Scielo RSS <![CDATA[SAMJ: South African Medical Journal]]> http://www.scielo.org.za/rss.php?pid=0256-957420130011&lang=pt vol. 103 num. 11 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Food security: The optimal diet for people and the planet</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Looking for the next breakthrough in tobacco control and health</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100002&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>South Africa's bad habits</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100003&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Pre-hospital rapid sequence induction: Factual inaccuracies? With a response from Matthew Gunning</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100004&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Cutaneous adverse drug reactions caused by FDCAs - we need to characterise and manage them urgently</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100005&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Corruption-breeding political patronage an albatross - former E-Cape health chief</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100006&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Smoke, fire and mirrors: The e-cigarette debate</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100007&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Quality of life <i>can</i> be part of the cure</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100008&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Get off your butt - and live longer</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100009&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Ralph Kirsch Golden Pen Award</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100010&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>The Hungry Season: Feeding Southern Africa's Cities</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100011&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>The Women's Health Initiative Randomized Controlled Dietary Modification Trial: An inconvenient finding and the diet-heart hypothesis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100012&lng=pt&nrm=iso&tlng=pt One goal of the US$700 million Women's Health Initiative Randomized Controlled Dietary Modification Trial was to determine whether post-menopausal women who adopted what was regarded as a 'heart healthy' low-fat diet, high in vegetables, fruits and grains, reduced their risk of developing cardiovascular disease. The trial substantially favoured the outcome in the intervention group, who also received an intensive nutritional and behaviour education programme not offered to the control group. These studies neatly disprove the diet-heart hypothesis since adoption of 'heart healthy' eating not only failed to influence future cardiac events in the healthy but it increased such events in the unhealthy and worsened diabetic control in those with type 2 diabetes mellitus. <![CDATA[<b>Low-carbohydrate and high-fat intake can manage obesity and associated conditions: Occasional survey</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100013&lng=pt&nrm=iso&tlng=pt This study analyses 127 communications from individuals self-reporting their weight change following adoption of a low-carbohydrate, high-fat (LCHF) eating plan. Total combined self-reported weight loss was 1 900 kg (range 5 kg gain to 84 kg loss). The mean ± standard deviation weight loss of 15 (±12) kg is among the largest yet described. Sixteen subjects reported the LCHF 'cured' (i.e. medications no longer required) one or more of their medical conditions, most commonly type 2 diabetes mellitus (T2DM) (n=14), hypertension (n=8) and hypercholesterolaemia (n=7). Another 9 subjects with either type 1 diabetes mellitus or T2DM reduced medications as did 7 patients with hypertension; 8 no longer suffered from irritable bowel syndrome. These data show that significant and rapid weight loss is possible on an unsupervised eating plan that severely restricts daily carbohydrate intake to approximately <75 g/day. Better weight loss on a carbohydrate-restricted LCHF eating plan than on an iso-caloric high-carbohydrate, low-fat (HCLF) diet is well described in the literature, probably due to a paradoxical reduction of hunger by carbohydrate restriction. A randomised controlled clinical trial is urgently required to disprove the hypothesis that the LCHF eating plan can reverse cases of T2DM, metabolic syndrome and hypertension without pharmacotherapy. <![CDATA[<b>A comprehensive, health-promotion approach to tobacco control</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100014&lng=pt&nrm=iso&tlng=pt This study analyses 127 communications from individuals self-reporting their weight change following adoption of a low-carbohydrate, high-fat (LCHF) eating plan. Total combined self-reported weight loss was 1 900 kg (range 5 kg gain to 84 kg loss). The mean ± standard deviation weight loss of 15 (±12) kg is among the largest yet described. Sixteen subjects reported the LCHF 'cured' (i.e. medications no longer required) one or more of their medical conditions, most commonly type 2 diabetes mellitus (T2DM) (n=14), hypertension (n=8) and hypercholesterolaemia (n=7). Another 9 subjects with either type 1 diabetes mellitus or T2DM reduced medications as did 7 patients with hypertension; 8 no longer suffered from irritable bowel syndrome. These data show that significant and rapid weight loss is possible on an unsupervised eating plan that severely restricts daily carbohydrate intake to approximately <75 g/day. Better weight loss on a carbohydrate-restricted LCHF eating plan than on an iso-caloric high-carbohydrate, low-fat (HCLF) diet is well described in the literature, probably due to a paradoxical reduction of hunger by carbohydrate restriction. A randomised controlled clinical trial is urgently required to disprove the hypothesis that the LCHF eating plan can reverse cases of T2DM, metabolic syndrome and hypertension without pharmacotherapy. <![CDATA[<b>The electronic cigarettes debate</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100015&lng=pt&nrm=iso&tlng=pt Electronic cigarettes (e-cigarettes) are relatively new in South Africa and their popularity is increasing. Their appearance coincides with intensifying attempts by government and society to reduce tobacco smoking through stricter limitation on its sale, advertising and use. Debate has been triggered on their use regarding the potential risks of increasing nicotine addiction and encouraging people to start smoking, or whether e-cigarettes might serve rather as an efficient means of treating addiction, thus assisting smokers to quit. Opinions among doctors regarding e-cigarettes vary, some seeing potential for good, others condemning them outright. Several professional medical societies have taken the stand that, whatever their potential as a smoking-cessation method, they cannot be encouraged since they are produced and promoted by the tobacco industry. Also, that research supported by the manufacturers of e-cigarettes may not be presented at their meetings or in their medical journals. We present the following arguments for the potential benefit and harms of e-cigarettes, based on the currently available evidence. <![CDATA[<b>Electronic cigarettes: The potential risks outweigh the benefits</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100016&lng=pt&nrm=iso&tlng=pt Electronic cigarettes (e-cigarettes) are relatively new in South Africa and their popularity is increasing. Their appearance coincides with intensifying attempts by government and society to reduce tobacco smoking through stricter limitation on its sale, advertising and use. Debate has been triggered on their use regarding the potential risks of increasing nicotine addiction and encouraging people to start smoking, or whether e-cigarettes might serve rather as an efficient means of treating addiction, thus assisting smokers to quit. Opinions among doctors regarding e-cigarettes vary, some seeing potential for good, others condemning them outright. Several professional medical societies have taken the stand that, whatever their potential as a smoking-cessation method, they cannot be encouraged since they are produced and promoted by the tobacco industry. Also, that research supported by the manufacturers of e-cigarettes may not be presented at their meetings or in their medical journals. We present the following arguments for the potential benefit and harms of e-cigarettes, based on the currently available evidence. <![CDATA[<b>Raising the CD4<sup>+</sup> initiation threshold with our eyes wide open</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100017&lng=pt&nrm=iso&tlng=pt Electronic cigarettes (e-cigarettes) are relatively new in South Africa and their popularity is increasing. Their appearance coincides with intensifying attempts by government and society to reduce tobacco smoking through stricter limitation on its sale, advertising and use. Debate has been triggered on their use regarding the potential risks of increasing nicotine addiction and encouraging people to start smoking, or whether e-cigarettes might serve rather as an efficient means of treating addiction, thus assisting smokers to quit. Opinions among doctors regarding e-cigarettes vary, some seeing potential for good, others condemning them outright. Several professional medical societies have taken the stand that, whatever their potential as a smoking-cessation method, they cannot be encouraged since they are produced and promoted by the tobacco industry. Also, that research supported by the manufacturers of e-cigarettes may not be presented at their meetings or in their medical journals. We present the following arguments for the potential benefit and harms of e-cigarettes, based on the currently available evidence. <![CDATA[<b>A decade of tobacco control: The South African case of politics, health policy, health promotion and behaviour change</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100018&lng=pt&nrm=iso&tlng=pt BACKGROUND: The South African (SA) government has implemented comprehensive tobacco control measures in line with the requirements of the Framework Convention on Tobacco Control. The effect of these measures on smoking prevalence and smoking-related attitudes, particularly among young people, is largely unknown. OBJECTIVE: To describe the impact of a comprehensive health promotion approach to tobacco control amongst SA school learners. METHODS: Four successive cross-sectional Global Youth Tobacco Surveys (GYTSs) were conducted in 1999, 2002, 2008 and 2011 among nationally representative samples of SA grades 8 - 10 school learners. We assessed the prevalence of current smoking (having smoked a cigarette on ≥1 day in the 30 days preceding the survey) and smoking-related attitudes and behaviours. RESULTS: Over the 12-year survey period current smoking among learners declined from 23.0% (1999) to 16.9% (2011) - a 26.5% reduction. Reductions in smoking prevalence were less pronounced amongst girls and amongst black learners. We observed an increase in smoking prevalence amongst learners between 2008 and 2011. Smoking-related attitudes and behaviours showed favourable changes over the survey period. CONCLUSION: These surveys demonstrate that the comprehensive and inter-sectorial tobacco control health promotion strategies implemented in SA have led to a gradual reduction in cigarette use amongst school learners. Of concern, however, are the smaller reductions in smoking prevalence amongst girls and black learners and an increase in smoking prevalence from 2008 to 2011. Additional efforts, especially for girls, are needed to ensure continued reduction in smoking prevalence amongst SA youth. <![CDATA[<b>The effects of obesity, smoking, and excessive alcohol intake on healthcare expenditure in a comprehensive medical scheme</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100019&lng=pt&nrm=iso&tlng=pt BACKGROUND: Health risks such as tobacco use, excessive alcohol consumption and unhealthy body weight contribute to the development of chronic health problems. OBJECTIVE: To estimate the associations of tobacco use, excessive alcohol consumption and obesity with healthcare expenditure and chronic diseases among South Africans on a comprehensive medical scheme. METHODS: We performed a cross-sectional analysis of health survey and medical claims data for 70 000 South Africans during 2010. RESULTS: Moderately obese individuals, with a body mass index (BMI) of 30 - 35 kg/m² averaged R2 300 (11%) higher annual medical expenditure in the year 2010 than never-smokers with a BMI <30 kg/m². This increase is comparable with being a current or past smoker (expenditure increase by R2 600; 13%). Severely obese individuals (BMI &gt;35 kg/m²), however, had increased healthcare costs of R4 400 (23% increase). This exceeds the difference between a 40- and a 50-year-old (increase of R3 200). Being overweight or excessive consumption of alcohol was not significantly associated with medical expenditures. Absolute and relative excess expenditures associated with these health risks are higher among older individuals. In the 54 - 69-year age group, estimated additional expenses were R6 200 for smoking (20% increase over never-smokers with BMI <30 kg/m²), R6 600 for moderate obesity (21%) and R15 800 for severe obesity (51% increase). Overweight or heavy drinking was not statistically significantly associated with healthcare expenditure. CONCLUSION: Obesity and tobacco use are associated with significantly increased healthcare expenditure. Severe obesity doubles these excess costs. <![CDATA[<b>The extent of problematic alcohol and other drug use within selected South African workplaces</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100020&lng=pt&nrm=iso&tlng=pt BACKGROUND: The use of alcohol and other drugs (AODs) in the workplace has a major impact on the health and productivity of the workforce globally. Yet information on this issue is limited in South Africa (SA). OBJECTIVE: To describe the nature and extent of AOD problems in selected workplace settings in SA. METHODS: Secondary data analysis was conducted on a large dataset compiled by an Employee Assistance Programme (EAP) service provider in SA. As part of an EAP risk audit, assessments for AOD-related problems were completed for each employee accessing EAP services (n=10 428) between 2005 and 2011. Data on the socio-demographic profiles, AOD use and impact of AOD use on the work performance of employees were analysed. RESULTS: Findings indicate that employed men are more likely to experience alcohol-related problems than women, the latter demonstrating a higher percentage of drug-related problems. The majority of referrals to the EAPs emanate from the public, industrial and financial sectors. AOD-related problems were also found to significantly impact on employee work performance. CONCLUSIONS: The study begins to address the knowledge gap on the extent of AOD use in SA workplaces and points to the need for further investigations into the exact nature of AOD use. In addition, the study highlights the need for intervention programmes and policies suited to the workplace. <![CDATA[<b><i>Hookah</i></b><b> pipe smoking among health sciences students</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100021&lng=pt&nrm=iso&tlng=pt BACKGROUND: Hookah pipe smoking is a social practice and has gained popularity, especially among South African youth. The extent of this practice among health sciences students, and their knowledge regarding the health risks, are unknown. This is important, as these students will become future health professionals possibly influencing the practice of individuals and communities. OBJECTIVE: To explore the knowledge, attitudes and practices of hookah pipe smoking among students at the Faculty of Health Sciences, University of Cape Town. METHODS: A cross-sectional study was conducted among undergraduate and postgraduate students. A self-administered questionnaire was distributed as a hard copy and online survey. RESULTS: Of 228 participants, 66% had smoked a hookah pipe before, with 18% still smoking. Most began smoking in high school, with 25% initiating at university. Of the current smokers, 65% smoked occasionally socially, commonly at friends' houses for 30 - 60 min/session. A further 11% smoked cigarettes concurrently and 30% added other substances, mainly cannabis, to pipes. Most current hookah smokers had no interest in quitting (84%). Only 30% of participants had prior health information about hookah pipe smoking. Most knew that it was harmful (91%), with many not knowing why. A total of 80% of participants perceived that the practice was socially acceptable and 84% would recommend it to others. CONCLUSION: The poor knowledge about the dangers of hookah pipe smoking and the extent of its practice among health sciences students is alarming. These findings highlight the need for school and university health-promotion campaigns, and for better regulation of hookah pipe smoking. <![CDATA[<b>Road traffic crashes in South Africa: The burden of injury to a regional trauma centre</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100022&lng=pt&nrm=iso&tlng=pt BACKGROUND: Globally, 90% of road traffic crash (RTC) deaths occur in low- and middle-income countries. OBJECTIVE: To document the mortality and morbidity associated with RTCs managed at a busy regional hospital in South Africa and investigate potentially preventable factors associated with RTCs. METHODS: This was a prospective study of all patients presenting to Edendale Hospital following a RTC over a 10-week period from late 2011 to early 2012. All fatalities recorded at the police mortuary for the same period were included. Medical records were reviewed and all admitted patients were interviewed about the circumstances of the accident. We calculated an injury pyramid to compare our data with European data. RESULTS: A total of 305 patients were seen over the study period, 100 required admission and there were 45 deaths due to RTCs in the area. Of the patients admitted, 41 were pedestrians involved in pedestrian vehicle crashes (PVCs) and 59 motor vehicle occupants involved in motor vehicle crashes (MVCs). The majority (n=58) of crashes involved a private vehicle. Only 17% of MVC patients were wearing a seatbelt and 8 were allegedly under the influence of alcohol. On average, RTC patients spent 19 days in hospital and 62 patients required at least 1 operation. According to our injury pyramid, the number of severe and fatal injuries was higher than in Europe. CONCLUSION: Our results demonstrate a high incidence of RTCs associated with a high injury score and significant morbidity. Most crashes were associated with a number of high-risk behaviours. <![CDATA[<b>Prevalence, risk factors and risk perception of tuberculosis infection among medical students and healthcare workers in Johannesburg, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100023&lng=pt&nrm=iso&tlng=pt BACKGROUND: Tuberculin skin test (TST) and interferon gamma release assays (IGRAs) are both recommended for routine screening of healthcare workers (HCWs) in low tuberculosis (TB)-burden countries. More recently, based on scarce data, the World Health Organization strongly recommended that IGRA should not be used for occupational screening in high-burden settings. OBJECTIVE: To assess the prevalence of latent tuberculosis infection (LTBI) determined among highly exposed HCWs and low-exposed medical students in Johannesburg, South Africa. METHODS: We performed a cross-sectional study using both TSTs and IGRAs to determine the prevalence rate of LTBI in 79 medical students and 120 HCWs providing HIV and/or TB care. RESULTS: The prevalence of LTBI among HCWs was 2- to 4-fold higher than that among medical students (56.7% v. 26.6% TST-positive; 69.2% v.15.2% IGRA-positive, respectively), with 3-fold higher odds for TST positivity and 12-fold higher odds for IGRA positivity among HCWs compared with students. Despite the perception of being at high risk, few HCWs protected themselves against LTBI. The majority of HCWs reported that they would participate in annual TST or IGRA screening. CONCLUSION: Infection control strategies and occupational screening programmes for professional and lay HCWs, as well as medical students, should be implemented in all high-burden settings. Further research is needed to determine whether IGRA or TST is the optimal assay for periodical screening of HCWs in high-burden settings. <![CDATA[<b>The prevalence of smoking and the knowledge of smoking hazards and smoking cessation strategies among HIV-positive patients in Johannesburg, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100024&lng=pt&nrm=iso&tlng=pt BACKGROUND: While the detrimental effects of smoking among HIV-positive patients have been well documented, there is a paucity of data regarding cigarette smoking prevalence among these patients in South Africa (SA). OBJECTIVES: To establish the frequency, demographics, knowledge of harmful effects, and knowledge of smoking cessation strategies among HIV-positive patients in Johannesburg, SA. METHODS: We conducted a prospective cross-sectional survey using a structured questionnaire to interview HIV-positive patients attending the HIV Clinic at the Charlotte Maxeke Johannesburg Academic Hospital between 1 July and 31 October 2011. RESULTS: Of 207 HIV-positive patients attending an antiretroviral therapy (ART) roll-out clinic, 31 (15%) were current smokers (23.2% of males and 7.4% of females) and a further 45 (21.7%) were ex-smokers. Most of the current smokers (30/31 patients) indicated their wish to quit smoking, and among the group as a whole, most patients were aware of the general (82.1%) and HIV-related (77.8%) risks of smoking and of methods for quitting smoking. Despite this, however, most (62.3%) were not aware of who they could approach for assistance and advice. CONCLUSIONS: Given the relatively high prevalence of current and ex-smokers among HIV-positive patients, there is a need for the introduction of smoking-cessation strategies and assistance at ART roll-out clinics in SA. <![CDATA[<b>Re-defining the extent of malaria transmission in South Africa: Implications for chemoprophylaxis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100025&lng=pt&nrm=iso&tlng=pt BACKGROUND: Malaria case numbers reported in South Africa have reduced considerably over the last decade, necessitating a revision of the national risk map to guide malaria prevention, including the use of chemoprophylaxis. OBJECTIVES: To update the national malaria risk map based on recent case data and to consider the implications of the new transmission profile for guiding prophylaxis. METHODS: The geographical distribution of confirmed malaria cases detected both passively and actively over the last six malaria seasons was used to redefine the geographical distribution and intensity of malaria transmission in the country. RESULTS: The national risk map was revised to reflect zones of transmission reduced both in their extent and their intensity. Most notably, the area of risk has been reduced in the north-western parts of Limpopo Province and is limited to the extreme northern reaches of KwaZulu-Natal Province. Areas previously considered to be of high risk are now regarded to be of moderate risk. CONCLUSION: Chemoprophylaxis is now only recommended from September to May in the north-eastern areas of Limpopo and Mpumalanga Provinces. The recommended options for chemoprophylaxis have not changed from mefloquine, doxycycline or atovaquone-proguanil. <![CDATA[<b>Carboxyhaemoglobin levels, health and lifestyle perceptions in smokers converting from tobacco cigarettes to electronic cigarettes</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100026&lng=pt&nrm=iso&tlng=pt BACKGROUND: Chronic obstructive pulmonary disease and lung cancer are diseases associated with smoking tobacco cigarettes. Smokers find cessation difficult. OBJECTIVES: To determine whether smoking the Twisp electronic cigarette (e-cigarette), containing nicotine in a vegetable-based glycerine substance, would reduce carboxyhaemoglobin (COHb) levels in regular cigarette smokers by (i) comparing arterial and venous COHb levels before and after smoking the Twisp e-cigarette for 2 weeks; and (ii) evaluating changes in participants' perception of their health and lifestyle following the use of Twisp e-cigarettes. METHODS: A single group within-subject design was used where tobacco cigarette smokers converted to Twisp e-cigarettes for 2 weeks. Prior to using the Twisp e-cigarette and after using this device for 2 weeks, arterial COHb, venous COHb and venous cotinine levels were determined. Additionally, the participants were asked to complete a questionnaire outlining their perceptions on health and lifestyle. RESULTS: Thirteen participants of median age 38 years (range 23 - 46) with a smoking median of 20 cigarettes/day (range 12 - 30) completed the study. COHb levels (%) were significantly reduced after smoking Twisp e-cigarettes for 2 weeks (mean ± standard deviation (SD) arterial COHb before 4.66±1.99 v. after 2.46±1.35; p=0.014 and mean ±SD venous COHb before 4.37±2.1 v. after 2.50±1.23; p=0.018). There was excellent agreement between arterial and venous COHb levels (intraclass correlation coefficient 0.916). A decrease in cotinine levels (p=0.001) and an increase in oxygen saturation (p=0.002) were also observed. The majority of participants perceived improvements in their health and lifestyle parameters. CONCLUSION: Smoking the Twisp e-cigarette may be a healthier and more acceptable alternative to smoking tobacco cigarettes. <![CDATA[<b>South African tobacco smoking cessation clinical practice guideline</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742013001100027&lng=pt&nrm=iso&tlng=pt Tobacco smoking (i.e. cigarettes, rolled tobacco, pipes, etc.) is associated with significant health risks, reduced life expectancy and negative personal and societal economic impact. Smokers have an increased risk of cancer (i.e. lung, throat, bladder), chronic obstructive pulmonary disease (COPD), tuberculosis and cardiovascular disease (i.e. stroke, heart attack). Smoking affects unborn babies, children and others exposed to second hand smoke. Stopping or 'quitting' is not easy. Nicotine is highly addictive and smoking is frequently associated with social activities (e.g. drinking, eating) or psychological factors (e.g. work pressure, concerns about body weight, anxiety or depressed mood). The benefits of quitting, however, are almost immediate, with a rapid lowering of blood pressure and heart rate, improved taste and smell, and a longer-term reduction in risk of cancer, heart attack and COPD. Successful quitting requires attention to both the factors surrounding why an individual smokes (e.g. stress, depression, habit, etc.) and the symptoms associated with nicotine withdrawal. Many smokers are not ready or willing to quit and require frequent motivational input outlining the benefits that would accrue. In addition to an evaluation of nicotine dependence, co-existent medical or psychiatric conditions and barriers to quitting should be identified. A tailored approach encompassing psychological and social support, in addition to appropriate medication to reduce nicotine withdrawal, is likely to provide the best chance of success. Relapse is not uncommon and reasons for failure should be addressed in a positive manner and further attempts initiated when the individual is ready. Key steps in smoking cessation include: (i) identifying all smokers, alerting them to the harms of smoking and benefits of quitting; (ii) assessing readiness to initiate an attempt to quit; (iii) assessing the physical and psychological dependence to nicotine and smoking; (iv) determining the best combination of counselling/support and pharmacological therapy; (v) setting a quit date and provide suitable resources and support; (vi) frequent follow-up as often as possible via text/telephone or in person; (vii) monitoring for side-effects, relapse and on-going cessation; and (viii) if relapse occurs, providing the necessary support and encourage a further attempt when appropriate.