Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. Objectives To evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. Randomized or quasi-randomized controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters were used. Sixty-five trials met the inclusion criteria. Among smokers who contacted helplines, quit rates were higher for groups randomized to receive multiple sessions of proactive counselling (nine studies, >24,000 participants, risk ratio (RR) for cessation at longest follow up 1.37, 95% confidence interval (CI) 1.26 to 1.50). There was mixed evidence about whether increasing the number of calls altered quit rates but most trials used more than two calls. Two studies comparing different counselling approaches during a single quitline contact did not detect significant differences. Of three studies that provided access to a hotline two detected a significant benefit and one did not. Telephone counselling not initiated by calls to helplines also increased quitting (44 studies, >24,000 participants, RR 1.29, 95% CI 1.20 to 1.38). In the subgroup of studies offering 1-2 calls the effect was small and not significant. A further seven studies were too diverse to contribute to meta-analyses and are discussed separately.

Telephone counselling for smoking cessation.

http://faculty.fortlewis.edu/burke_b/MI/MI%20Readings/Lundahl,%20Burke,%20et%20al.%202013.pdf

Motivational interviewing in medical care settings: A systematic review and meta-analysis of randomized controlled trials

Background
Smoking contributes to reasons for hospitalisation, and the period of hospitalisation may be a good time to provide help with quitting.

Objectives
To determine the effectiveness of interventions for smoking cessation that are initiated for hospitalised patients.

Search methods
We searched the Cochrane Tobacco Addiction Group register which includes papers identified from CENTRAL, MEDLINE, EMBASE and PsycINFO in December 2011 for studies of interventions for smoking cessation in hospitalised patients, using terms including (hospital and patient*) or hospitali* or inpatient* or admission* or admitted.

Selection criteria
Randomized and quasi-randomized trials of behavioural, pharmacological or multicomponent interventions to help patients stop smoking, conducted with hospitalised patients who were current smokers or recent quitters (defined as having quit more than one month before hospital admission). The intervention had to start in the hospital but could continue after hospital discharge. We excluded studies of patients admitted to facilities that primarily treat psychiatric disorders or substance abuse, studies that did not report abstinence rates and studies with follow-up of less than six months. Both acute care hospitals and rehabilitation hospitals were included in this update, with separate analyses done for each type of hospital.

Data collection and analysis
Two authors extracted data independently for each paper, with disagreements resolved by consensus.

Main results
Fifty trials met the inclusion criteria. Intensive counselling interventions that began during the hospital stay and continued with supportive contacts for at least one month after discharge increased smoking cessation rates after discharge (risk ratio (RR) 1.37, 95% confidence interval (CI) 1.27 to 1.48; 25 trials). A specific benefit for post-discharge contact compared with usual care was found in a subset of trials in which all participants received a counselling intervention in the hospital and were randomly assigned to post-discharge contact or usual care. No statistically significant benefit was found for less intensive counselling interventions. Adding nicotine replacement therapy (NRT) to an intensive counselling intervention increased smoking cessation rates compared with intensive counselling alone (RR 1.54, 95% CI 1.34 to 1.79, six trials). Adding varenicline to intensive counselling had a non-significant effect in two trials (RR 1.28, 95% CI 0.95 to 1.74). Adding bupropion did not produce a statistically significant increase in cessation over intensive counselling alone (RR 1.04, 95% CI 0.75 to 1.45, three trials). A similar pattern of results was observed in a subgroup of smokers admitted to hospital because of cardiovascular disease (CVD). In this subgroup, intensive intervention with follow-up support increased the rate of smoking cessation (RR 1.42, 95% CI 1.29 to 1.56), but less intensive interventions did not. One trial of intensive intervention including counselling and pharmacotherapy for smokers admitted with CVD assessed clinical and health care utilization endpoints, and found significant reductions in all-cause mortality and hospital readmission rates over a two-year follow-up period. These trials were all conducted in acute care hospitals. A comparable increase in smoking cessation rates was observed in a separate pooled analysis of intensive counselling interventions in rehabilitation hospitals (RR 1.71, 95% CI 1.37 to 2.14, three trials).

Authors' conclusions
High intensity behavioural interventions that begin during a hospital stay and include at least one month of supportive contact after discharge promote smoking cessation among hospitalised patients. The effect of these interventions was independent of the patient's admitting diagnosis and was found in rehabilitation settings as well as acute care hospitals. There was no evidence of effect for interventions of lower intensity or shorter duration. This update found that adding NRT to intensive counselling significantly increases cessation rates over counselling alone. There is insufficient direct evidence to conclude that adding bupropion or varenicline to intensive counselling increases cessation rates over what is achieved by counselling alone.

/pdf/interventions-for-smoking-cessation-in-hospitalised-patients-59mm6prxdh.pdf

Interventions for smoking cessation in hospitalised patients

Background: Motivational interviewing is widely used to help people to stop smoking. It is a counselling style which helps people to explore and resolve their uncertainties about changing their behaviour. It tries to avoid an aggressive or confrontational approach and instead steer people towards choosing to change their behaviour, and encouraging their self belief. The aim of this review is to discover whether motivational interviewing helps more people to quit than brief advice or usual care, when used to help people to stop smoking. Study characteristics: We searched for new studies to add to this review in August 2014 and found 14 new studies. Twenty-eight randomized or cluster-randomized controlled trials are now included in this review. Studies were included if participants were tobacco users; provided participants were not pregnant women or adolescents; if the intervention being tested was based on motivational interviewing principles; if the study included some kind of monitoring of the motivational interviewing intervention, such as staff training or a measure of the quality of counselling delivered, or both; if the control/comparison condition was brief advice or usual care; and if the study reported smoking abstinence at least six months after the start of the programme. Between them these studies recruited 16,803 tobacco users. Two of the studies recruited smokeless tobacco users, and the rest recruited cigarette smokers. The majority of studies provided motivational interviewing support face-to-face; however seven studies delivered the support by telephone only. Key findings: Our review found that motivational interviewing appears to help more people to quit smoking than brief advice or usual care when provided by general practitioners and by trained counsellors. Motivational interviewing carried out by general practitioners appeared to be more successful than when carried out by nurses or counsellors. Shorter motivational interviewing sessions (less than 20 minutes per session) were more effective than longer ones. A single session of treatment appeared to be marginally more successful than multiple sessions, but both delivered successful outcomes. The evidence for the value of follow-up telephone support was unclear, and face-to-face counselling did not help more people to quit than telephone counselling. Both approaches were more successful than brief advice or usual care. Quality of evidence: We have assessed the evidence presented in this review as of moderate quality. Our results should be interpreted with caution, due to variations in study characteristics and how the treatment was delivered. In a number of cases it was difficult to assess the quality of included studies due to a lack of reporting of study details. Finally there is some evidence that studies which did not find an effect of motivational interviewing were less likely to be published and therefore this may impact upon our results.

Motivational interviewing for smoking cessation

Introduction Suicide is a preventable cause of death. After about two centuries of research in suicide prevention, the effectiveness of a number of interventions has been demonstrated and various risk factors have been placed in perspective. Thus, "it is no longer acceptable to state blandly that there is no convincing evidence for the effectiveness of suicide prevention measures ..." and, even more importantly, "... the unacceptable rate of suicide worldwide can be reduced." WHO estimated that 877 000 deaths were due to suicide in the year 2002, (2) the majority of which (85%) occurred in low- and middle-income countries. (3) Attempted suicide can be up to 40 times more frequent than completed suicide. (4,5) Many of those who attempt suicide require medical attention and they are at high risk for completed suicide. (6-8) Self-inflicted injuries represented 1.4% of the global burden of disease in 20022 and are expected to increase to 2.4% by 2020. As suicide is among the top three causes of death in the population aged 15-34 years, (9) there is a massive loss to societies of young people in their productive years of life. Suicide mortality statistics are available at: http://www.who.int/mental_health! prevention/suicide/country_reports/en/ index.html. There have been several recent reviews of interventions that may be considered effective in reducing suicides. (1,10-12) Under the framework of universal, selective, and indicated interventions, (13) the general population is targeted by universal interventions (e.g. restricting access to means of suicide) and selective interventions focus on high-risk subgroups (e.g. people with mental disorders), whereas those who have attempted suicide are considered high-risk individuals and are therefore addressed with indicated interventions, which include a range of behavioural therapies and approaches such as cognitive therapy. (14) Among indicated interventions, various approaches have been tested to prevent subsequent suicidal behaviour by suicide attempters; extensive review articles are available. (15,16) Usually, the primary outcome measure used for these interventions was repeated suicide attempts. It is suggested that extrapolation from attempted to completed suicide is valid. (17) As completed suicide is a rare outcome in statistical terms, large numbers of suicide attempters would be needed to demonstram the effectiveness of an intervention in terms of a reduction of completed suicides. The multisite study presented here tried to tackle this challenge by combining data from different sites that had applied the same research protocol. Previously, completed suicides were used as an outcome measure in a study that investigated the maintenance of long-term contact (i.e. a total of 5 years and 24 contacts) with high suicide-risk psychiatric patients refusing further treatment. (18-20) The contact comprised regular short letters expressing concern for the person's well-being and inviting them to respond. This was associated with a significant reduction in suicide rates for at least 2 years after discharge from the in-patient setting. In addition, a "tele-help/tele-check" service (i.e. an alarm system that can be activated to call for help and a service that contacts a person twice a week for assessment of their needs and to provide emotional support) could significantly reduce the number of suicide deaths in the elderly, who typically have an elevated risk of suicide compared with an age-adjusted number for the general population. (21,22) These two examples demonstrate that it is possible to reduce the suicide rate in populations at risk by keeping in regular contact with patients. Brief interventions for alcohol problems are another promising type of intervention that have not been previously applied to suicidal behaviours. (23-25) These are designed to address the specific behaviour of drinking with information, feedback, health education and practical advice and focus in order to raise awareness of the problem and advise change. …

Effectiveness of Brief Intervention and Contact for Suicide Attempters: A Randomized Controlled Trial in Five Countries/ Efficacite D'une Intervention et D'un Contact Brefs Chez Les Personnes Ayant Tente De Se Suicider : Essai Controle Randomise Dans Cinq pays/Eficacia De Una Intervencion De Informacion Y Contactos En Los Casos De Intento De Suicidio: Ensayo Controlado Aleatorizado En Cinco Paises

This study aimed to estimate the lifetime prevalence rates for suicidal ideation, suicide plans, and attempted suicide, based on a cluster sample of 515 residents of Campinas, Sao Paulo State, Brazil. The Multisite Intervention Study on Suicidal Behavior interview was performed, and lifetime prevalence rates and 95% confidence intervals (95%CI) were calculated. Lifetime prevalence rates were 17.1% (95%CI: 12.9-21.2) for suicidal ideation, 4.8% (95%CI: 2.8-6.8) for suicide plans, and 2.8% (95%CI: 0.09-4.6) for attempted suicide. Suicidal behavior was more frequent among women and young adults. The suicide plan/attempt ratio was approximately 5:3. Only one-third of those who attempted suicide contacted a health service following the attempt. Prevalence rates for suicidal behavior were similar to most studies from other countries. Suicide prevention strategies should take data from community-based studies into account.

/pdf/prevalencias-de-ideacao-plano-e-tentativa-de-suicidio-um-4ra1hylini.pdf

Prevalências de ideação, plano e tentativa de suicídio: um inquérito de base populacional em Campinas, São Paulo, Brasil

This paper aims to identify variables associated with suicidal ideation during the previous 12 months in the city of Campinas, Sao Paulo, Brazil. Using a case-control design, risk factors for suicidal ideation were investigated through analysis of independent variables related to the individual, family, and health. Some 29 cases of suicidal ideation and 166 controls were interviewed. Cases were identified through a previous cross-sectional study, and controls were randomly selected from the same population base among those with no history of suicidal ideation in the previous 12 months. Regression models were used to control for confounders and effect modifiers. According to the results, demographic variables were not associated with suicidal ideation. In the final model, the variables that remained statistically significant were depressive symptoms, emotional difficulties, lack of neighborhood support, and less frequent church attendance. Suicidal ideation was consistently associated with factors related to depressive symptoms, especially lack of energy and depressed mood.

/pdf/factors-associated-with-suicidal-ideation-in-the-community-a-1j9bvx4n2o.pdf

[Factors associated with suicidal ideation in the community: a case-control study].

This study aimed to estimate the lifetime preva-lence rates for suicidal ideation, suicide plans, and attempted suicide, based on a cluster sample of 515 residents of Campinas, Sao Paulo State, Brazil. The Multisite Intervention Study on Sui-cidal Behavior interview was performed, and lifetime prevalence rates and 95% confidence in-tervals (95%CI) were calculated. Lifetime preva-lence rates were 17.1% (95%CI: 12.9-21.2) for sui-cidal ideation, 4.8% (95%CI: 2.8-6.8) for suicide plans, and 2.8% (95%CI: 0.09-4.6) for attempted suicide. Suicidal behavior was more frequent among women and young adults. The suicide plan/attempt ratio was approximately 5:3. Only one-third of those who attempted suicide con-tacted a health service following the attempt. Prevalence rates for suicidal behavior were simi-lar to most studies from other countries. Suicide prevention strategies should take data from com-munity-based studies into account.Attempted Suicide; Suicide; Self-Injurious Be-havior Introducao

/pdf/prevalencias-de-ideacao-plano-e-tentativa-de-suicidio-um-29p8lpft45.pdf

Prevalências de ideação, plano e tentativa de suicídio: um inquérito de base populacional

Factors associated with suicide ideation among medically and surgically hospitalized patients

OBJETIVO: Detectar fatores associados a historico de tentativa de suicidio (TS) em pacientes internados em hospital geral que fazem uso nocivo de bebidas alcoolicas. METODO: 4.352 pacientes admitidos consecutivamente foram avaliados utilizando-se um rastreamento do qual constavam as escalas AUDIT (Alcohol Use Disorder Identification Test) e HAD (Escala Hospitalar de Ansiedade e Depressao). Fixando-se historico de tentativa de suicidio ao longo da vida como variavel dependente, foram realizados testes do qui-quadrado e regressao logistica multipla. RESULTADOS: Uso nocivo de alcool (AUDIT > 8) foi detectado em 423 pacientes. Dentre eles, 60 (14,2%) apresentavam sintomas de depressao (HAD > 8) e 34 (8%) tinham historico de TS. Este se associou a ser adulto jovem [razao de chance (RC) = 3,4], depressao (RC = 6,6), uso pregresso de psicofarmaco (RC = 7) e ter SIDA (RC = 24). CONCLUSAO: Os resultados fortalecem a necessidade de detectar e tratar adequadamente condicoes que, combinadas, aumentam consideravelmente o risco de suicidio.

/pdf/tentativa-de-suicidio-entre-pacientes-com-uso-nocivo-de-209zzssyj6.pdf

Viviane Franco da Silva

Papers

Prevalências de ideação, plano e tentativa de suicídio: um inquérito de base populacional em Campinas, São Paulo, Brasil

[Factors associated with suicidal ideation in the community: a case-control study].

Prevalências de ideação, plano e tentativa de suicídio: um inquérito de base populacional

Factors associated with suicide ideation among medically and surgically hospitalized patients

Tentativa de suicídio entre pacientes com uso nocivo de bebidas alcoólicas internados em hospital geral