The pros and cons of using nicotine patchesJane Allen
Nicotine patches are a popular nicotine replacement therapy to help people stop smoking. They work by gradually delivering nicotine through the skin to reduce withdrawal symptoms and cravings. Some pros are that they are convenient, reduce cravings, and come in varying dosages. However, they do not eliminate cravings completely and can cause skin irritation. Success rates increase when combined with willpower and a support program. The document provides details on how to properly use nicotine patches and tips for increasing the chances of success when quitting smoking.
The rationale for establishing low-toxicity smokeless nicotine product polici...TobaccoFindings
The document discusses tobacco harm reduction through the use of low-toxicity smokeless tobacco products like Swedish snus. It summarizes evidence from Swedish population studies that finds little risk of snus leading to smoking, strengthening nicotine addiction, or weakening smokers' efforts to quit. The evidence suggests that snus use can substantially reduce tobacco-related disease risk and that some smokers who switch to snus do subsequently quit nicotine altogether. There is little scientific evidence to support arguments against tobacco harm reduction and good evidence to reject such arguments.
The pros and cons of using nicotine patchesJane Allen
Nicotine patches are a popular nicotine replacement therapy to help people stop smoking. They work by gradually delivering nicotine through the skin to reduce withdrawal symptoms and cravings. Some pros are that they are convenient, reduce cravings, and come in varying dosages. However, they do not eliminate cravings completely and can cause skin irritation. Success rates increase when combined with willpower and a support program. The document provides details on how to properly use nicotine patches and tips for increasing the chances of success when quitting smoking.
The rationale for establishing low-toxicity smokeless nicotine product polici...TobaccoFindings
The document discusses tobacco harm reduction through the use of low-toxicity smokeless tobacco products like Swedish snus. It summarizes evidence from Swedish population studies that finds little risk of snus leading to smoking, strengthening nicotine addiction, or weakening smokers' efforts to quit. The evidence suggests that snus use can substantially reduce tobacco-related disease risk and that some smokers who switch to snus do subsequently quit nicotine altogether. There is little scientific evidence to support arguments against tobacco harm reduction and good evidence to reject such arguments.
The role of harm reduction in tobacco controlTobaccoFindings
The document discusses the role of harm reduction in tobacco control. It argues that for current tobacco users who cannot quit, switching to a nicotine product that is markedly less harmful than cigarettes, such as nicotine replacement therapy or low-nitrosamine smokeless tobacco, can significantly reduce health risks compared to continuing smoking. While prevention and smoking cessation efforts are important, harm reduction strategies are also needed to help smokers unable or unwilling to quit nicotine use altogether. Regulating alternative nicotine products to ensure they are much safer than cigarettes can achieve public health benefits as part of a comprehensive approach to tobacco control.
Tobacco is a plant that is consumed in various forms worldwide, with dried leaves mainly smoked in cigarettes, cigars, pipes, and shisha. Tobacco use causes over 5 million deaths annually and is the leading preventable cause of death. Smokeless tobacco products like chewing tobacco and dipping tobacco are also harmful, increasing risks of cancer, heart disease, addiction, and oral health issues. Education about tobacco's dangers and quitting techniques can help reduce tobacco consumption.
NYU College of Global Health - E-cigarette seminar - New YorkClive Bates
E-Cigarettes: The Tectonic Shift in Nicotine and Tobacco Consumption: Opportunity or Threat to Saving Lives?
Clive Bates
Friday, October 19, 2018
NYU School of Law, Greenberg Lounge
40 Washington Square South, New York, New York
Snus as a Substitution for Smoking: The Swedish ExperienceTobaccoFindings
The document summarizes a study on tobacco use in Sweden. It finds that among males, use of snus (a form of smokeless tobacco) is more common than smoking, but less common among females. Snus seems to reduce smoking initiation and increase smoking cessation rates. The study shows snus is an effective smoking cessation aid commonly used by males in Sweden.
This document discusses the application of health psychology and prevention of health problems. It specifically discusses cigarette smoking, alcohol use, and weight control. Regarding cigarette smoking, it discusses reasons why people smoke despite health risks and various techniques used to help people quit smoking. It notes high relapse rates and that prevention by deterring youth from starting is most effective. For alcohol, it discusses prevalence of drinking, health risks of heavy use, and various treatment approaches for alcohol abuse/dependence that have high relapse rates. Controlled drinking is a controversial treatment approach.
Perception of health status among different groups of tobacco users in SwedenTobaccoFindings
This document summarizes a study comparing self-reported health perceptions among different groups of tobacco users in Sweden. The study found that:
1) Current daily smokers reported poorer satisfaction with their health, life, and higher numbers of sick days than other groups.
2) Daily snus users, both with and without a history of smoking, reported health perceptions similar to non-users and better than current smokers.
3) Former smokers who now use snus daily reported better mental health and life satisfaction than current smokers.
The results suggest that smoking impairs perceived health while switching from smoking to snus may improve it.
The document discusses the topic of snuff (tobacco). It begins by defining snuff and describing its native origins in America. It then discusses the history of snuff use and how it spread from Native Americans to Europeans. The document outlines the various harmful chemicals and health effects of smoking snuff, including addiction to nicotine and increased risk of various cancers and heart and lung diseases. It describes the psychological and social reasons for smoking. Finally, it discusses the stages of quitting smoking and provides tips on how to quit.
The document summarizes key findings from Indonesia's 2011 Global Adult Tobacco Survey:
- Over 36% of Indonesian adults used tobacco, with 67% of men and 4.5% of women using tobacco products. Kretek cigarettes were the most commonly smoked tobacco product.
- Half of current smokers planned to quit smoking. However, exposure to secondhand smoke was widespread, with over half of adults exposed at work and over three-quarters exposed at home.
- Tobacco advertising was widely noticed by adults, though over 80% believed smoking causes serious illness. The average cost of cigarettes was about $1.30, consuming a significant portion of individual incomes.
The document discusses statistics on tobacco-related deaths from various WHO regions in 1998. It then discusses the percentage of total deaths attributable to tobacco use in different regions in 1990 and projections for 2020. The document also discusses why people smoke and maintain smoking habits, signs of nicotine addiction, classification of tobacco use disorders, and different intervention strategies to reduce tobacco-related harm including decreasing uptake, increasing cessation, and exploring potentially less harmful tobacco products.
Regulation of tobacco ingredients for largest possible reduction of health risksTobaccoFindings
Oral presentation by Lars Ramström at Workshop on tobacco ingredients, National Institute for Public Health and the Environment, Bilthoven, The Netherlands, 30 and 31 October 2003
Meaningful public education by labelling on tobacco packages: Some elements o...TobaccoFindings
Information provided on tobacco packages should clarify that:
1. A smoker's nicotine intake from cigarettes varies widely based on how they smoke and depends on their personal nicotine needs, not machine-measured yields.
2. Intake of other harmful substances depends on the brand-specific ratio of each substance to nicotine.
3. Health risk information should make clear that nicotine itself poses little risk, while combustion products in smoked tobacco are highly dangerous, and nicotine replacement therapies and smokeless tobacco are much less risky than smoking.
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)MuskanShingari
Skin is the largest organ of the human body, serving crucial functions that include protection, sensation, regulation, and synthesis. Structurally, it consists of three main layers: the epidermis, dermis, and hypodermis (subcutaneous layer).
1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
Skin performs essential functions such as regulating body temperature through sweat production and blood flow control, synthesizing vitamin D when exposed to sunlight, and serving as a sensory interface with the external environment.
Maintaining skin health is crucial for overall well-being, involving proper hygiene, hydration, protection from sun exposure, and avoiding harmful substances. Skin conditions and diseases range from minor irritations to chronic disorders, emphasizing the importance of regular care and medical attention when needed.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
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The role of harm reduction in tobacco controlTobaccoFindings
The document discusses the role of harm reduction in tobacco control. It argues that for current tobacco users who cannot quit, switching to a nicotine product that is markedly less harmful than cigarettes, such as nicotine replacement therapy or low-nitrosamine smokeless tobacco, can significantly reduce health risks compared to continuing smoking. While prevention and smoking cessation efforts are important, harm reduction strategies are also needed to help smokers unable or unwilling to quit nicotine use altogether. Regulating alternative nicotine products to ensure they are much safer than cigarettes can achieve public health benefits as part of a comprehensive approach to tobacco control.
Tobacco is a plant that is consumed in various forms worldwide, with dried leaves mainly smoked in cigarettes, cigars, pipes, and shisha. Tobacco use causes over 5 million deaths annually and is the leading preventable cause of death. Smokeless tobacco products like chewing tobacco and dipping tobacco are also harmful, increasing risks of cancer, heart disease, addiction, and oral health issues. Education about tobacco's dangers and quitting techniques can help reduce tobacco consumption.
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Snus as a Substitution for Smoking: The Swedish ExperienceTobaccoFindings
The document summarizes a study on tobacco use in Sweden. It finds that among males, use of snus (a form of smokeless tobacco) is more common than smoking, but less common among females. Snus seems to reduce smoking initiation and increase smoking cessation rates. The study shows snus is an effective smoking cessation aid commonly used by males in Sweden.
This document discusses the application of health psychology and prevention of health problems. It specifically discusses cigarette smoking, alcohol use, and weight control. Regarding cigarette smoking, it discusses reasons why people smoke despite health risks and various techniques used to help people quit smoking. It notes high relapse rates and that prevention by deterring youth from starting is most effective. For alcohol, it discusses prevalence of drinking, health risks of heavy use, and various treatment approaches for alcohol abuse/dependence that have high relapse rates. Controlled drinking is a controversial treatment approach.
Perception of health status among different groups of tobacco users in SwedenTobaccoFindings
This document summarizes a study comparing self-reported health perceptions among different groups of tobacco users in Sweden. The study found that:
1) Current daily smokers reported poorer satisfaction with their health, life, and higher numbers of sick days than other groups.
2) Daily snus users, both with and without a history of smoking, reported health perceptions similar to non-users and better than current smokers.
3) Former smokers who now use snus daily reported better mental health and life satisfaction than current smokers.
The results suggest that smoking impairs perceived health while switching from smoking to snus may improve it.
The document discusses the topic of snuff (tobacco). It begins by defining snuff and describing its native origins in America. It then discusses the history of snuff use and how it spread from Native Americans to Europeans. The document outlines the various harmful chemicals and health effects of smoking snuff, including addiction to nicotine and increased risk of various cancers and heart and lung diseases. It describes the psychological and social reasons for smoking. Finally, it discusses the stages of quitting smoking and provides tips on how to quit.
The document summarizes key findings from Indonesia's 2011 Global Adult Tobacco Survey:
- Over 36% of Indonesian adults used tobacco, with 67% of men and 4.5% of women using tobacco products. Kretek cigarettes were the most commonly smoked tobacco product.
- Half of current smokers planned to quit smoking. However, exposure to secondhand smoke was widespread, with over half of adults exposed at work and over three-quarters exposed at home.
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Similar to Revisiting Harm Reduction - An Update of Pros and Cons (11)
The document discusses statistics on tobacco-related deaths from various WHO regions in 1998. It then discusses the percentage of total deaths attributable to tobacco use in different regions in 1990 and projections for 2020. The document also discusses why people smoke and maintain smoking habits, signs of nicotine addiction, classification of tobacco use disorders, and different intervention strategies to reduce tobacco-related harm including decreasing uptake, increasing cessation, and exploring potentially less harmful tobacco products.
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Information provided on tobacco packages should clarify that:
1. A smoker's nicotine intake from cigarettes varies widely based on how they smoke and depends on their personal nicotine needs, not machine-measured yields.
2. Intake of other harmful substances depends on the brand-specific ratio of each substance to nicotine.
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Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)MuskanShingari
Skin is the largest organ of the human body, serving crucial functions that include protection, sensation, regulation, and synthesis. Structurally, it consists of three main layers: the epidermis, dermis, and hypodermis (subcutaneous layer).
1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
Skin performs essential functions such as regulating body temperature through sweat production and blood flow control, synthesizing vitamin D when exposed to sunlight, and serving as a sensory interface with the external environment.
Maintaining skin health is crucial for overall well-being, involving proper hygiene, hydration, protection from sun exposure, and avoiding harmful substances. Skin conditions and diseases range from minor irritations to chronic disorders, emphasizing the importance of regular care and medical attention when needed.
Nutritional deficiency Disorder are problems in india.
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BBB and BCF
control the entry of compounds into the brain and
regulate brain homeostasis.
restricts access to brain cells of blood–borne compounds and
facilitates nutrients essential for normal metabolism to reach brain cells
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
Allopurinol, a uric acid synthesis inhibitor acts by inhibiting Xanthine oxidase competitively as well as non- competitively, Whereas Oxypurinol is a non-competitive inhibitor of xanthine oxidase.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Revisiting Harm Reduction - An Update of Pros and Cons
1. Revisiting Harm Reduction - An Update of Pros and Cons
Lars M. Ramström, Institute for Tobacco Studies (ITS), Stockholm, Sweden, E-mail: lars.ramstrom@tobaccostudies.com.
Tom Wikmans, Research Group for Societal and Information Studies (FSI), Stockholm, Sweden, E-mail: tom@forskningsgruppen.com.
In order to, as close as possible, achieve a tobacco-free society there is a need for a combination of strategies:
• Prevention strategies • Cessation strategies • Harm Reduction strategies that can serve as;
stepping stone towards final cessation of all nicotine use or, if this is not possible, minimization of tobacco-related ill-health also for non-cessation-prone tobacco users.
Harm Reduction is basically a matter of letting nicotine dependent smokers replace the highly toxic combustion products in all tobacco smoke with low-toxicity nicotine products. Possible options include medicinal products
(nicotine chewing gum etc) and some non-medicinal products such as Low-Toxicity Oral Tobacco (LoTOT), for example the Swedish type, Snus, but not certain other types of oral tobacco. While the primary objective is to ter-
minate smoking, increasing attention is now given to the possibility of a second step where all nicotine use is abandoned.
There is no longer any controversy about the far-reaching health benefits for the individual smoker who switches to LoTOT, for example, Snus. But there are remaining questions regarding possibly negative consequences in a
public health perspective. There is a current discussion on pros and cons of Harm Reduction focusing on a number of issues that could be elucidated by research in Sweden so as described here below. The results presented in
this poster are based on surveys conducted from January 2001 to February 2011.
Does primary Snus-use serve as a gateway to smoking Are smokers who take up Snus-use less likely to make quit-
and thereby increase smoking? smoking-attempts?
Tobacco use can start as smoking or as Snus-use. In each case a secondary initiation of other kind of tobacco Most, but not all, smokers make attempts to quit smoking. In the FSI / ITS surveys 2003 – 2005 all Ever
use may or may not occur. The figure below shows how the patterns of initiation of daily tobacco use in Daily Smokers were asked about their quit attempts.
Sweden have changed from around 1960 (those born in the 1940s) till around 2000.
Occurrence of quit-smoking-attempts in Sweden.
Initiation of daily tobacco use. Comparison between daily smokers with and without
Swedish men and women in different birth cohorts.
subsequent initiation of daily Snus-use
Men Women Men Women
Never any daily
100%
tobacco use OR 95% CI OR 95% CI
90%
Snus-use, 2.22 1.75-2.81 3.08 1.79-5.20
80%
never smoking Source: FSI / ITS surveys 2003 – 2005
70%
60% First Snus, Among primary daily smokers who have subsequently started daily Snus-use the odds of having made a
later smoking
50% quit-smoking-attempt were found to be two to three times higher than among those without Snus-use. A
40% First smoking, possible reason for this may be that the widespread awareness in Sweden that Snus can be an effective aid to
30% later Snus quit smoking serves as an encouragement to make quit attempts.
20% Smoking,
10% never snus
0%
1940s 1950s 1960s 1970s 1980s 1940s 1950s 1960s 1970s 1980s
Can Snus be an effective cessation aid?
Birth cohorts Close to half of Swedish smokers who make quit attempts use some self-administered nicotine product as a
Source: FSI / ITS surveys 2003-2006 cessation aid. The figure below shows how common different such practices are and what outcome they
yield.
Among men there has been a striking increase of “primary” Snus-initiation (green and yellow segments). The Percentages of “Self-help quit-attempts” made with different aids
subsection “First Snus, later smoking” (yellow segments) is a very small and decreasing fraction. The subsec- and
tion “Snus-use, never smoking” (green segments) is the dominating and increasing part of the initiation pat- Outcome of the quit-attempt
terns. This development has been accompanied by a drastic decrease of initiation of “primary” smoking Men Women
(dark blue and red segments). The expansion of Snus-use has thereby become associated with increasing pro-
portions of “Never any daily tobacco use”. 51% Outcome of the Quit-attempt
Continued smoking
Among women snus use is still rather uncommon. Initiation of smoking has been decreasing less markedly Quit smoking completly
among women and is still higher than among men. 33% (quit rate)
23%
19%
Does start of subsequent Snus-use among daily smokers lead to 16%
12%
0.71 13% 13% 12%
8%
dual use rather than to cessation of smoking? 0.40
0.60
0.43 0.34 0.62 0.36 0.30 0.50 0.27
When primary daily smokers start subsequent Snus-use, their tobacco use will eventually change into either Nicotine Nicotine Snus Other Combined Nicotine Nicotine Snus Other Combined
dual use, daily Snus-use only, no daily tobacco use or they will go back to smoking only. The figure below gum patch only single aid use gum patch only single aid use
only only aid only only aid
shows the current tobacco-use status of Swedish daily smokers who subsequently have taken up Snus-use.
Source: FSI / ITS surveys 2003-2006
Current status of Swedish daily smokers who have taken up Snus-use
Among men Snus is the most commonly used self-help aid. Among women nicotine gum or patch is more
Men Women common.
49%
47% The quit rates in the different groups suggest that Snus is a more effective aid than any of the other alternati-
40% ves – both for men and for women.
38%
Among men the combination of high usage and high efficiency means that the majority of successful self-
help quit attempts (green segments) have been achieved by use of Snus as cessation aid.
The role of Snus in smoking cessation in Sweden is further illustrated by survey results showing that,
among male Ever Daily Smokers, 85 % of those with experience of Snus-use have quit smoking completely
compared to 56% of those without Snus-use.
8% 7%
5% 6%
Conclusions:
Daily Snus- Free of Dual use Continuing Daily Snus- Free of Dual use Continuing The data presented above suggest following answers to the above five questions in red:
use only daily tobacco daily use only daily tobacco daily
use smoking use smoking
Source: FSI / ITS surveys 2003-2011 • Primary Snus-use does not serve as a gateway to smoking, rather as a
resistance against smoking.
Among those daily smokers who have taken up snus use, a vast majority, 87% of men as well as of women, • Initiation of Snus-use among smokers will lead to cessation of smoking
have quit daily smoking completely. Among men 38% have terminated all daily tobacco use. Among women rather than to dual use.
the corresponding figure is 40%. Dual use is a very small fraction, 8% among men and 6% among women.
• Switching from daily smoking to daily Snus-use will weaken rather than
strengthen nicotine dependence.
Will switching from daily smoking to daily Snus-use • Smokers who take up Snus-use are more likely to make quit-smoking-attempts.
strengthen nicotine dependence? • Evidence from Sweden demonstrates that Snus can be an effective
For smokers who switch from cigarettes to Snus Level of dependence for continuing primary daily smokers smoking cessation aid and has been a major contributory factor behind the
there is not only a change of product but also a and former daily smokers who have switched to daily record low prevalence of smoking in Sweden.
Snus-use
change of the way nicotine is delivered. This is im-
portant, since there is evidence from basic research
1%
Level 6
In summary:
on drug dependence that: 16%
Harm reduction strategies substituting Snus for cigarettes could play an important role in
45%
Level 6
64% 44% Higher the efforts to achieve a tobacco-free society.
• Nicotine addictiveness is mainly determined by Higher Level 5 dependence
the speed of delivery to the brain. dependence Level 5 + 6
48%
Level 5 Level 5 + 6 The results presented in this poster are based on three different surveys conducted by the Research Group for Societal
• Nicotine delivery from snus is substantially slower and Information Studies (FSI).
than from cigarettes.
41% VAKT, Smoke
Level 4 Is a prospective study of 1000 smokers followed over a period of two years. The study was conducted in collaboration with the
Snus-use could therefore be expected to be less ad- 36%
Level 4 Norwegian Institute for Alcohol and Drug Research (SIRUS) and the Institute for Tobacco Studies (ITS).
dictive than cigarette smoking. This is supported by
14% VAKT, Snus
empirical data shown in the figure to the right. In Level 3
Is a Web-based study where 1000 daily Snus-users were asked the same questions as in the VAKT, smoke base-line study.
the underlying study respondents were categorized Primary daily smokers Daily Snus users who The study was conducted in collaboration with the Institute for Tobacco Studies (ITS).
in six levels of dependence based on time to the day’s with no switched
Snus-use from daily smoking
first cigarette/Snus, type of Snus and amount of FSI/ITS-survey
Source: VAKT-smoke,VAKT-Snus An ongoing national postal survey reaching approximately 10.000 respondents during every year. The study is conducted in
cigarettes/Snus per day. collaboration with the Institute for Tobacco Studies (ITS).
The survey data suggest that former daily smokers who have switched to daily Snus-use have a lower level of
dependence than continuing daily smokers with no Snus-use. Funding: The surveys are funded by FSI, ITS and SIRUS Disclaimer: No conflict of interest