Supporting smoking cessation in healthcare: obstacles in scientific understanding and tobacco addiction management

Despite ongoing efforts to reduce tobacco smoking, the smoking prevalence in many countries has remained stable for years. This may be a consequence of either lack of knowledge about effective ways to reduce smoking, or failing treatment of tobacco addiction in healthcare. This study explored gaps in the current understanding of smoking cessation and the challenges facing tobacco addiction management in order to formulate recommendations for future research and healthcare practice. A narrative review was written to determine areas in which more research is needed as well as areas in which sufficient knowledge is already available. Recommendations for future research were prioritised using a Delphi-procedure. Recommendations for healthcare practice were confirmed by expert’s assessment. Smoking is not widely acknowledged as an addiction and a relatively small number of smokers ask help from a healthcare professional when trying to stop smoking. Most healthcare professionals recognise the importance of advising patients to stop smoking, but experience certain barriers to actually do this. Overall, healthcare professionals need to be convinced that tobacco smoking is an addiction and should be treated likewise. If all healthcare professionals systematically advise their patients to give up smoking, eventually more smokers will successfully stop smoking.

Personal control in rehabilitation: An internet platform for patients with schizophrenia and their caregivers

In order to facilitate optimal quality and continuity of care and self-management of patients with schizophrenia, Personal Control in Rehabilitation (PCR) has been developed, a comprehensive internet-based platform. PCR aims to reach patients with schizophrenia or related psychotic disorders and their (in)formal caregivers. It provides caregivers and patients with a kind of dashboard giving them (tailored) information about the physical and psychosocial situation of the patient, their compliance with treatment, and facilitates optimal self-management for patients. With the use of PCR, informal caregivers have access to information about treatment and can consult formal caregivers, formal caregivers have easy access to the multidisciplinary guideline schizophrenia and to the regional care plans. Patients and their formal and informal caregivers completed questionnaires about empowerment, quality of life, quality of care and workload before the introduction of PCR and nine months later. A sample of them also participates in focus group discussions about the usefulness and usability of PCR and bottle necks in using the platform. Response to the questionnaires, especially at followup, was not adequate for statistical analyses of its results. Therefore, the focus of this paper is on the process evaluation of the implementation of PCR in two large mental health organisations in the Netherlands. Data for this evaluation are results of a number of open questions of the questionnaire and results of the focus group discussions. In these discussions, 19 patients, 12 informal caregivers, 33 formal caregivers and three managers participated. Preliminary results of this study show that the implementation of PCR is feasible and patients, formal and informal caregivers were satisfied with the use of PCR and frequently used PCR to communicate, make appointments, give feedback and look for information about their disease and its treatment. PCR is considered as a help in reaching more self-management by patients, to facilitate communication between patients and caregivers, and to match treatment and support. It seems useful also for other patient groups and their (in)formal caregivers like patients with depression, autism and addiction disorders.

Risk factors in cardiovascular patients:Challenges and opportunities to improve secondary prevention

BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease(CVD).The Survey of Risk Factors in Coronary Heart Disease(SURF CHD)II study is a clinical audit of the recording and management of CHD risk factors.It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology(ESC).Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate.Azerbaijan is a country in the South Caucasus,a region at a very high risk for CVD.AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku(Azerbaijan).METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021.Information on demographics,risk factors,physical and laboratory data,and medications was collected using a standard questionnaire in consecutive patients aged≥18 years with established CHD during outpatient visits.Data from 687 patients(mean age 59.6±9.58 years;24.9%female)were included in the study.RESULTS Only 15.1%of participants were involved in cardiac rehabilitation programs.The rate of uncontrolled risk factors was high:Systolic blood pressure(BP)(SBP)(54.6%),low-density lipoprotein cholesterol(LDL-C)(86.8%),diabetes mellitus(DM)(60.6%),as well as overweight(66.6%)and obesity(25%).In addition,significant differences in the prevalence and control of some risk factors[smoking,body mass index(BMI),waist circumference,blood glucose(BG),and SBP]between female and male participants were found.The cardiovascular health index score(CHIS)was calculated from the six risk factors:Non-or ex-smoker,BMI<25 kg/m2,moderate/vigorous physical activity,controlled BP(<140/90 mmHg;140/80 mmHg for patients with DM),controlled LDL-C(<70 mg/dL),and controlled BG(glycohemoglobin<7%or BG<126 mg/dL).Good,intermediate,and poor categories of CHIS were identified in 6%,58.3%,and 35.7%of patients,respectively(without statistical differences between female and male patients).CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and,in particular,the control rate of BP,are insufficient.Given the fact that patients with different comorbid pathologies are at a very high risk,this is of great importance in the management of such patients.This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures,especially in the regions at a high risk for CVD.A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.

Nurses Opinions Regarding Delirium Care in the Older General Hospital Population and in Older Cardiac Surgery Patients Specifically: A Multicentre Survey among Dutch Nurses

Background: Delirium is a high prevalent postoperative complication in older cardiac surgery patients and can have drastic consequence for the patient. Preventive interventions, diagnosis and treatment of delirium require specialized knowledge and skills. Objective: To gain insight in the current opinion and beliefs of nurses in hospitals concerning prevention, diagnosis and treatment of delirium in older hospital patients in general and specifically in older cardiac surgery patients. Methods: In a cross-sectional study from February to July 2010, we distributed a survey on beliefs on delirium care among 368 nurses in three hospitals in the Netherlands, in one hospital in all wards with older patients and in two hospitals in the cardiac surgery wards only. Results: Although in literature incidence rates up to 54.9% in cardiac surgery patients in hospitals are reported, with a response rate of 68% (250), half of the nurses believe that the incidence of delirium is not even 10%. Two thirds think that delirium in patients is preventable. Although, the Delirium Observation Scale is most often used for screening delirium, nearly all nurses do not routinely screen patients for delirium. Opinions on delirium of nurses working in cardiac surgery wards did not differ from nurses caring for older patients in other hospital wards. Conclusions: Nurses do have knowledge on delirium care, but there is a gap between the reported incidence in literature and the estimation of the occurrence of delirium by nurses. A two-way causal relationship emerges: because nurses underestimate the occurrence, they do not screen patients on a routine basis. And because they do not screen patients on a routine basis they underestimate the incidence.

Non-invasive Angiographic-based Fractional Flow Reserve:Technical Development,Clinical Implications,and Future Perspectives

New non-and less-invasive techniques have been developed to overcome the procedural and operator related burden of the fractional flow reserve(FFR)for the assessment of potentially significant stenosis in the coronary arteries.Virtual FFR-techniques can obviate the need for the additional flow or pressure wires as used for FFR measurements.This review provides an overview of the developments and validation of the virtual FFR-algorithms,states the challenges,discusses the upcoming clinical trials,and postulates the future role of virtual FFR in the clinical practice.

Haplotype of prostaglandin synthase 2/cyclooxygenase 2 is involved in the susceptibility to inflammatory bowel disease

AIM： Prostaglandin G/H synthase 2 （PTGS2 or COX2） is one of the key factors in the cellular response to inflammation. PTGS2 is expressed in the affected intestinal segments of patients with inflammatory bowel diseases （IBD）. In IBD patients, non-steroidal anti-inflammatory drugs, which have been shown to reduce both the production and activity of PTGS2, may activate IBD and aggravate the symptoms. We aimed at examining genetic variants of PTGS2 that may be risk factors for IBD. METHODS： We genotyped 291 individuals diagnosed with IBD and 367 controls from the Dutch population for the five most frequent polymorphisms of the PTG52 gene. Clinical data were collected on all patients. DNA was extracted via normal laboratory methods. Genotyping was carried out using multiplex PCR followed by the Invader Assay and the 5＇ exonuclease assay （TaqMan）. New polymorphism screening was performed by pre-screening with denaturing high-performance liquid chromatography, followed by fluorescent sequencing. RESULTS： Allele 5209G was weakly associated with Crohn＇s disease （odds ratio [OR] 1.63, 95% confidence interval [CI] 1.03-2.57）, and allele 8473T with ulcerativecolitis （OR 1.50, 95%CI 1.00-2.27）. The haplotype including both alleles showed a strong association with IBD （OR 13.15, 95%CI 3.17-116.15）. This haplotype, while rare （-0.3%） in the general population, is found more frequently in patients （3.5%）. CONCLUSION： Our data suggest that this haplotype of PTGS2 contributes to the susceptibility of IBD.

影响颅内动脉瘤破裂风险的患者个体特征(英文)

BACKGROUND AND PURPOSE Knowledge about risk factors contributes to understanding the pathophysiological mechanisms that cause intracranial aneurysm rupture and helps to develop possible treatment strategies.We aimed to study lifestyle and personal characteristics as risk factors for the rupture of intracranial aneurysms.METHODS We performed a case-control study with 250 patients with an aneurysmal subarachnoid hemorrhage and 206 patients with an unruptured intracranial aneurysm.All patients with an aneurysmal subarachnoid hemorrhage and patients with a unruptured intracranial aneurysm were asked to fill in a structured questionnaire about their lifestyle and medical history.For patients with an unruptured intracranial aneurysm,we also collected data on the indication for imaging.With logistic regression analysis,we identified independent risk factors for aneurysmal rupture.RESULTS Reasons for imaging in patients with an unruptured intracranial aneurysm were atherosclerotic disease(23%),positive family history(18%),headache(8%),preventive screening(3%),and other(46%).Factors that increased risk for aneurysmal rupture were smoking(odds ratio,1.9;95% confidence interval,1.2-3.0) and migraine(2.4;1.1-5.1);hypercholesterolemia decreased this risk(0.4;0.2-1.0),whereas a history of hypertension did not independently influence the risk.CONCLUSIONS Smoking,migraine and,inversely,hypercholesterolemia are independent risk factors for aneurysmal rupture.Data from the questionnaire are insufficient to conclude whether hypercholesterolemia or its treatment with statins exerts a risk-reducing effect.The pathophysiological mechanisms through which smoking and migraine increase the risk of aneurysmal rupture should be investigated in further studies.Although a history of hypertension does not increase risk of rupture,a sudden rise in blood pressure might still trigger aneurysmal rupture.

瑞舒伐他汀对存在亚临床动脉粥样硬化的低危人群颈动脉内膜中层厚度进展的影响——METEOR试验

背景：动脉粥样硬化往往在机体出现症状之前就已有所进展。目前，我们尚不清楚Framingham风险评分（Framinghaln risk score，FRS）较低的轻中度亚临床动脉粥样硬化中年人群是否能从治疗中获益。 目的：评价为期2年的他汀类药物治疗能否减缓颈动脉内膜中层厚度（carotid intimamedia thickness，CIMT）继续增厚或使粥样斑块消退。 设计、地点及参试者：“瑞舒伐他汀对内膜中层厚度影响的测评研究（Measuring Effects on Intima-Media Thickness：an Evaluation of Rosuvastatin，METEOR）”是2002年8月至2006年5月在美国及欧洲61个基层医疗中心开展的一项随机、双盲、安慰剂对照研究，共纳入984名参试者，有的参试者仅以年龄（平均年龄，57岁）为冠心病的危险因素，有的参试者10年内FRS低于10％、CIMT重庞增厚（1．2～3．5mm）、LDL胆固醇水平有所升高（平均值，154mg／dL）。 干预：参试者服用40mg瑞舒伐他汀或安慰剂。 主要观测指标：12个颈动脉位点最大CIMT的变化率（经B超检测）；颈总动脉位点、颈动脉窦位点及颈内动脉位点最大CIMT的变化，颈总动脉位点平均CIMT的变化。仅在瑞舒伐他汀组中评估CIMT的消退情况。 结果：瑞舒伐他汀组参试者LDL胆固醇平均（SD）水平由基线时的155（24．1）mg／dL降至78（27．5）mg／dL，平均降低49％（与安慰剂组相比P〈0.001）。瑞舒伐他汀组12个颈动脉位点最大CIMT的变化值为-0．0014（95％CI，-0．0041～0.0014）mm／y，安慰剂组12个颈动脉位点最大CIMT的变化值为Q0131（95％CI，Q0087～Q0174）mm／y（P〈0.001）。瑞舒伐他汀组颈总动脉位点最大CIMT的变化值为-0.0038（95％CI，-0.0064～-0.0013）mm／y（P〈0.001），颈动脉窦位点最大CIMT的变化值为-0.0040（95％CI，-0.0090～0.0010）mm／y（P〈0.001），颈内动脉位点最大CIMT的变化值为0.0039（95％CI，-0.0009～0.0088）mm／y（P=0.02）。瑞舒伐他汀组颈总动脉位点平均CIMT的变化值为0.0004（95％CI，-0.0011～0.0019）mm／y（P〈0.001）。P值均为与安慰剂组相比。总的来说，瑞舒伐他汀具有良好的耐受性，很少引发严重的心血管不良事件（在2年内有6名参试者[0.86％]出现8起不良事件[1．1％]）。 结论：对于FRS低于10％的亚临床动脉粥样硬化中年人群而言，瑞舒伐他汀能够在2年内显著降低最大CIMT的进展速率，与安慰剂相比差异具有统计学显著性。但是，瑞舒伐他汀无法诱导病变消退。今后，我们仍需开展大型远期试验来明确上述研究结果的临床意义．

Wells规则不能完全排除初级保健患者深静脉血栓形成

Background: Using data from secondary care outpatients, Wells and colleagues developed a diagnostic rule to estimate the probability of the presence of deep venous thrombosis(DVT). The accuracy of the Wells rule has not been properly validated for use in primary care patients in whom DVT is suspected. Objective: To validate the diagnostic accuracy of the Wells rule, with and without D-dimer testing, in a primary care setting. Design: Cross-sectional study with prospective data collection from 1 January 2002 to 1 March 2003. Setting: 110 primary care practices in a circumscribed geographic region in The Netherlands. Participants: 1295 consecutive patients who consulted their primary care physician about symptoms suggestive of DVT. Measurements: All patients underwent history-taking and physical examination to calculate the Wells rule score, and D-dimer testing. Repeated leg ultrasonography was the reference standard to determine the true presence or absence of DVT. Results: In the primary care setting, 12.0%of patients in the low-risk group had DVT; the original study by Wells and colleagues reported a rate of 3%among such patients. When combined with negative results on a D-dimer test, the Wells rule yielded a prevalence of DVT of 2.9%in the lowest-risk group, whereas the prevalence was 0.9%in the original study. Limitations: Patients with previous DVT were included, and the diagnostic reference standard was different from that used in Wells and colleagues’original study. Conclusion: The Wells rule, alone or in combination with D-dimer testing, does not guarantee accurate estimation of risk in primary care patients in whom DVT is suspected.

Torcetrapib对混合型高脂血症患者颈动脉内膜中层厚度的作用:随机、双盲RADIANCE 2研究

背景:混合型高脂血症患者表现为TG增高、HDL-C降低以及LDL-C升高。抑制胆固醇酯转运蛋白(CETP)升高HDL-C,可能对此类患者有益。因此,本研究探讨CETP抑制剂torcetrapib对混合型高脂血症患者颈动脉粥样硬化进展的影响。

常规胸部CT扫描的主动脉表现对心血管疾病的预测

目的通过胸部CT扫描发现常见的亚临床性主动脉异常表现以预测心血管疾病(cardiovascular disease,CVD)的发生。

男性与女性患者的急性心肌梗死后长期和短期预后的比较

当前公认的观点是:较之男性患者,急性心肌梗死(AMI)后女性患者的早期死亡率高,但是有几项研究并未显示出男女之间有此种差异。此外,对其长期差异还未有大量报道。

心脏病风险决定绝经年龄而非绝经年龄决定心脏病风险

Objectives: The purpose of this study was to investigate whether a harmful cardiovascular risk profile accelerates menopause. Background: Women with an early menopause are at an increased risk of cardiovascular disease. Although increased cardiovascular risk has been proposed as consequence of menopause, the alternative hypothesis, that increased premenopausal cardiovascular risk promotes early menopause, needs to be examined. Methods: We used data from the Framingham Heart Study cohort. This study started in 1948 and has followed up participants biennially since then. Women who were premenopausal at study entry and who reached natural menopause after at least two examination rounds were included in the study(n=695). Premenopausal age-independent levels of serum total cholesterol, relative weight, blood pressure, and Framingham risk score were determined, as well as premenopausal changes in cholesterol, body weight, and blood pressure. Results: A higher premenopausal serum total cholesterol level was statistically significantly associated with an earlier age at menopause, as were increases in total serum cholesterol, relative weight, and blood pressure in the premenopausal period. A decrease in total serum cholesterol during premenopause was statistically significantly associated with later age at menopause. Decreasing blood pressure was associated with a later menopausal age, but this association was not statistically significant. A decrease in relative weight was associated with a significant earlier age at menopause. Each 1%higher premenopausal Framingham risk score was associated with a decrease in menopausal age of 1.8 years(95%confidence interval -2.72 to-0.92). Conclusions: The findings support the view that heart disease risk determines age at menopause. This offers a novel explanation for the inconsistent findings on cardiovascular disease rate and its relationship to menopausal age and effects of hormone replacement therapy.

明显动脉粥样硬化患者中颈动脉内膜中层厚度与新发血管事件风险的关系:SMART研究结果

目的:在普通人群中,颈动脉内膜中层厚度(CIMT)是发生血管事件的独立预测因素。目前,对CIMT和明显动脉疾病患者新发血管事件的相关性知之甚少。本文旨在评估此相关性的强度。方法与结果:本研究纳入入选SMART(动脉疾病继发表现)队列研究的前2374例有明显动脉疾病的连续患者,SMART队列研究的对象是有明显动脉疾病或心血管疾病危险因素的患者。测量基线时双侧颈总动脉CIMT。

慢性阻塞性肺病稳定期老年患者中未被发现的心衰

Aims: To establish the prevalence of unrecognized heart failure in elderly patients with a diagnosis of chronic obstructive pulmonary disease, in a stable phase of their disease. Methods and results: In a cross-sectional study, patients ≥65 years of age, classified as having chronic obstructive pulmonary disease by their general practitioner and not known with a cardiologist-confirmed diagnosis of heart failure, were invited to our out-patient clinic. Four hundred and five participants underwent an extensive diagnostic work-up, including medical history and physical examination, followed by chest radiography, electrocardiography, echocardiography, and pulmonary function tests. As reference(i.e.‘gold’) standard the consensus opinion of an expert panel was used. The panel based the diagnosis of heart failure on all available results from the diagnostic assessment, guided by the diagnostic principles of the European Society of Cardiology(ESC) for heart failure(i.e., symptoms and echocardiographic systolic and/or diastolic dysfunction). The diagnosis of chronic obstructive pulmonary disease was based on the diagnostic criteria of the Global Initiative(GOLD) for chronic obstructive pulmonary disease. Of 405 participating patients with a diagnosis of chronic obstructive pulmonary disease, 83(20.5%, 95%CI 16.7-24.8) had previously unrecognized heart failure(42 patients systolic, 41 ‘isolated’diastolic, and none right-sided heart failure). In total, 244(60.2%) patients had chronic obstructive pulmonary disease according to the GOLD criteria and 50(20.5%, 95%CI 15.6-26.1) patients combined with unrecognized heart failure. Conclusion: Unrecognized heart failure is very common in elderly patients with stable chronic obstructive pulmonary disease. Closer co-operation among general practitioners, pulmonologists, and cardiologists is necessary to improve detection and adequate treatment of heart failure in this large patient population.

高血糖负荷和血糖生成指数饮食增加中年女性的心血管疾病风险:一项基于人群的随访研究

目的:评价高血糖负荷和血糖生成指数饮食是否会增加心血管疾病(CVD)风险。背景:饮食中血糖生成指数和血糖负荷与CVD风险的关系尚未确定,特别是对饮食血糖负荷适度的人群。而且。

Carotid Intima-media Thickness Measurements： Relations with Atherosclerosis, Risk of Cardiovascular Disease and Application in Randomized Controlled Trials

Cardiovascular disease （CVD） is the leading cause of death worldwide and contributes considerably to morbidity The underlying cause is atherosclerosisThe development of new preventive therapies is one of the steps to control the CVD epidemic. It is increasingly demanded that promising therapies be evaluated in trials using cardiovascular （CV） morbidity and mortality （M and M） as a primary outcome.

Contact tracing-Old models and new challenges

Contact tracing is an effective method to control emerging infectious diseases.Since the 1980’s,modellers are developing a consistent theory for contact tracing,with the aim to find effective and efficient implementations,and to assess the effects of contact tracing on the spread of an infectious disease.Despite the progress made in the area,there remain important open questions.In addition,technological developments,especially in the field of molecular biology(genetic sequencing of pathogens)and modern communication(digital contact tracing),have posed new challenges for the modelling community.In the present paper,we discuss modelling approaches for contact tracing and identify some of the current challenges for the field.

Prevalence of the Metabolic Syndrome Among Employees in Northeast China

Background：The metabolic syndrome is a clustering of metabolic abnormalities and has been associated with increased risk of type 2 diabetes mellitus and cardiovascular disease.This study aimed to estimate the prevalence of the metabolic syndrome among employees in Northeast China.Methods：Totally,33,149 employees who received health screening in the International Health Promotion Center in the First Hospital of Jilin University were enrolled.Height,weight,waist circumference,blood pressure,fasting plasma glucose,triglyceride,high-density lipoprotein,and low-density lipoprotein were recorded.Three definitions for the metabolic syndrome were applied,revised National Cholesterol Education Program＇s Adult Treatment Panel Ⅲ （NCEP ATP Ⅲ） criteria,the International Diabetes Federation （IDF） criteria,and the Chinese Diabetes Society （CDS） criteria.Results：Overall,the age-standardized prevalence of the metabolic syndrome was 22.9%,20.6%,and 15.3% based on dcfinitions of revised NCEP ATP Ⅲ criteria,the IDF criteria,and the CDS criteria,respectively.Men had higher age-standardized prevalence than women in all three definitions （P 〈 0.05）.The prevalence was 27.1%,24.5%,and 20.4% for men;17.1%,15.4%,and 8.3% for women,respectively.The most common metabolic component with the metabolic syndrome was overweight （54.7% of men had an elevated body mass index,and 35.9% of women had central obesity）.Conclusions：A large proportion of employees among Northeast China have the metabolic syndrome.These findings place emphasis on the need to develop aggressive lifestyle modification for patients with the metabolic syndrome and population level strategies for the prevention,detection,and treatment of cardiovascular risk.

复合参照标准在诊断性研究中的应用价值

在诊断精确性的试验中，优化疾病状态最终分类的方法常常是综合几项不同的试验来进行分析，但这种方法使用起来却常常令人摸不着头脑。本文旨在讨论如何恰当的运用和报告复合参照标准。