Background and Methods Use of nicotine-replacement therapies and the antidepressant bupropion helps people stop smoking. We conducted a double-blind, placebo-controlled comparison of sustained-release bupropion (244 subjects), a nicotine patch (244 subjects), bupropion and a nicotine patch (245 subjects), and placebo (160 subjects) for smoking cessation. Smokers with clinical depression were excluded. Treatment consisted of nine weeks of bupropion (150 mg a day for the first three days, and then 150 mg twice daily) or placebo, as well as eight weeks of nicotine-patch therapy (21 mg per day during weeks 2 through 7, 14 mg per day during week 8, and 7 mg per day during week 9) or placebo. The target day for quitting smoking was usually day 8. Results The abstinence rates at 12 months were 15.6 percent in the placebo group, as compared with 16.4 percent in the nicotine-patch group, 30.3 percent in the bupropion group (P<0.001), and 35.5 percent in the group given bupropion and the nicotine patch (P<0.001). B...

https://www.nejm.org/doi/pdf/10.1056/NEJM199903043400903

A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation

ContextIn 1998, 33 million US adults aged 18 to 64 years lacked health insurance.
Determining the unmet health needs of this population may aid efforts to improve
access to care.ObjectiveTo compare nationally representative estimates of the unmet health needs
of uninsured and insured adults, particularly among persons with major health
risks.Design and SettingRandom household telephone survey conducted in all 50 states and the
District of Columbia through the Behavioral Risk Factor Surveillance System.ParticipantsA total of 105,764 adults aged 18 to 64 years in 1997 and 117,364 in
1998, classified as long-term (≥1 year) uninsured (9.7%), short-term (<1
year) uninsured (4.3%), or insured (86.0%).Main Outcome MeasuresAdjusted proportions of participants who could not see a physician when
needed due to cost in the past year, had not had a routine checkup within
2 years, and had not received clinically indicated preventive services, compared
by insurance status.ResultsLong-term– and short-term–uninsured adults were more likely
than insured adults to report that they could not see a physician when needed
due to cost (26.8%, 21.7%, and 8.2%, respectively), especially among those
in poor health (69.1%, 51.9%, and 21.8%) or fair health (48.8%, 42.4%, and
15.7%) (P<.001). Long-term–uninsured adults
in general were much more likely than short-term–uninsured and insured
adults not to have had a routine checkup in the last 2 years (42.8%, 22.3%,
and 17.8%, respectively) and among smokers, obese individuals, binge drinkers,
and people with hypertension, elevated cholesterol, diabetes, or human immunodeficiency
virus risk factors (P<.001). Deficits in cancer
screening, cardiovascular risk reduction, and diabetes care were most pronounced
among long-term–uninsured adults.ConclusionsIn our study, long-term–uninsured adults reported much greater
unmet health needs than insured adults. Providing insurance to improve access
to care for long-term–uninsured adults, particularly those with major
health risks, could have substantial clinical benefits.

https://jamanetwork.com/journals/jama/articlepdf/193207/JOC00915.pdf

Unmet Health Needs of Uninsured Adults in the United States

Cigarette smoking is the single most important preventable cause of death and illness. Smoking cessation is associated with substantial health benefits. Weight gain is cited as a primary reason for not trying to quit smoking. There is a great variability in the amount of weight gain but younger ages, lower socio-economic status and heavier smoking are predictors of higher weight gain. Weight change after smoking cessation appears to be influenced by underlying genetic factors. Besides, weight gain after smoking cessation is largely because of increased body fat and some studies suggest that it mostly occurs in the subcutaneous region of the body. The mechanism of weight gain includes increased energy intake, decreased resting metabolic rate, decreased physical activity and increased lipoprotein lipase activity. Although there is convincing evidence for the association between smoking cessation and weight gain, the molecular mechanisms underlying this relationship are not well understood. This review summarizes current information of the effects of nicotine on peptides involved in feeding behaviour. Smoking was shown to impair glucose tolerance and insulin sensitivity and cross-sectional studies have demonstrated that smokers are insulin-resistant and hyperinsulinaemic, as compared with non-smokers. Smoking cessation seems to improve insulin sensitivity in spite of the weight gain. Nicotine replacement - in particular nicotine gum - appears to be effective in delaying post-cessation weight gain. In a group of women who failed to quit smoking because of weight gain, a dietary intervention (intermittent very-low-calorie diet) plus nicotine gum showed to both increase success rate in terms of smoking cessation and prevent weight gain. On the other hand, body weight gain at the end of treatment was significantly lower in the patients receiving bupropion or bupropion plus nicotine patch, compared with placebo. Studies with new drugs available for the treatment of obesity - sibutramine and orlistat - are warranted.

Smoking cessation and weight gain.

Many complications after renal transplantation can be prevented if they are detected early. Guidelines have been developed for the prevention of diseases in the general popu- lation, but there are no comprehensive guidelines for the pre- vention of diseases and complications after renal transplanta- tion. Therefore, the Clinical Practice Guidelines Committee of the American Society of Transplantation developed these guidelines to help physicians and other health care workers provide optimal care for renal transplant recipients. The guide- lines are also intended to indirectly help patients receive the access to care that they need to ensure long-term allograft survival, by attempting to systematically define what that care encompasses. The guidelines are applicable to all adult and pediatric renal transplant recipients, and they cover the outpa- tient screening for and prevention of diseases and complica- tions that commonly occur after renal transplantation. They do not cover the diagnosis and treatment of diseases and compli- cations after they become manifest, and they do not cover the pretransplant evaluation of renal transplant candidates. The guidelines are comprehensive, but they do not pretend to cover every aspect of care. As much as possible, the guidelines are evidence-based, and each recommendation has been given a subjective grade to indicate the strength of evidence that sup- ports the recommendation. It is hoped that these guidelines will provide a framework for additional discussion and research that will improve the care of renal transplant recipients.

Recommendations for the Outpatient Surveillance of Renal Transplant Recipients

Chronic obstructive pulmonary disease (COPD) is easily detected in its preclinical phase using spirometry, and successful smoking cessation (a cost-effective intervention) prevents further disease progression. This consensus statement recommends the widespread use of office spirometry by primary-care providers for patients > or = 45 years old who smoke cigarettes. Discussion of the spirometry results with current smokers should be accompanied by strong advice to quit smoking and referral to local smoking cessation resources. Spirometry also is recommended for patients with respiratory symptoms such as chronic cough, episodic wheezing, and exertional dyspnea in order to detect airways obstruction due to asthma or COPD. Although diagnostic-quality spirometry may be used to detect COPD, we recommend the development, validation, and implementation of a new type of spirometry-office spirometry--for this purpose in the primary-care setting. In order to encourage the widespread use of office spirometers, their specifications differ somewhat from those for diagnostic spirometers, allowing lower instrument cost, smaller size, less effort to perform the test, improved ease of calibration checks, and an improved quality-assurance program.

Office spirometry for lung health assessment in adults: a consensus statement from the National Lung Health Education Program.

Objective. —To summarize theSmoking Cessation Clinical Practice Guidelinethat provides recommendations for 3 groups of professionals: primary care clinicians, smoking cessation specialists, and health care administrators, insurers, and purchasers. Participants. —An independent panel of scientists, clinicians, consumers, and methodologists selected by the US Agency for Health Care Policy and Research. Evidence. —English-language, peer-reviewed literature published between 1975 and 1994 that addresses the assessment and treatment of tobacco dependence, nicotine addiction, and clinical practice. Consensus Process. —Four panel meetings were held over 2 years to evaluate meta-analytic and other results, to synthesize the results, and to develop recommendations. TheGuidelinewas repeatedly reviewed and revised. Conclusions. —The panel recommendations address 3 audiences. Major recommendations for primary care clinicians are to use officewide systems to identify smokers, treat every smoker with a cessation or motivational intervention, offer nicotine replacement except in special circumstances, and schedule follow-up contact to occur after cessation. Major recommendations to smoking cessation specialists are to use multiple individual or group counseling sessions lasting at least 20 minutes each with sessions spanning multiple weeks, offer nicotine replacement, and provide problem-solving and social support counseling. Major recommendations for health care administrators, insurers, and purchasers are that tobacco-user identification systems be used in all clinics and that smoking cessation treatment be supported through staff education and training, dedicated staff, changes in hospital policies, and the provision of reimbursement for tobaccodependence treatment. (JAMA. 1996;275:1270-1280)

https://www.primarycare.theclinics.com/article/S0095-4543(05)70115-9/pdf

The agency for health care policy and research smoking cessation clinical practice guideline

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The agency for health care policy and research smoking cessation clinical practice guideline