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Zhang YY, Su YZ, Tian ZY, Liang SB, Liu YJ, Li YF, Qiao HF, Robinson N, Liu JP. Acupuncture and related acupoint therapies for smoking cessation: An umbrella review and updated meta-analysis. Tob Induc Dis 2024; 22:TID-22-64. [PMID: 38638420 PMCID: PMC11025526 DOI: 10.18332/tid/186147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Acupuncture and related acupoint therapies have been widely used for smoking cessation. Some relevant systematic reviews (SRs) have been published. There is a need to summarize and update the evidence to inform practice and decision-making. METHODS Eight databases were searched from their inception to December 2023. SRs, any randomized controlled trials (RCTs) comparing acupuncture therapies with sham acupuncture, pharmacotherapy, behavioral therapy, or no treatment, were included. The primary outcome was the abstinence rate. AMSTAR-2 was employed to assess the quality of SRs. An updated meta-analysis was conducted based on SRs and RCTs. Data were synthesized using risk ratios (RR) with 95% confidence intervals (CIs). The GRADE approach was employed to assess the certainty of the updated evidence. RESULTS Thirteen SRs and 20 RCTs outside of the SRs were identified. The SRs were of low or very low quality by AMSTAR-2. Sixteen (80%) RCTs were at high risk of performance bias. Eight acupuncture and related acupoint therapies were involved. The short-term (≤6 months) abstinence rate outcome was summarized as follows. Most SRs suggested that filiform needle acupuncture or acupressure had a better effect than sham acupuncture, but the findings were inconsistent. The updated meta-analysis also suggested that filiform needle acupuncture was more effective than sham acupuncture (RR=1.44; 95% CI: 1.02-2.02; I2 = 66%; low certainty; 9 RCTs, n=1358). Filiform needle acupuncture combined with acupressure was comparable to nicotine patches (RR=0.99; 95% CI: 0.74-1.32; low certainty; 6 RCTs, n= 524). Acupressure was superior to counseling (RR=1.46; 95% CI: 1.14-1.87; I2=5%; low certainty; 8 RCTs, n=595). No serious adverse events were reported in these SRs or RCTs. CONCLUSIONS Low certainty evidence suggests that filiform needle acupuncture and auricular acupressure appear to be safe and effective in achieving short-term smoking cessation. However, long-term follow-up data are needed.
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Affiliation(s)
- Ying-Ying Zhang
- College of Acupuncture-Moxibustion and Tuina, Shaanxi University of Chinese Medicine, Xianyang, China
- Key Laboratory of Acupuncture and Medicine in Shaanxi Province, Xianyang, China
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - You-Zhu Su
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Zi-Yu Tian
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shi-Bing Liang
- Clinical Study Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yi-Jie Liu
- College of Acupuncture-Moxibustion and Tuina, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Yu-Fei Li
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Hai-Fa Qiao
- College of Acupuncture-Moxibustion and Tuina, Shaanxi University of Chinese Medicine, Xianyang, China
- Key Laboratory of Acupuncture and Medicine in Shaanxi Province, Xianyang, China
| | - Nicola Robinson
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute of Health and Social Care, London South Bank University, London, United Kingdom
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Zeng J, Liao Y, Wei X, Chen G, Cai Z, Chen M, Gou Y, Lin G. Efficacy and safety of acupuncture combined with auricular acupressure for smoking cessation: A study protocol of a multicentre, randomized, controlled clinical trial. Front Neurol 2022; 13:921054. [PMID: 35968287 PMCID: PMC9363779 DOI: 10.3389/fneur.2022.921054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundNicotine dependence is an addictive behavioral disease facilitated by habitually smoking cigarettes. In many countries, acupuncture and auricular acupressure have attracted growing attention as complementary or alternative treatments for smoking cessation; however, there is a lack of rigorous randomized, controlled studies evaluating the combination of these two interventions specifically for smoking cessation. The aim of this study is to evaluate the efficacy and safety of using acupuncture combined with auricular acupressure (A&AA) to increase the rates of smoking cessation and ultimately reduce the rates of relapse.MethodsThis is a multicentre, prospective, parallel, randomized, controlled trial. A total of 360 patients with severe nicotine dependence will be randomized into test (A&AA) or control (nicotine replacement therapy, NRT) groups. The test group will be treated with A&AA twice weekly, while the control group will use an NRT patch daily. All treatments will be administered for 8 weeks, with a follow-up period of 4 months. The primary outcome will be the smoking abstinence rate at week 24, with a combined safety assessment. The secondary outcomes will be smoking cessation rates at other timepoints, saliva cortisone test results, and scores on the Fagerstrom Test for Nicotine Dependence, the Autonomy over Tobacco Scale, the Hamilton Anxiety Rating Scale, the Self-rating Anxiety Scale, and the Pittsburgh Sleep Quality Index. The cost of treatment will also be used to evaluate the economic effects of different smoking cessation interventions. Statistical analysis on the data collected from both the intention-to-treat (all randomly assigned patients) and per-protocol (patients who complete the trial without any protocol deviations) patients, will be performed using the statistical software package, IBM SPSS 27.0.DiscussionThis study will provide rigorous clinical evidence evaluating the efficacy and safety of using A&AA as a smoking cessation therapy.Trial registrationChinese Clinical Trial Registry (Registration number: ChiCTR1900028371).
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Affiliation(s)
- Jinchun Zeng
- Department of Rehabilitation, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yizu Liao
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaojing Wei
- Clinical Research and Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guangxian Chen
- Department of Rehabilitation, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zibin Cai
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Min Chen
- Department of Chinese Medicine Services, Pok Oi Hospital, Hong Kong, China
| | - Yanhua Gou
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Guohua Lin
- Department of Rehabilitation, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
- Shenzhen Nanshan Hospital of Traditional Chinese Medicine, Shenzhen, China
- *Correspondence: Guohua Lin
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Hata A, Komiyama M, Yasoda A, Wada H, Yamakage H, Satoh-Asahara N, Morimoto T, Takahashi Y, Hasegawa K. Psychological Effects of Aromatherapy on Smokers With Depressive Tendencies During Smoking Cessation Treatment: Protocol for a Pre-Post Single-Arm Clinical Trial. JMIR Res Protoc 2022; 11:e38626. [PMID: 35797095 PMCID: PMC9305445 DOI: 10.2196/38626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/24/2022] [Accepted: 06/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Cessation of smoking can markedly reduce the incidence of cardiovascular disease, improve health economics, and benefit society. Aromatherapy has the potential to be a novel option as an adjuvant therapy for smoking cessation that may alleviate depressive symptoms. However, research on the efficacy of aromatherapy as an adjuvant therapy for smoking cessation is scarce. Objective The aim of this study was to examine the potential effects of aromatherapy on psychological states in smokers with depressive tendencies and to determine if it is reasonable to proceed to the next step (ie, a phase III trial). Methods This is a pre-post single-arm clinical trial. Smokers with depression will be subjected to aromatherapy during smoking cessation treatment for 12 weeks. We will evaluate changes in scores on the Zung Self-Rating Depression Scale and the Profile of Mood States from pretreatment screening to 4 weeks and 12 weeks after the start of aromatherapy. Moreover, we will compare the group treated with aromatherapy with the group that received standard treatment in our previous randomized controlled trial (ie, the control group in that study). Furthermore, we will compare successful smoking cessation rates after 12 weeks. In addition, we will conduct an exploratory analysis of the efficacy of aromatherapy. The target sample size is 100, which is the number of subjects expected to be enrolled in this study during the 2-year study period. Results This study was approved by the Kyoto Medical Center Institutional Review Board (IRB approval No. 19-016). Enrollment started on July 1, 2019. As of May 2022, 76 patients have been recruited. In the original plan, recruitment should have been finished on June 30, 2021. However, the number of subjects decreased due to the COVID-19 pandemic, and the study inclusion period was extended by 1 year (ie, until the end of June 2022) with the approval of the IRB on May 17, 2021. Analyses of the results will be completed subsequently. Conclusions This study has some limitations. This is not a rigorous validation study because it compares the same subjects who received standard treatment in a previous study. Moreover, the sample size and methods of statistical analysis were not fully set with prior consideration of statistical rigor. To address these limitations, we plan to conduct a phase III trial that will reflect the exploratory findings of this study. This is the first study to evaluate the psychological effects of aromatherapy during a smoking cessation program, and it may help improve the quality of treatment for smoking cessation in the future. Trial Registration UMIN Clinical Trials Registry UMIN000043102; https://tinyurl.com/tn3hvt9w International Registered Report Identifier (IRRID) DERR1-10.2196/38626
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Affiliation(s)
- Akiko Hata
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Maki Komiyama
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akihiro Yasoda
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiromichi Wada
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hajime Yamakage
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Noriko Satoh-Asahara
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tatsuya Morimoto
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yuko Takahashi
- Health Informatics, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Hasegawa
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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The efficacy and safety of acupuncture and nicotine replacement therapy for smoking cessation: study protocol for a randomized controlled trial. Trials 2022; 23:465. [PMID: 35668503 PMCID: PMC9169389 DOI: 10.1186/s13063-022-06384-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 05/07/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Tobacco hazard is one of the most serious public health problems, accounting for up to 6 million deaths worldwide p.a. We aim to determine the efficacy and safety of acupuncture and/or nicotine replacement therapy on smoking cessation. METHODS We will recruit 96 participants who are willing to quit smoking by acupuncture and/or nicotine replacement therapy in Chengguan, Xigu and Heping Districts, Lanzhou city, for multicenter randomized, double-blind, double-dummy controlled clinical trial. Following obtained the informed consent forms, all eligible participants will be randomly divided into 4 groups: (1) acupuncture combined with nicotine patch, (2) acupuncture combined with sham nicotine patch, (3) sham acupuncture combined with nicotine patch, and (4) sham acupuncture combined with sham nicotine patch. These participants will be treated with different intervention modalities for 8 weeks and then will be followed-up for 8 weeks. The SPSS 26.0 software will be applied to analyze the clinical effects and adverse reactions of different intervention measures for smoking cessation. DISCUSSION This trial is a prospective, pragmatic, randomized, multicenter trial study protocol. The outcomes will illustrate the efficacy and safety of acupuncture and/or nicotine patches for smoking cessation. Provide smokers with a superior smoking cessation program. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100042912 . Registered on January 31, 2021.
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Abstract
BACKGROUND Mindfulness-based smoking cessation interventions may aid smoking cessation by teaching individuals to pay attention to, and work mindfully with, negative affective states, cravings, and other symptoms of nicotine withdrawal. Types of mindfulness-based interventions include mindfulness training, which involves training in meditation; acceptance and commitment therapy (ACT); distress tolerance training; and yoga. OBJECTIVES To assess the efficacy of mindfulness-based interventions for smoking cessation among people who smoke, and whether these interventions have an effect on mental health outcomes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's specialised register, CENTRAL, MEDLINE, Embase, PsycINFO, and trial registries to 15 April 2021. We also employed an automated search strategy, developed as part of the Human Behaviour Change Project, using Microsoft Academic. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs that compared a mindfulness-based intervention for smoking cessation with another smoking cessation programme or no treatment, and assessed smoking cessation at six months or longer. We excluded studies that solely recruited pregnant women. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. We measured smoking cessation at the longest time point, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of intervention and type of comparator. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. We summarised mental health outcomes narratively. MAIN RESULTS We included 21 studies, with 8186 participants. Most recruited adults from the community, and the majority (15 studies) were conducted in the USA. We judged four of the studies to be at low risk of bias, nine at unclear risk, and eight at high risk. Mindfulness-based interventions varied considerably in design and content, as did comparators, therefore, we pooled small groups of relatively comparable studies. We did not detect a clear benefit or harm of mindfulness training interventions on quit rates compared with intensity-matched smoking cessation treatment (RR 0.99, 95% CI 0.67 to 1.46; I2 = 0%; 3 studies, 542 participants; low-certainty evidence), less intensive smoking cessation treatment (RR 1.19, 95% CI 0.65 to 2.19; I2 = 60%; 5 studies, 813 participants; very low-certainty evidence), or no treatment (RR 0.81, 95% CI 0.43 to 1.53; 1 study, 325 participants; low-certainty evidence). In each comparison, the 95% CI encompassed benefit (i.e. higher quit rates), harm (i.e. lower quit rates) and no difference. In one study of mindfulness-based relapse prevention, we did not detect a clear benefit or harm of the intervention over no treatment (RR 1.43, 95% CI 0.56 to 3.67; 86 participants; very low-certainty evidence). We did not detect a clear benefit or harm of ACT on quit rates compared with less intensive behavioural treatments, including nicotine replacement therapy alone (RR 1.27, 95% CI 0.53 to 3.02; 1 study, 102 participants; low-certainty evidence), brief advice (RR 1.27, 95% CI 0.59 to 2.75; 1 study, 144 participants; very low-certainty evidence), or less intensive ACT (RR 1.00, 95% CI 0.50 to 2.01; 1 study, 100 participants; low-certainty evidence). There was a high level of heterogeneity (I2 = 82%) across studies comparing ACT with intensity-matched smoking cessation treatments, meaning it was not appropriate to report a pooled result. We did not detect a clear benefit or harm of distress tolerance training on quit rates compared with intensity-matched smoking cessation treatment (RR 0.87, 95% CI 0.26 to 2.98; 1 study, 69 participants; low-certainty evidence) or less intensive smoking cessation treatment (RR 1.63, 95% CI 0.33 to 8.08; 1 study, 49 participants; low-certainty evidence). We did not detect a clear benefit or harm of yoga on quit rates compared with intensity-matched smoking cessation treatment (RR 1.44, 95% CI 0.40 to 5.16; 1 study, 55 participants; very low-certainty evidence). Excluding studies at high risk of bias did not substantially alter the results, nor did using complete case data as opposed to using data from all participants randomised. Nine studies reported on changes in mental health and well-being, including depression, anxiety, perceived stress, and negative and positive affect. Variation in measures and methodological differences between studies meant we could not meta-analyse these data. One study found a greater reduction in perceived stress in participants who received a face-to-face mindfulness training programme versus an intensity-matched programme. However, the remaining eight studies found no clinically meaningful differences in mental health and well-being between participants who received mindfulness-based treatments and participants who received another treatment or no treatment (very low-certainty evidence). AUTHORS' CONCLUSIONS We did not detect a clear benefit of mindfulness-based smoking cessation interventions for increasing smoking quit rates or changing mental health and well-being. This was the case when compared with intensity-matched smoking cessation treatment, less intensive smoking cessation treatment, or no treatment. However, the evidence was of low and very low certainty due to risk of bias, inconsistency, and imprecision, meaning future evidence may very likely change our interpretation of the results. Further RCTs of mindfulness-based interventions for smoking cessation compared with active comparators are needed. There is also a need for more consistent reporting of mental health and well-being outcomes in studies of mindfulness-based interventions for smoking cessation.
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Affiliation(s)
- Sarah Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
| | - Emma Norris
- Health Behaviour Change Research Group, Brunel University London, London, UK
| | | | - Emily Hayes
- Centre for Behaviour Change, University College London, London, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Essenmacher C, Baird C, Houfek J, Spielmann MR, Adams S. Developing Competency-Based Nursing Treatment for Persons With Tobacco Use Disorder. J Am Psychiatr Nurses Assoc 2022; 28:23-36. [PMID: 34763557 DOI: 10.1177/10783903211058785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tobacco continues to have a deleterious impact on health outcomes in the United States. Professional nurses at all levels of practice have an opportunity to be a part of the solution. The development of nurse-specific competencies for treating tobacco use disorder (TUD) disorder is long overdue. A task force of American Psychiatric Nurses Association (APNA) subject matter experts was assembled to engage in the process of reviewing the available peer-reviewed literature and additional evidence-based resources (e.g., professional organization position statement, toolkits, national survey results) to create the Nursing Competencies for Treating Tobacco Use Disorders. OBJECTIVE The aim of this article is ultimately to improve patient access to quality, evidence-based TUD nursing care by all nurses who are competent, full partners in TUD multidisciplinary care. METHOD Search terms were defined and a scoping search and review of the TUD literature and resources was performed from November 2018 to November 2020. RESULTS Over 300 articles and evidence-based resources (e.g., professional organization position statements, toolkits, etc.) were discovered. Thirteen competencies were developed and were internally and externally reviewed prior to APNA Board of Director's approval. CONCLUSION TUD competencies have the potential to guide nursing education, practice, and research, allowing nurses to be full partners in the design, development, and implementation of effective TUD treatment.
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Affiliation(s)
- Carol Essenmacher
- Carol Essenmacher, PMHCNS-BC, DNP, Saginaw Valley State University, University Center, MI, USA
| | - Carolyn Baird
- Carolyn Baird, DNP, MBA, RN-BC, CARN-AP, CAADC, FIAAN, Meredith Counseling and Consulting, McMurray, PA, USA
| | - Julia Houfek
- Julia Houfek, PhD, APRN-CNS, University of Nebraska, Omaha, NE, USA
| | - M Rene Spielmann
- M. Rene Spielmann, DNP, ARNP, FNP-BC, PMHNP-BC, Gonzaga University, Spokane, WA, USA
| | - Sara Adams
- Sara Adams, PhD, RN, CNE, Rush University, Chicago, IL, USA
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Lhommeau N, Huchet A, Castera P. [Acupuncture and smoking cessation, a review of the literature]. Rev Mal Respir 2020; 37:474-478. [PMID: 32416946 DOI: 10.1016/j.rmr.2020.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/24/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Tobacco smoking represents the main cause of death in industrialised countries. Acupuncture is proposed as an aid to stopping smoking. What are the current studies? BACKGROUND We found 23 controlled randomised studies with differing protocols in terms of intensity of treatment and methodology. The meta-analyses undertaken were contradictory. The short-term effect of acupuncture is well documented but the medium term effect is more uncertain. OUTLOOK The undertaking of well-standardised, high-intensity protocols is necessary to produce evidence of a medium term effect. CONCLUSION Acupuncture can be offered to patients wishing to stop smoking within the framework of a global management programme. The association of acupuncture with classical aids increases the chances of the patient stopping. The conditions of intervention should be defined precisely within the framework of a randomised controlled trial.
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Affiliation(s)
- N Lhommeau
- Rue Maurice-Daniel, 44230 Saint-Sébastien-sur-Loire, France.
| | - A Huchet
- Boulevard du Manoir-Saint-Lô, 44300 Nantes, France
| | - P Castera
- Département de médecine générale, université de Bordeaux, Bordeaux, France
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