ABSTRACT
OBJECTIVE: To describe the process and results of the Smoking Cessation Program in order to answer this question: Does the lack of time and resources justify poor involvement of physicians in helping patients to stop smoking? METHODS: Prospective series of cases that included all smokers (n = 1203) who for any reason attended seven general practices over a period of one year. The behaviour of smokers when the program was offered as well as the workload generated by the implementation of the process are described. Subjects who stopped smoking were those who did not smoke two years after enrolment in a sustained and validated form for least 12 months. RESULTS: A total of 7.3% of all smokers quit (95% confidence interval [CI]: 5.9-8.9). Enrolment of subjects caused an increase in the consultation time of 23 seconds and decreased from a mean of 30 new smokers per month per practice during the first three months to 12 at the end of the first year. All received advise to stop smoking (mean increase of 3 min and 33 s) but only 17.5% accepted the therapeutic plan during the first year (95% CI: 15.4-19.9) that had a duration of 72:11 min and generated a mean of six programmed appointments a month in each practice. Twenty percent of subjects who participated in the therapeutic plan stopped smoking (95% CI: 14.8-26.1). CONCLUSIONS: Identification and universal advice to smokers, together with treatment of those who are motivated to quit, achieved important success rates without increasing excessively ordinary work loads.
Subject(s)
Smoking Cessation , Smoking/therapy , Adult , Female , Humans , Male , Program Evaluation , Surveys and QuestionnairesABSTRACT
Objetivo: Describir el proceso y resultados al año del Programa de Abandono del Tabaco, para responder a la siguiente pregunta: «¿Justifica la falta de tiempo y recursos la escasa intervención de los médicos sobre el tabaquismo?».Métodos: Serie de casos prospectiva formada por todos los fumadores (1.203) que acudieron durante un año por cualquier motivo a la consulta de siete médicos de familia. Se describe el comportamiento de los fumadores ante el programa y las cargas de trabajo que genera. Se consideró que habían abandonado el tabaco aquellos que estaban sin fumar a los2 años de su captación de forma validada y mantenida durante al menos 12 meses. Resultados: Dejaron de fumar el 7,3% de todos los fumadores (intervalo de confianza [IC] del 95%: 5,9-8,9). La captación incrementó el tiempo de consulta en 23 s y descendió desde un promedio de 30 nuevos fumadores al mes por consulta durante los tres primeros meses hasta 12 al final del primer año. Todos fueron aconsejados (incremento promedio de3 min y 33 s) pero sólo un 17,5% realizó el plan terapéutico durante el primer año (IC del 95%: 15,4-19,9), que tuvo una duración promedio de 72 min y 11 s, y generó una media de6 citas programadas al mes por consulta. El 20% de los que realizaron dicho plan lograron dejar de fumar (IC del 95%: 14,8-26,1).Conclusiones: La identificación y el consejo universal a los fumadores, junto con el tratamiento de los motivados, logra importantes éxitos sin incrementar excesivamente las cargas de trabajo habituales (AU)
Objetive: To describe the process and results of the «Smoking Cessation Program» in order to answer this question: Does the lack of time and resources justify poor involvement of physicians in helping patients to stop smoking? Methods: Prospective series of cases that included all smokers(n = 1203) who for any reason attended seven general practices over a period of one year. The behaviour of smokers when the program was offered as well as the workload generated by the implementation of the process are described. Subjects who stopped smoking were those who did not smoke two years after enrolment in a sustained and validated form for least 12 months. Results: A total of 7.3% of all smokers quit (95% confidence interval [CI]: 5.9-8.9). Enrolment of subjects caused an increase in the consultation time of 23 seconds and decreased from a mean of 30 new smokers per month per practice during the first three months to 12 at the end of the first year. All received advise to stop smoking (mean increase of 3 min and 33 s) but only 17.5% accepted the therapeutic plan during the first year (95% CI: 15.4-19.9) that had a duration of72:11 min and generated a mean of six programmed appointments a month in each practice. Twenty percent of subjects who participated in the therapeutic plan stopped smoking(95% CI: 14.8-26.1).Conclusions: Identification and universal advice to smokers, together with treatment of those who are motivated to quit, achieved important success rates without increasing excessively ordinary work loads (AU)
Subject(s)
Humans , Smoking/prevention & control , Smoking Cessation/methods , Smoking Prevention , Evaluation of the Efficacy-Effectiveness of Interventions , Outcome and Process Assessment, Health Care , Primary Health Care/methods , Patient Compliance/statistics & numerical dataABSTRACT
BACKGROUND: Smoking cessation clinical practice guidelines are based on randomised clinical trials reporting outcomes in persons who participate in these studies. However, many practitioners are sceptical about the effectiveness of these recommendations when applied to the general population in everyday routine consultation. AIM: To evaluate the results of a comprehensive smoking cessation programme in routine primary care practice. METHOD: All smokers consulting in 10 general practices during one year participated in a non-randomised controlled trial. The percentages of subjects in the intervention (n = 1203, seven practices) and control (n = 565, three practices) groups who reported sustained abstinence between six and 12 months follow-up and were validated biochemically were compared. The effect of the programme was adjusted to baseline differences in both groups by multiple logistic regression analyses. RESULTS: The programme resulted in an increase of five percentage points (95% CI = 3.1%-6.8%) in the validated and sustained one-year abstinence probability, with 7.1% for all of the intervention practices (adjusted OR = 3.7, 95% CI = 2.4-5.7). CONCLUSION: Programmes that combine advice to stop smoking to all smokers attending general practices with the offering of support, follow-up, and nicotine patches to those willing to stop are feasible and effective in routine practice, as primary care clinicians need only identify 20 smokers to get one additional success attributable to the programme.
Subject(s)
Smoking Cessation/statistics & numerical data , Administration, Cutaneous , Adolescent , Adult , Aged , Algorithms , Evidence-Based Medicine , Family Practice , Female , Humans , Male , Middle Aged , Multivariate Analysis , Nicotine/administration & dosage , Nicotine/agonists , Program Evaluation , Smoking Cessation/methods , Socioeconomic FactorsABSTRACT
One of female MZ twins presented with muscular dystrophy. Physical examination, creatine phosphokinase levels, and muscle biopsy were consistent with Duchenne muscular dystrophy (DMD). However, because of her sex she was diagnosed as having limb-girdle muscular dystrophy. With cDNA probes to the DMD gene, a gene deletion was detected in the twins and their mother. The de novo mutation which arose in the mother was shown by novel junction fragments generated by HindIII, PstI, or TaqI when probed with cDNA8. Additional evidence of a large gene deletion was given by novel SfiI junction fragments detected by probes p20, J-Bir, and J-66 on pulsed-field gel electrophoresis (PFGE). Immunoblot analysis of muscle from the affected twin showed dystrophin of normal size but of reduced amount. Immunofluorescent visualization of dystrophin revealed foci of dystrophin-positive fibers adjacent to foci of dystrophin-negative fibers. These data indicate that the affected twin is a manifesting carrier of an abnormal DMD gene, her myopathy being a direct result of underexpression of dystrophin. Cytogenetic analysis revealed normal karyotypes, eliminating the possibility of a translocation affecting DMD gene function. Both linkage analysis and DNA fingerprint analysis revealed that each twin has two different X chromosomes, eliminating the possibility of uniparental disomy as a mechanism for DMD expression. On the basis of methylation differences of the paternal and maternal X chromosomes in these MZ twins, we propose uneven lyonization (X chromosome inactivation) as the underlying mechanism for disease expression in the affected female.
