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When examining data and statistics one thing is very clear. Smoking tobacco is causing a lot of different problems both in an individual’s health and in the society. Even though there is abundant evidence regarding its hazardous consequences, tobacco holds still a lot of users under its influence. Most of tobacco users do want to quit but they cannot make it last and relapse on their old habits. Tobacco is consumed everywhere in the world but effective products for quitting it, are still not that many available. Thus, it is made clear that there is a need for a product that will help counterattack this addiction. Deversify is an Uppsala-based start-up that wants to introduce to the market a tool for facilitating permanent smoking cessation. Their solution is a product called Aspirable. Aspirable is a breathalyzer that records the level of carbon monoxide (CO) in the exhaled breath, and it is accompanied with an app that will make use not only the recordings of the CO levels for a factual check but also help the user identify their habits to facilitate quitting. Regardless of the size of ones’ business, one thing is the same; it is better to first analyse if an idea is an endeavor worth trying. This project has utilized a case study for Aspirable, in order to explore in depth, the product and most importantly its market. Information available on the web was used to construct a picture on the smoking cessation market. Different aspects were examined inside theoretical frameworks such as the 7 dimensions of Aaker and Porter’s 5 forces. We made comparisons between Greece and Sweden to explore if another geographical market would be a better start for launching the product. In addition, we looked into what kind of consumer would be the best. Among those options, were governments, businesses, and individuals. The recommendation would be to aim at entering the Swedish market by approaching clinical trials so as to gain more scientific proof for the effectiveness of the product and also help indirectly another research be more reliable. Meanwhile, it would be best to avoid the public health system due to complicated regulations, segmented market due to each county having its own budget and decision-making processes.

I Sverige drabbas 1000 personer varje år av huvud- och halscancer. Rökning är den största enskilda orsaken till denna typ av cancer. Att motivera patienterna till att sluta röka är angeläget då fortsatt rökning har negativ inverkan på behandlings-resultatet samt förvärrar biverkningarna av behandlingen. Syftet med denna studie var att undersöka om patienter med huvud- och halscancer fick information om rökning och rökavvänjning inför och under strålbehandling, vad denna informa-tion innehöll samt att beskriva hur patienten upplevde informationen. Metoden var en intervjustudie som genomfördes på strålbehandlingsavdelningen, UMAS, Malmö. Åtta intervjuer genomfördes och resultatet visade att endast tre informan-ter erhållit information kring rökavvänjning från läkare och onkologisjuksköters-kor på strålbehandlingsavdelningen. Alla informanterna hade berättat för läkarna att de rökte men majoriteten upplevde inte att någon notis tagits vid denna infor-mation. En informant hade bett om hjälp för att sluta röka men avråtts av läkare vilket han upplevde som väldigt negativt. De som fått information kring rökav-vänjning upplevde detta som positivt samt kände att de blivit bekräftade. Majoriteten av informanterna hade velat delta i rökavvänjningsintervention om sådan funnits på kliniken. Det dagliga mötet mellan onkologisjuksköterskor och patienter på en strålbehandlingsavdelning innebär en möjlighet för sjuksköterskan att informera, stödja och bekräfta patienten i en rökavvänjningsintervention. / In Sweden 1000 individuals are diagnosed with head and neck cancer each year. Smoking is the major, single cause of this type of cancer. Motivating the patients to quit smoking is of great importance since smoking during treatment increases risks for treatment failure and increased side effects. The aim of this study was to investigate if patients with head and neck cancer received information about smoking and smoking cessation before and during radiation therapy, the content of the information and to describe patients' experience of the information. The method was an interview study and took place in the Department of radiation therapy, UMAS, Malmö. Eight interviews were carried out and the findings showed that only three respondents had received information of smoking cessa-tion from doctors or oncology nurses in the Department of radiation therapy. All of the respondents had informed the doctor of their smoking habit but the majority experienced that they were left without any response. One respondent had asked for smoking cessation aid but had been recommended not to quit smoking during treatment, which he had experienced as very negative. The patients who had re-ceived smoking cessation information experienced this information positive and felt both confirmed and supported. The majority of the respondents would have liked to participate in a smoking cessation intervention if such was available at the department. The daily meeting between nurses and patients in the Department of radiation therapy means an opportunity to give information, support and to con-firm the patient in a smoking cessation intervention.

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<p>Cigarette smoking is prevalent in HIV-infected people, resulting in higher mortality rate and more premature heart and lung diseases in the highly active antiretroviral therapy era. Smoking is a modifiable risk factor for these adverse outcomes and smoking cessation in HIV-positive smokers is feasible, although further efforts are needed to improve smoking cessation programs in HIV-positive persons.</p> <p>In this thesis, I examined the role of smoking in mortality and morbidity in HIV-positive Ontarians, and piloted a smoking cessation program featuring a novel smoking cessation aid, varenicline, in HIV-infected smokers. In addition, I explored three different methods to resolve missing data, by excluding, grouping and multiply imputing missing data. I adopted three different study designs in my thesis studies: retrospective cohort, cross-sectional and open label study.</p> <p>We found smoking prevalence in HIV-infected people was consistently higher than in the general population. Smoking was associated with a higher risk of death, of respiratory symptoms, hospitalization and chronic obstructive pulmonary disease, and with reduced lung function and less CD4-T-lymphocyte improvement over time. We found varenicline was as effective in HIV-positive smokers as in non-HIV smokers reported by previous studies.</p> / Doctor of Philosophy (PhD)

<p>Please insert 2 pages into the main thesis - page 39 and page 40</p> <p>- 2 separate PDF attachments will be included plus the main thesis.</p> / <p><strong>Background:</strong></p> <p><strong> </strong> Academic detailing (AD) provides evidence-based education to healthcare professionals in their practice setting and has been found to improve knowledge and prescribing in many situations. Personalized academic detailing (PAD) is a new initiative by the Hamilton Family Health Team (FHT) in which pharmacists integrated within the FHT provide an AD service to prescribers in their office.</p> <p><strong>Objective: </strong></p> <p>To describe and determine the feasibility of a smoking cessation (SC) PAD program.</p> <p><strong>Methods:</strong></p> <p>Design: Descriptive retrospective cohort pilot project</p> <p>Setting: Primary Care Setting</p> <p>Participants: FHT pharmacists, physicians, nurse practitioners (NPs) and their patients</p> <p>Intervention:</p> <p>Pharmacists receive basic AD training and education (upskilling) on SC; and provide education to clinicians</p> <p><strong>Feasibility Criteria for success:</strong> <ol> <li>PAD coordinator time to train pharmacists <40 >hours</li> <li>Average time for upskilling <20 >hours</li> <li>Average time for PAD session are <60 minutes and><30 minutes for initial and follow-up>visits, respectively</li> <li>Percentage of clinicians detailed within 3 and 6 months are >50% and >70%, respectively</li> <li>Number of new SC referrals to the pharmacist at 3 and 6 months are >5 patients/1.0 full-time equivalent (FTE) pharmacist and >10 patients/1.0 FTE pharmacist, respectively.</li> </ol></p> <p><strong>Results:</strong></p> <p>Eight pharmacists (5.8 FTE) received basic AD training and upskilling on SC PAD. Consent was obtained from 48/54 (88.9%) physicians and 9/10 (90.0%) NPs.</p> <p>The PAD coordinator training time was 29.1 hours. The median time for upskilling was 3.1 hours. The median time for PAD session was 15 and 5 minutes for an initial visit and follow-up visit, respectively. The number of clinicians detailed within 3 and 6 months were 50/64 (78.1%) and 57/64 (89.1%), respectively. The number of new SC referrals at 3 and 6 months was 66 and 200 patients, respectively.</p> <p><strong>Conclusion:</strong></p> <p>This pilot study showed that the main study is feasible with respect to the management, resources, process and scientific components.</p> / Master of Science (MSc)

Det finns ca 1,9 miljoner människor som dagligen använder tobak i Sverige. 6,1 procent av den svenska befolkningen röker tobak. Hjärt-och kärlsjukdomar, cancer och lungsjukdomar har stark koppling till tobaksrökning, dessa kan leda till döden. Sjuksköterskans roll är att främja hälsa och förebygga sjukdomar och leder på så sätt till syftet som denna litteraturstudie vill utforska. Syftet i denna litteraturstudie är att belysa sjuksköterskans roll att främja rökavvänjning. Litteraturstudien är kvalitativ och sökningarna gjordes i databaserna Pubmed samt Cinahl. Litteraturstudien baseras på tio kvalitativa studier som sedan kvalitetsgranskats enligt SBU:s granskningsmall. Resultatet påvisade att sjuksköterskans roll berör rådgivning, motivation, information och utbildning samt proaktiv identifiering. Sjuksköterskans främsta roll är att främja hälsa, detta går i enlighet med att aktivt arbeta med rökavvänjning för patienter. Sjuksköterskans roll stötte även på etiska dilemman vid svårmotiverade patienter och på så sätt påverkades sjuksköterskans roll negativt. Konklusionen av denna litteraturstudie visade att sjuksköterskans roll för att främja rökavvänjning är att skapa goda relationer för att vinna förtroende hos patienterna för att därefter öka motivationen hos patienten för att främja rökavvänjning. Vidare forskning är nödvändig för att kunna nå ett rökfritt samhälle i Sverige / There are approximately 1.9 million people who use tobacco daily in Sweden. 6.1 percent of the Swedish population smokes tobacco. Cardiovascular diseases, cancer and lung diseases are strongly linked to tobacco smoking, these can lead to death. The nurses role is to promote health and prevent disease and thus leads to the purpose that this literature study wants to explore. The purpose of this literature study is to highlight the nurses role in promoting smoking cessation. The literature study is qualitative and the searches were made in the databases Pubmed and Cinahl. The literature study is based on ten qualitative studies which have then been quality-reviewed according to SBU's review template. The results showed that the nurses role concerns counselling, motivation, information and education as well as proactive identification. The nurses main role is to promote health, this goes in accordance with actively working with smoking cessation for patients. The nurses role also encountered ethical dilemmas with difficult-to-motivate patients and in this way the nurse's role was negatively affected. The conclusion of this literature study showed that the nurse's role in promoting smoking cessation is to create good relationships in order to gain the trust of the patients in order to subsequently increase the motivation of the patients to promote smoking cessation. Further research is necessary to be able to reach a smoke-free society in Sweden.

Tobacco smoking has consistently been the leading cause of preventable diseases and premature deaths. Currently, pharmacological interventions have only shown limited smoking cessation efficacy and sometimes are associated with severe side effects. As an alternative, nicotine vaccines have emerged as a promising strategy to combating nicotine addiction. However, conventional conjugate nicotine vaccines have shown limited ability to induce a sufficiently strong immune response due to their intrinsic shortfalls. In this study, a lipid-poly(lactic-co-glycolic acid) (PLGA) nanoparticle-based next-generation nicotine vaccine has been developed to overcome the drawbacks of conjugate nicotine vaccines. Also, the influence of multiple factors, including nanoparticle size, hapten density, hapten localization, carrier protein, and molecular adjuvants, on its immunogenicity has been investigated. Results indicated that all these studied factors significantly affected the immunological efficacy of the nicotine nanovaccine. First, 100 nm nanovaccine was found to elicit a significantly higher anti-nicotine antibody titer than the 500 nm nanovaccine. Secondly, the high-density nanovaccine exhibited a better immunological efficacy than the low- and medium-density counterparts. Thirdly, the nanovaccine with hapten localized on both carrier protein and nanoparticle surface induced a significantly higher anti-nicotine antibody titer and had a considerably better ability to block nicotine from entering the brain of mice than the nanovaccines with hapten localized only on carrier protein or nanoparticle surface. Fourthly, the nanovaccines carrying cross reactive materials 197 (CRM197) or tetanus toxoid (TT) showed a better immunological efficacy than the nanovaccines using keyhole limpet hemocyanin (KLH) or KLH subunit as carrier proteins. Finally, the co-delivery of monophosphoryl lipid A (MPLA) and Resiquimod (R848) achieved a considerably higher antibody titer and brain nicotine reduction than only using MPLA or R848 alone as adjuvants. Collectively, the findings from this study may lead to a better understanding of the impact of multiple factors on the immunological efficacy of the hybrid nanoparticle-based nicotine nanovaccine. The findings may also provide significant guidance for the development of other drug abuse and nanoparticle-based vaccines. In addition, the optimized lipid-PLGA hybrid nanoparticle-based nicotine nanovaccine obtained by modulating the studied factors can be a promising candidate as the next-generation nicotine vaccine for treating nicotine addiction. / PHD / Tobacco smoking is prevalent and represents one of the largest public health concerns in the world. Tobacco use remains to be the leading cause of preventable diseases and premature deaths. Typically, smokers without medications experience huge difficulty in quitting smoking due to the addictiveness of nicotine. Although several pharmacological interventions are available to smokers, they have only shown limited smoking cessation efficacy. In recent years, nicotine vaccines that can induce the production of nicotine specific antibodies have been proposed as a promising strategy for smoking cessation. Currently, almost all the already-developed nicotine vaccines are conjugate nicotine vaccines in which nicotine haptens are attached to a carrier protein for presentation. However, conventional conjugate nicotine vaccines suffer from many innate shortcomings that largely limit their immunological efficacy. This study aimed to develop a nanoparticle-based next-generation nicotine vaccine to overcome the drawbacks of conventional conjugate nicotine vaccines. Because many factors may potentially affect the immunological efficacy of a nicotine vaccine, this study focused on investigating the influence of multiple factors, including nanoparticle size, hapten density, hapten localization, carrier protein, and molecular adjuvants, on the immunological efficacy of the developed hybrid nanoparticle-based nicotine vaccine. Results from this study revealed that all these studied factors significantly influenced the immunological efficacy of the nicotine nanovaccine. By modulating v these factors, enhanced immune responses that can result in higher titers of anti-nicotine antibodies and better ability in blocking nicotine from entering the brain of mice could be achieved. The findings from this study would lead to a better understanding of how multiple factors influence the immunological efficacy of a nanoparticle-based nicotine vaccine. In addition, the findings from this study can also provide significant guidance for the development of other drug abuse and nanoparticle-based vaccines. More importantly, the hybrid nanoparticle-based nicotine nanovaccine can be a promising candidate for smoking cessation.

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