Improving smoking cessation after myocardial infarction by systematically implementing evidence-based treatment methods.

We compared the odds of smoking cessation at 2-months post-myocardial infarction (MI), before and after implementing routines optimizing use of evidence-based smoking cessation methods, with start during admission. The following routines were implemented at six Swedish hospitals: cardiac rehabilitation nurses offering smokers consultation during admission, optimizing nicotine replacement therapy and varenicline prescription, and contacting patients by telephone during the 1st week post-discharge. Using logistic regression, odds for smoking cessation at 2-months before (n smokers/n admitted = 188/601) and after (n = 195/632) routine implementation were compared. Secondary outcomes included adherence to implemented routines and assessing the prognostic value of each routine on smoking cessation. After implementation, a larger proportion of smokers (65% vs. 54%) were abstinent at 2-months (OR 1.60 [1.04-2.48]). Including only those counselled during admission (n = 98), 74% were abstinent (2.50 [1.42-4.41]). After implementation, patients were more often counselled during admission (50% vs. 6%, p < 0.001), prescribed varenicline (23% vs. 7%, p < 0.001), and contacted by telephone post-discharge (18% vs. 2%, p < 0.001). Being contacted by telephone post-discharge (adjusted OR 2.74 [1.02-7.35]) and prescribed varenicline (adjusted OR 0.39 [0.19-0.83]) predicted smoking cessation at 2-months. In conclusion, readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with beneficial effects for post-MI patients.

[Nicotine, alcohol and opioids - three interacting substances]. / Mycket stora hälsovinster med att förhindra ungas tobaksdebut.

Nicotine users are at greater risk of developing alcohol dependence. Conversely, alcohol is often consumed when young people test tobacco. The prevalence of smokers is high among alcohol dependent individuals and people who overconsume alcohol get more nicotine withdrawal symptoms when trying to quit tobacco and are less likely to succeed. Alcohol as well as smoking provides a high burden of disease, and combined use often causes multiplier damage effects. Alcohol dependent persons die more often from smoking-related illness than from alcohol. Nicotine cessation is more successful if alcohol advice is included. Cross-tolerance and other interactions between nicotine and opioids increase the likelihood of dependence. Tobacco smokers need higher opioid doses against pain. Despite evidence of association between smoking and chronic pain, understanding of causality is limited. Smoking is associated with an increased risk of opioid dependence. Nicotine is recognized as an important underlying factor. Further research in humans concerning the interactions between nicotine and opioids is urgent. Treatment of nicotine dependence in the medical management of opioid dependence seems promising, but at what point in the course - simultaneously, shortly after, or far behind - has yet to be determined.

Effectiveness of tobacco cessation interventions for different groups of tobacco users in Sweden: a study protocol for a national prospective cohort study.

INTRODUCTION: Tobacco is still one of the single most important risk factors among the lifestyle habits that cause morbidity and mortality in humans. Furthermore, tobacco has a heavy social gradient, as the consequences are even worse among disadvantaged and vulnerable groups. To reduce tobacco-related inequity in health, those most in need should be offered the most effective tobacco cessation intervention. The aim of this study is to facilitate and improve the evaluation of already implemented national tobacco cessation efforts, focusing on 10 disadvantaged and vulnerable groups of tobacco users. METHODS AND ANALYSIS: This is a prospective cohort study. Data will be collected by established tobacco cessation counsellors in Sweden. The study includes adult tobacco or e-cigarette users, including disadvantaged and vulnerable patients, receiving in-person interventions for tobacco or e-cigarette cessation (smoking, snus and/or e-cigarettes). Patient inclusion was initiated in April 2020. For data analyses patients will be sorted into vulnerable groups based on risk factors and compared with tobacco users without the risk factor in question.The primary outcome is continuous successful quitting after 6 months, measured by self-reporting. Secondary outcomes include abstinence at the end of the treatment programme, which could be from minutes over days to weeks, 14-day point prevalence after 6 months, and patient satisfaction with the intervention. Effectiveness of successful quitting will be examined by comparing vulnerable with non-vulnerable patients using a mixed-effect logistic regression model adjusting for potential prognostic factors and known confounders. ETHICS AND DISSEMINATION: The project will follow the guidelines from the Swedish Data Protection Authority and have been approved by the Swedish Ethical Review Authority before patient inclusion (Dnr: 2019-02221). Only patients providing written informed consent will be included. Both positive and negative results will be published in scientific peer-reviewed journals and presented at national and international conferences. Information will be provided through media available to the public, politicians, healthcare providers and planners as these are all important stakeholders. TRIAL REGISTRATION NUMBER: NCT04819152.

Occupation, socioeconomic status and chronic obstructive respiratory diseases - The EpiLung study in Finland, Estonia and Sweden.

OBJECTIVE: To study occupational groups and occupational exposure in association with chronic obstructive respiratory diseases. METHODS: In early 2000s, structured interviews on chronic respiratory diseases and measurements of lung function as well as fractional expiratory nitric oxide (FENO) were performed in adult random population samples of Finland, Sweden and Estonia. Occupations were categorized according to three classification systems. Occupational exposure to vapours, gases, dusts and fumes (VGDF) was assessed by a Job-Exposure Matrix (JEM). The data from the countries were combined. RESULTS: COPD, smoking and occupational exposure were most common in Estonia, while asthma and occupations requiring higher educational levels in Sweden and Finland. In an adjusted regression model, non-manual workers had a three-fold risk for physician-diagnosed asthma (OR 3.18, 95%CI 1.07-9.47) compared to professionals and executives, and the risk was two-fold for healthcare & social workers (OR 2.28, 95%CI 1.14-4.59) compared to administration and sales. An increased risk for physician-diagnosed COPD was seen in manual workers, regardless of classification system, but in contrast to asthma, the risk was mostly explained by smoking and less by occupational exposure to VGDF. For FENO, no associations with occupation were observed. CONCLUSIONS: In this multicenter study from Finland, Sweden and Estonia, COPD was consistently associated with manual occupations with high smoking prevalence, highlighting the need to control for tobacco smoking in studies on occupational associations. In contrast, asthma tended to associate with non-manual occupations requiring higher educational levels. The occupational associations with asthma were not driven by eosinophilic inflammation presented by increased FENO.

Parallel gradients in FENO and in the prevalences of asthma and atopy in adult general populations of Sweden, Finland and Estonia - A Nordic EpiLung study.

The prevalence of asthma is higher in Sweden and Finland than in neighbouring eastern countries including Estonia. Corresponding difference in bronchial eosinophilic inflammation could be studied by FENO measurements. We aimed to compare FENO in adult general populations of Sweden, Finland, and Estonia, to test the plausibility of the west-east disparity hypothesis of allergic diseases. We conducted clinical interviews (N = 2658) with participants randomly selected from the general populations in Sweden (Stockholm and Örebro), Finland (Helsinki), and Estonia (Narva and Saaremaa), and performed FENO (n = 1498) and skin prick tests (SPT) in 1997-2003. The median (interquartile range) of FENO (ppb) was 15.5 (9.3) in Sweden, 15.4 (13.6) in Finland and 12.5 (9.6) in Estonia. We found the lowest median FENO values in the Estonian centres Saaremaa 13.1 (9.5) and Narva 11.8 (8.6). In the pooled population, asthma was associated with FENO ≥25 ppb, odds ratio (OR) 3.91 (95% confidence intervals: 2.29-6.32) after adjusting for SPT result, smoking, gender and study centre. A positive SPT test increased the likelihood of asthma OR 3.19 (2.02-5.11). Compared to Saaremaa, the likelihood of having asthma was higher in Helsinki OR 2.40 (1.04-6.02), Narva OR 2.45 (1.05-6.19), Örebro OR 3.38 (1.59-8.09), and Stockholm OR 5.54 (2.18-14.79). There was a higher prevalence of asthma and allergic airway inflammation in adult general populations of Sweden and Finland compared to those of Estonia. Atopy and elevated FENO level were independently associated with an increased risk of asthma. In conclusion, the findings support the earlier west-east disparity hypothesis of allergic diseases.

Spirometry to increase smoking cessation rate: A systematic review.

INTRODUCTION: Addressing tobacco use is an important issue in general health care. In order to improve smoking cessation advice, spirometry values can be displayed to the smoker to demonstrate possible lung function impairment. The estimate of so-called lung age may show a decrease in lung function associated with smoking. It has been suggested that performing spirometry on patients who smoke but are asymptomatic can be a useful way to show the adverse effects of smoking. The aim of this systematic review was to determine if providing spirometry results in combination with smoking cessation counselling can increase smoking cessation rates compared to what is achieved through counselling alone. METHODS: In this systematic review, we included randomized controlled trials (RCTs) evaluating smoking cessation interventions for adult smokers. The systematic search was performed in PubMed, Medline, Cochrane Library, Cinahl, Embase, Amed and PsycInfo. RESULTS: The literature search resulted in 946 studies, which, after reading by two independent reviewers, were reduced to seven trials that matched the inclusion criteria. Two RCTs showed significant improvement in smoking cessation when giving patients feedback on spirometry results in combination with smoking cessation counselling, compared to patients who received only smoking cessation counselling. In both studies, the spirometry results were expressed as lung age. In the other five studies no difference was found. Five further published study protocols for ongoing RCT studies in the field have been found, and therefore this systematic overview will likely need to be updated within a few years. CONCLUSIONS: Few studies have been undertaken to examine the efficacy of spirometry in increasing smoking quit rates. Studies conducted to date have shown mixed results, and there is currently limited evidence in the literature that smoking cessation counselling that includes feedback from spirometry and a demonstration of lung age promotes quit rates.

Is the Capacity for Vocal Learning in Vertebrates Rooted in Fish Schooling Behavior?

The capacity to learn and reproduce vocal sounds has evolved in phylogenetically distant tetrapod lineages. Vocal learners in all these lineages express similar neural circuitry and genetic factors when perceiving, processing, and reproducing vocalization, suggesting that brain pathways for vocal learning evolved within strong constraints from a common ancestor, potentially fish. We hypothesize that the auditory-motor circuits and genes involved in entrainment have their origins in fish schooling behavior and respiratory-motor coupling. In this acoustic advantages hypothesis, aural costs and benefits played a key role in shaping a wide variety of traits, which could readily be exapted for entrainment and vocal learning, including social grouping, group movement, and respiratory-motor coupling. Specifically, incidental sounds of locomotion and respiration (ISLR) may have reinforced synchronization by communicating important spatial and temporal information between school-members and extending windows of silence to improve situational awareness. This process would be mutually reinforcing. Neurons in the telencephalon, which were initially involved in linking ISLR with forelimbs, could have switched functions to serve vocal machinery (e.g. mouth, beak, tongue, larynx, syrinx). While previous vocal learning hypotheses invoke transmission of neurons from visual tasks (gestures) to the auditory channel, this hypothesis involves the auditory channel from the onset. Acoustic benefits of locomotor-respiratory coordination in fish may have selected for genetic factors and brain circuitry capable of synchronizing respiratory and limb movements, predisposing tetrapod lines to synchronized movement, vocalization, and vocal learning. We discuss how the capacity to entrain is manifest in fish, amphibians, birds, and mammals, and propose predictions to test our acoustic advantages hypothesis.

Effects of sounds of locomotion on speech perception.

Human locomotion typically creates noise, a possible consequence of which is the masking of sound signals originating in the surroundings. When walking side by side, people often subconsciously synchronize their steps. The neurophysiological and evolutionary background of this behavior is unclear. The present study investigated the potential of sound created by walking to mask perception of speech and compared the masking produced by walking in step with that produced by unsynchronized walking. The masking sound (footsteps on gravel) and the target sound (speech) were presented through the same speaker to 15 normal-hearing subjects. The original recorded walking sound was modified to mimic the sound of two individuals walking in pace or walking out of synchrony. The participants were instructed to adjust the sound level of the target sound until they could just comprehend the speech signal ("just follow conversation" or JFC level) when presented simultaneously with synchronized or unsynchronized walking sound at 40 dBA, 50 dBA, 60 dBA, or 70 dBA. Synchronized walking sounds produced slightly less masking of speech than did unsynchronized sound. The median JFC threshold in the synchronized condition was 38.5 dBA, while the corresponding value for the unsynchronized condition was 41.2 dBA. Combined results at all sound pressure levels showed an improvement in the signal-to-noise ratio (SNR) for synchronized footsteps; the median difference was 2.7 dB and the mean difference was 1.2 dB [P < 0.001, repeated-measures analysis of variance (RM-ANOVA)]. The difference was significant for masker levels of 50 dBA and 60 dBA, but not for 40 dBA or 70 dBA. This study provides evidence that synchronized walking may reduce the masking potential of footsteps.

Tool-use-associated sound in the evolution of language.

Proponents of the motor theory of language evolution have primarily focused on the visual domain and communication through observation of movements. In the present paper, it is hypothesized that the production and perception of sound, particularly of incidental sound of locomotion (ISOL) and tool-use sound (TUS), also contributed. Human bipedalism resulted in rhythmic and more predictable ISOL. It has been proposed that this stimulated the evolution of musical abilities, auditory working memory, and abilities to produce complex vocalizations and to mimic natural sounds. Since the human brain proficiently extracts information about objects and events from the sounds they produce, TUS, and mimicry of TUS, might have achieved an iconic function. The prevalence of sound symbolism in many extant languages supports this idea. Self-produced TUS activates multimodal brain processing (motor neurons, hearing, proprioception, touch, vision), and TUS stimulates primate audiovisual mirror neurons, which is likely to stimulate the development of association chains. Tool use and auditory gestures involve motor processing of the forelimbs, which is associated with the evolution of vertebrate vocal communication. The production, perception, and mimicry of TUS may have resulted in a limited number of vocalizations or protowords that were associated with tool use. A new way to communicate about tools, especially when out of sight, would have had selective advantage. A gradual change in acoustic properties and/or meaning could have resulted in arbitrariness and an expanded repertoire of words. Humans have been increasingly exposed to TUS over millions of years, coinciding with the period during which spoken language evolved. ISOL and tool-use-related sound are worth further exploration.

Self-generated sounds of locomotion and ventilation and the evolution of human rhythmic abilities.

It has been suggested that the basic building blocks of music mimic sounds of moving humans, and because the brain was primed to exploit such sounds, they eventually became incorporated in human culture. However, that raises further questions. Why do genetically close, culturally well-developed apes lack musical abilities? Did our switch to bipedalism influence the origins of music? Four hypotheses are raised: (1) Human locomotion and ventilation can mask critical sounds in the environment. (2) Synchronization of locomotion reduces that problem. (3) Predictable sounds of locomotion may stimulate the evolution of synchronized behavior. (4) Bipedal gait and the associated sounds of locomotion influenced the evolution of human rhythmic abilities. Theoretical models and research data suggest that noise of locomotion and ventilation may mask critical auditory information. People often synchronize steps subconsciously. Human locomotion is likely to produce more predictable sounds than those of non-human primates. Predictable locomotion sounds may have improved our capacity of entrainment to external rhythms and to feel the beat in music. A sense of rhythm could aid the brain in distinguishing among sounds arising from discrete sources and also help individuals to synchronize their movements with one another. Synchronization of group movement may improve perception by providing periods of relative silence and by facilitating auditory processing. The adaptive value of such skills to early ancestors may have been keener detection of prey or stalkers and enhanced communication. Bipedal walking may have influenced the development of entrainment in humans and thereby the evolution of rhythmic abilities.

The optic chiasm: a turning point in the evolution of eye/hand coordination.

The primate visual system has a uniquely high proportion of ipsilateral retinal projections, retinal ganglial cells that do not cross the midline in the optic chiasm. The general assumption is that this developed due to the selective advantage of accurate depth perception through stereopsis. Here, the hypothesis that the need for accurate eye-forelimb coordination substantially influenced the evolution of the primate visual system is presented. Evolutionary processes may change the direction of retinal ganglial cells. Crossing, or non-crossing, in the optic chiasm determines which hemisphere receives visual feedback in reaching tasks. Each hemisphere receives little tactile and proprioceptive information about the ipsilateral hand. The eye-forelimb hypothesis proposes that abundant ipsilateral retinal projections developed in the primate brain to synthesize, in a single hemisphere, visual, tactile, proprioceptive, and motor information about a given hand, and that this improved eye-hand coordination and optimized the size of the brain. If accurate eye-hand coordination was a major factor in the evolution of stereopsis, stereopsis is likely to be highly developed for activity in the area where the hands most often operate.The primate visual system is ideally suited for tasks within arm's length and in the inferior visual field, where most manual activity takes place. Altering of ocular dominance in reaching tasks, reduced cross-modal cuing effects when arms are crossed, response of neurons in the primary motor cortex to viewed actions of a hand, multimodal neuron response to tactile as well as visual events, and extensive use of multimodal sensory information in reaching maneuvers support the premise that benefits of accurate limb control influenced the evolution of the primate visual system. The eye-forelimb hypothesis implies that evolutionary change toward hemidecussation in the optic chiasm provided parsimonious neural pathways in animals developing frontal vision and visually guided forelimbs, and also suggests a new perspective on vision convergence in prey and predatory animals.

Incidental sounds of locomotion in animal cognition.

The highly synchronized formations that characterize schooling in fish and the flight of certain bird groups have frequently been explained as reducing energy expenditure. I present an alternative, or complimentary, hypothesis that synchronization of group movements may improve hearing perception. Although incidental sounds produced as a by-product of locomotion (ISOL) will be an almost constant presence to most animals, the impact on perception and cognition has been little discussed. A consequence of ISOL may be masking of critical sound signals in the surroundings. Birds in flight may generate significant noise; some produce wing beats that are readily heard on the ground at some distance from the source. Synchronization of group movements might reduce auditory masking through periods of relative silence and facilitate auditory grouping processes. Respiratory locomotor coupling and intermittent flight may be other means of reducing masking and improving hearing perception. A distinct border between ISOL and communicative signals is difficult to delineate. ISOL seems to be used by schooling fish as an aid to staying in formation and avoiding collisions. Bird and bat flocks may use ISOL in an analogous way. ISOL and interaction with animal perception, cognition, and synchronized behavior provide an interesting area for future study.

Binocular vision and ipsilateral retinal projections in relation to eye and forelimb coordination.

It is commonly proposed that the number of fibers that do not cross in the optic chiasm (OC) is proportional to the size of the binocular visual field, and that the major advantage of binocular vision is acute depth perception. I present an alternative, an 'eye-forelimb' (EF) hypothesis, suggesting that alterations in the OC influence the length of neural pathways that transmit visual information to motor nuclei and somatosensory areas involved in forelimb coordination. Evolutionary processes resulting in increased ipsilateral retinal projections (IRP) are of adaptive value in animals that regularly use the forelimbs in a frontal position, while evolutionary change towards reduced IRP is of value for animals that mainly use the forelimbs in lateral positions. Primates and cats, to a large extent, use visually guided forelimb maneuvers, and both groups have high proportions of IRP. The fact that vertebrates' IRP arise exclusively from the temporal retina supports the hypothesis, since IRP from the nasal retina would increase the length of neural pathways involved in forelimb coordination. The EF hypothesis offers new perspectives on why a high proportion of IRP among early limbless vertebrates became reduced during the evolution of laterally situated limbs, and why reptiles that lost their limbs (snakes) evolved more IRP. Anatomical, neurophysiological, phylogenetic, ontogenetic and ecological data suggest that mutations changing the proportions of ipsilateral visual connections in the OC may have selective value for EF coordination.