Tandvården har goda möjligheter att få kännedom om patienters tobaksvanor eftersom flertalet människor besöker tandvården regelbundet. Det finns därför goda möjligheter att utföra tobaksavvänjning med de som röker eller snusar. Syftet med litteraturstudien var att belysa metoder som finns för tobaksavvänjning och vilka resultat dessa metoder ger. Sökningen gjordes i databasen Pubmed och begränsades till artiklar som är publicerade under de senaste tio åren och till studier som har utförts inom tandvården. Litteraturstudien inkluderade åtta studier. Resultatet visade att det finns flera olika kombinationsmetoder som används för tobaksavvänjning. I tre artiklar har 5A metoden använts i kombination med nikotinersättningsmedel. I övriga artiklar användes fem olika kombinationsmetoder med olika uppföljningstider. I en av kombinationsmetoderna beskrevs två metoder. Utöver dessa metoder fanns en metod för snusavvänjning. Resultatet visade skillnader i lyckandefrekvens med upphörande av tobaksvanor. Tolv månaders avvänjning och uppföljning i två av kombinationsmetoderna samt metoden för snusavvänjning gav högst lyckandefrekvens (36 %, 25 % och 30 %). Lägst lyckandefrekvens var 7 % efter tolv månaders uppföljning i en av 5A metoderna. Studiens slutsats är att det finns få publicerade studier om tobaksavvänjning inom tandvården som är baserade på utvärdering av tobaksavvänjningsmetoder som är utförda på patienter. Uppföljning och rådgivning samt stöttning har betydelse för resultatet. / Patients with tobacco habits visit the dental care regularly, therefore it is well placed to carry out tobacco cessation for those who smoke or use snuff. The purpose of this study was to highlight methods available for tobacco cessation and results of these methods. The authors searched in the database PubMed and was limited to articles published during the last ten years and performed in the dental care. The framework was limited to eight studies which were performed in the dental care. The results showed that there are several different combination methods for tobacco cessation. In three articles, the 5A method was used in combination with nicotine replacement therapy. In other articles five different combination methods with different follow-up times were used. In one of those with combined approach two methods are described. In addition a method was used for snuff cessation. The result showed differences in frequency of success to tobacco stop. The best result was shown after twelve months tobacco cessation and a follow up in two of the combination methods and the method for snuff cessation (36%, 25% and 30%). The lowest success rate was 7% after twelve months follow up with one of the 5A methods. The conclusion of the study is that there are few published studies regarding tobacco cessation in the dental care, which are based on evaluation of methods performed among patients. Follow up, counselling and support have essential effects on the result.

<p>Härtill 5 uppsatser</p> / digitalisering@umu

Age, male sex, hypertension, smoking, diabetes, dyslipidaemia, and obesity are considered as established risk factors for cardiovascular diseases. Several of these established cardiovascular risk factors are strongly influenced by lifestyle. Novel biomarkers from different mechanistic pathways have been associated with cardiovascular risk, but their clinical utility is still uncertain. The overall objective of the thesis was to evaluate the associations between certain lifestyle factors (physical activity and snuff use), biomarkers reflecting the haemostatic and the inflammatory systems and risk of a future first-ever myocardial infarction.  A prospective incident nested case-control study design was used with a total of 651 cases of myocardial infarction and 2238 matched controls from the population-based Northern Sweden Health and Disease Study.  The effects of commuting activity, occupational and leisure time physical activity on risk of myocardial infarction were studied. A clearly increased risk of myocardial infarction was found for car commuting compared to active commuting (walking, cycling or going by bus). High versus low leisure time physical activity was associated with decreased risk of myocardial infarction. Low occupational physical activity was associated with risk of myocardial infarction in men.  The risk of myocardial infarction or sudden cardiac death was studied in male snuff users compared to non-tobacco users. No increased risk was found for myocardial infarction or sudden cardiac death among snuff users without a previous history of smoking. However, for sudden cardiac death the study did not have statistical power to detect small differences in risk.  Plasma levels of haemostatic markers have previously shown to be associated with risk of myocardial infarction, but as haemostatic markers are also acute-phase reactants, it is not clear if their association with myocardial infarction is independent of inflammatory markers. In the present study, the haemostatic markers D-dimer, von Willebrand factor (VWF), tissue plasminogen activator (t-PA), and tissue plasminogen activator/plasminogen activator inhibitor-1 complex (t-PA/PAI-1 complex) were associated with risk of myocardial infarction after adjustment for established risk factors and the inflammatory markers C-reactive protein (CRP) and interleukin 6 (IL-6). Furthermore, the addition of eight haemostatic and inflammatory markers could improve the predictive ability for future myocardial infarction beyond that of a model utilizing only established risk factors.  Established risk factors and novel biomarkers were explored as potential mediators of the reduced risk of myocardial infarction related to active commuting. A combination of established risk factors, haemostatic and inflammatory markers appeared to explain a substantial proportion (40%) of the difference in risk for myocardial infarction between active commuters and car commuters. IL-6, t-PA, t-PA/PAI-1 complex, apo B/apo A-1 ratio, and BMI seemed to be the largest potential mediators when tested individually. In conclusion, regular physical activity such as active commuting is associated with reduced risk of a first-ever myocardial infarction. This effect could in part be mediated through a beneficial influence on haemostasis and inflammation, as well as a positive impact on established risk factors. Several haemostatic markers are associated with risk of myocardial infarction independent of established risk factors and inflammatory markers. The combination of haemostatic and inflammatory markers may enhance predictive ability beyond established risk factors. Our findings do not support the hypothesis that snuff use increases the risk of myocardial infarction.