RESUMEN
WHY BAN CIGARETTE FILTERS? Tobacco consumption in the form of cigarettes is still perceived as being so ordinary that its result, the production of cigarette ends and their disposal, has long been invisible and overlooked. A cigarette end is composed of two parts: a remnant of unsmoked tobacco and a single-use plastic filter made of cellulose acetate. These two components are saturated with the many toxic products generated by cigarette combustion. The relatively recent growing awareness of the major contribution of cigarette filters to plastic pollution of soil, waterways, seas, and oceans has led to active national and international debate on the possibility and desirability of banning the use of these filters for environmental purposes. If such a ban were to be considered, it would be essential to anticipate the possible health consequences for cigarette smokers of such a measure. According to the World Health Organization (WHO), cigarette filters have no beneficial effect on smokers'health, and banning them is therefore becoming an ecologicalemergency.
POURQUOI FAUT-IL INTERDIRE LES FILTRES DE CIGARETTES ? La consommation de tabac sous la forme de cigarettes reste considérée comme tellement banale que ses conséquences, la production de mégots et leur élimination, ont longtemps été invisibles et négligées. Un mégot est constitué de deux parties : un reste de tabac non fumé entouré de papier et un filtre plastique à usage unique composé d'acétate de cellulose. Ces deux composants sont imprégnés par les nombreux produits toxiques résultant de la combustion de la cigarette. La prise de conscience, relativement récente, de l'importance majeure de la responsabilité des filtres de cigarettes dans la pollution plastique et chimique des sols, des cours d'eau, des mers et des océans conduit à une réflexion active, nationale et internationale, sur la possible et souhaitable interdiction de l'usage de c es filtres dans un bu t environnemental. Dans l'hypothèse où une telle interdiction serait envisagée, il est nécessaire d'anticiper les éventuelles conséquences sanitaires pour les fumeurs de cigarettes. Selon l'Organisation mondiale de la santé, les filtres de cigarettes n'ont aucun effet bénéfique sur la santé des fumeurs, et leur interdiction devient une urgence écologique.
Asunto(s)
Fumar , Productos de Tabaco , Humanos , Fumar/efectos adversos , Contaminación AmbientalRESUMEN
Nicotine industry: harm reduction, an exclusively financial objective The knowledge of tobacco smoking health effects, combined with the implementation of measures efficient on its use, leads to tobacco sale reduction with tobacco industry financial losses that, in order to survive, has to recruit new young consumers, and maintain current smokers' use. The industry promotes a new way for tobacco use that, according to it, would reduce harm: heat-not-burn tobacco. But, there is currently no independent scientific proof for such a harm reduction. In the meantime, it promotes a confusion among electronic cigarettes and heat-not-burn tobacco. Heat-not-burn tobacco is promoted via foundations, NGOs, prestigious third parties, mechanic sports financing, and publicity with a strong marketing targeting young people through social networks. The current French regulation concerning smoked tobacco, including plain pack and high taxes, doesn't apply on heat-not-burn tobacco.
"Industrie de la nicotine : réduction des risques, un objectif exclusivement financier La connaissance des risques liés au tabac fumé associée à la prise de mesures efficaces pour réduire sa consommation conduit à la baisse des ventes avec chute des profits de l'industrie du tabac qui, pour survivre, doit recruter de nouveaux jeunes consommateurs et maintenir les usagers actuels dans leur consommation. L'industrie propose un nouveau mode de consommation qui, selon elle, permettrait de réduire les risques : le tabac chauffé. Or, aucune preuve scientifique indépendante n'existe d'une telle réduction de risques. En même temps, elle entretient la confusion entre cigarettes électroniques et tabac chauffé. Le tabac chauffé est promu par le biais de fondations, associations, relais prestigieux, financement des sports mécaniques et publicités avec un marketing intense ciblant les jeunes par les réseaux sociaux. La réglementation française concernant le tabac fumé ne s'applique pas au tabac chauffé, lui permettant ainsi d'échapper au paquet neutre et autorisant des profits majeurs par taxation plus légère."
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Industria del Tabaco , Productos de Tabaco , Adolescente , Humanos , Nicotina , Conducta de Reducción del Riesgo , Fumar TabacoRESUMEN
"Tobacco industry strategies to attract new and young smokers .Tobacco consumption, the paradigm of an industrial pandemic, has been declining in recent years around the world, following implementation of the recommendations of the WHO Framework Convention on Tobacco Control (FCTC). To survive, the four transnational companies that control the market must adapt their strategy, which they do by shifting from the tobacco trade to the wider nicotine trade through the promotion of new products (electronic cigarettes and heated tobacco products). However, two intangible but well-established facts remain: the initiation to tobacco/nicotine consumption occurs almost exclusively during childhood; on the other hand and that age group is very sensitive to marketing and purchasing impulses. Therefore, the industrials must target young people and ease their access to their products. Once the initial nicotine intake has been established, the drug takes over and enforces continuous consumption due to its highly addictive nature. Nonetheless, as explicit targeting of the youth is not a socially acceptable practice, the industry will conceal its strategy behind the façade of promoting harm reduction for adult smokers who wish to do this. Although communication channels are recent, such as the Internet, social media, platforms and more generally, what is commonly accepted as « communication below the line ¼, the methods that aim at reinforcing established nicotine consumption as a social norm are of the same nature as those previously used for the promotion of cigarettes: glamour, seduction, youth, motorsports, tech, adventure, independence, maturity. Unfortunately, the rate of smoking among young people in France remains high due to the effectiveness of this marketing, combined with the easy accessibility to the product, due to non-compliance by tobacco sellers with the current legislation prohibiting sales to minors."
"Stratégie de l'industrie du tabac pour recruter de nouveaux et jeunes fumeurs .Paradigme d'une pandémie industrielle, la consommation de tabac baisse depuis quelques années dans le monde, à la suite de la mise en oeuvre des recommandations de la Convention-cadre de l'Organisation mondiale de la santé pour la lutte antitabac (CCLAT). Pour survivre, les quatre compagnies transnationales qui contrôlent le marché doivent adapter leur stratégie, ce qu'elles font en glissant du commerce du tabac vers celui, plus large, de la nicotine à travers la promotion de nouveaux produits (cigarettes électroniques et tabac chauffé). Toutefois, deux faits connus de longue date restent intangibles : l'initiation à la consommation de tabac/nicotine se fait presque exclusivement dans l'enfance, et cet âge est très sensible au marketing et aux impulsions d'achat. Les industriels doivent donc cibler les jeunes et leur faciliter l'accessibilité à ses produits. Une fois la première consommation de nicotine assurée, celle-ci prend le relais en imposant la poursuite de son usage par son pouvoir addictif majeur. Cependant, cibler les jeunes n'étant pas énonçable, car socialement inacceptable, les industriels vont cacher leur stratégie derrière le faux nez que constitue la promotion d'une réduction des risques aux fumeurs adultes qui le souhaitent. Si les canaux de communication sont nouveaux, tels internet, les réseaux sociaux, les plateformes et, plus globalement, ce qu'il est convenu d'appeler « la communication sous le radar ¼, les thèmes visant à conforter la consommation de nicotine comme une norme sociale établie sont de même nature que ceux utilisés précédemment pour la promotion des cigarettes : glamour, séduction, jeunesse, sports mécaniques, technicité, aventure, autonomie, maturité. Malheureusement, le tabagisme des jeunes en France demeure encore élevé du fait de l'efficacité de ce marketing, combinée à la facilité d'achat de ces produits due au non-respect par les buralistes de la réglementation actuelle interdisant leur vente aux mineurs."
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Industria del Tabaco , Productos de Tabaco , Adolescente , Adulto , Francia , Humanos , FumadoresRESUMEN
Preventing tobacco sales to minors. Since 2009, selling tobacco products in France to minors less than 18 years of age is forbidden by law, but this law is poorly enforced even though tobacco use mainly begins at adolescence. The aim of this study was to identify measures implemented by foreign countries leading to a better enforcement of tobacco sale ban to minors. The main measures are: organizing tobacco retailers training programs; using automated age-verification systems; requiring a valid photo ID from anyone who looks under the age of 25; developing communication campaigns directed to the general public in order to explain and promote age control for customers. Furthermore, in all studied countries, the only effective controls rely on "mystery shopping" with underage shoppers accompanied by dedicated inspectors, attempting to purchase tobacco products. In case of non-compliance with the law, these controls must lead to dissuasive financial as well as administrative penalties. In all studied countries, an efficient implementation of these measures has led to reduced tobacco sales to minors, and thus contributed to bring down underage smoking.
Pour qu'acheter du tabac ne soit plus un jeu d'enfant ! En France, la vente de tabac est interdite aux moins de 18 ans depuis 2009, mais la loi est peu respectée alors que la plupart des nouveaux fumeurs commencent leur consommation à l'adolescence. Cette étude a pour objectif d'identifier les mesures mises en Åuvre par des pays tiers permettant une meilleure application de l'interdiction de vente de tabac aux mineurs. Parmi ces mesures : la formation des détaillants de tabac ; l'utilisation dans les points de vente de systèmes de vérification automatisée de l'âge ; une vérification de l'âge de toute personne ayant l'apparence d'avoir moins de 25 ans ; le développement de campagnes de communication grand public pour expliquer et promouvoir le contrôle de l'âge des clients. Par ailleurs, les inspections « clients mystères ¼ apparaissent dans tous les pays étudiés comme le seul moyen de contrôle efficace. En cas de non-respect de la loi, ces inspections doivent donner lieu à des sanctions réelles et dissuasives, financières et administratives. Dans les pays étudiés, la mise en place conjointe de ces différentes mesures a permis de réduire la vente de tabac aux mineurs et de contribuer ainsi à diminuer le tabagisme des adolescents.
Asunto(s)
Menores , Nicotiana , Adolescente , Comercio , Francia , Humanos , Fumar , Prevención del Hábito de FumarRESUMEN
French governments only very recently introduced comprehensive tobacco control policies including several measures recommended by WHO Framework Convention on Tobacco Control, leading to a speeding-up of tobacco smoking decrease, but still with a high current level of use. In the meantime, research confirms that nicotine is highly addictive, that smoking just a cigarette a day is highly detrimental for health, and that health professionals are efficient in helping smokers to give up. These measures are such diverse as tobacco taxes increases, introducing plain packs, promoting November as month without tobacco, getting tobacco cessation medications paid for by health insurances, implementing a comprehensive advertising ban of tobacco products in retailor shops, and increasing protection of public health policies from tobacco industry intrusion. This industry via frenzied marketing reacts by promoting "heat not burn tobacco" as a harm reduction mean, which it is not, and invests in e-cigarettes, whose most recent ones are as addictive as classic tobacco cigarettes.
LUTTE CONTRE LE TABAGISME EN FRANCE: QUOI DE NOUVEAU ?. Les gouvernements français proposent depuis seulement quelques années des programmes complets de mesures contre l'usage du tabac en s'appuyant sur les recommandations de la convention-cadre de l'Organisation mondiale de la santé pour la lutte anti-tabac, ce qui se traduit par une accélération de la baisse de sa consommation, avec toutefois une prévalence encore élevée. Parallèlement, les études confirment que la nicotine est une drogue forte, que fumer une seule cigarette par jour présente des risques sanitaires majeurs, et que les professionnels de santé peuvent aider les fumeurs à arrêter. Les mesures prises sont variées : augmentation des taxes, paquet neutre, Mois sans tabac, remboursement des traitements de la dépendance au tabac, interdiction de la publicité sur les lieux de vente, protection des politiques publiques de l'ingérence de l'industrie du tabac Cette industrie réagit en promouvant le tabac chauffé via un marketing forcené sur une réduction des risques inexistante, et investit dans les cigarettes électroniques, dont les plus récentes sont aussi addictogènes que les cigarettes classiques.
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Nicotiana/efectos adversos , Industria del Tabaco , Productos de Tabaco , Francia , Humanos , Prevención del Hábito de Fumar , Políticas de Control Social , Industria del Tabaco/legislación & jurisprudencia , Productos de Tabaco/efectos adversosRESUMEN
We report on five adult cases of the rare association of asthma with humoral immunodeficiency (huID). All patients had uncontrolled asthma related to recurrent respiratory infections. Asthma was diagnosed according to the Global Initiative for Asthma (GINA) guidelines, and bronchiectasis was ruled out by a CT chest scan. Two men (aged 28 and 60) presented with pollen allergies, chronic rhinosinusitis, and IgG deficiency (7.8 and 7.6 g/L, respectively). Both patients underwent surgery for nasal polyposis but relapsed with acute sinusitis and severe asthma exacerbations requiring treatment with oral corticosteroids and antibiotics. The immunoglobulin replacement therapy (IRT) partially relieved the asthma by reducing the number of exacerbations. A 55-year-old woman presented with nonallergic, corticosteroid-dependent asthma (20 mg/day prednisone) and IgG deficiency (5.72 g/L). IRT improved asthma control (fall in the Asthma Control Questionnaire (ACQ)-7 score from 3.5 to 1.7) and enabled withdrawal of the corticosteroids. In a 47-year-old woman with an IgG2 subclass deficiency (1.9 g/L) and asthma, IRT increased the degree of asthma control (fall in the ACQ-7 score from 2.8 to 1.1). A 75-year-old woman presented with corticosteroid-dependent asthma (40 mg/day prednisone), IgM and IgG deficiencies (0.28 g/L and 5.36 g/L, respectively), and recurrent respiratory, skin and urinary infections. Again, IRT improved asthma control (fall in the ACQ-7 score from 2.5 to 1.2), reduced the number of hospitalizations for asthma exacerbations, and enabled a 10-mg reduction in the daily dose of prednisone. These observations suggest that IRT may improve disease control in some patients with asthma and associated huID.
Asunto(s)
Asma/complicaciones , Asma/tratamiento farmacológico , Deficiencia de IgG/complicaciones , Deficiencia de IgG/tratamiento farmacológico , Inmunoglobulina G/uso terapéutico , Adulto , Anciano , Asma/fisiopatología , Femenino , Humanos , Síndromes de Inmunodeficiencia/complicaciones , Masculino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: The prognosis of lung cancer remains poor; only 20% of patients can undergo surgery. N2 non-small cell lung cancer (NSCLC) is a heterogeneous disease. We conducted a retrospective study to analyze the impact of N2 location on survival. METHODS: This study included 342 NSCLC with N2 involvement between 1988 and 2014. Patient-related data were collected through the CRB biobank and included demographic, therapeutic, and survival data. Survival was analyzed according to Kaplan-Maier method. Cox's regression analysis and analysis of variance (ANOVA) were used to determine factors significantly associated with survival. RESULTS: The population average age was 61.6 years; 82.2% were men, a majority were former smokers (87.1%), and 45.3% had adenocarcinoma. The main prognostic factors were male gender (p = 0.01), number of nodes (p < 0.0001), and tumor size (p < 0.0001). N2 disease had a poor survival (16 months) compared with N0 (32 months) and N1 (21.1 months) disease (p < 0.0001). The patients with involvement of station 4 (survival = 17.8 months) seemed to have a prognosis between those with station 7 (survival = 10.5 months) and N1 (survival = 22.6 months), p = 0.0005. CONCLUSIONS: N2 location has a prognostic impact in surgically NSCLC, and station 4 involvement has a better prognostic than station 7.
Asunto(s)
Adenocarcinoma/secundario , Carcinoma de Pulmón de Células no Pequeñas/secundario , Carcinoma de Células Escamosas/secundario , Neoplasias Pulmonares/patología , Ganglios Linfáticos/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Vasos Sanguíneos/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Células Escamosas/cirugía , Femenino , Francia , Hospitales , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/cirugía , Metástasis Linfática , Masculino , Mediastino , Persona de Mediana Edad , Invasividad Neoplásica , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores Sexuales , Tasa de Supervivencia , Fumar Tabaco , Tráquea , Carga TumoralRESUMEN
Smoking is a public health problem of particular importance during the perioperative period, since it exposes patients scheduled for surgery to risk increases of 20% in hospital mortality and 40% in major postoperative complications. In addition, current smoking increases almost all specific surgical complications. The perioperative period offers a genuine opportunity for smoking cessation. The rate of preoperative smoking cessation can be increased significantly by offering behavior management and the prescription of a nicotine substitute before any scheduled surgical intervention. Preoperative smoking cessation should be routinely recommended independently of the timing of the intervention, even though the benefits increase in proportion with the length of cessation. All professionals of the care pathway (general practitioners, surgeons, anesthetists-intensivists, caregivers) must inform smokers of the positive effects of smoking cessation and offer them dedicated management and personalized follow-up. In children, cessation of parental smoking or removal of the child from environmental tobacco smoke as long before surgery as possible is indispensable.
Asunto(s)
Atención Perioperativa/métodos , Periodo Perioperatorio , Fumar , Terapia Conductista , Sistemas Electrónicos de Liberación de Nicotina , Guías como Asunto , Humanos , Nicotina/uso terapéutico , Agonistas Nicotínicos/uso terapéutico , Derivación y Consulta , Cese del Hábito de Fumar , Fumar TabacoRESUMEN
BACKGROUND AND AIMS: We investigated the beliefs and behaviours about tobacco among inflammatory bowel disease (IBD) patients. MATERIALS AND METHODS: A questionnaire of 18 items was developed and administered to all consecutive patients followed for IBD at Nancy University Hospital from October 2012 to March 2013. RESULTS: Two hundred and thirty-one patients participated in the survey [Crohn's disease (CD)=171, ulcerative colitis (UC)=60]. Among IBD patients who were smokers at diagnosis, 10.5% of CD patients versus 14.3% of UC patients believed that tobacco could have triggered their IBD; about half the CD smokers at diagnosis were not aware that smoking might promote their disease. Three quarters of smokers after diagnosis knew that tobacco was not beneficial for their CD, whereas all UC were aware that smoking had a beneficial effect on their disease course. About half of the CD patients had stopped smoking during a flare-up. Four former smokers with UC (21.1%) resumed smoking during a relapse. Nearly 90% of IBD current smokers wished to quit smoking. About half the IBD patients were aware of the relation between smoking and IBD, and the Internet was a source for 24.3% of these patients. CONCLUSION: The majority of IBD patients are unaware of the effects of tobacco on their disease. Better information through a therapeutic education programme should be systematically recommended in IBD.
Asunto(s)
Conductas Relacionadas con la Salud , Enfermedades Inflamatorias del Intestino/etiología , Enfermedades Inflamatorias del Intestino/psicología , Cese del Hábito de Fumar , Fumar/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Colitis Ulcerosa/etiología , Colitis Ulcerosa/psicología , Enfermedad de Crohn/etiología , Enfermedad de Crohn/psicología , Estudios Transversales , Cultura , Progresión de la Enfermedad , Femenino , Francia/epidemiología , Humanos , Incidencia , Enfermedades Inflamatorias del Intestino/diagnóstico , Enfermedades Inflamatorias del Intestino/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Fumar/epidemiología , Cese del Hábito de Fumar/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: We explored, for the first time, young adult roll-your-own smokers' response to using plain packaging in real-world settings. METHODS: Naturalistic research was employed, where 133 French young adult smokers (18-25 years of age) used plain roll-your-own packs for 10 days; the plain packs they were provided with contained their usual brand of rolling tobacco and displayed the name of their usual brand. Participants were recruited in five cities in France (Paris, Marseille, Metz, Nantes, Toulouse) and completed two questionnaires to measure their response to their own branded packs and the plain packs. Both questionnaires assessed pack perceptions, brand attachment, product perceptions (eg, taste, quality, natural), feelings about smoking (satisfying, pleasurable), feelings when using the pack in front of others (embarrassment, image), warning response (credibility, awareness of risks) and smoking-related behaviour (eg, consumption, quitting). RESULTS: Compared to their own fully branded packs, plain packs were associated with less positive pack and product perceptions, lower brand attachment and less positive feelings about smoking and feelings when using the pack in front of others. Participants were also more likely to report feeling like reducing consumption and quitting when using the plain packs, and more likely to feel like missing out on rolling a cigarette. No significant differences between the two pack types (plain and branded) were found in terms of credibility of warnings and perceptions of level of tar. CONCLUSIONS: The study suggests that the impacts of plain packaging for roll-your-own cigarette smokers are the same as for smokers of factory-made cigarettes.
Asunto(s)
Actitud , Nicotiana , Embalaje de Productos , Fumar , Productos de Tabaco , Adolescente , Adulto , Concienciación , Ciudades , Embalaje de Medicamentos , Emociones , Femenino , Francia , Humanos , Masculino , Percepción , Placer , Etiquetado de Productos , Cese del Hábito de Fumar , Encuestas y Cuestionarios , Gusto , Adulto JovenRESUMEN
UNLABELLED: Although studied for years, the nature of the relationships between tobacco consumption, bronchial preinvasive lesions and lung cancer are still not completely elucidated. Objectives were to determine the relationship between tobacco consumption and lung mucosa preinvasive and invasive lesions and to describe patients' evolution according to baseline characteristics. METHODS: Bronchial biopsy specimens were taken at six predetermined sites in 156 males, current smokers, aged above 18 years. Relationships between smoking characteristics and preinvasive lesions indexes and between baseline characteristics and lung cancer occurrence during a prospective follow-up were examined. RESULTS: Maximum grade was hyperplasia for 16.7% of patients, metaplasia 33.3%, dysplasia 25.0%, and carcinoma in situ 1.3%. For 23.7% of patients, all biopsies were considered normal. Preinvasive lesion indexes were related to smoking intensity (cigarettes/day). Lung cancer incidence during the follow-up was 19.9%. No association between severity of mucosa lesions at baseline and incidence of cancer during the follow-up period was observed. CONCLUSION: The majority of smokers had mucosa lesions, but a relatively small number of them would have a cancer, and there was a poor correlation between severity of mucosalesions and incidence of cancer. Even if an evolution from preinvasive lesions to an invasive cancer is plausible and coherent with current concepts, this link does not appear strong enough to recommend the use of systematic classic endoscopy for targeting of a sub-group of higher risk smokers who would require a closer follow up.
Asunto(s)
Neoplasias Pulmonares/etiología , Lesiones Precancerosas/etiología , Mucosa Respiratoria/patología , Fumar/efectos adversos , Adulto , Esófago/patología , Humanos , Hiperplasia/epidemiología , Hiperplasia/etiología , Pulmón/patología , Neoplasias Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Lesiones Precancerosas/epidemiología , Estudios ProspectivosAsunto(s)
Prótesis Dental/efectos adversos , Odontólogos , Enfermedades Pulmonares/inducido químicamente , Pulmón/efectos de los fármacos , Osificación Heterotópica/inducido químicamente , Dióxido de Silicio/efectos adversos , Anciano de 80 o más Años , Drenaje , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/cirugía , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/cirugía , Masculino , Salud Laboral , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/cirugía , Neumotórax/inducido químicamente , Valor Predictivo de las Pruebas , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: To evaluate the public health efficacy of a community-based smoking cessation program (TABADO) among vocational school trainees (15 to 20 years old). METHODS: This prospective, controlled, quasi-experimental study was conducted in eight vocational training centres (VTC) in France. The intervention group underwent the TABADO program, which included a general information session for all students and small-group sessions plus individual counselling and nicotine therapy, if needed, for volunteers in an enhanced program. The control group received no specific intervention other than the educational services usually available. The primary outcome was 30-day point prevalence abstinence at 12 months. RESULTS: The mean age of the 1,814 students included was 16.9 years (SD = 1.0); 84.7% were males. At baseline, 52% were smokers and 5.7% ex-smokers. In the intervention group, 24.6% of smokers volunteered for the enhanced program and 18.1% could be included. By 12-month follow-up, with participants lost to follow-up considered non-abstinent, 10.6% of smokers in the intervention group had become abstinent versus 7.4% in the control group (adjusted p = 0.03; odds ratio [OR] = 1.8; 95% confidence interval [CI] = 1.05-3.0); considering lost to follow-up as missing data, 17% of intervention group participants were abstinent versus 11.9% in the control group (univariate p = 0.08; adjusted p = 0.008; OR = 2.1; 95% CI = 1.2-3.6). CONCLUSION: The TABADO program, targeting teenagers in vocational schools, was effective in producing a higher 12-month abstinence rate among all smokers in the intervention group. TRIAL REGISTRATION: Clinical trial identification number is NTC00973570.
Asunto(s)
Servicios de Salud Escolar , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Prevención del Hábito de Fumar , Educación Vocacional , Adolescente , Femenino , Estudios de Seguimiento , Francia , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Adulto JovenRESUMEN
Endobronchial ultrasound-guided transbronchial needle aspiration has demonstrated its accuracy in the diagnostic workup of enlarged mediastinal lymph nodes. In addition to conventional smears, the use of liquid-based cytology (LBC) and cell block preparations (CBP) has been introduced more recently. The aim of our study was to determine the performance of each of the different techniques, separately and combined, in terms of diagnostic yield and sensitivity. A total of 290 consecutive patients were included. The pathological examination was based on smear cytology, LBC, and CBP. Adequate sampling was defined by the presence of pathological material or lymphocytes. The global diagnostic yield was 82.7 % and the sensitivity was 89.1 %. The diagnostic yield was 72.8 % for smears, 78.8 % for LBC, and 69.9 % for CBP. The combination of smears with CBP significantly increased diagnostic yield (p = 0.01) and sensitivity (p = 0.006), but not the combination of smears with LBC (yield: p = 0.07; sensitivity: p = 0.13). The combination of the three techniques further increased yield (p = 0.007) and sensitivity (p = 0.006), compared with smears alone. CBP were more sensitive than smears for both diagnoses of carcinoma (p = 0.01) and granulomatous inflammation (p = 0.048). Conversely, LBC was less sensitive than smears for granulomatous inflammation (p = 0.004), but the difference was not significant for carcinoma (p = 0.42). CBP, as a complement to smears, increases diagnostic yield and sensitivity for both diagnoses of carcinoma and granulomatous inflammation. LBC, if used alone, increases the risk of a false-negative result.
Asunto(s)
Citodiagnóstico/métodos , Errores Diagnósticos/prevención & control , Enfermedades Pulmonares/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina/métodos , Citodiagnóstico/normas , Granuloma/diagnóstico , Humanos , Neoplasias Pulmonares/diagnóstico , Ganglios Linfáticos/patología , Linfoma/diagnóstico , Persona de Mediana Edad , Estadificación de Neoplasias , Reproducibilidad de los Resultados , Sarcoidosis/diagnóstico , Sensibilidad y Especificidad , Carcinoma Pulmonar de Células Pequeñas/diagnóstico , Manejo de Especímenes , Adulto JovenRESUMEN
Clinically, our ability to predict disease outcome for patients with early stage lung cancer is currently poor. To address this issue, tumour specimens were collected at surgery from non-small cell lung cancer (NSCLC) patients as part of the European Early Lung Cancer (EUELC) consortium. The patients were followed-up for three years post-surgery and patients who suffered progressive disease (PD, tumour recurrence, metastasis or a second primary) or remained disease-free (DF) during follow-up were identified. RNA from both tumour and adjacent-normal lung tissue was extracted from patients and subjected to microarray expression profiling. These samples included 36 adenocarcinomas and 23 squamous cell carcinomas from both PD and DF patients. The microarray data was subject to a series of systematic bioinformatics analyses at gene, network and transcription factor levels. The focus of these analyses was 2-fold: firstly to determine whether there were specific biomarkers capable of differentiating between PD and DF patients, and secondly, to identify molecular networks which may contribute to the progressive tumour phenotype. The experimental design and analyses performed permitted the clear differentiation between PD and DF patients using a set of biomarkers implicated in neuroendocrine signalling and allowed the inference of a set of transcription factors whose activity may differ according to disease outcome. Potential links between the biomarkers, the transcription factors and the genes p21/CDKN1A and Myc, which have previously been implicated in NSCLC development, were revealed by a combination of pathway analysis and microarray meta-analysis. These findings suggest that neuroendocrine-related genes, potentially driven through p21/CDKN1A and Myc, are closely linked to whether or not a NSCLC patient will have poor clinical outcome.
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Adenocarcinoma/metabolismo , Biomarcadores de Tumor/genética , Carcinoma de Células Escamosas/metabolismo , Regulación Neoplásica de la Expresión Génica , Neoplasias Pulmonares/metabolismo , Transcripción Genética , Adenocarcinoma/genética , Adenocarcinoma/patología , Algoritmos , Inteligencia Artificial , Biomarcadores de Tumor/metabolismo , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patología , Minería de Datos , Progresión de la Enfermedad , Femenino , Perfilación de la Expresión Génica , Redes Reguladoras de Genes , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Masculino , Redes y Vías Metabólicas , Análisis de Secuencia por Matrices de Oligonucleótidos , Fenotipo , Análisis de Componente Principal , Biología de SistemasRESUMEN
INTRODUCTION: The aim of this study was to describe associations between lung tumor location and smoking as well as selected occupational exposures. In the context of lung cancer screening by computed tomography scan, tumor location may have an interest. Computed tomography scan is known to better detect more peripheral tumors. METHODS: Lung cancer cases diagnosed in two French University hospitals between 1997 and 2009 were included. Tumors visible on white-light bronchoscopy were defined as central. Occupational exposures were assessed by the same expert. Data were analyzed by case-case comparisons using unconditional logistic regressions. RESULTS: A total of 1701 cases were included, comprising mainly men (86.3%), current smokers (52.8%), or former smokers (42.8%). Main histological subtypes of cancer were adenocarcinomas (33.8%) and squamous cell carcinomas (32.6%). The tumor location was found to be central in 61% of cases, and never smokers and women had more often peripheral tumors. Exposure to asbestos was significantly associated with central location with dose-response relationship (odds ratio [OR] for peripheral tumors = 0.45, 95% confidence interval [CI] 0.29-0.70) for the highest level of exposure. Exposure to silica dust was significantly associated with peripheral tumor (OR for peripheral tumors = 3.28, 95%CI 1.50-7.17) for the highest level of exposure. Exposure to welding fumes was associated with central location (OR for peripheral tumors = 0.51, 95% CI 0.26-0.96) for the first level of exposure). CONCLUSIONS: Smoking characteristics and occupational exposures have to be considered to define more accurately high-risk populations suitable for lung cancer screening or early detection programs.
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Neoplasias de los Bronquios/patología , Carcinoma/patología , Pulmón/patología , Exposición Profesional/efectos adversos , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/etiología , Adenocarcinoma/patología , Adolescente , Adulto , Anciano , Amianto/efectos adversos , Neoplasias de los Bronquios/diagnóstico por imagen , Neoplasias de los Bronquios/etiología , Broncoscopía , Carcinoma/diagnóstico por imagen , Carcinoma/etiología , Carcinoma de Células Grandes/diagnóstico por imagen , Carcinoma de Células Grandes/etiología , Carcinoma de Células Grandes/patología , Carcinoma de Células Pequeñas/diagnóstico por imagen , Carcinoma de Células Pequeñas/etiología , Carcinoma de Células Pequeñas/patología , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/patología , Niño , Preescolar , Polvo , Femenino , Gases/efectos adversos , Humanos , Lactante , Modelos Logísticos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Oportunidad Relativa , Factores Sexuales , Dióxido de Silicio/efectos adversos , Fumar/efectos adversos , Tomografía Computarizada por Rayos X , Soldadura , Adulto JovenRESUMEN
BACKGROUND: In the face of comprehensive bans on the marketing of tobacco products, packaging has become an increasingly important promotional tool for the tobacco industry. A ban on the use of branding on tobacco packaging, known as 'plain' packaging, has emerged as a promising regulatory strategy. The current study sought to examine perceptions of cigarette packaging among adults in France. METHODS: Adult smokers and non-smokers (N=836) were surveyed using computer-assisted personal interviewing to assess perceptions of pack design by comparing 'regular' branded packs and 'limited edition' packs (with novel designs or innovations) with 'plain' versions of these packs with all branding, including colour, removed. RESULTS: Plain packs (PP) were less likely than regular packs, and particularly limited edition packs, to be considered attractive, attention grabbing and likely to motivate youth purchase. PPs were also rated as the most effective in convincing non-smokers not to start and smokers to reduce consumption and quit. Logistic regression showed that smokers motivated to quit, in comparison to smokers not motivated to quit, were significantly more likely to consider the PPs as the packs most likely to motivate cessation. CONCLUSIONS: Novel cigarette packaging, in the form of limited edition packs, had the highest ratings of consumer appeal, ahead of regular branded packs and also PPs. Interestingly, PPs were perceived to be the packs most likely to promote cessation among those adults with quitting intentions. Plain packaging, therefore, may be a means of helping existing adult smokers motivated to quit to do so.
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Comportamiento del Consumidor , Mercadotecnía , Percepción , Embalaje de Productos , Cese del Hábito de Fumar , Prevención del Hábito de Fumar , Productos de Tabaco , Adolescente , Adulto , Anciano , Actitud Frente a la Salud , Recolección de Datos , Femenino , Humanos , Entrevistas como Asunto , Modelos Logísticos , Masculino , Persona de Mediana Edad , Motivación , Etiquetado de Productos , Industria del Tabaco , Adulto JovenRESUMEN
The optimal way to display constituent levels (e.g. tar) on tobacco packaging has not received adequate attention but has important policy implications. Adult smokers and non-smokers (n = 836) were surveyed in France using Computer Assisted Personal Interviewing to assess perceptions of constituent levels displayed numerically (brand-specific tar and nicotine numbers from smoking machines and the current format in European Union), descriptively (a short sentence describing chemicals and their health effects but without any brand-specific numbers) or as a pack insert (a card placed on the inside of the pack describing the presence of chemicals and their health effects in more detail, as well as information on cessation). We also assessed perceptions of identically packaged cigarettes differing only on nicotine levels. Displaying information regarding ingredients either descriptively or on pack inserts was perceived as more comprehensible and informative than displaying them numerically. Numeric yields were associated with false beliefs: almost half the sample perceived packs with lower nicotine levels (0.8 mg vs. 0.9 mg) to be safer.