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ASH Daily news for 02 June 2010

HEADLINES

  • Quit smoking after fracture surgery for improved healing

    Smokers who refrain from using tobacco during the six-week period following emergency surgery for an acute fracture heal more quickly and experience fewer complications than patients who continue to smoke during the healing process, according to a study published in the June 2010 issue of The Journal of Bone and Joint Surgery (JBJS).

    "Our results indicate that a smoking cessation intervention program during the first six weeks after acute fracture surgery decreases the risk of postoperative complications by nearly half," said Hans Nåsell, MD, senior surgical consultant, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.

    While earlier research has clearly indicated refraining from smoking prior to surgery results in better healing and fewer postoperative complications, this multi-center, randomized study was the first to examine the effects of smoking cessation following surgery.

    "Tobacco smoking is a major health and economic concern and also is known to have a significant negative effect on surgical outcomes," Dr. Nåsell said. "The benefits of a smoking cessation program prior to elective surgery are well known, but there have not been any studies about the benefit of smoking cessation following emergency surgery. Our aim was to assess whether a smoking cessation programme, started soon after hospitalisation and continuing for six weeks following surgery, could reduce the number of postoperative complications."

    In the study, conducted at three hospitals in Stockholm, daily smokers who underwent emergency surgery for an acute fracture were offered a smoking cessation program within two days of surgery, and then followed for six weeks.

    Patients included in the program were offered one or two in-person meetings, in addition to regular telephone contact with a nurse trained in the cessation program. During the six-week follow-up, patients were encouraged not to smoke and free nicotine substitution was offered to those who needed it.

    Up until this point, the belief was that you needed to stop smoking prior to surgery to gain any benefit," Dr. Nåsell said. "It was surprising, and encouraging, to see that even stopping smoking following surgery for a period of time can offer significant benefits, including nearly a 50 percent reduction in wound complications.

    "The smoking cessation programme only requires two to three hours of support from the nursing staff, which is significantly less time than would be required for the treatment of side effects such as poor wound healing which can occur as a side effect of smoking," he added.

    Smoking inhibits circulation and lowers blood oxygen levels, which can affect short-term and long-term healing in several ways, including:

    - failure or delayed healing of bone, skin and other soft tissues; or
    - causing wound site infections.

    "In elective surgery, smoking cessation can become part of a plan preoperatively to reduce risks during and after surgery," noted Dr. Nåsell. "But with emergency surgery, such as acute fracture surgery, stopping smoking before surgery is not an option. Therefore, it's very encouraging to see that stopping smoking following surgery offers some of the same benefits as preoperative smoking cessation."

    Dr. Nåsell said he hopes the results of the study will encourage hospitals and clinics to begin offering smoking cessation programs routinely to patients undergoing emergency surgery. He also added that in Sweden, hospitals are required by The National Board of Health and Welfare to offer a smoking cessation program as an option to any patient undergoing surgery, whether planned or emergency.

    "Other studies have shown that most individuals who smoke would like to quit," he noted. "Having a smoking cessation program available to all patients pre-surgery can serve as a motivator to get them to quit. Even though this intervention lasts for six weeks, it may be all that is needed to help patients quit for good."

    Source: Science Daily, 01 June 2010
    Link: http://bit.ly/a7pril

  • Cigarette smoking 'could increase risk of depression'

    New research published in the British Journal of Psychiatry suggests smoking could increase the risk of depression. 

    The study, carried out by researchers from the University of Otago in New Zealand, followed over 1,000 people. At the ages of 18, 21 and 25, the participants were asked about their smoking habits and whether they had symptoms of depression.

    The researchers found a strong association between smoking and depression. People who were dependent on nicotine were more than twice as likely to have symptoms of depression as those who were not nicotine dependent.

    The researchers looked at this relationship in more detail using a sophisticated statistical technique called structural equation modelling (SEM). This analysis showed that smoking increases the risk of developing depressive symptoms, rather than people being more likely to smoke because they're depressed.

    Commenting on the results, lead researcher Professor David Fergusson said: "Our findings are consistent with the conclusion that there is a cause and effect relationship between smoking and depression, in which cigarette smoking increases the risk of developing symptoms of depression.

    "The reasons for this relationship are not clear. However, it's possible that nicotine causes changes to neurotransmitter activity in the brain, leading to an increased risk of depression."

    Professor Fergusson and colleagues do emphasise that their study does not prove that smoking causes depression, and said that the study "should be viewed as suggestive rather than definitive".

    Source: Medical News Today, 02 June 2010
    Link: http://bit.ly/9gJSb7

  • USA: More carcinogens in American cigarettes

    American smokers receive higher doses of the most potent carcinogens than do smokers in many foreign countries because of variations in the way tobacco is processed for cigarettes, researchers from the Centers for Disease Control and Prevention reported.

    American cigarettes are typically made from "American blend" tobacco, a specific blend that, because of growing and curing practices, contains higher levels of cancer-causing tobacco-specific nitrosamines. The most popular Canadian, Australian and British brands, in contrast, are made from "bright" tobacco, which is lighter in color and cured differently.

    The study was designed primarily to correlate how well levels of the chemicals in cigarettes correlate with levels of their metabolites in smokers' urine. The data about exposure to the chemicals in different countries were an added benefit. The CDC team enlisted 126 regular smokers in Australia, Canada, Britian and, in the U.S., in New York and Minesota. All smoked one brand routinely, typically the most popular brands in their country. Smokers in Minnesota smoked Marlboro, Newport, Marlboro Light and Camel Light, while those in New York smoked Marlboro, Newport, Newport Light, Camel Light and Marlboro Menthol.

    The team focused on the most lethal carcinogen in the tobacco smoke, 4-(methylnitrosoamino)-1-(3-pyridyl)-1-butanone (NNK), and its primary metabolite in urine, known informally as NNAL. They collected cigarette butts from each smoker over a 24-hour period and analyzed them for the content of NNK, an indicator of how much of the carcinogen the smokers were exposed to. They also collected urine and measured levels of NNAL. The team reported in the journal Cancer Epidemiology Biomarkers and Prevention that the amount of NNAL in urine was directly related to the amount in the cigarette butts and that significantly higher levels were found in U.S. smokers, with levels in New York higher than those in Minnesota. The lowest levels were found in Australia and Canada, while the British smokers displayed intermediate levels.

    "We know that cigarettes from around the world vary in their ingredients and the way they are produced," Dr. Jim Pirkle of CDC's National Center for Environmental Health said in a statement. "All of these cigarettes contain harmful levels of carcinogens, but these findings show that amounts of tobacco-specific nitrosamines differ from country to country, and U.S. brands are the highest in the study." Changes in curing and blending practices could reduce U.S. smokers' exposure to this particular carcinogen, he added, but that would not necessarily result in a safer product.

    Source: Los Angeles Times, 01 June 2010
    Link: http://bit.ly/9cyqNR

  • Ireland: Call for tobacco industry levy over litter caused by cigarette butts

    The Irish tobacco industry should pay a levy to compensate for the amount of litter caused by cigarette butts, ASH Ireland has said.

    Speaking yesterday, on World No Tobacco Day, the anti-tobacco lobby group said close to 50 per cent of urban litter in Ireland is tobacco related and its clean-up places a burden on local authorities.

    The organisation highlighted, in particular, the presence of cigarette butts around the country which are made from cellulose acetate, a type of plastic that can take up to 12 years to fully decompose. It said an estimated 4.5 trillion cigarette ends discarded across the world each year are believed to kill millions of birds, fish and other animals and are sometimes eaten by young children.

    Dr Angie Brown, chairwoman of ASH Ireland said the organisation met Minister for the Environment John Gormley last November and their proposal to impose a levy on the tobacco industry was well received.

    “Surely we should be applying the ‘polluter pays’ principle in this instance,” Ms Brown said.

    She suggested an environmental tax of 50 per cent per pack of 20 cigarettes to be levied directly on the tobacco industry.

    “Our Government is strapped for cash and the tobacco industry is hugely profitable, so why are our taxes being used to clear up the litter of such a wealthy industry?” Ms Brown asked.

    A spokeswoman for John Player Sons in Mullingar, owned by international company Imperial Tobacco, said it would be opposed to a litter levy on cigarettes.

    “This proposed levy supposes all smokers are litterers; that is not the case,” she said.

    The spokeswoman said the company would embrace any initiatives to help address litter in conjunction with, for example, fast food outlets.

    Source: Irish Times, 01 June 2010
    Link: http://bit.ly/c0MOW4

  • Spain proposes total smoking ban in bars and restaurants

    For many British tourists, the stench of strong tobacco is as synonymous with Spain as serrano ham and rioja wine. But they may soon say Adios to grey clouds hovering at Spain's infamously smoggy tapas bars and cafés with a ban on smoking in enclosed public spaces.

    In 2006, the government introduced a partial ban that offered loopholes to the country's many tiny, family-owned eateries and bars. Now the Spanish health ministry has drafted a tougher law that cracks down on the entire dining-and-drinking scene, from multi-level discos to 10-seat bars. The Spanish parliament is expected to approve the ban this month, and it is expected to take effect in 2011.

    "Non-smokers don't want to breathe secondhand smoke, and tourists increasingly want smokefree spaces," the Health Minister, Trinidad Jimenez, told a parliamentary committee.

    But bar and restaurant owners are pushing hard to block the total ban. They fear that restricting smoking could hurt their already-ailing sector and eventually cause precarious small businesses to close – a dire prospect in a country with 20 per cent unemployment.

    Jose Luis Guerra, vice president of the national federation of bars and restaurants said, "We understand that we are justifiably moving toward prohibition, but let's go slower – give us more time. A smoking ban would cause consumption to drop by 7 per cent in bars and 20 per cent in discos."

    Medical associations and trade unions support the ban to protect the 1.25 million waiters, cooks and other service workers who inhale the secondhand smoke of their clients.

    Source: Independent, 02 June 2010
    Link: http://bit.ly/azWguy