupta, Chief Dental Surgeon, Dr. Gupta's Dental Specialities Centre, deals with Tobacco Cessation Methodologies.
Tobacco is the number one killer in the world and kills around 9 lakh people annually in India alone. The victims succumb to tobacco in the most productive years of their life. To curb this issue the World Health Organization has brought out a public health legal treaty called ‘Frame Work Convention on Tobacco Control (FCTC)’ which more than 176 countries have signed and ratified the same. India has signed in the year 2005 and initiated measures to bring down the demand and supply of tobacco in India as mandated by the FCTC. India has the second highest number of tobacco users in the world, at an alarming number of 274 million users (GATS Report, 2010) and it is high time we act together to make India Tobacco Free for a healthier and wealthier tomorrow
5 A’s of smoking cessation guidelines, Nicotine replacement therapy (NRT), Bupropion, Varenicline, Tips to quit smoking and Complementary Health Approaches for Smoking Cessation are discussed in this presentation.
Smoking cessation by
Dr. Fazle Rabbi Mohammed
MBBS, MD (Chest)
7 of the worst diseases smoking causes
Lung Cancer: more people die of lung cancer than any other type of cancer
COPD: it is the third leading cause of death worldwide
Heart disease: can cause many heart diseases & heart disease is the number one cause of death in US population
Stroke: triggered by smoking & it is the fourth leading cause of death in US
Asthma: smoking cause exacerbation of asthma
Over 10 other types of cancer, including Colon, Cervix, Liver, Stomach, Pancreatic cancer.
Diabetes Mellitus
Associate Consultant,Department of Respiratory Medicine
Square Hospitals Ltd
Nicotine Replacement Therapy (NRT) can help with the withdrawal symptoms in patients who find it difficult to quit tobacco. It is available in the form of - gums, patches, sprays, inhalers or lozenges.
Similar to Challenges to Tobacco Dependence Treatment in Europe -- Hayden McRobbie, M.B., Ch.B., Ph.D. (20)
Webinar: Waterpipe use from the Middle East to Western CountriesGlobal Bridges
This presentation will discuss the epidemiology, toxicology, and harms of waterpipes, as well as what further research is needed and the challenges in providing treatment for those interested in quitting. Presented as a webinar for Global Bridges on 26 February, 2014.
Dr. Bianco: Humo de segunda mano y riesgos cardiovascularesGlobal Bridges
Los profesionales de la salud, incluso aquellos relacionados con la salud cardiovascular, son conscientes
que el tabaco es uno de los principales factores de riesgo para muchas enfermedades, pero la
mayoría de ellos no han sido entrenados para reconocer al consumo de tabaco como una adicción,
no son conscientes de los mecanismos por los cuales el consumo de tabaco y la exposición al humo
del tabaco causan daños cardiovasculares. La mayoría de ellos tampoco han sido entrenados sobre
cómo abordar al paciente fumador en su práctica clínica diaria y como usar los medicamentos para el
tratamiento de la dependencia al tabaco. Esta conferencia tiene la intención de informar a los asistentes
sobre todos estos temas y estimularlos a obtener más información sobre ellos.
Going mobile: the potential of mHealth for tobacco dependence treatmentGlobal Bridges
Erik Augustson, PhD, MPH, is the Program Director of the Tobacco Control Research Branch of the National Cancer Institute. He serves on a number of national committees in the United States to improve population-based tobacco control such as the Department of Health and Human Services eHealth and mHealth Cessation Interventions committee, Smoking Cessation Subcommittee of the DHHS, the National Tobacco Control Strategy Committee and the North American Quitline Consortium. In addition, Dr. Augustson serves as the federal co-lead on the Smokefree.gov Initiative which represents the first web and mobile based cessation resource developed by the United States federal government.
During this webinar, Dr. Augustson discussed the use of mHealth for health behavior interventions, particularly in tobacco dependence. MHealth has been defined as “health related services delivered by mobile communication devices,” which can be in the form of SMS messaging, smartphone applications, or the mobile web. This webinar focused on text-message based interventions such as NCI’s SmokefreeTXT and the opportunity to implement such interventions at an international level. Dr. Augustson has worked on mHealth interventions not only in the United States but also in China and shared preliminary results from program evaluations and discussed the future potential of mobile interventions to treat tobacco dependence on a population level.
WEBINAR: Secondhand Smoke: The Science and Big Tobacco's SmokescreenGlobal Bridges
Webinar presented for Global Bridges on February 27, 2013
By Dr. Richard Hurt, Director of Mayo Clinic Nicotine Dependence Center
The science behind the harmful effects of tobacco smoke will be reviewed in detail, including results from Dr. Hiryama’s landmark study of female Japanese lung cancer patients who are non-smoking wives of smoking husbands, as well as the most recent study showing that smoke-free workplace laws are associated with a reduction in the incidence of acute myocardial infarctions.
The presentation also highlights Big Tobacco’s decades long public relations and media campaigns to deceive the public and create doubt and controversy about the harmful effects of secondhand smoke. These data come from previously secret tobacco industry documents made public as a result of the Minnesota Tobacco Trial of 1998 and the Department of Justice case that resulted in the conviction of Big Tobacco for violating the U.S. racketeering laws.
Global Bridges: Pharmacotherapy for Tobacco DependenceGlobal Bridges
May 2012: Dr. Richard Hurt, director of the Nicotine Dependence Center at the Mayo Clinic and chair of Global Bridges: Healthcare Alliance for Tobacco Dependence Treatment, discusses pharmacotherapy for tobacco dependence at a workshop in Jamaica.
Global Bridges: Farmacoterapia para la dependencia del tabaco (español)Global Bridges
On April 4, 2012, Global Bridges presented the webinar "Farmacoterapia para la dependencia del tabaco," which featured Dr. Richard Hurt, founder and director of the Mayo Clinic Nicotine Dependence Center and chair of Global Bridges: Healthcare Alliance for Tobacco Dependence Treatment.
The Critical Importance of Health Care Worker Leadership in the Tobacco Contr...Global Bridges
Presentation by Eduardo Bianco, M.D., Framework Convention Alliance, Uruguay, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
Pharmacotherapy for Tobacco Dependence -- Richard D. Hurt, M.D., Mayo ClinicGlobal Bridges
On April 4, 2012, Global Bridges presented the webinar "Pharmacotherapy for Tobacco Dependence," which featured Richard D. Hurt, M.D., founder and director of the Mayo Clinic Nicotine Dependence Center.
For the audio/video from this presentation, please visit http://www.youtube.com/watch?v=NqndR9wWfZo
Competence-Based Training for a National Stop-Smoking Service: An English Cas...Global Bridges
Presentation by Andy McEwen, Ph.D., National Centre for Smoking Cessation and Training, UK, at the 15th World Conference on Tobacco OR Health in Singapore.
Challenges in Expanding the Role of Health Care Providers and Delivering Trea...Global Bridges
Presentation by Lekan Ayo-Yusuf, D.D.S., M.P.H., Ph.D., regional director of the Global Bridges African region, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
Challenges in Expanding the Role of Health Care Providers and Delivering Trea...Global Bridges
Presentation by Jagdish Kaur, MBBS, Union Health Ministry, India, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
Challenges in Implementing Tobacco Dependence Treatment in Jordan and the Eas...Global Bridges
Presentation by Feras Hawari, M.D., a pulmonologist and the Global Bridges regional director for the Eastern Mediterranean region, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
Role of Health Care Systems and Providers in Changing Tobacco Dependence Trea...Global Bridges
Presentation by Gustavo Zabert, M.D., a pulmonologist and the Global Bridges regional director for the Latin American region, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
Tobacco Dependence Treatment Training -- J. Taylor Hays, M.D.Global Bridges
Presentation by J. Taylor Hays, M.D., a Global Bridges co-investigator and professor of medicine at Mayo Clinic, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
Overview of Tobacco Treatment Provisions at a National Level -- Martin RawGlobal Bridges
Presentation by Martin Raw, UK Centre for Tobacco Control Studies and National Institute of Alcohol and Drug Policies, Brazil, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
Introduction to Global Bridges -- Richard D. Hurt, M.D.Global Bridges
Presentation by Richard D. Hurt, M.D., chair of Global Bridges and founding director of the Mayo Clinic Nicotine Dependence Center, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Challenges to Tobacco Dependence Treatment in Europe -- Hayden McRobbie, M.B., Ch.B., Ph.D.
1. Europe
Tobacco Dependence Treatment
Hayden McRobbie MB ChB PhD
Wolfson Institute of Preventive Medicine, Queen Mary University of London
Faculty of Health & Environmental Sciences, Auckland University of Technology
Inspiring Limited
2. Male smoking prevalence
World Health Organization. The Tobacco Atlas. http://www.who.int/tobacco/statistics/tobacco_atlas/en
4. Treatment to help dependent
smokers stop
Item Score /10
Recording of smoking status in medical notes
Legal or financial incentive to record smoking status in all medical notes or patient files 1
Brief advice in primary care
Family doctors reimbursed for providing brief advice 1
Quitline
National quitline or quitlines in all major regions of country 1
ADDITIONAL POINT FOR
Quitline counselors answering at least 30 hours a week (not recorded messages) 1
Network of smoking cessation support and its reimbursement
Cessation support network covering whole country; free 4
Cessation support network but only in selected areas; free 3
Cessation support network covering whole country; partially or not free 3
Cessation support network but only in selected areas; partially or not free 2
Reimbursement of medications
Medications totally reimbursed or free to users or 2
Medications partially reimbursed 1
5. Tobacco Treatment Scores
Country Treatment Score Country Treatment Score
UK 9 Italy 5
Denmark 7 Portugal 5
Romania 7 Hungary 5
Poland 7 Finland 4
Luxembourg 7 Spain 4
Ireland 6 Cyprus 4
France 6 Germany 4
Malta 6 Czech Republic 4
Sweden 6 Austria 4
Belgium 6 Turkey 3
Switzerland 6 Lithuania 3
Netherlands 6 Greece 3
Slovenia 6 Iceland 2
Estonia 6 Bulgaria 2
Slovakia 6 Latvia 0
Norway 5
6. Challenges
Lack of routine brief interventions
Lack of systems to help HCPs to
deliver brief interventions and
referral
Lack of reimbursement
8. Belgium
~350 "tobaccologists" trained for at least 1 year in smoking cessation
• Majority of them work within CAF (Centre d'Aide Aux Fumeurs)
• Staffed by at least one MD and one tobaccologist
• The majority of CAF are situated in hospital facilities.
Pharmacotherapy
• NRT is not reimbursed, but mutual funds give 50 € for help in smoking cessation
• Varenicline is reimbursed after the first 15 days of treatment which are paid by the
smokers
• Bupropion is reimbursed in patients with COPD
8 consultations for smoking cessation (over a maximum of 2 years) are
reimbursed for any MD, or a psychologist-tobaccologist.
A minority of GP received a short training in smoking cessation provided by their
professional scientific association.
With thanks to Dr. Pierre Bartsch, professor of lung medicine at the University of Liege in Belgium
9. France
Train ‘Tobaccologists’ (Smoking Cessation Specialist) in post-graduate courses at 5
medical schools
• 100 hours of classes, 20 hours of clinical practice, written exam, 20-30 page thesis
• Physicians can put this after their name (although not recognized as a medical
specialty), and midwives can use the title “Smoking Cessation Specialist Midwife”
SCS can have a
• dedicated state paid position in hospitals and/or private practice
• Approximately 600 smoking cessation clinics/practices across France
Society: http://www.societe-francaise-de-tabacologie.com/
Treatments
• All forms of NRT (except Nasal Spray) available on prescription and OTC
• Varenicline and bupropion are prescription drugs
• Counseling is mandatory with prescription medicines
• All but varenicline is reimbursed (50 euros/year/person)
• Pregnant women: NRT reimbursed up to 150 euros/pregnancy
With thanks to Professor Ivan Berlin
10. Spain
Three regions (Madrid, Navarra and La Rioja) have well designed smoking cessation
programmes
• Clinics in primary and secondary care facilities
• Staffed by part-time specialists
• Medications are reimbursed in some cases
• E.g. Smokers with COPD, CVD, asthma, diabetes, cancer, pregnant women and
those with psychiatric illness
In regions where no good smoking cessation programmes exist
• A few clinics, most in hospitals
• Treatments not reimbursed
Treatments
• NRT – gum lozenges and patch (OTC)
• Bupropion and varenicline on prescription
Training is provided by medical societies and some universities in post-graduate courses
The US Tobacco Dependence Treatment Guidelines have been translated into Spanish
With thanks to Professor Carlos Jimenez-Ruiz
1
11. Germany
Smoking cessation services vary across Germany, especially in the new Federal states
In the new Federal states, the supply of smoking cessation services is insufficient
• Smoking cessation providers lack the specialised skills needed for smoking
cessation counselling and treatment
The barriers against engagement most commonly reported included:
• lack of adequate reimbursement
• lack of training in smoking cessation promotion
• lack of demonstration materials.
Most German health insurance funds provide reimbursement for cognitive-behavioural
group-based courses for smoking cessation
• However, the reimbursement for non-pharmacological interventions which is around
€75-100 is insufficient to cover the staff costs for providing these services
• Although physicians, hospital departments and insurance companies may provide
smoking cessation services, smokers have to pay for any pharmacotherapies they
receive
With thanks to Dr Tobias Raupach
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12. United Kingdom
Behavioural support and pharmacotherapy fully subsidized
Services reaching high needs areas
In 2010/11 the English services
• Saw over 700,000 people
• About 384,000 people reported successfully quitting
at the 4 week follow-up
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13. Treatment format
∗ Brose L, West R, McDermott M, Fidler J, Croghan E, McEwen A (2011) What makes for an
effective stop-smoking service? Thorax.
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14. Medication options used
Brose L, West R, McDermott M, Fidler J, Croghan E, McEwen A (2011) What makes for
an effective stop-smoking service? Thorax.
1
15. United Kingdom
Behavioural support and pharmacotherapy fully subsidized
Services reaching high needs areas
In 2010/11 the English services
• Saw over 700,000 people
• About 384,000 people reported successfully quitting
at the 4 week follow-up
However more basic levels of brief intervention are not
routinely occurring in secondary care, and primary care
could do more
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16. Addressing the Basics
My Intervention :: Page1-Opening http://ncsct-training.co.uk/player/play/VBA
Very Brief Advice on Smoking
Introduction
A training module developed by the National Centre
for Smoking Cessation and Training (NCSCT) on
how to deliver very brief advice to smokers
This training module should take you less than 30
minutes to complete
To begin click the 'Continue' button below
Continue
http://ncsct-training.co.uk/player/play/VBA?thiz=Page1-Opening
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18. The Western Pacific
Large geographical
area
Many different
cultures and
languages
Vastly different
levels of tobacco
control
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19. Barriers to smoking cessation
Economic factors
Lack of awareness by policy makers of the health
consequences and costs of tobacco
Low perception of risks among the public
Lack of policies that promote cessation
Smoking behaviour of service providers and their own lack
of knowledge or awareness
Poor healthcare systems
Lack of infrastructure
Industry action
Abdullah & Husten Thorax 2004;59:623–630
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20. Pacific Smoking Prevalence
Males Females
Rasanathan &TukuitongaJournal of the New Zealand Medical Association, 12-October-2007, Vol 120 No 1263
2
21. Tobacco Control in the Pacific
All independent Pacific countries are parties to the FCTC
Willingness to adopt strong solutions
• Smokefree villages
• In 2007 Premier of Niue has suggested the novel
approach of financial payments of up to NZ$1700 to
each of Niue’s estimated 200 smokers to quit smoking
as a means of reducing the greater cost to the
Government of treating smoking-related illnesses
Extensive provision of smoking cessation support which
could include face-to-face services at community meetings,
village events, and sports clubs as well as personalised
services via quitlines.
Wilson et al (2007) Journal of the New Zealand Medical
Association, 30-November-2007, Vol 120 No 1266
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22. A smokefree Fijian village
1986 – a group of HCPs (Surfers Medical
Association) started a small scale treatment
and health promotion programme in the
Fijian village of Nabila
1990 – ‘stocktake’
• 238 ethnic Fijians in Nabila
• 147 > 16 years of age
• 31% smokers
Groth-Marnat et al (1996) Soc. Sci. Med 43(4) 473-477
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23. A pledge to become smokefree
If all of the smokers in the
village abstained, then the
medical team promised to
match whatever money was
raised for building a
community centre
3 months later the medical
team received a letter to
say that Nabila was now a
smokefree village
Groth-Marnat et al (1996) Soc. Sci. Med 43(4) 473-477
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24. Becoming smokefree
Village aversive smoking
Followed by a ceremony where all remaining
cigarettes were destroyed
Kava ceremony
Tabu established
Village wide commitment
Further kava ceremonies to reinforce
commitment
Groth-Marnat et al (1996) Soc. Sci. Med 43(4) 473-477
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25. Relapse did happen
In 4 people – with consequences
• The 1st tripped after smoking and lacerated his
scalp
• The 2nd was attacked by a dog
• The 3rd developed testicular swelling
• The 4th collapsed unconscious immediately
after smoking, whilst drinking kava
All sought forgiveness from the elders and
got back on track
Groth-Marnat et al (1996) Soc. Sci. Med 43(4) 473-477
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26. Australian GP Guidelines
Recommend that HCPs
should
• Give brief advice to stop
smoking
• Make an assessment of the
smoker’s interest in quitting
• Make an offer of
pharmacotherapy and
counselling where
appropriate
• Provide self help material
• Refer to more intensive
support such as Quitline and
other local programs that
may be available in each
state.
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27. Guidelines aim to address barriers
Belief Evidence
Assistance with smoking Most patients think smoking cessation
cessation is not part of my role assistance is part of your clinical role
I have counselled all my smokers Only 45–71% of smokers are counselled
Smokers aren’t interested in Nearly all smokers are interested in quitting and more
quitting than 40% of smokers make quit attempts each year
and more think about it
I routinely refer patients for Referrals to Quitline are low (10–25%)
smoking cessation assistance
I’m not effective Clinicians can achieve substantial quit rates over 6–12
months, 12–25% abstinence, which have important
public health benefits
Smokers will be offended by Visit satisfaction is higher when smoking is addressed
enquiry appropriately
I don’t have time to counsel Effective counselling can take as little as a minute
smokers
The RACGP, Supporting smoking cessation: a guide for health professionals
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29. The ABCs
A - ask whether a
person smokes
B - give brief advice
to quit to all people
who smoke and
C – make and offer
of and refer to
cessation treatment
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30. The Health Target
95% of hospitalised
smokers will be provided
with advice and help to
quit by July 2012
90% of enrolled patients
who smoke and are seen
in General Practice, will
be provided with advice
and help to quit by July
2012. 3
32. The case in Malaysia
Have TDT guidelines
Lack of training for HCPs to
undertake brief interventions
Over 300 Quit Clinics in almost every
district
• Not well utilized
Access to most pharmacotherapies
• NRT is expensive
• Pharmacists can supply
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33. Are TDTs Cost-effective?
Agreed that TDTs are extremely cost-effective – but it depends upon the
definition
World Health Organization thresholds of being ‘cost-effective’ if less
than three times gross domestic product (GDP) per capita and ‘very
cost-effective’ if less than GDP per capita
Vietnam example: GDP per capita VND 11 500 000 ($US1160)
Intervention VND per DALY averted
Physician brief advice 1,742,000
Nicotine patch 287,684,000
Bupropion 172,582,000
Varenicline 108,412,000
Higashi & Barendregt (2011) Addiction, 107, 658–670
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High income, relatively low smoking prevalence 15.1% of people in Australia, aged 14 years or older, were daily smokers Quitline - www.quitbecauseyoucan.org.au Some face-to-face services Medicines - Pharmaceuticals benefits scheme (PBS) Patches – 12 weeks/year (2 courses for Aboriginal or Torres Strait Islander) – An authority prescription is required and the support program being used needs to be specified. Varenicline - can be prescribed for up to 24 weeks of continuous Bupropion one course per year
Big challenge ahead – requires a big approach. Smoking cessation treatment is a significant part of New Zealand’s multi-pronged, comprehensive strategy for getting to a smokefree 2025. The two main thrusts of our smoking cessation strategy are firstly to motivate more quit attempts, and secondly to ensure that those quit attempts are well supported with cessation treatments and lead to good smokefree outcomes.
New Zealand’s comprehensive approach, which includes this range of options for cessation treatment is set out in the ABC programme. The ABCs highlight the important but different roles played by health care workers and cessation service providers to provide good help for smokers to quit. The ABCs are about addressing smoking with every patient, and ensuring that they get joined up with cessation treatment that works for them. ABC is about Asking every patient if they smoke, providing brief advice to quit, and providing smoking cessation medications and or referring on to more intensive cessation support services. And then, of course, the role of cessation services in the ABC is to provide the C in a high quality, evidence based way.
The Government recognises the value of the ABC approach. And while cessation support services have been doing their part for years, it took a health target to get the healthcare sector on board. The health target is that: 95% of hospitalised smokers will be provided with advice and help to quit by July 2012. And in primary care that: 90% of enrolled patients who smoke and are seen in General Practice , will be provided with advice and help to quit by July 2012.
This shows that the target has seen great success. When it first started smoking was sometimes recorded in the patient notes as part of someone's social history but was not consistently screened for, nor addressed in health care settings In Q4 of 2010-11, 85% of hospitalised patients that smoke were offered brief advice to quit smoking so nearly everyone that smokes was offered help to quit in hospitals. Last year 105,000 smokers were identified and 80,000 smokers received brief advice to quit. And the percentages continue to increase. The coverage achieved through the health target is unprecedented for a smoking cessation treatment and extending the health target to Primary care will extend the reach of the intervention tremendously - Indeed we know that aout 94% of patients are enrolled with a GP and about 85% of these will see their GP each year. So the vast majority of the NZ population are likely to be screened for smoking and provided brief advice and help to quit this year, if we achieve the target!