Development and Validation of a Model to Predict Neonatal Abstinence Syndrome.

OBJECTIVES: To develop and validate clinical risk prediction tools for neonatal abstinence syndrome (NAS). STUDY DESIGN: We developed prediction models for NAS based on a set of 30 demographic and antenatal exposure covariates collected during pregnancy. Data (outpatient prescription, vital, and administrative records), were obtained from enrollees in the Tennessee Medicaid Program from 2009 to 2014. Models were created using logistic regression and backward selection based on improvement in the Akaike information criterion, and internally validated using bootstrap cross-validation. RESULTS: A total of 218 020 maternal and infant dyads met inclusion criteria, of whom 3208 infants were diagnosed with NAS. The general population model included age, hepatitis C virus infection, days of opioid used by type, number of cigarettes used daily, and the following medications used in the last 30 day of pregnancy: bupropion, antinausea medicines, benzodiazepines, antipsychotics, and gabapentin. Infant characteristics included birthweight, small for gestational age, and infant sex. A high-risk model used a smaller number of predictive variables. Both models discriminated well with an area under the curve of 0.89 and were well-calibrated for low-risk infants. CONCLUSIONS: We developed 2 predictive models for NAS based on demographics and antenatal exposure during the last 30 days of pregnancy that were able to risk stratify infants at risk of developing the syndrome.

The Novel CYP2A6 Inhibitor, DLCI-1, Decreases Nicotine Self-Administration in Mice.

During tobacco and e-cigarette use, nicotine is mainly metabolized in the human liver by cytochrome P450 2A6 (CYP2A6). Given that a slower CYP2A6 metabolism has been associated with less vulnerability to develop nicotine dependence, the current studies sought to validate a novel CYP2A6 inhibitor, (5-(4-ethylpyridin-3-yl)thiophen-2-yl)methanamine (DLCI-1), for its effects on intravenous nicotine self-administration. Male and female mice were trained to self-administer nicotine across daily sessions. Once stable responding was achieved, DLCI-1 or vehicle control was administered prior to nicotine sessions. We found that the lower 25 mg/kg and moderate 50 mg/kg doses of DLCI-1 induced a significant decrease in nicotine intake for both males and females. DLCI-1 was further shown to be more effective than a moderate 1 mg/kg dose of bupropion on reducing nicotine intake and did not exert the adverse behavioral effects found with a high 75 mg/kg dose of bupropion. Although mice treated with DLCI-1 self-administered significantly less nicotine, similar nicotine-mediated behavioral effects on locomotion were observed. Together, along with the analysis of nicotine metabolites during self-administration, these findings support the contention that blocking hepatic nicotine metabolism would allow for similar activation of nicotinic acetylcholine receptors at lower nicotine doses. Moreover, these effects of DLCI-1 were specific to nicotine self-administration, as DLCI-1 did not result in any behavioral changes during food self-administration. Taken together, these studies validate DLCI-1 as a novel compound to decrease nicotine consumption, which may thereby promote tobacco and nicotine product cessation. SIGNIFICANCE STATEMENT: Current pharmacological approaches for nicotine and tobacco cessation have only been able to achieve limited efficaciousness in promoting long-term abstinence. In this work, we characterize the effects of a novel compound, (5-(4-ethylpyridin-3-yl)thiophen-2-yl)methanamine (DLCI-1), which inhibits the main enzyme that metabolizes nicotine, and we report a significant decrease in intravenous nicotine self-administration in male and female mice, supporting the potential of DLCI-1 as a novel tobacco cessation pharmacotherapeutic.

[The prevalence of strategies for cessation of tobacco use in primary health care: an integrative review]. / Prevalência de estratégias para cessação do uso do tabaco na Atenção Primária à Saúde: uma revisão integrativa.

The habit of tobacco use/smoking, which is a major concern of Primary Health Care (PHC), is a serious public health problem and the main avoidable cause of death in the world. The relevance of actions, whose focus is to facilitate the cessation of this habit, motivates the discussion of studies that have different approaches to tackle this issue by seeking to train PHC professionals accordingly. A search was conducted in the Lilacs, MEDLINE and Web of Science databases for recent scientific publications (2010-2015). The key words were combined with Boolean operators and, after analysis of the articles found, 75 are discussed in this article since they have strategies with a higher prevalence in PHC. The conclusion drawn is that the brief or intense individual approach using the 5A method (Transtheoretical Model) is the most widely adopted, as well as bupropion and nicotine replacement patches. The increasing use of hard technology requires new studies that examine their impact on the treatment of smokers. It was clearly revealed that there is a need for health professionals to be better prepared to address the issue with the users, in addition to a lack of stimulus and proper conditions to work in the PHC team directly reflecting scientific advances in clinical practice.

O hábito de fumar, ou tabagismo, preocupação da Atenção Primária à Saúde (APS), é um grave problema de saúde pública e a principal causa de morte evitável no mundo. A relevância de ações, cujo foco seja facilitar a cessação deste vício, motiva a discussão de estudos que apresentam diferentes abordagens para tal enfrentamento visando contribuir para a formação dos profissionais da APS. Utilizou-se as bases de dados Lilacs, Medline e Web of Science considerando as produções científicas recentes (2010 a 2015). Os descritores foram combinados a operadores boleanos e, após análise dos artigos encontrados, 75 são discutidos nesta revisão por apresentarem estratégias de maior prevalência na APS. Conclui-se que a abordagem individual breve ou intensa a partir do método dos 5A's (Modelo Transteórico) é a mais adotada, assim como os fármacos adesivos de Nicotina e Bupropiona. O uso crescente de tecnologia dura necessita de novos estudos que averiguem os seus impactos no tratamento a tabagistas. Evidenciou-se a necessidade de o profissional de saúde ser mais bem preparado para abordar o tema com os usuários, além de carecer do estímulo e das condições próprias para atuar na equipe de APS refletindo diretamente os avanços científicos em sua prática clínica.

SMOKING CESSATION TREATMENTS: CURRENT PSYCHOLOGICAL AND PHARMACOLOGICAL OPTIONS.

BACKGROUND: Smoking is considered an epidemic, indeed, one of the most important public health problems worldwide. It is also the most significant preventable cause of death, of a high number of premature deaths, and avoidable chronic diseases. It is considered an enormous economic burden for the world. OBJECTIVE: To provide an overview of smoking-cessation treatments, including pharmacological and psychological options, and to gather current scientific evidence available on them. METHODS: Research included reviewing publications from 2007-2018 in four databases using algorithms related to bupropion, varenicline, nicotine replacement therapy, smoking cessation, psychological treatment, motivational interview, cognitive-behavioral therapy and clinical guidelines for smoking treatment. Meta-analyses or systematic reviews and randomized or quasi-randomized trials were selected. We also included clinical guidelines for smoking treatment from Mexico and other countries. RESULTS: After refining the search, 37 articles met the criteria and were included in the review. The results were grouped by type of intervention. CONCLUSIONS: It is necessary to conduct research on combinations of both kinds of treatment with an integral, multidisciplinary vision. Current standard for smoking cessation is a combined psychological and pharmacological treatment.

Prevalência de estratégias para cessação do uso do tabaco na Atenção Primária à Saúde: uma revisão integrativa / The prevalence of strategies for cessation of tobacco use in primary health care: an integrative review

Resumo O hábito de fumar, ou tabagismo, preocupação da Atenção Primária à Saúde (APS), é um grave problema de saúde pública e a principal causa de morte evitável no mundo. A relevância de ações, cujo foco seja facilitar a cessação deste vício, motiva a discussão de estudos que apresentam diferentes abordagens para tal enfrentamento visando contribuir para a formação dos profissionais da APS. Utilizou-se as bases de dados Lilacs, Medline e Web of Science considerando as produções científicas recentes (2010 a 2015). Os descritores foram combinados a operadores boleanos e, após análise dos artigos encontrados, 75 são discutidos nesta revisão por apresentarem estratégias de maior prevalência na APS. Conclui-se que a abordagem individual breve ou intensa a partir do método dos 5A's (Modelo Transteórico) é a mais adotada, assim como os fármacos adesivos de Nicotina e Bupropiona. O uso crescente de tecnologia dura necessita de novos estudos que averiguem os seus impactos no tratamento a tabagistas. Evidenciou-se a necessidade de o profissional de saúde ser mais bem preparado para abordar o tema com os usuários, além de carecer do estímulo e das condições próprias para atuar na equipe de APS refletindo diretamente os avanços científicos em sua prática clínica.

Abstract The habit of tobacco use/smoking, which is a major concern of Primary Health Care (PHC), is a serious public health problem and the main avoidable cause of death in the world. The relevance of actions, whose focus is to facilitate the cessation of this habit, motivates the discussion of studies that have different approaches to tackle this issue by seeking to train PHC professionals accordingly. A search was conducted in the Lilacs, MEDLINE and Web of Science databases for recent scientific publications (2010-2015). The key words were combined with Boolean operators and, after analysis of the articles found, 75 are discussed in this article since they have strategies with a higher prevalence in PHC. The conclusion drawn is that the brief or intense individual approach using the 5A method (Transtheoretical Model) is the most widely adopted, as well as bupropion and nicotine replacement patches. The increasing use of hard technology requires new studies that examine their impact on the treatment of smokers. It was clearly revealed that there is a need for health professionals to be better prepared to address the issue with the users, in addition to a lack of stimulus and proper conditions to work in the PHC team directly reflecting scientific advances in clinical practice.

Smoking cessation treatments: current psychological and pharmacological options

Abstract Background Smoking is considered an epidemic, indeed, one of the most important public health problems worldwide. It is also the most significant preventable cause of death, of a high number of premature deaths, and avoidable chronic diseases. It is considered an enormous economic burden for the world. Objective To provide an overview of smoking-cessation treatments, including pharmacological and psychological options, and to gather current scientific evidence available on them. Methods Research included reviewing publications from 2007-2018 in four databases using algorithms related to bupropion, varenicline, nicotine replacement therapy, smoking cessation, psychological treatment, motivational interview, cognitive-behavioral therapy and clinical guidelines for smoking treatment. Meta-analyses or systematic reviews and randomized or quasi-randomized trials were selected. We also included clinical guidelines for smoking treatment from Mexico and other countries. Results After refining the search, 37 articles met the criteria and were included in the review. The results were grouped by type of intervention. Conclusions It is necessary to conduct research on combinations of both kinds of treatment with an integral, multidisciplinary vision. Current standard for smoking cessation is a combined psychological and pharmacological treatment.