Middle-term effectiveness of a support program for smokers implemented in primary care
Efectividad a medio plazo de un plan de ayuda al fumador desarrollado en atención primaria
a General Directorate of Accounts and Finances, Health and Health Services Council, Principality of Asturias, Spain.
b Preventive Medicine and Public Health Specialist, Primary Care Directorate, Health Area VIII, Asturias, Spain.
c Family and Community Medicine Specialist, La Felguera Health Center, Health Area VIII, Asturias, Spain.
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"etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Preventive Medicine and Public Health Specialist, Primary Care Directorate, Health Area VIII, Asturias, Spain." "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Family and Community Medicine Specialist, La Felguera Health Center, Health Area VIII, Asturias, Spain." "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Efectividad a medio plazo de un plan de ayuda al fumador desarrollado en atención primaria" ] ] "textoCompleto" => "<p class="elsevierStylePara">Introduction</p><hr></hr><p class="elsevierStylePara">In Spain, smoking is beginning to be considered a socially unacceptable behavior,<span class="elsevierStyleSup">1</span> and its prevalence is decreasing in older age groups, although not in women. However, the decreases are smaller than in other European countries.<span class="elsevierStyleSup">2</span> The benefits of quitting are evident:<span class="elsevierStyleSup">3</span> quitting is the most important step smokers can take to improve their health, therefore patients should be informed about the risks of smoking, the benefits of quitting, and the options available to quit successfully. Given that the effectiveness of these measures is beyond question,<span class="elsevierStyleSup">7-9</span> anti-smoking advice should be provided systematically, as should advice about the most suitable treatment to help smokers quit.<span class="elsevierStyleSup">4-6</span> Because of its coverage and accessibility, primary care is the ideal setting for these interventions.<span class="elsevierStyleSup">10-12</span> In recent years general practitioners have developed programs of systematic intervention aimed at dealing with smoking as a risk factor in public health,<span class="elsevierStyleSup">4,13,14</span> but these programs should be more widely used.</p><p class="elsevierStylePara">To facilitate the timely contact and interaction with smokers and provide personalized advice and follow-up to the more highly motivated among them,<span class="elsevierStyleSup">15,16</span> the Support Program for Smokers (SPS) was implemented in Health Area VIII of Asturias, Spain.<span class="elsevierStyleSup">17</span> This article reports on the effectiveness of the program in helping smokers to quit. A secondary goal was to determine the mean time to relapse in order to evaluate the need to intensify follow-up measures for smokers who wish to quit.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Methods </p><hr></hr><p class="elsevierStylePara"><img src="27v30n09-13040171tab01.gif"></img></p><p class="elsevierStylePara">Design</p><p class="elsevierStylePara">The participants were patients older than 14 years who took part in the SPS between 1 July 1998 and 30 September 2001. They were chosen from among a total of 987 patients who had been seen for any reason at primary care centers in Health Area VIII, Asturias. We excluded patients who did not live in Health Area VIII at the time of the study, or who had died. We considered as participants smokers who, having agreed to take part in the program, were given appointments for a number of scheduled activities which consisted of at least Richmond and Fagerström tests. These patients received systematic minimal intervention and ­ if their degree of dependence was high ­ nicotine replacement therapy (NRT). A sample size of 400 persons was calculated on the basis of the total number of patients who took part in the SPS, with an expected prevalence of 50%, a precision of 5% and a drop-out rate of 35%. To ensure that part of the sample was followed for more than 24 months, the participants were distributed in two equal groups on the basis of date of entry in the SPS. In both groups the sample was chosen randomly from a list of patients included in the SPS and a table of random numbers.</p><p class="elsevierStylePara">Main outcome variables</p><p class="elsevierStylePara">Smoker/nonsmoker status, relapses, mean duration of abstention and number of attempts to quit after the study period were noted. This information was obtained by health care staff who surveyed participants by telephone.</p><p class="elsevierStylePara">Independent variables</p><p class="elsevierStylePara">Information obtained from the patient´s medical record and noted on the data sheets used in the SPS included age, sex, duration of smoking habit in years, number of cigarettes smoked per day at the time of enrolment, chronic illnesses, previous attempts to quit, score on the Richmond and Fagerström tests, use of NRT, previous telephone reinforcement, and number and mean duration of follow-up visits.</p><p class="elsevierStylePara">Statistical analysis</p><p class="elsevierStylePara">Quantitative variables are reported as the mean, standard deviation and median; qualitative variables are reported as absolute and relative frequency distributions. Survival analysis is used to describe the findings for relapses, and 95% confidence intervals are reported for each estimator. Differences for each item in comparison to the control variables are evaluated with the chi-squared or Student´s <span class="elsevierStyleItalic">t</span> test. The differences were considered statistically significant when <span class="elsevierStyleItalic">P</span> was less than 0.05. All analyses were done with SPSS software.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Results </p><hr></hr><p class="elsevierStylePara">Of the 400 patients initially included in the study, we were able to contact 289 (72.3%). There was no statistically significant difference in response rates between observers. For the group of patients who could not be reached, we recorded all available data from the data sheet and found no statistically significant differences in the distribution of values for any variable. Of the final sample, 143 patients (49.5%) had been included in the SPS before the year 2000. Mean age was 44 years, 75% of the participants were younger than 50 years, and 177 participants (58.9%) were men. Mean duration of the smoking habit was 24 years, with a mean daily consumption of 26 cigarettes. Mean scores on the tests for dependence and motivation to quit were 5.3 and 7.8, respectively. Of all participants, 83.4% had at least one chronic illness, and 67% had tried to quit before. The data sheet was available for 281 patients (97%), 31 (11%) of whom did not attend any of the follow-up visits after initial enrollment («enrolled only»). Mean number of visits, duration of follow-up, use of NRT and previous reinforcement are shown in Table 1. Of the 289 smokers, 181 quit initially, and at the end of the study 78 continued to abstain from smoking.</p><p class="elsevierStylePara"><img src="27v30n09-13040171tab02.gif"></img></p><p class="elsevierStylePara">There were no statistically significant differences in success rates (proportion of patients who said they had quit) between observers, although we did find significant differences in some variables between patients who quit and those who did not (Table 2). Of the 108 patients who failed to quit, 71.1% (64.7%-76.9%) made no further attempt, and among those who did try again, 58.1% (45.5%-69.8%) tried only once more. Of the 103 patients who relapsed, only 98 recalled how long they had refrained from smoking: the mean was 5.25 months (3.9-6.6 months). Figure 1 shows the survival curves; 50% relapsed within the first 2 months (1.4-2.6 months), and 75% within the first 6 months (4.6-7.4 months).</p><p class="elsevierStylePara"><img src="27v30n09-13040171tab03.gif"></img></p><p class="elsevierStylePara"><img src="27v30n09-13040171tab04.gif"></img></p><p class="elsevierStylePara">Figure 1. Percentage of patients who had still not relapsed (referred to unity) at different points in time (only patients who relapsed).</p><p class="elsevierStylePara">We found a statistically significant relationship between relapse rates and certain variables (Table 3). Patients who had not resumed smoking at the end of the study had abstained for a mean of 23.19 months (95% CI, 20.8-25.6 months), hence 80% had not smoked for 1 year, and 50% had not smoked for more than 23 months. Considering only smokers who joined the program more than 12 months previously and those who had abstained for at least 1 year, the overall success rate was 27.2% (21.8%-33.1%, ie, 65 of 239 patients).</p><p class="elsevierStylePara"><img src="27v30n09-13040171tab05.gif"></img></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Discussion </p><hr></hr><p class="elsevierStylePara"><img src="27v30n09-13040171tab06.gif"></img></p><p class="elsevierStylePara">The relatively high drop-out rate (27.7%) may have skewed the results; however, we believe the patients who could not be contacted for follow-up did not differ significantly in the main outcome variables from those who completed the study program. Comparison of the information obtained about the independent variables from the data sheet failed to reveal any significant differences between the two groups in the distribution of values for these variables, or in the results obtained by different observers.</p><p class="elsevierStylePara">As in other studies,<span class="elsevierStyleSup">18,19</span> most patients who took part in the SPS were men; mean age was higher than in earlier surveys, as there as no age limit for enrollment. Eleven percent of the participants did not attend any of the follow-up appointments, and we assumed they had dropped out of the program or that their participation had not been recorded. However, this figure was clearly lower than that reported in an earlier study,<span class="elsevierStyleSup">19</span> in which 32.8% of those initially enrolled did not participate in any further interventions. The SPS was evaluated yearly when the center´s regular services were reviewed; this may have contributed to the better rate of participation.</p><p class="elsevierStylePara">In contrast with at least one earlier study,<span class="elsevierStyleSup">19</span> 56.6% of the participants had received previous reinforcement. In our health area, the SPS is implemented jointly by physicians and nurses, and involvement of the nursing staff is fundamental in this type of program. Success was greatest in smokers who were more highly motivated and who participated in the program for longer, but, in contrast to other studies,<span class="elsevierStyleSup">11,20</span> the program was less successful when NRT was used. We have no explanation for this finding; although patients treated with NRT smoked more and were more dependent on nicotine, they were also more highly motivated.</p><p class="elsevierStylePara">We did not evaluate adverse effects. The percentage of ex-smokers was greater than in an earlier report<span class="elsevierStyleSup">18</span> on a systematic, opportunistic intervention in a nonselected population, but these participants did not use NRT and their initial level of motivation was clearly lower than in our patients. The percent success rate in the present study was also higher than that found in another study<span class="elsevierStyleSup">4</span> with NRT. However, our results were worse than those obtained by Torrecilla et al.<span class="elsevierStyleSup">11</span> with systematic minimal intervention and NRT. One of the most noteworthy biases in our study arises from the fact that our main outcome variable was evaluated with information obtained by telephone survey, with no further analysis to corroborate the patients´ responses, despite the fact that Bedfont breath CO monitors are available at the health centers in our area for use at follow-up appointments. The administration of the study was centralized, and we realized that giving appointments for follow-up visits might have increased the number of drop-outs. This bias may have led us to overestimate the effectiveness of the intervention as a result of underreporting of smoker status. Some have estimated underreporting at 2%-4%,<span class="elsevierStyleSup">1</span> whereas others<span class="elsevierStyleSup">21,22</span> have reported a deception rate of 15% or 17.6%, although we note that these latter surveys were done by staff members of the health center. Our survey was run by four family physicians at different health centers and by a health care technician, hence false positives were unlikely to be due to the patient´s desire to please the physician. Moreover, the survey was done outside the health center setting, and no observer-dependent differences were found in drop-out rates. As an added measure, responses were checked against the information entered in the data sheet.</p><p class="elsevierStylePara">Another limitation arises from the characteristics of the study: because no control group was used, we cannot determine whether the success rates were the result of the intervention we set out to evaluate, or of other factors. Among the earlier studies we reviewed, the program most similar to ours was that described by Martín Cantera et al.,<span class="elsevierStyleSup">19</span> which achieved an 18% success rate. Although this figure is lower than our success rate, no mention of the use of NRT was made in this study. We achieved an initial success rate of 62.6%, although of those who quit at the start of the program, 56.9% resumed smoking, half within the first 2 months and one-fourth after the first 6 months.</p><p class="elsevierStylePara">It would seem reasonable to follow participants more closely during the first months of the program, and to use telephone reinforcement (especially for participants who skip scheduled appointments), to instill in participants the idea that relapses are part of the quitting process, and to support subsequent attempts to quit.</p><p class="elsevierStylePara">The effectiveness of the SPS appears to have been acceptable. Coverage was low: we estimate a target population of 25 109 patients,<span class="elsevierStyleSup">15</span> of whom 987 ­ 4% of all smokers in the area served by our health centers ­ were enrolled in the program. Other programs have been implemented individually by physicians interested in smoking prevention and cessation,<span class="elsevierStyleSup">5,23</span> whereas our program forms part of an institutional policy aimed at gradually involving all primary care professionals in attempts to deal with this health problem. Raising their awareness of the problem takes time, and we did not set highly ambitious goals for the primary care teams in this initial study. Despite the low coverage, it should be recalled that smokers who enrolled in the program agreed to take part and attended at least one appointment. However, the SPS aims to identify smokers, inform them about their habit, advise them and offer help. Thus, in addition to the patients initially enrolled, others received advice, and we expect at least 5% of this latter group to quit smoking.<span class="elsevierStyleSup">24</span></p><p class="elsevierStylePara">In the light of evidence that the program is effective, more ambitious goals should be considered, and coverage should be extended to make the program available to the large percentage of smokers who intend to quit.<span class="elsevierStyleSup">25</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Acknowledgments </p><hr></hr><p class="elsevierStylePara">We thank doctors Carlos Fernández Benítez and José Fuentes for their help with the telephone surveys.</p>" "pdfFichero" => "27v30n09a13040171pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec692895" "palabras" => array:4 [ 0 => "Tabaco" 1 => "Tabaquismo" 2 => "Plan de ayuda al fumador" 3 => "Atención primaria" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec692894" "palabras" => array:4 [ 0 => "Tobacco" 1 => "Smoking" 2 => "Support program for smokers" 3 => "Primary care" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "Aim. To determine the middle-term effectiveness of a support program for smokers (SPS) wishing to quit. Design. Observational, cohort follow-up study. Setting. Primary care. Participants. Random sample (n=289) of patients older than 14 years who took part in the SPS between 1 July 1998 and 30 September 2001, from among a total of 987 patients who had been seen in the primary care center for any reason during this period. Interventions. Systematic minimal intervention, nicotine replacement therapy (NRT), or both. Main outcome measures. A telephone survey was used to study smoker/ex-smoker status, relapses, mean period of abstention and number of attempts to quit after the study period. Information obtained from the data sheets used in the program included sociodemographic characteristics, smoking habits, chronic illnesses, degree of dependence and motivation, use of NRT, and participation in the program. Results. Of all patients in the program, 27% quit, with a mean period of abstinence of 23 months at the time of the study. The success rate was higher among older participants, men, participants who has been smokers for longer periods, those who were more highly motivated to quit, and those who did not use NRT. Of all participants, 35.6% failed to quit, and of these, 75% relapsed within the first 6 months. Conclusions. The SPS offered within the primary care setting was effective and feasible, although participants should be followed closely during the first months so they can be advised to accept the fact that relapses are part of the quitting process." ] "es" => array:1 [ "resumen" => "Objetivo. Conocer la efectividad de un plan de ayuda al fumador (PAF) a medio plazo. Diseño. Estudio observacional de seguimiento de una cohorte. Emplazamiento. Atención primaria. Participantes. Muestra aleatoria (n = 289) de los pacientes captados en el PAF entre el 1 de julio de 1998 y el 30 de septiembre de 2001, entre aquellos fumadores mayores de 14 años que habían sido atendidos en consulta de atención primaria por cualquier motivo (se incluyeron en ese período 987). Intervenciones. Intervención mínima sistematizada y/o tratamiento sustitutivo con nicotina. Mediciones principales. A través de encuesta telefónica, se estudiaron: estado de fumador o ex fumador, recaída, tiempo medio sin fumar y número de intentos de abandono posteriores al estudiado. A partir de las hojas de seguimiento se recogieron datos sociodemográficos, características del hábito tabáquico, patologías crónicas, grado de dependencia y motivación, terapia sustitutiva con nicotina (TSN) y desarrollo del programa. Resultados. El 27% de los pacientes dejó de fumar, con una media de 23 meses de abstinencia en el momento del estudio. La tasa de éxitos es superior entre varones, de mayor edad, que llevan más tiempo fumando, están más motivados y no utilizan TSN. El 35,6% recae, y el 75% de las recaídas se produce en los 6 primeros meses. Conclusiones. El desarrollo del PAF en el ámbito de atención primaria es efectivo y factible, si bien es necesario intensificar el seguimiento en los primeros meses ayudando a aceptar las recaídas como parte del proceso." ] ] "multimedia" => array:12 [ 0 => array:6 [ "identificador" => "tbl1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "27v30n09-13040171tab01.gif" "imagenAlto" => 469 "imagenAncho" => 347 "imagenTamanyo" => 14233 ] ] ] ] ] ] 1 => array:6 [ "identificador" => "tbl2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "27v30n09-13040171tab02.gif" "imagenAlto" => 208 "imagenAncho" => 367 "imagenTamanyo" => 7718 ] ] ] ] ] ] 2 => array:6 [ "identificador" => "tbl3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "27v30n09-13040171tab03.gif" "imagenAlto" => 630 "imagenAncho" => 763 "imagenTamanyo" => 18811 ] ] ] ] ] ] 3 => array:8 [ "identificador" => "tbl4" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "27v30n09-13040171tab04.gif" "imagenAlto" => 307 "imagenAncho" => 355 "imagenTamanyo" => 4362 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Percentage of patients who had still not relapsed (referred to unity) at different points in time (only patients who relapsed)." ] ] 4 => array:6 [ "identificador" => "tbl5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "27v30n09-13040171tab05.gif" "imagenAlto" => 639 "imagenAncho" => 762 "imagenTamanyo" => 18475 ] ] ] ] ] ] 5 => array:6 [ "identificador" => "tbl6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "27v30n09-13040171tab06.gif" "imagenAlto" => 354 "imagenAncho" => 357 "imagenTamanyo" => 11868 ] ] ] ] ] ] 6 => array:5 [ "identificador" => "tbl7" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 7 => array:5 [ "identificador" => "tbl8" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 8 => array:5 [ "identificador" => "tbl9" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 9 => array:5 [ "identificador" => "tbl10" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 10 => array:5 [ "identificador" => "tbl11" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 11 => array:5 [ "identificador" => "tbl12" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tendencias seculares del tabaquismo según el nivel educativo entre 1986-1996: estudio MONICA-Cataluña. 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Article information
ISSN: 02126567Original language: English
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| 2024 November | 2 | 2 | 4 |
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| 2018 December | 1 | 3 | 4 |
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| 2018 September | 5 | 3 | 8 |
| 2018 August | 4 | 1 | 5 |
| 2018 July | 3 | 0 | 3 |
| 2018 June | 1 | 2 | 3 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 2 | 3 | 5 |
| 2018 March | 4 | 0 | 4 |
| 2018 February | 1 | 0 | 1 |
| 2017 December | 5 | 1 | 6 |
| 2017 November | 1 | 0 | 1 |
| 2017 October | 8 | 1 | 9 |
| 2017 September | 7 | 0 | 7 |
| 2017 August | 8 | 1 | 9 |
| 2017 July | 8 | 4 | 12 |
| 2017 June | 11 | 0 | 11 |
| 2017 May | 6 | 3 | 9 |
| 2017 April | 10 | 10 | 20 |
| 2017 March | 18 | 8 | 26 |
| 2017 February | 14 | 0 | 14 |
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| 2016 December | 12 | 4 | 16 |
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| 2016 August | 14 | 3 | 17 |
| 2016 July | 20 | 2 | 22 |
| 2016 June | 26 | 10 | 36 |
| 2016 May | 14 | 8 | 22 |
| 2016 April | 12 | 0 | 12 |
| 2016 March | 9 | 4 | 13 |
| 2016 February | 7 | 0 | 7 |
| 2016 January | 8 | 3 | 11 |
| 2015 December | 13 | 9 | 22 |
| 2015 November | 8 | 1 | 9 |
| 2015 October | 19 | 3 | 22 |
| 2015 September | 24 | 2 | 26 |
| 2015 August | 9 | 2 | 11 |
| 2015 July | 10 | 2 | 12 |
| 2015 June | 8 | 0 | 8 |
| 2015 May | 10 | 0 | 10 |
| 2015 April | 9 | 5 | 14 |
| 2015 March | 11 | 3 | 14 |
| 2015 February | 13 | 1 | 14 |
| 2015 January | 30 | 3 | 33 |
| 2014 December | 30 | 2 | 32 |
| 2014 November | 18 | 1 | 19 |
| 2014 October | 40 | 6 | 46 |
| 2014 September | 28 | 0 | 28 |
| 2014 August | 27 | 2 | 29 |
| 2014 July | 28 | 1 | 29 |
| 2014 June | 33 | 2 | 35 |
| 2014 May | 18 | 1 | 19 |
| 2014 April | 15 | 2 | 17 |
| 2014 March | 20 | 1 | 21 |
| 2014 February | 9 | 1 | 10 |
| 2014 January | 7 | 1 | 8 |
| 2013 December | 13 | 2 | 15 |
| 2013 November | 24 | 2 | 26 |
| 2013 October | 20 | 0 | 20 |
| 2013 September | 14 | 1 | 15 |
| 2013 August | 15 | 1 | 16 |
| 2013 July | 15 | 0 | 15 |
| 2002 November | 527 | 0 | 527 |
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