This document discusses methods of tobacco cessation. It begins with an introduction to tobacco use as the leading preventable cause of death globally. It then covers the history of tobacco, forms of tobacco used in India, and the health effects of tobacco use. Barriers to cessation like nicotine addiction and lack of support are examined. The document outlines goals of cessation programs like long term abstinence. It discusses behavioral management, pharmacotherapies, and counseling approaches. India's tobacco control laws aiming to restrict advertising and smoking in public are also summarized.
Cigarette smoking is one of the major preventable causes
of morbidity and mortality all over the world.
• According to World Health Organization (WHO, 2018)
Tobacco is the second major cause of death. It is currently
responsible for the death of 1 in 10 adults.
Cigarette smoking is one of the major preventable causes
of morbidity and mortality all over the world.
• According to World Health Organization (WHO, 2018)
Tobacco is the second major cause of death. It is currently
responsible for the death of 1 in 10 adults.
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 video for this presentation is available on our Youtube channel:
https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
Part of the Addiction counselor training curriculum
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.
The Chandler dentists at Shumway Dental Care will make sure you have a healthy mouth and a beautiful smile. Whether you need cosmetic dentistry, bridges or crowns, or just a checkup, their staff will make sure your visit is comfortable. Visit http://www.shumwaydental.com/
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2008 Smoking Cessation Health Promotion Power point filled with history of glamour movie stars who died from smoking, medical/military history, statistics and facts, myth/truth, perception/reality, Nurses' role, Health effects of smoking, Helps to quit: web sites, medications: Zyban, Chantix, Addiction notations. Factual/non-fiction.
14 slides plus 2 reference slides. 2008.
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 video for this presentation is available on our Youtube channel:
https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
Part of the Addiction counselor training curriculum
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.
The Chandler dentists at Shumway Dental Care will make sure you have a healthy mouth and a beautiful smile. Whether you need cosmetic dentistry, bridges or crowns, or just a checkup, their staff will make sure your visit is comfortable. Visit http://www.shumwaydental.com/
3150 S Gilbert Rd Suite 1
Chandler, AZ 85286
(480) 659-7800
2008 Smoking Cessation Health Promotion Power point filled with history of glamour movie stars who died from smoking, medical/military history, statistics and facts, myth/truth, perception/reality, Nurses' role, Health effects of smoking, Helps to quit: web sites, medications: Zyban, Chantix, Addiction notations. Factual/non-fiction.
14 slides plus 2 reference slides. 2008.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. CONTENTS
1.INTRODUCTION
2.HISTORY OF TOBACCO
USE
3.TOBACCO ADDICTION
“YOUNG SMOKERS”
4.WHY TOBACCO
CESSATION?
5.BARRIERS OF TOBACCO
CESSATION
INTERVENTIONS
3. 6.GOALS AND GUIDELINES OF
CESSATION PROGRAMMES
7.BEHAVIORAL MANAGEMENT
8.PHARMACOTHERAPIES
9.COUSELLING FOR THOSE
UNWILLING TO QUIT
10.CONCLUSION
11..REFERENCES
4. INTRODUCTION:
Tobacco use is described as the single most
important preventable cause of mortality and
morbidity globally.
It has been considered one of the strangest
human behaviors , which is necessary neither for
the maintenance of life nor for the satisfaction of
social , cultural or spiritual needs.
Inspite of the known association of major diseases
with tobacco,its continued use is an important
PUBLIC HEALTH ISSUE.
5. A BRIEF ACCOUNT OF TOBACCO RELATED
FACTS:
Plant product
obtained from
genus
NICOTIANA
plants belonging
to potatoe
family.
Carries in its
leaves an
alkaloid
NICOTINE
6. HISTORY OF TOBACCO
Accounts back to 500 yrs.
In 1492,after tobacco was
introduced to
CHRISTOPHER
COLUMBUS by native
Americans , when he
discovered AMERICA
7. INDIAN SCENARIO:
Introduced by
Portuguese traders in
about 1600 A.D.
Offered to emperor
Akbar.
Hookah was invented.
Addiction spread like
wildfire.
Soon it became a
symbol of aristocracy.
8. ALARMING FACTS ABOUT TOBACCO USE:
GLOBAL PICTURE:
Tobacco kills nearly 6
million people world wide.
According to WHO,
100 million premature deaths
were attributed to tobacco
use in 20th century.
If current trend continues ,no
.is expected to rise to 1 billion
in 21st century.
9. Estimates of the Global Adult
Tobacco Survey conducted
among persons of 15 yrs or
older during 2009-2010
indicate:
34.6% Of The Adults(47.9% Are
Males And 20.3% Females) Are
Current Tobacco Smokers.
14% Adults Smoke(24.3% Males
And 2.9% Females)
25.9% use smokeless
tobacco(32.9%males and 18.4%
females)
GLOBAL ADULT TOBACCO
SURVEY (GATS) INDIA:2009-2010
AVAILABLE
FROM:http://www.searo.who.int
INDIAN SCENARIO
10. VARIOUS FORMS OF TOBACCO USED IN INDIA:
SMOKELESS TOBACCO
PAN WITH TOBACCO
GUTKHA
MANIPURI TOBACCO
MAWA
KHAINI
MISHRI
SNUFF
ZARDA
15. It is known to
activate the
dopamine reward
system of the body
leading to the
release of
dopamine and
endorphins i.e
associated with the
feeling of pleasure
16. STARTING TO SMOKE: IT IS MAINLY INITIATED
BY FOLLOWING FACTORS.
Environmental
Parental smoking
Deprieved backgrounds.
24. TOBACCO CESSATION…………..WHY?
THE BENEFITS…………….
Estimation states that if adult consumption were to
decrease by 50% by the year 2020,approx 180 million
tobacco related deaths could be avoided.
To reduce tobacco related deaths and diseases
current smokers must quit tobacco.
25. Fact sheet about health benefits of smoking
cessation.
A)Immediate And Long Term Health Benefits Of
Quitting For All Smokers.
TIME SINCE QUITTING BENEFICIAL HEALTH CHANGES
Within 20 min Heart rate and blood pressure drops.
Within 12 hrs CO level in blood drops
2-12 weeks Circulation improves and lung function increases.
1-9 months Coughing and shortness of breath decreases.
1 year Risk of coronary heart disease is about half that
of a smoker.
5 years Stroke risk is reduced to that of a non smoker
10 years Risk of lung cancer falls to about half of a smoker
and risk of cancer of
mouth,throat,esophagus,cervix and pancreas
decreases.
26. B)People of all ages who have already developed
smoking elated health problems can still benefit from
quitting.
Time of quitting Benefits in comparison with those
who continued
At about 30 Gain almost 10 yrs of life expectancy
At about 40 Gain 9 years of life expectancy
At about 50 Gain 6 yrs of life expectancy.
At about 60 Gain 3 yrs of life expectancy.
After the onset of life
threatening disease
Rapid benefit,people who quit smoking
after having a heart attack reduce their
chances of having of having heart attack
by 50%
27. 3)Quitting smoking decreases the excess risk of
many diseases related to second hand smoke in
children,such as respiratory diseases e.g., asthma
and ear infections.
4)Quitting smoking reduces the chances of
impotence ,having difficulty getting pregnant ,
having premature births , babies with low
birthweights and miscarriage.
28. BARRIERS TO TOBACCO CESSATION
INTERVENTIONS:
1.Lack of knowledge:
Of the health effects of the tobacco use.
2.Nicotine Dependence:
Nature of nicotine dependence itself is the
single most important factor affecting smoking
cessation interventions.Even smoking a single
cigarette can cause nicotine dependence.
29. 3.Deeply ingrained cultural habits particularly in rural
areas.
4.Lack of tobacco cessation motivation,Advice and
support/Lack of Trained Health professionals:
A recent study in India reported that 83% of tobacco
users wanted to quit,of whom 51% were unsuccessful
because of lack of motivation and advice.
Another reason can be the inefficiency of the health
professionals to provide smoking counselling.
30. 5.Lack of interest in smoking intervention by Health
Professionals:
They do not have time to provide smoking cessation during
clinical consultations.
Myth among Health Professionals that giving unwanted
smoking cessation counselling may upset the clinician-patient
relationship.
6.Health professional’s own use of tobacco:
13.5% of male medical
11.4% of dental students
used tobacco.
In a study in kerala,
15% of male medical
13%of physicians
14% of medical students
reported tobacco use.
31. SMOKING CESSATION INTERVENTIONS-
GUIDELINES AND GOALS:
The WHO expert committee on smoking control had
formulated certain guidelines in 1979 which recommended
the following:
1. 1.Non smoking should be regarded as normal social
behaviour and all actions which can promote the
development of this attitude are taken into
consideration.
2. There should be a total prohibition of all forms of
tobacco promotion.
3. Promotion of the export of tobacco and tobacco
products should be discouraged.Tobacco growing and
manufacturing industries should progressively be
reduced in size as rapidly as possible.
32. As per the US Public Health Service report, the aims of the smoking
cessation treatment should be as follows:-
1.The achievement of long term or permanent abstinence.
2.Effective treatment should be offered to all tobacco users.
3.There should be consistent identification ,documentation
and treatment of every tobacco user at each visit to the
hospital.
4.Brief tobacco dependence treatment is also effective and
thus should be offered.
33. 5.A strong relationship exists between the intensity of
tobacco dependence ,counseling and its
effectiveness.
6.Practical counseling and social support , arrange
outside of treatment are helpful.
7.Of all the effective pharmacotherapies ,atleast one
of these medications should be prescribed in the
absence of contraindications.
8.Tobacco dependence treatments are cost effective
and should be covered by health insurance plans.
34. REGULATORY OR LEGISLATIVE APPROACH:
India has a short history of tobacco related
legislation. But India has played a leadership role in
global tobacco control.
With the growing evidence of harmful and
hazardous effects of tobacco ,the government of
India enacted various legislations and
comprehensive tobacco control measures.
35. 1) CIGARETTE ACT(regulation of
production,supply and distribution in 1975):
First national Level
Anti-Tobacco
legislation.
Passed in 1975
Prescribed all
packages to carry
the warning.
36. 2) Pollution act:
Introduced in 1988.
Included smoking in the definition of air pollution.
3) Motor vehicle act 1988:
Made it illegal to smoke and spit in a public vehicle.
37. 4)Tobacco prohibition act
of 1990:
TOBACCO SMOKING WAS
PROHIBITED IN
All health care
establishments,
Educational instiutions,
Domestic flights,
Suburban trains
Air conditioned buses
38. 5)Prevention Of Food Adulteration Act (PFA)
Amendment 1990:
Under The Prevention Of Adulteration
Act(PFA) Amendment 1990,statutory Warnings
Regarding Harmful Effects Were Made Mandatory
For Paan Masala And Chewing Tobacco.
39. 6)Drugs and cosmetics act 1940(amendment):
In 1992.
Use of tobacco in all dental products was banned.
40. 7)The Cable Television Networks(amendment ) Act
2000:
Prohibited tobacco advertising in electronic media
and publications including cable television.
8)Revised smoke free rules:
It came into effect from 2nd oct.2008.
Included the ban on smoking in public places
including work place also.
41. 9)Cigarettes And Other Tobacco Products(prohibition Of
Advertisement And Regulation Of Trade And Commerce
, production ,Supply Distribution)act (COTPA),in 2003:
The Indian Parliament passed the bill in April 2003.
This bill became an act on 18 May 2003.
42. THE KEY PROVISIONS OF COTPA-2003 ARE AS
FOLLOWS:
1.)Prohibition Of Smoking In Public Places
Implemented From 2nd October 2008
43. 2.Prohibition Of Advertisement-direct Or Indirect
And Promotion Of Tobacco Products.
44. 2.)Prohibition of sales to minors(tobacco products
cannot be sold to children less than 18yrs of age and
cannot be sold within a radius of 100 yards of any
educational institutions
45. 3.)Regulation of health warning in tobacco products
pack . English and one more Indian language to be used
for health warnings on tobacco packs . Pictorial health
warnings also to be included.
46. 4.)Regulations and testing of tar and nicotine
content of tobacco products and declaring on
tobacco product packages.
47. 5.)Law pertaining to pictorial health warnings on
tobacco product packages:
Implemented with effect from 31st May 2009.
48. NATIONAL TOBACCO CONTROL
PROGRAMME
As the implementation of various provisions under
COTPA lies mainly with the state governments,
effective enforcement of tobacco control law remains
a big challenge.
Government of India piloted National Tobacco
Control Program(NTCP) in 2007-2008.
49. MAIN COMPONENTS:
At National Level:
1. Public awareness/mass media campaigns for
awareness building and behavior change.
2.Establishment of tobacco product testing
laboratory to build regulatory capacity,as mandated
under COTPA,2003.
3.Mainstreaming the program components as part of
the health care delivery mechanism under the
National Rural Health Framework.
50. 4.Mainstream Research and Training on alternate
crops and livelihoods in collaboration with other nodal
ministeries.
5.Monitoring an Evaluation including surveillance. e.g
Global Adult Tobacco Survey (GATS),India.
51. At State Level:
Tobacco control cells with dedicated manpower for
effective implementation and monitoring of anti tobacco
laws and initiatives.
At District Level:
1. Training of health and social workers,SHGs,
NGOs,School teachers.
2. Local IEC activities.
3. Setting up tobacco cessation facilities.
4. School programmes.
5. Monitoring Tobacco Control Laws.
52. WHO TOBACCO FREE INITIATIVE IN INDIA:
The WHO Framework Convention on Tobacco
Control(WHO FCTC) is the first treaty negotiated
under the auspices of the World Health
Organisation.
The WHO FCTC treaty opened for signature on 16
June to 22 June 2003 in Geneva , and when
closed,had 168 signatories which makes it the
most widely embraced treaties in UN history.
53. The Convention entered into force on 27 Feb 2005.
The WHO FCTC was developed in response to the
globalization of the tobacco epidemic. It asserts the
importance of demand reduction strategies as well
as supply issues.
54. THE DEMAND REDUCTION PROVISIONS ARE:
Price and tax measures to reduce the demand
for tobacco,and
Non-Price measures to reduce the demand for
tobacco namely:
Protection from exposure to tobacco smoke.
Regulation of the contents of tobacco products.
55. Regulation Of Tobacco Product Disclosures.
Packaging And Labelling Of Tobacco Products.
Education,communication,training And Public
Awareness.
Tobacco Advertising,promotion And Sponsorship.
Demand Reduction Measures Concerning Tobacco
Cessation.
56. THE SUPPLY REDUCTION PROVISIONS ARE:
To stop illicit trade in tobacco products.
To stop sales to and by minors.
Provision of support for economically viable
alternative activities.
Article 14 of WHO FCTC also requires countries to
take effective measures to promote cessation of
tobacco use and adequate treatment for tobacco
dependence.
57. Setting up of Tobacco Cessation Clinics in India
has been one of the major highlights of
WHO/Ministry of health and family welfare
collaborative programe in the area of tobacco
control.
During 2001-02 a series of 13 Tobacco Cessation
Clinics were set up in 12 states across the country
in diverse settings such as Cancer treatment
hospitals,psychiatric hospitals ,medical colleges
,NGOs and Community settings to help users quit
tobacco use.
58. This network of tobacco cessation clinics was
further expanded in 2005 to cover 5 new clinics in
Regional Cancer Centres (RCCs) in 5 states having
high prevalence of tobacco use.
The Tobacco Cessation clinics were renamed as
Tobacco Cessation Centres and their role was
expanded to include trainings on cessation and
developing awareness generation on tobacco
cessation.
59. The role of TCCs was further expanded in 2009 and
they were designated as Resource Centre For
Tobacco Control(RCTC).Many of them have
developed outreach programes for the community
and are regularly doing awareness programs at
schools ,colleges ,slums and work places.
The emphasis is now being laid on mainstreaming
tobacco cessation in the Health Care Institutes to
set up tobacco cessation facilities in their respective
premises utilizing their existing infrastructure.
60. Under GOI-WHO collaborative Tobacco Free
Initiative, consultants have been provided in 12 out of
21 NTCP states to support state governments in
implementation of the programme.
WHO has also been supporting activities on World
No Tobacco Day(WNTD),every year on 31st May.
61. BEHAVIORAL MANAGEMENT
This refers to the skills and techniques that are
critical to the care of all patients with nicotine
dependence.
Initial intervention:
The National Cancer Institute advices a
5A based intervention in a primary care setup for
those who are willing to quit.
Smoking cessation programmes show a
predictable success rate of 40% or 20% with or without
nicotine replacement therapy respectively.
63. ASK
Identification of patient’s
tobacco use
status(current,former) is the
first step.
Check for the oral signs of
tobacco use:
• Stained teeth
• Halitosis
• Periodontal disease
• Discoloured patches on the
mucousa-
white,red,dark,precancerous
lesions.
64. FAGERSTORM TEST
Used to score the cigarette addiction level.
Based on answers to questions about
Timing of first cigarette smoked in the day.
Difficulty in not smoking in forbidden areas.
Most important cigarette in the day.
No. of cigarettes smoked in the day.
Timing of most intense smoking.
Smoking when ill.
Higher the scores indicate more addicted smokers
65. ADVISE
Clear, strong, personalized advice
to quit tobacco
• Clear: “My best advice is for you to
quit smoking.”
• Strong: “As your healthcare
provider, I need to you to know that
quitting smoking is the most
important thing you can do to
protect your health.”
• Personalized: Impact of smoking
on the baby, the family, and the
patient’s well being.
66. ASSESS
Assess the patient’s willingness to quit within the
next 30 days.
If a patient responds that they would like to quit
within the next 30 days, move to the Assist step.
If a patient does not want to try to quit try to
increase their motivation.
67. ASSIST
Suggest and encourage the use of problem-solving
methods and skills for tobacco cessation.
Provide social support as part of the treatment.
Arrange social support in the smoker’s
environment.
Provide self-help tobacco cessation materials.
68. ARRANGE
Follow-up to monitor progress and provide support.
Encourage the patient.
Express willingness to help.
Ask about concerns or difficulties.
Invite them to talk about their success.
69. SOMATIC TREATMENT:
Pharmacotherapies can be divided into:-
Nicotine Replacement Therapy.
Medication that mimic nicotine effects.
Antagonists.
Medication that make intake aversive.
70. NICOTINE REPLACEMENT THERAPY
Effective treatment to reduce cravings.
Do not cause the subjective effects.
Suppress the symptoms of nicotine withdrawal.
72. Chewing gum:
Available in 2 and 4 mg
Nicotine is present in the form of a
complex with methacrylic acid
polymer(nicotine polacrilex)
Persons who smoke 20 or
>cigarettes per day should start with
the 2mg strength gum,to be chewed
slowly over 30 when there is an
urge to smoke.
Those smoking <20 cigarettes per
day should use 4mg gum.
Has an unpleasant taste initially and
some find chewing difficult.
Requires frequent doing and also
causes jaw pain and soreness of the
mouth.
73. Sub lingual tablets:
Equivalent of 2mg nicotine
Recommended dose is 1-2
tabs sublingually.
Can be increased to a
maximum of 40 tabs daily if
necessary for atleast 3
months.
Dose should be gradually
reduced and then withdrawan.
74. Lozenges
Contain 1mg of nicotine(as
tartrate)
Initial dose is one lozenge
every 1-2 hrs
Can be increased upto a
maximum of 25 lozenges daily.
Treatment should continue for
atleast for 3 months after which
it is gradually withdrawan.
75. Adhesive transdermal patch:
designed to be applied for 16-
24hrs.
Available in different strengths ,
delivering 5-22 mg nicotine during
the recommended wear time.
Patches are applied on the hip
,trunk, upper arm.
Different site of application should
be used each day.
Gradual withdrawal is
recommended by reducing the
dose every 2-8 weeks.
Local untoward effects such as
itching and irritation may occur.
76. Nasal Spray:
suggested initial dose for a
nasal spray
(500µg/actuation) is one
spray into each nostril twice
an hour.
Can be used upto a
maximum of 80 sprays daily
for the first 8 weeks and
reduced there after .
May cause local irritation
77. Nicotine inhalator
cartridges:
Contain 10mg nicotine for
use in an inhaler.
Initial dose is 6-16
cartridges/day for 12
weeks.
Reduced gradually.
Produces mouth and
throat irritation.
78. MEDICATION THAT MIMIC NICOTINE EFFECTS:
1.Bupropion Hydrochloride:
Given as a modified release preparation(Bupropion SR)
Initial dose is 150 mg once daily for 6 days , increasing
to twice daily on day 7
Treatment should be started 1 week before the patient
attempts to stop smoking.
If there is no significant progress towards smoking
abstinence by the 7th week , then therapy should be
stopped.
79. 2.Clonidine:
Post synaptic a2 agonist that dampens sympathetic
activity originating at the locus ceruleus.
0.1-0.4 mg/day for 2-6 weeks has been used.
3.Anxiolytics:
Anxiety is a prominent sympton of nicotine withdrawal.
So temporily replacing the anxiolytic effects of nicotine
with another medication during first week of cessation
might make cessation easier.
Diazepam, Beta blockers have been widely used.
80. 4.Antidepressants:
Many antidepressants have been tried with varied
results.
Helpful only when the patients have underlying
depression.
5.Stimulants:
Aim is to replace the stimulant effects of nicotine.
Amphetamine is the most common drugs used,
81. 6.Anorectics:
Initially were used to combat post cessation hunger and
weight gain.
Encouraging results were obtained with fenfluramine and
phenylpropanolamine in short term trials.
7.Sensory replacement:
Black pepper extracts,Denicotinised tobacco flavorings
all decrease cigarette craving and withdrawals.
A citric acid inhaler has also been developed and
showed some promise in two clinical trials.
82. 8.Acupuncture:
Rationale behind is that acupuncture can release
endorphins that assist in cessation.
9.Devices:
Filters have been used to help smokers gradually
reduce the amount of smoking.
83. (C) ANTAGONISTS:
Goal is to prevent cigarettes from producing
positive reinforcing and subjective effects.
Mecamylamine
Naltrexone
84. (D) MEDICATION THAT MAKE INTAKE AVERSIVE:
Silver acetate combines with sulphides in tobacco
smoke to produce bad taste.
85. COUNSELLING THOSE UNWILLING TO QUIT:
MOTIVATIONAL ASSISTANCE “5R” APROACH
Relevance of quitting
Risk of continuing tobacco use.
Reward of quitting.
Roadblocks to quitting
Repetion
86. CONCLUSION:
Given the high global morbidity and mortality from
tobacco use in India,there is a need to develop
evidence based,cost effective interventions for both
smoking and smokeless tobacco use.
Public health awareness , raising a mass
movement against tobacco , sensitizing and
educating all health care professionals for tobacco
control and cessation by incorporating the topic in
medical undergraduate curriculum,nursing
curriculum can have a huge impact.
87.
88.
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