E-learning course improves knowledge in tobacco dependence, electronic nicotine delivery systems and heat-not-burn products in Medical School students.

BACKGROUND: Adequate training in tobacco, nicotine dependence and treatment is lacking in Medical School education. With the rise in popularity of electronic alternatives to cigarettes, future physicians should also be provided with the more recent scientific evidence on these products during their undergraduate studies. We introduced an e-learning course for Medical School students and assessed its effec-tiveness of increasing knowledge on these topics. METHODS: We developed 16 didactic modules divided in 3 courses: tobacco dependence (TDI), treating tobacco dependence (TDII) and electronic products and tobacco control (TDIII). The course was offered to 4th, 5th, and 6th year Medical School students in Italy. To assess learning outcomes, we examined the pre- to post- changes in knowledge scores associated with each course. Paired and independent samples t-tests were performed overall, and among smokers and non-smokers separately. RESULTS: A total of 1318 students completed at least one of the courses; 21% were self-reported smokers. A significant increase in knowledge was observed at the end of TDI (pre-course: 52.1±15.9, post-course: 79.9±13.5, p<0.001), TDII (pre-course: 52.5±13.0, post-course: 66.5±12.0, p<0.001) and TDIII (pre-course: 52.2±15.3, post-course: 76.1±17.7, p<0.001). Smokers showed significantly lower improvements compared to non-smokers. CONCLUSIONS: The e-learning course was effective in increasing knowledge about tobacco dependence, treatments, and electronic ni-cotine products in advanced medical students. Given the fundamental role for healthcare practitioners in encouraging and assisting people in quitting smoking, e-learning may be a useful tool in providing up-to-date and standardized training in the area during Medical School.

Global Health Professions Student Survey among Healthcare students: a cross sectional study.

BACKGROUND: Healthcare professionals have the potential to influence patients' smoking status; however, their smoking habits and their opinions about tobacco use can hamper an effective counselling about smoking to patients. METHODS: A cross-sectional survey was carried out among healthcare students from the Sapienza University of Rome using a previously validated Italian version of Global Health Professions Student Survey (GHPSS) online questionnaire. RESULTS: Overall, 349 students filled out the online survey: 158 (45%) were current smokers and 191 (55%) were nonsmokers. Nurses students had the highest percentage of smokers (55%). Healthcare students declared they had learned about the health consequences about tobacco use during their academic course (90%), however, only 24% received specific training on smoking cessation. CONCLUSIONS: It is necessary to implement a smoking cessation course in the undergraduate curriculum in order to train healthcare professionals to provide patients an effective counselling against smoking.

Effectiveness of a training course on smoking cessation knowledge and behaviour for health profession students: the SISMA project.

INTRODUCTION: University students are at risk of starting smoking or continuing and increasing the consumption of tobacco products. The aim of the study was to assess the impact of the training course, Sisma Project, about smoking in healthcare degree courses, in terms of knowledge, behaviour and to evaluate the course. METHODS: SISMA project was a pre- post study about an intervention delivered to healthcare profession students about smoking and smoking cessation. It had a before-after design and was an online optional course available on the eLearning platform Moodle 2. The course was structured in four lessons of sixty minutes, a debate among experts and a final test of evaluation. The McNemar test was used to measure the effectiveness of Sisma on smoking behaviour of students after the intervention. Students rated the course assigning a score from one to ten, and expressed free comments about point of strength and weakness of Sisma project. RESULTS: The participants were 365 students, 28.5% males and 71.5% females, most were nursing 194 (53.2%) and dental hygienists students 105 (28.8%). Current smokers were 161 (44.1%) before and 142 (38.9%) after the course, there was statistical significant difference in smoking status after attending the course (p < 0.001). Students evaluated the course giving a high score with a mean of 8.13 (SD: 1.1); the main points of strength were the content (33.2%), the structure (15.6%) and knowledge given by the course (12.6%). The main point of weakness were the online structure 62 (37%), problem related to length and time 17 (10%) and the final test 15 (9%). DISCUSSION: Given the central role health professionals play in patient care, students need to be aware and trained in tobacco cessation techniques. Our results indicate that smoking behaviour significantly changed after attending a university course for smoking cessation and students appreciated its contents and structure.

Smoking E-CigaRette and HEat-noT-burn products: validation of the SECRHET questionnaire.

BACKGROUND: The nicotine market has rapidly evolved with the emergence of newer forms of smoking device that have been expanded worldwide, such as electronic cigarettes (eCig) which heat a solution (e-liquid) to create vapour and heat-not-burn (HNB) tobacco products, which heats tobacco at a temperature below the point of combustion. Their use is increasing at an alarming rate; it is believed it will surpass the use of traditional cigarettes in next 5 years, mostly among never-smokers and young people. OBJECTIVE: There are not many studies investigating knowledge and behaviour about heat tobacco products (HTP) among teenagers, so the aim of this study is to validate the SECRHET questionnaire (Smoking E-CigaRette and HEat-noT-burn products) on knowledge and behaviour on cigarette and HTP among youth. METHODS: The study was conducted in February and March 2019 inside Sapienza University of Rome and high school Giulio Cesare of Rome. A self-administered anonymous questionnaire was performed to investigate smoking habits and measures knowledge about HTP among Italian teenagers. OUTCOMES: A sample of 60 students took part in the validation of the questionnaire. The overall Cronbach's alpha was 0,635, corresponding to a sufficient reliability. CONCLUSIONS: There is little or no data on consumption or perceptions of HTP products among youth and evidence suggests the usefulness of a standardized and validated questionnaire available to monitoring of awareness, interest in trying and prevalence of use of these novel products among young people.

Knowledge of nicotine dependence and treatment in clinical practice improved after an e-learning course among medical students.

OBJECTIVE: Tobacco smoking is the leading cause of preventable death in developed countries and smokers should be encouraged to quit. Physicians are instrumental in this, but recent reports suggest inadequate training in medical school. We aimed to assess the knowledge of nicotine dependence and its treatment among Italian medical students. STUDY DESIGN: Prospective observational study. METHODS: We developed an online course consisting of 11 Didactic Modules (6 for Tobacco Dependence I, TDI, and 5 for TDII) on nicotine dependence and treatment. The course was administered to 4th and 5th year medical students in Italy in Academic Years 2016-17 (Course A) and 2017-18 (Course B). A validated questionnaire was used before and after each part in order to measure knowledge of smoking epidemiology, health effects and benefits of giving up smoking ("Score 1", TDI), and effectiveness of cessation treatments ("Score 2", TDII). RESULTS: 324 students took both TDI and TDII and completed all questionnaires (Course A, n = 245; Course B, n = 79). 55 students were current smokers (17%). A significant increase in score 1 and 2 was observed at the end of both TDI (pre-course 47.2±13.1, post-course 66.0±12.3, p <0.0001) and TDII (pre-course 55.6±11.5, post-course 68.1±10.9, p <0.0001). The prevalence of students wishing for a smoke-free medical school significantly increased between the beginning of TDI (74.4%, 241/324) and the end of TDII (88%, 285/324; p <0.0001). CONCLUSIONS: This e-learning course has proven to be an effective tool in teaching students on nicotine dependence and treatment.

The synergistic effect between Positivity, socio-demographic factors and smoking cessation: results of a cohort study.

OBJECTIVE: To examine the extent to which a effect does exist between Positivity (POS), smoking and socio-demographic factors in determining quitting smoking in subjects participating in a Group Counselling Program (GCP) for smoking cessation. METHODS: 481 subjects were contacted through a telephone call. A logistic regression analysis was carried out. Possible interaction between sociodemographic variables and POS level was tested using the Synergism Index (SI). RESULTS: For individuals with a POS level over or equal to 3.4 the odds of being smoker was significantly higher among females (OR = 1.55), who smoked at home (OR = 2.16) and lower if there had children at home (OR = 0.53). For individuals with a POS level under 3.4, the only significant variable associated with smoking was beinga female (OR = 2.58). As far concerns the synergistic effect between the variables considered does exist between POS levels and having children at home (SI=1.13) and female gender (SI = 2.8). CONCLUSIONS: The synergistic effect between POS and sociodemographic factors adds evidence on the use of POS as possible determinants of individual happiness.

Smoking cessation practice among family doctors in Lithuania: a Survey.

OBJECTIVES: Relatively low proportion of ex-smokers and high rates of smoking-related diseases are estimated in Lithuania. The aim of this survey was to assess the extent of smoking cessation assistance among family doctors in Lithuania, and to identify factors associated with cessation interventions. MATERIALS AND METHODS: Data were collected using a questionnaire addressing family doctors' cessation assistance practice; knowledge of smoking epidemiology and health effects; knowledge of cessation assistance guidelines; smoking status; and attendance on Courses/Conferences on Smoking and smoking cessation Assistance (CCSA). The study included 718 family doctors in Lithuania in 2014. RESULTS: The results show that 23% of family doctors always ask their patients about smoking habits. Although 59% of family doctors always advise smoking patients to quit smoking, only 26% recommend a follow-up appointment, 22% refer for a specialized smoking cessation treatment, 15% prescribe nicotine replacement therapy, and 6% prescribe Varenicline or Bupropion. The study demonstrated limited knowledge of family doctors in relation to epidemiological aspects of tobacco use and effective cessation assistance methods. Cessation assistance is influenced by family doctors' age, smoking status, knowledge of cessation assistance guidelines and CCSA attendance. CONCLUSIONS: Effective training of family doctors' in smoking epidemiology, health hazards and in smoking cessation assistance is warranted in Lithuania. In addition, coordinated efforts in primary health care institutions are required to improve help for smokers who intend to quit.

Artificial neural network assessment of substitutive pharmacological treatments in hospitalised intravenous drug users.

Artificial neural networks (ANNs) provide better solutions than linear discriminant analysis (LDA) to problems of classification and estimation involving a large number of non-homogeneous (categorical and metric) variables. In this study, we compared the ability of traditional LDA and a feed-forward back-propagation (FF-BP) ANN with self-momentum to predict pharmacological treatments received by intravenous drug users (IDUs) hospitalised for coexisting medical illness. When medical staff considered detoxification appropriate they usually suggested methadone (MET) and (or) benzodiazepines (BDZ). Given four different treatment options (MET, BDZ, MET+BDZ, no treatment) as dependent variables and 38 independent variables, the FF-BP ANN provided the best prediction of the consultant's decision (overall accuracy: 62.7%). It achieved the highest level of predictive accuracy for the BDZ option (90.5%), the lowest for no treatment (29.6), often misclassifying no treatment as BDZ. The LDA yielded a lower mean accuracy (50.3%). When the untreated group was excluded, ANN improved its absolute recognition rate by only 1.2% and the BDZ group remained the best predicted. In contrast, LDA improved its absolute recognition rate from 50.3 to 58.9%, maximum 65.7% for the BDZ group. In conclusion, the FF-BP ANN was more accurate than the statistical model (discriminant analysis) in predicting the pharmacological treatment of IDUs.

Analysis of cocaethylene, benzoylecgonine and cocaine in human urine by high-performance thin-layer chromatography with ultraviolet detection: a comparison with high-performance liquid chromatography.

Cocaine and ethanol are frequently used at the same time, resulting in the formation of cocaethylene by transesterification. We studied the capability of high-performance thin-layer chromatography (HPTLC) to simultaneously detect cocaethylene, cocaine and benzoylecgonine in 16 urine specimens of drug addicts, previously tested as positive for benzoylecgonine at immunoenzymatic screening. Accuracy and precision, as well as detection and quantitation limits of the method, were evaluated by comparison with high-performance liquid chromatography (HPLC). HPTLC limit of quantitation was 1.0 microg/ml for the three compounds, whereas HPLC limits were 0.2 microg/ml for benzoylecgonine and cocaine, and 0.1 microg/ml for cocaethylene. The relative standard deviation (RSD) ranged from 1.03 to 12.60% and from 1.56 to 16.6% for intra- and inter-day HPTLC analysis, respectively. In the case of the HPLC method, the RSD for the intra-day precision ranged from 0.79 to 5.05%, whereas it ranged from 1.19 to 10.64% for the inter-day precision. In comparison with HPLC, HPTLC is less expensive and faster, requiring 2-3 h to analyze 10-12 samples on a single plate. In conclusion, HPTLC is suitable for determinations of the three analytes only for samples with high concentrations.

[Toxicologic approach to the clinical aspects of drug dependence: rational choice of dependence evaluation scales]. / L'approccio tossicologico alla clinica delle tossicodipendenze: scelta ragionata delle scale di intensità della dipendenza.

Fast but reliable approaches to evaluate the dependence syndrome to psychoactive substances are needed, particularly in those environmental conditions that do not allow a long interview with the drug addict. In this direction, easy to be administered questionnaires have been recently proposed. We used some of these questionnaires, such as SDS (severity of dependence scale) CAGE (cut down, annoyed, guilty, eye-opener) and VAS (visual analogical scales) in association with scales for clinical quantitation of alcohol and opiate withdrawal syndrome, to study a sample of 87 heroin addicts. Answers obtained were compared with clinical examination data and specific laboratory determinations. Our preliminary results demonstrate that the use of fast evaluation scales represents a reliable approach to estimate the dependence syndrome as well as to identify pharmacological therapies to be administered.

Illicit use of methadone in heroin addicts in Rome.

Although in several countries heroin addicts have been found to engage in illicit use of methadone, no studies have been addressed to this behavior in Italy. The present study gives evidence that methadone dispensed by public health services in Rome is paralleled by a black market in this drug. Of sixty-five heroin addicts hospitalized for medical or surgical problems, the majority (89.2%) referred to the existence of an illicit methadone market in Rome, and 38% used it. When asked why they bought illicit methadone the addicts stated that the daily dose obtainable from public health services was inadequate. However this statement is in contrast with the evidence that the heroin addicts using illicit methadone had highest daily doses similar to those of heroin addicts not referring to the illicit methadone market. We wonder whether illicit use of methadone is influenced by the therapeutic benefit that addicts expect to obtain from methadone. These "expectations" may lead heroin addicts to extend consumption of methadone to alleviate problems altogether unrelated to the withdrawal syndrome. If so, the illicit market in methadone may be sustained not by the drug's addictive properties but by its therapeutic effects.

Khat chewing spread to the Somali community in Rome.

The habit of chewing Khat (Catha edulis) to experience its euphorizing and psychostimulant effects has prevailed for centuries among the inhabitants of the Horn of Africa and the Arabian peninsula. In recent years, air transport has removed the major obstacle to the diffusion of Khat, its perishableness. Khat is now air-freighted to Europe and we were able to buy some in Rome. We report the results of interviews with 20 members of the Somali community in Rome, who had continued their habit of chewing Khat whilst abroad. They asserted that they gathered together whenever possible, but preferably at weekends, to chew moderate quantities of Khat (one bundle, about 400 g). The customary habit of drinking tea or other soft drinks containing methylxantines during Khat sessions was maintained and very few subjects admitted drinking alcohol. In this small study sample, Khat chewing still seems to be a social event, as it is in Somalia.

Effect of nimodipine on drinking behavior measured in the runway: comparison and interaction with (+/-)-amphetamine.

The aim of the present study was to evaluate the ability of the calcium channel blocker (CCE), nimodipine (NIM), to interact with (+/-)-amphetamine (AMPH) in modifying ingestive behavior. Rats performed in a water-reinforced runway paradigm with multiple trials. Water was available in sufficient quantity to produce satiety under control conditions as measured by a decline in response rate over the session. NIM and AMPH, given alone, did not produce significant effects on performance but produced behavioral changes when administered in combination. In particular, the combination of the highest doses (13 mg/kg i.p. NIM plus 0.56 mg/kg i.p. AMPH) initially depressed both running and drinking, whereas in later trials it increased running rate, without producing a parallel increase in water intake. These results suggest that NIM enhances AMPH-produced inhibition of drinking, whereas it first depresses and then enhances the AMPH-mediated runway performance, suggesting the rate dependency of this latter effect.

[Glucose-6-phosphate dehydrogenase deficiency in a general hospital of Salvador, Bahia, Brazil (author's transl)]. / Deficiência de glicose-6-fosfato desidrogenase em pacientes de um hospital geral de Salvador, Bahia, Brasil.

Eight hundreds and fifteen patients of the Prof. Edgard Santos Hospital, Salvador, Bahia, were studied for G6PD deficiency by the spot test. The frequencies of deficients were 11,39% for the blacks, 7,85% for the dark mulattoes and 6,98% for the medium mulattoes. There was no difference in the percentage of deficients between out patients and patients in the wards. Also, there was no difference in the means for hematocrit, hemoglobin, frequency of hospitalization and type of disease between patients with the deficiency and the control patients. However, a past history for jaundice was significantly more frequent among the deficient patients (22,22%) than among the control patients (12,76%) (x 2(1) = 4,43; p less than 0,03). These results suggest that, in Northeastern Brazil, G6PD deficiency is not severe enough to require hospitalization but is able to cause clinically detectable jaundice.