Heavy dependent nicotine smokers--Newfound lifestyle appreciation after quitting successfully. Experiences from inpatient smoking cessation therapy.

OBJECTIVES: This is an evaluation of an ongoing inpatient smoking cessation program available in Austria and aims to show to what extent even heavy nicotine dependent smokers can benefit from a three-week inpatient therapy. STUDY DESIGN: A particular focus lies on analyzing the benefits and changes in lifestyle and sense of well-being. METHODS: 270 initially heavy nicotine dependent smokers are observed for a one year period consisting of recruitment, therapy and two post-therapy follow-up visits; post program smokers are compared to post program ex-smokers. RESULTS: 12 month post-therapy, 42.6% of participants are identified by carbon monoxide-verifications as ex-smokers, 34% as smokers and the remaining did not attend follow-up visits. Significant changes in lifestyle satisfaction are reported by ex-smokers compared to still smokers. CONCLUSIONS: Convincing heavy dependent nicotine smokers that significant changes in lifestyle satisfaction can be expected as part of a successful cessation process should lead to enough motivation for these individuals to seek such inpatient smoking cessation program.

[Health awareness as dominating impact factor on the development of overweight--a health questionnaire among the rural population of Austria]. / Gesundheitsbewusstsein als dominierender Einflussfaktor auf die Entstehung von Übergewicht--eine Gesundheits-befragung bei der bäuerlichen Bevölkerung Österreichs.

Using a health survey among the rural population of Austria (n=12,484), risk factors for overweight and obesity are analysed. Health awareness turned out as essential mediator, which helps to promote a weight-stabilising life-style. An adverse health behaviour is often due to an unrealistic assessment of a risky overweight condition in connection with a negative attitude to reduce weight. Target groups should be informed about the clearly better health status in normal weight compared with that in overweight and obese people, in order to raise health awareness and motivate people at risk to undergo a modification of their life-style.

[Psychosocial characteristics of deaf people: evaluation of data from a special outpatient clinic for the deaf]. / Psychosoziale Merkmale bei Gehörlosen Daten aus einer Spezialambulanz für Gehörlose.

In this publication, data from a special outpatient clinic for deaf patients in a general hospital are presented. All members of the treatment team have competency in sign language. From the patients who consecutively attended the outpatient clinic, 352 were investigated for medical and psychosocial problems. In social contacts, there is a strong orientation towards other deaf people, and communication is mainly based on sign language. Of the deaf patients, 85% of their partners are also deaf, whereas only 10.1% of children of the deaf group are also deaf. The prevalence of selected psychiatric disorders (ICD 10 F1, F2, F3, F4, F6) in deaf people was found to be similar to that in hearing populations, with the exception of somatoform disorders, which seem to be more frequent in the deaf. Deaf people also more often present with somatic and other complaints such as nervousness, anxiety, and stress. With specific outpatient clinics for the deaf in which members of the therapeutic team are competent in sign language, access to health services is equally possible for deaf people.

The COMpliance Praxis Survey (COMPASS): a multidimensional instrument to monitor compliance for patients on antihypertensive medication.

Low compliance is suspected as a major reason for treatment failure in hypertensive patients. To identify patients with low compliance at the commencement of antihypertensive treatment, the compliance praxis survey (COMPASS) was utilised. A total of 161 physicians identified 2389 hypertensive patients treated by ACE-inhibitor. The physicians rated the compliance of the patients at baseline and at 6-month follow-up prospectively. Standard care was given. The mean age of patients was 64.5 years (54.4% women). The baseline overall score of compliance was medium to high in 97.3% of patients. A quarter of all patients (24.7%) were described as having difficulties to follow lifestyle changes, 22.3% lacked sufficient social support, and 31.0% were unwilling to obtain additional information about illness and treatment. Patients who had received prior treatment for cardiovascular disease were less compliant than those who received first treatment within this study (P=0.05). Younger (P<0.01), male patients (P<0.01), and those without prior cardiovascular disease (P<0.001) were significantly more likely to stop the antihypertensive treatment without a doctor's recommendation. Doctors' rating of compliance at baseline correlated well with ongoing treatment at 6-month follow-up. In conclusion, the COMPASS survey questionnaire is a useful instrument for doctors to differentiate between patients who lack resources and to then counsel patients based on their individual needs.

Nocturnal sleep-disturbing nicotine craving: a newly described symptom of extreme nicotine dependence.

In our research on smoking and nicotine dependence we have noticed a sleep disturbance, which is a further symptom of extreme nicotine dependence. We call this symptom "nocturnal sleep-disturbing nicotine craving" (NSDNC). NSDNC is characterised by craving for cigarettes during the individual sleep times. The smoker awakes (one or several times per week) during his regular sleep time, and has to smoke a cigarette before he/she continues sleeping. This symptom can be explained by the decreasing nicotine levels during the sleep time, which results in nicotine craving. However, NSDNC should be carefully separated from other sleep disturbances, or sleep disturbing events (nycturia, medication side effects), when nicotine craving is not the main reason for awakening.

[Analysis of the needs for diagnosis and therapy of tobacco dependence in Austria]. / Diagnostik und Therapie der Tabakabhängigkeit--eine Analyse des Bedarfs in Osterreich.

In Austria we find 2.3 Mio. tobacco users (29% of the population). 1.3 Mio. are dissonant smokers, they want to stop (18%) or reduce (37%) tobacco consumption. The assumption that 10% of dissonant smokers (130,000 tobacco users) need a diagnosis and therapy leads to a bottleneck: 130,000 patients versus 20 therapists. Demanded consequences of this disproportion are training for health-care workers, implementation of diagnosis and treatment, financing and refunding. Diagnosis and therapy of tobacco dependence should be offered in highly specialised organisations such as the prototypical Nicotine Institute in Vienna, in hospitals and in primary health care.

[Reduced smoking--a possible strategy for control of tobacco-associated illnesses?]. / Reduziertes Rauchen--eine mögliche Strategie zur Kontrolle tabakassoziierter Gesundheitsstörungen?

The aim of the publication is to discuss reduced smoking as a concept to control tobacco-related diseases. New scientific studies show that nicotine-replacement medications may be an untapped source in efforts to reduce smoking. This new indication for nicotine-replacement therapy was licensed for the first time in Denmark by the registration authority. Austrian data have shown that approximately 10 years after implementation, a 1% reduction in smoking could prevent 14 male cancers deaths each year. A 50% reduction could save 700 male lives. 100,000 lives (male and females) could be saved in the European Union annually by a reduction like this including other tobacco-related diseases. Even a 1% reduction would save 1,000 lives. These data are supplemented by the new hypothesis of longer induction time (of lung cancer): Even if this theory fails for the individual smoker, a remarkable gain in years of life will result for society if illness is a probability-based event. A new term of delayed and/or reduced incidence will be a result of this hypothesis. Nevertheless, primary abstinence will remain the most desirable goal in efforts to control tobacco-related diseases. However, most primary prevention campaigns failed, and it will take 30-40 years to translate primary prevention into major health benefits. Reduced smoking should be licensed as a valid method for those unwilling or unable to stop smoking.

[European Medical Association Smoking or Health (EMASH)--consensus on smoking cessation: guidelines for physicians]. / European Medical Association Smoking or Health (EMASH)--Konsensuspapier Rauchertherapie: Richtlinien für Arzte.

The present study summarizes the latest scientific findings on smoking cessation and the various therapeutic possibilities. The guidelines presented here were compiled by the experts of EMASH (European Medical Association Smoking or Health). Accurate diagnosis and adequate treatment of nicotine dependence is essential for achieving sustained abstinence. Diagnostic procedures including the Fagerström Test for Nicotine Dependence (FTND) and various modes of nicotine replacement therapy (chewing gum, plaster, nasal spray and inhaler) are described. New symptoms of nicotine dependence (nocturnal sleep disturbing nicotine craving, nicotine pre-abstinence syndrome), that permit a more precise diagnosis, are discussed.

[Vienna standard in diagnosis of nicotine dependence: Vienna Standard Smoking Inventory]. / Wiener Standard zur Diagnostik der Nikotinabhängigkeit: Wiener Standard Raucher-Inventar (WSR).

The Standard Vienna Smokers' Inventory (VSSI) ("Wiener Standard Raucher-Inventar" [WSR]) is based on the authors' experience and was designed to optimize primary and additional diagnostic procedures associated with smoking cessation treatment. The aim of this inventory is to enable therapists interested in smoking cessation interventions to initiate diagnostic procedures as well as to use efficient therapeutic modalities. The study also highlights those areas of the patient's history which should be given special attention and the theoretical background of these areas. The various comprehensive sections of the WSR include general data pertaining to the patient's life, the basic situation (basic rate), especially with regard to nicotine dependence, pre-abstinence syndrome and "tar" exposition values, follow-up of smoking habits, earlier attempts to give up smoking, and possible barriers to cessation of smoking--such as insufficient motivation, "nocturnal sleep disturbing nicotine craving" or carbohydrate dependence. Furthermore, previous illnesses, pre-existing risk factors and regular intake of drugs are also discussed. Finally, the study emphasizes that the WSR should be used by the therapist according to his/her level of training and experience, thus providing the possibility to use specific, individual approaches to deal with specific individuals and situations.

Measurement of expired carbon monoxide among medical students to assess smoking behaviour.

CO-Measurement of medical students was taken during a compulsory public health training at the University of Vienna. The students were not informed previously, so a non-response bias was excluded. Measurements were done with Bedfont EC50-MICRO Carbon monoxide monitor. The cut off point was set at 11 ppM. One hundred and seventy-three students were measured. Define indication of active smoking was found in 9%. With exception of one student all the others with carbon monoxide over 10 ppM called themselves active smokers. CO measurement will replace at some stage the usual question regarding the number of cigarettes consumed. Students also had the opportunity to learn a new diagnostic technique.

Alternative nicotine delivery systems (ANDS)--public health-aspects.

This paper deals with a relatively new category of pharmaceuticals, namely alternative nicotine delivery systems (ANDS). We do not refer to products like smokeless tobacco or other smoking devices. ANDS are designed to provide nicotine without the harmful substances contained in cigarette smoke. Several different nicotine replacement preparations exist, which are used in nicotine replacement therapy to obtain tobacco abstinence. There is a bulk of scientific literature on the clinical use of ANDS, but very little has been published on the public health aspects of the same. Nicotine dependence is associated with heavy consumption, tolerance, regulation of intake and withdrawal. We described a new symptom of extreme nicotine dependence, namely the nocturnal sleep disturbing nicotine craving (NSDNC), and developed a concept of a nicotine pre-abstinence syndrome (NPAS). Five nicotine replacement preparations are currently available: gum, patch, nasal spray, oral inhaler and sublingual tablet. As far as safety issues are concerned, scientific evidence shows that the use of ANDS involves almost no risk for consumers and patients, especially when compared with the consumption of tobacco products. New concepts developed by our group are the following: definition of possible endpoints of smoking control measures, reduced smoking, nicotine dependence and preventive oncology, chemoprevention of lung cancer by ANDS, public health impact by OTC availability of ANDS and the "let them choose approach" of ANDS focusing on the specific preferences and needs of the individual client. One may also speculate whether ANDS will, at some stage, replace cigarettes as the major source of nicotine for people who need this psychoactive drug.

[Health monitor (SERMO study)--concept, methodology and a paradigmatic result on subjective morbidity in headache]. / Gesundheitsmonitor (SERMO-Studie)--Konzept, Methodik und ein beispielhaftes Ergebnis zur subjektiv erlebten Morbidität von Kopfschmerz.

In Austria, microcensus surveys on self-reported morbidity are carried out at regular intervals every ten years, generally by the Federal Statistic Centre. In the following, we describe an epidemiological observational service which could be regarded as an additional public health instrument. This service is termed "health monitor", and the SERMO (self-reported morbidity) study is the scientific project associated with it. The "health monitor" data provide information on the prevalence of various illnesses and impairment, characteristics and variables of background morbidity by repeated short-term representative surveys on self-reported morbidity. The health monitor permits continual observation of the background morbidity of an entire population, while scientific questions pertaining to the SERMO study can be investigated via the health monitor data base. Self-reported morbidity data provide important information about the health of a general population, in addition to clinical and mortality data, and help to make decisions in health policy. By collecting informations (e.g. nearly every month) on background morbidity, "health monitor" and SERMO project could complement other Austrian public health systems to measure the overall health of the population in general.

[Diagnosis and therapy of nicotine dependence]. / Diagnostik und Therapie der Nikotinabhängigkeit.

The 1988 Report of the US-Surgeon General states very clearly, that the use of tobacco products is not a matter of free choice, but is the result of an addiction as scientifically valid as the addiction to heroin and other narcotics. Using the Fagerström Test for Nicotine Dependence (FTND) to assess nicotine dependence in a population 6,000 randomly selected Austrians were interviewed. 42% of men and 27% of women were found to be smokers. 3 groups of smokers differing in dependence can be described: 36.5% are nicotine addicted; 30.2% must be psychosocial dependent because they show nearly no sign of nicotine dependence; and there is a group between. The scientific literature provides informations on many methods and techniques for a smoking cessation, both pharmacological approaches have been tried to treat nicotine dependence in man. According to scientific standards and many controlled studies, nicotine has been the only drug found to be effective in treating nicotine dependence. Many techniques, ranging from self help to sophisticated combined therapeutic approaches including pharmacological interventions, are now available to deal with the nicotine addiction.

[Prevalence and significance of carbohydrate craving in Austria]. / Prävalenz und Bedeutung der Kohlenhydratsucht in Osterreich.

Among disorders of appetite and eating frequent craving of carbohydrate containing snacks between meals is well known. Excessive carbohydrate consumption causes increased caloric intake and may lead to overweight and risks of obesity regarding metabolism and vascular remodelling. Up to now prevalence and consequences of that disorder have never been studied in the Austrian population. Hence we investigated by questionnaires and interviews eating habits in samples of 1058 women and 942 men of the Austrian population. Evaluation showed that carbohydrate craving is a more or less serious problem for about 30% of Austrians. Women, especially those with overweight, were affected more frequently than men. In the whole population sample investigated there was a seasonal variation with a tendency to increased carbohydrate craving in fall and winter. This was, however, not significant for overweight women, they probably eat their snacks over the whole year. A subgroup of males reported craving of snacks containing sausage or meat instead of carbohydrate. Craving of carbohydrate is considered the consequence of a decrease of serotonin in appetite regulating neurons and centers of the brain. Treatment of craving by drugs inhibiting the re-uptake of serotonin into afferant neurons is discussed. Medication of this type is, however, hampered by cardiovascular side effects observed with fenfluramines.

Nicotine dependence versus smoking prevalence: comparisons among countries and categories of smokers.

OBJECTIVES: To collect available international data on nicotine dependence as defined by the Fagerström Test of Nicotine Dependence, and to compare levels of dependence among countries and categories of smokers. DATA SOURCES: Published and unpublished studies known to the authors and a search of EMBASE from 1985-1995. STUDY SELECTION: Studies included were those based on a nationally representative sample of a country's population, or a sample of smokers seeking cessation assistance. DATA SYNTHESIS: Smokers who seek help in stopping smoking are much more dependent than the average smoker. Men consistently score higher on dependence than women. Ex-smokers appear to have lower dependence than current smokers. A country with low smoking prevalence, the United States, seems to have smokers with higher dependence scores than countries where smoking is more prevalent (such as Austria and Poland). CONCLUSIONS: Successful tobacco control may result in a higher dependence among the remaining smokers (due to selective quitting by low-dependent smokers). The remaining highly dependent smokers may need more intensive treatment.

Problems in treatment and nursing of cancer patients.

Treatment and nursing of cancer patients place great demands on physicians, nurses and the patients' families. The enormous emotional strain on the patient may lead to frustration and 'burnout' among health-care professionals. This article consists of three steps: (a) a qualitative analysis based on a discussion with experts in oncology; (b) a questionnaire investigation of physicians and nurses; and (c) training courses for interested physicians and nurses. The majority of physicians and nurses pointed out that: the value of psychological support is generally underestimated, therapeutic complaints are often due to the patients' lack of information and administrative problems negatively influenced their relationship with patients.

[Psychological and physiological dependence in smokers and there effect on motivation for smoking cessation]. / Psychologische und physiologische Abhängigkeit bei Rauchern und deren Einfluss auf die Entwöhnungsmotivation.

The typical onset of cigarette smoking is determined on various psychological and social factors. The period of experimental smoking may be followed by habituation. Habituation involves development of skill in inhalation and regulation of nicotine dose, becoming accustomed to the mood-altering and other pharmacologic effects of nicotine, and development of a pattern of conditioned reinforcement from smoking. Many smokers continue to smoke because nicotine helps them to regulate mood. The nicotine intake leads promptly and noticeable to pleasant, desired psychotropic effects. In the event of physical dependence, the occurrence of withdrawal symptoms results in renewed nicotine intake. Psychological and physiological dependence could be very different among smokers and this has important implications on the motivation for smoking cessation. Using the Fagerström Test for Nicotine Dependence (FTND) to assess nicotine dependence in a population 6.000 randomly selected Austrians were interviewed. 42% of men and 27% of women were found to be smokers. 3 groups of smokers differing in dependence can be described: 36.5% are nicotine addicted; 30.2% must be psychosocial dependent because they show nearly no sign of nicotine dependence; and there is a group between, difficult to classify them as more psychological or more nicotine addicted.