RESUMO

OBJECTIVES: Few studies have examined the prevalence of electronic cigarette use among the inpatient population regardless of the patients' cessation goals. The objectives of this study were to examine the prevalence of electronic cigarette use among counseled tobacco users admitted to 2 academic hospitals. METHODS: Cross-sectional data of hospitalized adult tobacco users who were admitted between January 1, 2015 and December 31, 2015 and who received bedside tobacco cessation counseling from a tobacco treatment service counselor were examined. Demographic and smoking history items were compared as a function of electronic cigarette use using chi-square and independent t tests. Logistic regression was used to test independent associations with electronic cigarette use. RESULTS: Of 2194 hospitalized tobacco users counseled, 22% had used an electronic cigarette. Most of these patients used electronic cigarettes to quit or reduce use of combustible cigarettes. Adjusted odds of electronic cigarette use were higher for females (adjusted odds ratio [AOR] 0.60 for male patients, 95% confidence interval [CI] 0.47-0.76), younger patients (AOR 0.98 for older patients, 95% CI 0.97-0.99), and individuals who initiated tobacco use earlier in life (AOR 0.97 for later smoking initiation, 95% CI 0.95-0.99). CONCLUSIONS: Screening hospitalized cigarette smokers for electronic cigarette use offers an opportunity to counsel all patients on evidence-based quit aids. Young, female patients are most likely to use electronic cigarettes and may benefit most from directed discussions about electronic cigarette use and Federal Drug Administration-approved cessation methods during smoking cessation counseling.

Assuntos

Aconselhamento/estatística & dados numéricos , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Estudos Transversais , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Adulto Jovem

RESUMO

BACKGROUND/OBJECTIVE: To date, pharmacotherapy trials of depressed alcoholics (MDD/AUD) have focused on SSRI medications, with disappointing results, so effective treatments for that comorbid population are lacking. Mirtazapine is an FDA-approved medication for treating MDD with a unique pharmacological profile whose efficacy may exceed that of SSRIs. Results from our recent open label study suggest robust acute phase efficacy for mirtazapine for decreasing both the depression and the drinking of that population. However, to date, no studies have evaluated the longer-term efficacy of mirtazapine in that population. We now report findings from a first long-term (two-year) naturalistic follow-up evaluation involving subjects from the acute phase trial. We hypothesized that the improvements would persist at follow-up. METHODS: An eight-week open label study of mirtazapine and motivation therapy was conducted involving persons 18 to 55 years of age with DSM-IV diagnoses of comorbid MDD/AD. Two years after entry into the acute phase study, a long-term evaluation was conducted using the same instruments that had been used at baseline to assess whether the improvements seen during the acute phase trial had persisted. RESULTS: Ten of the twelve patients who entered the acute phase study participated in the follow-up study. The large magnitude improvements (p<.01) in depressive symptoms (BDI), drinking (TLFB), and sleep disturbance (HDRS) persisted at the follow-up evaluation. Two of the subjects demonstrated MDD on structured interview at follow-up, while all ten had demonstrated MDD at baseline. Six of the ten used antidepressants during the follow-up period. At baseline, three were employed, while at follow-up seven were employed. CONCLUSIONS: These findings suggest long-term efficacy for mirtazapine for decreasing the drinking and depression of depressed alcoholics. Double-blind, placebo-controlled studies are warranted to clarify the efficacy of mirtazapine in depressed alcoholics.

RESUMO

OBJECTIVE: This was a first pilot study evaluating the acute phase (8-week) efficacy of the antidepressant medication mirtazapine for the treatment of depressive symptoms and drinking of subjects with comorbid major depressive disorder and alcohol dependence (MDD/AD). We hypothesized that mirtazapine would demonstrate within-group efficacy for the treatment of both depressive symptoms and drinking in these subjects. METHODS: We conducted a first open label study of the second generation antidepressant mirtazapine in 12 adult outpatient subjects with comorbid major depressive disorder/alcohol dependence. The pharmacological profile of that medication is unique among antidepressants, unrelated to tricyclics or selective serotonin reuptake inhibitors. RESULTS: Mirtazapine was well tolerated in this treatment population. Self-reported depressive symptoms decreased from 31.8 to 8.3 on the Beck Depression Inventory, a 74.0% decrease (p<0.001), and drinking decreased from 33.9 to 13.3 drinks per week, a 60.8% decrease (p<0.05). None of the subjects were employed full-time at baseline, but 9 of the 12 (75%) were employed full-time at end-of-study. CONCLUSIONS: These preliminary findings suggest efficacy for mirtazapine for treating both the depressive symptoms and excessive alcohol use of comorbid major depressive disorder and alcohol dependence. Double-blind studies are warranted to further clarify the efficacy of mirtazapine in this population.

RESUMO

OBJECTIVES: : The purpose of this study was to explore healthcare access among injection drug users (IDUs) at a needle exchange program in Pittsburgh, PA. METHODS: : A 2-page survey was conducted using a questionnaire adapted from a previous study, focusing on demographics, health characteristics, health service utilization, and healthcare satisfaction. Binary logistic regression analyses were performed to identify statistically significant associations between IDU characteristics and healthcare access. RESULTS: : Among 95 subjects surveyed, 48% were uninsured, 31% reported having health conditions not followed by a physician, and 68% reported not seeing a physician regularly. The hospital emergency room was the site where most medical care was reportedly obtained. Twenty-three percent reported having problems as a result of not seeking needed medical care. The most commonly reported reason for not seeing a physician regularly was "financial." Young age and marriage/cohabitation were significantly associated with lacking health insurance (P < 0.005 and P < 0.05, respectively). Young age, uninsured status, and non-white race were significantly associated with not seeing a physician regularly (P < 0.05, P < 0.005, and P < 0.05, respectively). CONCLUSION: : The results suggest that many IDUs at the needle exchange site have overall poor access to healthcare. Needle exchange programs may use the results of this study to develop services that address uninsured status as a barrier to healthcare access and further improve the health of the IDU community.