Smoking

Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis, and management of cardiovascular risk. Key risk factors that need to be controlled in the peri-menopausal woman are hypertension, dyslipidaemia, obesity, and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older post-menopausal women can be applied to younger peri-menopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older post-menopausal women no longer displaying menopausal symptoms. Both gynaecologists and cardiovascular physicians have an important role to play in identifying peri-menopausal women at risk of cardiovascular morbidity and mortality and should work as a team to identify and manage risk factors such as hypertension.

Transtheoretical model as a framework for promoting cardiovascular health through behaviour change: a systematic review Introduction: Cardiovascular disease (CVD) remains the single leading cause of death around the globe. The Transtheoretical model (TTM) is a successful framework for guiding behaviour change programmes for several health behaviours, yet there are limited reviews on how TTM has been used to facilitate behaviour change associated with reduced CVD. Therefore, the aims of this systematic review are to determine (i) how TTM has been used in promoting physical activity, fruit and vegetable consumption, and smoking cessation and (ii) gaps in knowledge in the use of stage-based model to improve physical activity, intake of fruit and vegetables, and smoking cessation. Materials and Methods: The approach to this systematic review was informed by current recommendations known as Preferred Reporting Items for Systematic Reviews and Meta-analysis Approach (PRISMA). Results: Constructs of TTM were used in the design of studies, facilitation of health behaviour change, monitoring of change in the movement of the participants across the change continuum, and evaluation of the effectiveness of health behaviour programmes. TTM was incorporated with other models, including Health Belief Model (HBM), social-ecological model, and social cognitive theory to facilitate behaviour change. There were limited studies that used all the four constructs of TTM to promote health behaviour change. ABSTRACT IRJPH: https://escipub.com/international-research-journal-of-public-health/ 1 Ejiofor A. Ezika and Adaobi Nwankwo-Ezika, IRJPH, 2020; 4:46 IRJPH: https://escipub.com/international-research-journal-of-public-health/ 2

Aqueous extract of valerian root (Valeriana offcinalis L.) improves sleep quality in man. PHARMAC. BIOCHEM. BEHAV. 17(l) 65-71, 1982.-The effect of an aqueous extract of valerian (Valeriana officinalis L.) root on subjectively rated sleep measures was studied on 128 people. Each person received 9 samples to test (3 containing placebo, 3 containing 400 mg valerian extract and 3 containing a proprietary over-the-counter valerian preparation).

FOR CITATION: Indoor air pollution sources (particularly Skunk) and their impacts on health and the environment in the Occupied Palestinian Territories,” In: M.F. Yassin (Ed.), “Proceeding of Workshop on Air Quality in Hot Arid Climate (IAQHAC).” (pp: 204-221), Kuwait Institute for Scientific Research (KISR), Shuwaikh, Kuwait City, Kuwait, 3–4 April 2017. URL: ABSTRACT: Air pollution (AP) is generally defined as “the presence in, or introduction into the air of, a substance that has harmful or poisonous effects.” Outdoor air pollution (OAP) can be defined as “the presence of solids, liquids, or gases in outdoor air in amounts that are injurious or detrimental to human health and/or the environment,” or as “the substance (such as smoke, dust, and obnoxious odors) that interferes with the comfortable enjoyment of life and/or property.” Indoor air pollution (IAP) is defined as “the pollution that refers to chemical, biological, and physical contamination of indoor air.” As related to the 1967- Occupied Palestinian Territories (OPT), the air pollution’s (OAP and IAP) situation can be simply described as “catastrophic”, due to the several sources of OAI and IAP, resulted in health and environmental related impacts. However, something uniquely characterizes indoor air pollution in the OPT, in particular, which is the substance known as “Skunk”, with reference to the animal “Skunk”. What makes Skunk a unique IAP’s source is the fact that Skunk is used only in the OPT, and it is also beyond the control of the Palestinian people living in the OPT under the Israeli occupation. Skunk is a liquid with obnoxious odor that has become one of the characteristic weapons that frequently-used against innocent, nonviolent Palestinians in the OPT since August 2008, i.e. since it was first used in the West Bank’s village of Ni'lin. Since then, the Israeli occupation forces (IOF) regularly hose down Palestinian crowds and homes with the Skunk liquid in cities, towns, villages, and refugee camps, which raises suspicions that this practice has been regularly and indiscriminately used as a punitive measure against the Palestinians. As witnessed, reported, and documented by Israeli and international civil- and human-rights organizations, the Skunk liquid has been sprayed by the IOF at Palestinian protestors, homes, shops, schools, hospitals, hotels, restaurants, entire neighborhoods, and even at funeral processions. After Skunk makes contact with persons or objects, its putrid stench can stay for days and even weeks, making inside homes and neighborhoods smell very badly for long periods of time, and causing nausea, vomiting, skin rash, irritation and redness, eye irradiation, abdominal pain, suffocation, excessive coughing, headaches, ataxia, etc. In addition to the health and environmental harms that Skunk causes, the use of Skunk is also intended to cause humiliation to the Palestinians. The odor of the Skunk’s noisome substance is overpowering, as it feels like the smell of a mixture of raw sewage, sulfur, and rotten animal corpses. In this study, indoor air pollutants, particularly “Skunk”, are investigated, analyzed, and discussed, with respect to their health and environmental impacts, and in view of the geopolitical situation in the region. Such impacts have become even more damaging due to the effects of other factors, such as high temperatures, aridity and semi-aridity climate conditions affecting the region, and the OAP’s sources, such as sand- and dust-storms, stone industry, etc.

The global prevalence of dementia has been estimated to be as high as 24 million, and is predicted to double every 20 years until at least 2040. As the population worldwide continues to age, the number of individuals at risk will also increase, particularly among the very old. Alzheimer disease is the leading cause of dementia beginning with impaired memory. The neuropathological hallmarks of Alzheimer disease include diffuse and neuritic extracellular amyloid plaques in brain that are frequently surrounded by dystrophic neurites and intraneuronal neurofibrillary tangles. The etiology of Alzheimer disease remains unclear, but it is likely to be the result of both genetic and environmental factors. In this review we discuss the prevalence and incidence rates, the established environmental risk factors, and the protective factors, and briefly review genetic variants predisposing to disease.

, including 370 men engaged in sports in which weight-related performance classes are associated with weight cycling (boxers, weight lifters and wrestlers; further called as weight cyclers), and 834 matched control men with no athletic background. Outcome measure: Weight change since the age of 20 years, body mass index (BMI) and prevalence of obesity and overweight. Results: The weight cyclers gained 5.2 BMI units from age 20 years to their maximum mean weight, which was at age 58.7 years. Corresponding figures for the controls were 4.2 BMI units at 58.5 years and for other athletes 3.3 BMI units at age 62.5 years. The proportion of obese (BMIX30 kg/m 2) subjects was greatest among the weight cyclers both in 1985 and 1995. In 2001, the weight cyclers were more often obese than other athletes, but did not differ from the controls. The odds ratio for the weight cyclers to be obese compared to other athletes in 1985 was 3.18 (95% confidence intervals 2.09-4.83), and compared to the controls 2.0 (1.35-2.96). The enhanced weight gain of the weight cyclers was not accounted for by present health habits (smoking, alcohol use, use of high-fat milk or physical activity) or weight at age 20 years. Conclusions: Repeated cycles of weight loss and regain appear to enhance subsequent weight gain and may predispose to obesity. Chronic dieting with weight cycling may be harmful for permanent weight control.

To compare the ophthalmic artery (OA) perfusion of pregnant smokers and nonsmokers by Doppler indexes. Correlate these with the interval of last cigarette, cigarettes per day, years smoking and carbon monoxide expired (COex). Transversal study involving 70 pregnant smokers divided into 33 pregnant who smoked until 2 h: A group (AG) and B group (BG): 37, who smoked between 2 and 24 h before test. Control group (CG) was composed of 51 pregnant nonsmokers. Doppler indexes were assessed: PSV (Peak Systolic Velocity), EDV (End Diastolic Velocity), PI (Pulsatility Index), RI (Resistance Index) and PR (Peak Ratio). Groups were compared using ANOVA, Kruskal-Wallis test, Student's t test, Mann-Whitney and Pearson's correlation coefficient, whereas p < 0.05. RI and PI were higher (p < 0.01) and PSV and EDV were lower (p < 0.05) in B group compared to other groups. A group presented higher PR (p < 0.01) compared to control. AG presented years of smoking, cigarettes per day, COex greater than BG and lower interval of last cigarette than BG. The OA in pregnant smokers shows a biphasic pattern of perfusion correlated with the time of consumption of the last cigarette. There are signs of vasoconstriction and hypoperfusion to tobacco exposure between 2 and 24 and hyperperfusion in A Group compared to B Group.

Interest in the development of functions that estimate the likelihood of an individual suffering a future cardiovascular disease (CVD) event has increased in recent times (e.g. Framingham sheets, SCORE-Systematic COronary Risk Estimation, PROCAM, etc.). However, the estimates of absolute risk may show substantial variations between different populations, because of geographical, cultural, social, behavioural and genetic differences, as well as various methodological issues related to the predictive models employed. We sought to calibrate the SCORE equations to the Greek population. We used the SCORE system that offers an estimation of total fatal CVD risk in "high" and "low" CVD risk European countries. The project pulls together a pool of datasets from 12 European countries and 2.7 million person-years of observation. A mathematical procedure to adjust the risk estimates for individual countries was applied, based on local mortality and risk factor prevalence da...

To examine the number, type (menthol vs non-menthol), brand (Black, White, Women's, Other), and size of cigarette ads in Black, Latino, and White magazines. Analysis of digital photographs of 274 cigarette ads appearing in Ebony (Black), People (White), and People in Spanish (Latino) for the 4.5-year period of January 1998 to August 2002. Black magazines were 9.8 times and Latino magazines 2.6 times more likely than White magazines to contain ads for menthol cigarettes. Black and Latino magazines also contained significantly more ads for brands (Virginia Slims) that target women. The tobacco industry continues to target Blacks with menthol cigarette ads, appears now to be targeting Latinos similarly, and targets Black and Latino women with additional, tailored cigarette ads.

anagement of asthma often focuses on "crisis intervention," meaning that the disease is addressed only when a problem occurs. Shifting emphasis to a preventive health model, which includes guided self-management, has been shown to reduce costs related to hospital admissions and visits to emergency departments. 1 Education about asthma is an integral part of the recommendations of most guidelines for the management of asthma. 2-4 There is no consensus on the best model for education about asthma. A review of publications from 1991 through 2004 showed that only half of the studies identified were randomized controlled trials and that many studies used patients as their own historic controls. 4 Given that a regression to the mean is commonly observed in the data of such studies, with improvements in asthma over time, the use of historic controls is not an acceptable means of defining the impact of education. The studies reviewed also varied greatly in the demographic characteristics of the participants, the professional qualifications of the educators used, the nature of the interventions, the outcomes measured, the time frames for measurement and the inclusion of medical care and other services. These variations make it difficult to compare results and make firm recommendations. 5-15 Programs of education about asthma are typically directed toward the learner and conducted using either a one-on-one, large-group or small-group format. The intervention may consist of self-directed educational material, lectures (i.e., a teacher-focused format) or group interaction (i.e., a learnerfocused format). Effective change in behaviour occurs when learners actively interact with the content to be learned, with the teacher and with each other. 16 Small groups of fewer than 10 members allow for an ideal level of interaction. Westberg and Jason 17 cite several compelling reasons for using small groups to promote learning. Learners are more likely to take ownership of their education and may be more engaged with

Background: Noise is the most common occupational hazard. Noise-induced hearing loss (NIHL) is a known occupational disease. The economic costs of NIHL have been estimated to be billions of dollars. Besides, cigarette smoking is a common habit worldwide. Methods: In a cross-sectional study, we surveyed the effect of smoking on NIHL in 504 workers in a large wagon manufacturing company exposed to noise >85 dBA. All required data were obtained using direct interview and questionnaires. To determine noise exposure level, we used industrial hygienist's reports of sound level measurements. A qualified audiologist assessed hearing status using standardized audiometric examination. Results: We concluded that the frequency of hearing loss in smokers was higher than non-smokers [based on Model 1: odds ratio (OR) = 9.35, 95% confidence interval (CI) = 5.74-15.22 and P-value < 0.001; and based on Model 2: OR = 9.06, 95% CI = 5.93-13.84 and P-value < 0.001]. Besides, these results were confirmed by logistic regression statistical method. Conclusions: It can be concluded that smoking may accelerate NIHL, but for confirming this opinion, further studies are warranted.

Background: A potential new treatment in smoking cessation and relapse prevention is nicotine vaccination which is based on active immunization against the nicotine molecule. This immunization will elicit the immune system to produce nicotine-specific antibodies that sequester nicotine in the blood stream, after inhaling tobacco products. The resulting antibody-antigen is too large to cross the blood-brain barrier and is therefore postulated to attenuate the rewarding effect of nicotine by preventing the latter from reaching its receptors in the brain and causing the release of dopamine. The aim of this paper is to describe the design of a phase IIb, multi-center, double blind, randomized, placebo controlled trial to assess the efficacy of the nicotine vaccine NicVAX W co-administered with varenicline (Champix W) and intensive counseling as an aid in smoking cessation and relapse prevention. Methods/design: Two centers will include a total of 600 smokers who are motivated to quit smoking. At week −2 these smokers will be randomized, in a 1:1 ratio, to either 6 injections of NicVAX W or placebo, both co-administered with 12-weeks of varenicline treatment, starting at week 0. The target quit day will be set after 7 days of varenicline treatment at week 1. Smokers will be followed up for 54 weeks. The primary outcome is defined as biochemically validated prolonged smoking abstinence from week 9 to 52. Secondary outcomes include safety, immunogenicity, smoking abstinence from week 37 to 52, abstinence from week 9 to 24, abstinence in the subset of subjects with the highest antibody response, and lapse/relapse rate. Discussion: This is the first study to assess the efficacy of a nicotine conjugate vaccine in combination with an evidence-based smoking cessation pharmacotherapy (varenicline) to quit smoking. Although NicVAX W is primarily designed as an aid to smoking cessation, our study is designed to explore its potential to maintain abstinence and prevent relapse. The results of this trial will give a unique insight in the potential of nicotine vaccination for relapse prevention. Trial registration: ClinicalTrials.gov: (NCT00995033)

To determine (i) the extent to which recommended lifestyle healthy behaviors are adopted and the existence of positive attitudes to health; (ii) the relative influence of socio-demographic variables on multiple healthy lifestyle behaviors and positive attitudes to health; (iii) the association between healthy lifestyle behaviors and positive attitudes to health. Two distinct healthy behavioral measures were developed: (i) healthy lifestyles based on physical activity, no cigarette smoking, no/moderate alcohol drinking, maintaining a &quot;healthy&quot; weight and having no sleeping problems and (ii) positive health attitudes based on having positive emotional attitudes, such as: self-perceived good health status, being calm, peaceful and happy for most of the time, not expecting health to get worse and regular health check-ups. A composite healthy lifestyle index, ranging from 0 (none of behaviors met) to 5 (all behaviors met) was calculated by summing up the individual&#39;s scores...

A large number of micropropagated Euphorbia millii shoots from temporary immersion bioreactor showed thick broad leaves that were translucent, wrinkled and/or curled and brittle, symptoms of hyperhydricity. The environment inside bioreactor normally used in plant micropropagation is characterised by high relative humidity, poor gaseous exchange between the internal atmosphere of the bioreactor and its surrounding environment, and the accumulation of ethylene, conditions that may induce physiological disorders. A comparison of hyperhydric shoots (HS) with normal plants shows marked increase in malondialdehyde (MDA) content in HS plants. MDA, a decomposition product of polyunsaturated fatty acids hydroperoxides, has been utilized very often as a suitable biomarker for lipid peroxidation, which is an effect of oxidative damage. This hypothesis is also confirmed by the higher lipoxygenase (LOX) activity in HS plants. The potential role of antioxidant enzymes in protecting hyperhydric shoots from oxidative injury was examined by analyzing enzyme activities and isozyme profiles of hyperhydric and non-hyperhydric leaves of E. millii. Superoxide dismutase (SOD), peroxidase (POD) and catalase (CAT) activity were significantly higher in hyperhydric tissue as compared to non-hyperhydric normal leaf tissue. After native polyacrylamide gel electrophoresis (PAGE) analysis, seven SOD isoenzymes were detected and the increase in SOD activity observed in hyperhydric tissue seemed to be mainly due to Mn-SOD and Cu/Zn-SOD. The activity of ascorbate peroxidase (APX), glutathione reductase (GR), monodehydroascorbate reductase (MDHAR) and dehydroascorbate reductase (DHAR) was proportionally increased in HS tissue compared to normal leaves indicating a crucial role in eliminating toxic H 2 O 2 from plant cells. The depletion of GSH and total glutathione in spite of higher GR activities observed in HS tissue indicates that mechanism of antioxidant defense was by enhanced oxidation of GSH to GSSG by DHAR yielding ascorbate (AA). The antioxidant metabolism has been shown to be important in determining the ability of plants to survive in hyperhydric stress and the up regulation of these enzymes would help to reduce the build up of ROS.

This prospective cohort study examined the association between educational level and major causes of death in Japan.A baseline survey was conducted between 1988 and 1990 among 110,792 inhabitants of 45 areas aged 40–79 years. Follow-up surveys were conducted annually and causes of death were identified from death certificates. The analysis was restricted to 16,715 men and 23,284 women.During the follow-up period (377,139 person-years), 6628 deaths were recorded. Individuals with low levels of education had an increased overall risk of death [relative risk (RR) = 1.16, 95% confidence interval (CI): 1.08, 1.25, in men; RR = 1.26, 95% CI: 1.14, 1.39, in women], cancers (RR = 1.17, 95% CI: 1.04, 1.32, in men; RR = 1.10, 95% CI: 0.93, 1.30, in women), and death from external causes (RR = 1.81, 95% CI: 1.29. 2.54, in men; RR = 1.78, 95% CI: 1.18, 2.70, in women). Ischemic heart disease risk was marginally reduced in men with low levels of education (RR = 0.77, 95% CI: 0.58, 1.01).These results show that health inequalities exist in Japan, even though wealth inequalities are relatively low. Social and political initiatives will be needed to correct these inequities between different socioeconomic statuses.

Smoking habit is associated with diabetic macular edema in Type 1 diabetes mellitus patients Diabetic macular edema (DME) affects up to 29% of patients with diabetic retinopathy (DR) and is the most frequent cause of visual impairment in these patients . However, risk factors for DME have not been fully established. Recently, Romero et al. (2007) prospectively studied 112 type 1 diabetes mellitus (DM) patients (age 39.9±10.5 years; DM duration 23.4±7.5 years; 48.2% males) to evaluate risk factors for DME. After 15 years, the incidence of DME was 20.5%. In logistic multivariate regression models, adjusted for gender and age, A 1c test and low-density lipoprotein (LDL) cholesterol levels, arterial hypertension, macroangiopathy, severity of retinopathy, and macroalbuminuria were the recognized risk factors for DME. In a cross-sectional study, we evaluated 224 Type 1 DM patients aged 33.3±13.9 years, with 16.5±9.6 years of DM duration (105 males) regularly attending the DM outpatient clinic at Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. A complete clinical evaluation was performed as previously described . DME was defined as one or more of the following: any retinal thickening within 500 μm of the center of the macula, with or without loss of retinal transparency; hard exudates associated with retinal thickening within 500 μm of the center of the macula; or one disc area of thickening within one disc diameter of the center of the macula (ETDRS, 1985). Twenty-four percent of the patients had nonproliferative DR (mild, n=38; moderate, n=9; severe, n=7), and 20.7 % (n=46) proliferative DR. The prevalence of DME was 9.4% (n=21). In univariate analysis, patients with DME had higher levels of urinary albumin excretion (UAE) [26.2 mg/dl (0.1-1105) vs. 8.7 (0.1-71110), P=.049] than those without it. DM duration, body mass index, blood pressure levels, glycemic (A 1c test) and lipid profile (total, LDL, and high-density lipoprotein cholesterol and triglycerides) did not differ between groups. Current or former smoking habit (50% vs. 25%; P=.034) and diabetic nephropathy (micro-and macroalbuminuria) (58.8% vs. 29.5%; P=.026) were more frequent in patients with than those without DME. The severity of DR was also associated with DME (P for trend .027). In logistic multivariate regression analysis, with the presence of DME as the dependent variable and DM duration, smoking habit, systolic blood pressure, A 1c test, and UAE as independent ones, only the smoking habit was associated with DME (OR 2.02, 95%CI 1.01-4.00; P=.04). Differences between our results and those of Romero et al., besides study design, could be explained by the younger age and shorter DM duration of our patients: a difference of about 6 years of age [6.6 years (95% CI 3.6-9.5; Pb.0001)] and of 7 years of DM duration [6.9 years (95% CI 4.7-8.9; Pb.0001)]. The present data demonstrated that, besides glycemic, lipid, and blood pressure control, the smoking habit, a nontraditional DME risk factor, should also be taken into account in order to prevent it. To our knowledge, this is the first report of this association.

A method for delivery of precise doses of smoked cocaine-base to humans. PHARMACOL BIOCHEM BEHAV 36(1) 1-7, 1990.--Despite increasing smoked cocaine-base use, there have been relatively few parametric studies in this area. The major reason for the limited number of studies is the lack of a simple procedure for the administration of precise doses of smoked cocaine-base to human volunteers. This paper describes a new method that allows for the delivery of precise doses of smoked cocaine-base. A complete description of the method and the precision of the administration procedure are presented. Furthermore, a study is described which was undertaken to determine: 1) the reproducibility of peak blood cocaine levels when the same dose of cocaine was given on two separate occasions; and 2) the dose-related effects on smoking topography, biochemical, physiological and subjective measures. Subjects (N = 5) were administered three doses of cocaine-base (10, 20 and 40 mg). Four subjects were given repeated doses of cocaine-base. Subjects were blind to the dose and in most cases randomly assigned to different doses. The results showed: 1) a significant correlation of peak whole blood cocaine concentrations among similar doses within subjects (r = .99); 2) no significant effects of dose on smoking topography; and 3) significant dose effects for whole blood cocaine concentrations, heart rate and systolic blood pressure.

Pancreatic cancer is the fourth leading cause of cancer deaths in the USA in both sexes. Early diagnosis is difficult and the overall mortality rate is high. Individuals at high risk for pancreatic cancer include smokers, and persons with all forms of chronic alcoholic, metabolic, tropical or hereditary pancreatitis. The duration of exposure to inflammation seems to be the major factor involved in the transition from benign to malignant condition. Smoking, which appears to further accelerate the carcinogenic transformation, remains the strongest risk factor amenable to preventive intervention.

Promising data have suggested that retinoid chemoprevention may help to control second primary tumors (SPTs), recurrence, and mortality of stage I non-small-cell lung cancer (NSCLC) patients. We carried out a National Cancer Institute (NCI) Intergroup phase III trial (NCI #I91-0001) with 1166 patients with pathologic stage I NSCLC (6 weeks to 3 years from definitive resection and no prior radiotherapy or chemotherapy). Patients were randomly assigned to receive a placebo or the retinoid isotretinoin (30 mg/day) for 3 years in a double-blind fashion. Patients were stratified at randomization by tumor stage, histology, and smoking status. The primary endpoint (time to SPT) and the secondary endpoints (times to recurrence and death) were analyzed by log-rank test and the Cox proportional hazards model. All statistical tests were two-sided. After a median follow-up of 3.5 years, there were no statistically significant differences between the placebo and isotretinoin arms with respect to the time to SPTs, recurrences, or mortality. The unadjusted hazard ratio (HR) of isotretinoin versus placebo was 1.08 (95% confidence interval [CI] = 0.78 to 1.49) for SPTs, 0.99 (95% CI = 0.76 to 1.29) for recurrence, and 1.07 (95% CI = 0.84 to 1.35) for mortality. Multivariate analyses showed that the rate of SPTs was not affected by any stratification factor. Rate of recurrence was affected by tumor stage (HR for T(2) versus T(1) = 1.77 [95% CI = 1.35 to 2.31]) and a treatment-by-smoking interaction (HR for treatment-by-current-versus-never-smoking status = 3.11 [95% CI = 1.00 to 9.71]). Mortality was affected by tumor stage (HR for T(2) versus T(1) = 1.39 [95% CI = 1.10 to 1.77]), histology (HR for squamous versus nonsquamous = 1.31 [95% CI = 1.03 to 1.68]), and a treatment-by-smoking interaction (HR for treatment-by-current-versus-never-smoking = 4.39 [95% CI = 1.11 to 17.29]). Mucocutaneous toxicity (P&amp;amp;amp;lt;.001) and noncompliance (40% versus 25% at 3 years) were higher in the isotretinoin arm than in the placebo arm. Isotretinoin treatment did not improve the overall rates of SPTs, recurrences, or mortality in stage I NSCLC. Secondary multivariate and subset analyses suggested that isotretinoin was harmful in current smokers and beneficial in never smokers.

The Utrecht Diabetes Project (UDP) is a shared-care project providing remote diabetologist support for 85 GPs. In the UDP all examinations, performed by the GP, follow standardized procedures, results being sent to the diabetologist. Laboratory results are sent automatically to both GP and diabetologist. To study the composition of the UDP population; completeness of data recording; changes in biochemical variables of UDP patients; and GPs&amp;#39; motives for enrolling them. Data were extracted from the records of 19 GPs and a questionnaire was sent to all UDP GPs. Of 770 patients with Type 2 diabetes, 44% were treated with UDP support, 29% by their GPs alone, and 27% at out-patient clinics. The 336 UDP patients were representative of all UDP patients. Patients older than 75 years were the greater part of those treated by GPs alone; out-patient clinics had more patients with diabetes &amp;gt; 10 years or with complications. UDP patients&amp;#39; records were the most complete. Diabetes regulation, lipid levels and diastolic blood pressure in the UDP patients improved significantly after inclusion in the UDP. GPs tend to seek UDP aid especially for patients who are young, or of recent onset, at risk of macrovascular complications, or needing insulin. Standardized data transfer between GP, diabetologist and laboratory might establish an effective infrastructure for shared diabetes care. Diabet. Med. 18, 459-463 (2001)

Objective: To examine the incidence of allergic rhinoconjunctivitis and asthma, and to assess allergic rhinoconjunctivitis as a risk factor for incident asthma, we performed a 11-year followup postal survey. Methods: The original study population was a random population sample of 8000 inhabitants of Helsinki aged 20e69 years in 1996. Participants in the first postal questionnaire survey, 6062 subjects, were invited to this follow-up study, and provided 4302 (78%) answers out of 5484 traced subjects in 2007.

Understanding culture is an essential key to reducing tobacco use. Conceptualizations of culture vary across scientific disciplines and theoretical orientations. Because of the complexity of the causes and effects of tobacco use, no single discipline has sufficient capacity to undertake a comprehensive approach to studying culture and tobacco. Transdisciplinary research offers a means of bridging disciplinary perspectives. This paper reviews epidemiological data on observed variation in smoking patterns across national groups, ethnicities and genders, and presents reasons for studying culture in tobacco control research. We discuss and contrast conceptualizations and specific definitions of culture and identify aspects of each conceptualization that are relevant to research on tobacco. We present a multilevel, multidimensional conceptual framework for transdisciplinary research teams to use to think together about the influence of culture on tobacco and of tobacco on culture. The framework challenges researchers to think about how the sociocultural context influences tobacco use at micro, meso, and macro levels. Finally, we offer suggestions for improving transdisciplinary research on culture and tobacco.

The aim of this research was to identify a small set of indicators of an individual's deprivation that is appropriate for all ethnic groups and can be combined into a single and simple index of individual socioeconomic deprivation in New Zealand. The NZiDep index of socioeconomic deprivation was derived using the same theoretical basis as the national census-based small-area indices of relative socioeconomic deprivation. The index has been created and validated from the analysis of representative sample survey data obtained from approximately 300 Maori, 300 Pacific, and 300 non-Maori, non-Pacific adults. Twenty-eight deprivation-related characteristics, derived from New Zealand and overseas surveys, were analysed by standard statistical techniques (factor analysis, Cronbach's coefficient alpha, item-total correlations, principal component analysis). The index was validated using information on tobacco smoking, which is known to be strongly related to deprivation.

Active and passive maternal smoking has a damaging effect in every trimester of human pregnancy. Cigarette smoke contains scores of toxins which exert a direct effect on the placental and fetal cell proliferation and differentiation and can explain the increased risk of miscarriage, fetal growth restriction (FGR) stillbirth, preterm birth and placental abruption reported by epidemiological studies. In the placenta, smoking is associated from early in pregnancy, with a thickening of the trophoblastic basement membrane, an increase in collagen content of the villous mesenchyme and a decrease in vascularisation. These anatomical changes are associated with changes in placental enzymatic and synthetic functions. In particular, nicotine depresses active amino-acid (AA) uptake by human placental villi and trophoblast invasion and cadmium decreases the expression and activity of 11 beta-hydroxysteroid dehydrogenase type 2 which is causally linked to FGR. Maternal smoking also dysregulates trophoblast expression of molecules that govern cellular responses to oxygen tension. In the fetus, smoking is associated with a reduction of weight, fat mass and most anthropometric parameters and as in the placenta with alterations in protein metabolism and enzyme activity. These alterations are the results of a direct toxic effect on the fetal cells or an indirect effect through damage to, and/or functional disturbances of the placenta. In particular, smoking interferes strongly with the fetal brain and pancreas biological parameters and induces chromosomal instability, which is associated with an increase in the risk of cancer, especially childhood malignancies. ava i l a b l e a t w w w. s c i e n c e d i r e c t . c o m w w w. e l s ev i e r. c o m / l o c a t e / e a r l h u m d ev Early Human Development (2007) 83, 699-706

OBJECTIVE To assess the effect of smoking on sperm vitality, sperm DNA integrity, semen reactive oxygen species, and zinc levels in fertile men. METHODS One-hundred sixty men were investigated. They were divided into 2 equal groups: healthy fertile nonsmokers and healthy fertile smokers. They were subjected to history taking, clinical examination, and semen analysis. In their semen, sperm hypo-osmotic swelling test, sperm DNA fragmentation test, seminal reactive oxygen species, and zinc were assessed. RESULTS Compared with fertile nonsmokers, fertile smokers were significantly associated with lower hypo-osmotic swelling test and seminal zinc levels and significantly associated with higher sperm DNA fragmentation percent and seminal reactive oxygen species levels. CONCLUSION Smoking (cigarettes/day and duration) has detrimental effects on sperm motility, viability, DNA fragmentation, seminal zinc levels, and semen reactive oxygen species levels, even in fertile men, and it is directly correlated with cigarette quantity and smoking duration. UROLOGY 80: 822-825, 2012.

A national random sample of 505 early elementary school teachers completed a 47-item survey to determine their perceived self-efficacy for teaching tobacco prevention education based on the Centers for Disease Control and Prevention guidelines for grades K-3, their training status on tobacco prevention, and their level of teaching about tobacco prevention. Results indicated most of the teachers were female, White, held a bachelor's or master's degree, never smoked, and had not received formal tobacco prevention training. The teachers' scores were high for efficacy expectations. and for outcome expectations. Conversely, for outcome value. teachers ranked tobacco prevention fiifrh out of six health topics, as the most important health topic to teach elementary students. Also, teachers trained in four tobacco areas or more had statistically signrjicantly higher scores for efficacy expectations than those trained in three or fewer areas. Statistically significant positive associations were also found between years of teaching tobacco prevention and efficacy and outcome expectation scores, and between the amount of time that tobacco prevention was taught during the past school year and outcome value.

Background: Exposure to environmental tobacco smoke is a major threat to public health. Greece, having the highest smoking prevalence in the European Union is seriously affected by passive smoking. The purpose of this study was to measure environmental tobacco smoke (ETS) exposure in the non smoking areas of hospitality venues and offices in Greece and to compare the levels of exposure to levels in the US, UK and Ireland before and after the implementation of a smoking ban. Methods: Experimental measurements of particulate matter 2.5 µm (PM 2.5), performed during a cross sectional study of 49 hospitality venues and offices in Athens and Crete, Greece during February-March 2006. Results: Levels of ETS ranged from 19 µg/m 3 to 612 µg/m 3 , differing according to the place of measurement. The average exposure in hospitality venues was 268 µg/m 3 with ETS levels found to be highest in restaurants with a mean value of 298 µg/m 3 followed by bars and cafes with 271 µg/ m 3. ETS levels were 76% lower in venues in which smoking was not observed compared to all other venues (p < 0.001). ETS levels in Greek designated non-smoking areas are similar to those found in the smoking sections of UK hospitality venues while levels in Ireland with a total smoking ban are 89% lower and smoke-free communities in the US are 91-96% lower than levels in Greece. Conclusion: Designated non-smoking areas of hospitality venues in Greece are significantly more polluted with ETS than outdoor air and similar venues in Europe and the United States. The implementation of a total indoor smoking ban in hospitality venues has been shown to have a positive effect on workers and patrons' health. The necessity of such legislation in Greece is thus warranted.

There has been concern that the availability of alternative less harmful forms of nicotine might inhibit smoking cessation and/or encourage those who would not otherwise have smoked to do so. The plausibility of such effects can be best assessed by looking at population trends in use of smoking in relation to alternatives. This paper looks at the relationships between snus use and smoking in Sweden. Analyses are based on a data set for the period January 2003 to February 2011 from a long-term study covering nationally representative samples of the Swedish population aged 18-79, with a total study population of 60,675 individuals. Questionnaires made it possible to identify detailed tobacco use categories and use trajectories. The results showed that uptake of snus use is much more common in males than females. Those who began daily tobacco use using snus were much less likely to subsequently take up smoking than those who had not, both among males (17.6% vs. 45.9%), and females (8.2% vs. 40.2%). Further, among those who started using snus after starting as smokers, 76.3% of men and 71.6% of women had stopped smoking completely, including 31.5% of the men and 28.6% of the women who had quit all forms of tobacco. Indeed, those who were primary snus users were also more likely to have quit altogether than those who only ever smoked. Snus was also reported as the most common smoking cessation aid among men and yielded higher success rates than nicotine replacement therapy and other alternatives. As conclusions, snus has both contributed to decreasing initiation of smoking and, when used subsequent to smoking, appears to facilitate smoking cessation. All these effects suggest that the availability and use of snus has been a major factor behind Sweden's record-low prevalence of smoking and the lowest level of tobacco-related mortality among men in Europe.

The purpose of this study was to assess prognostic factors, treatment outcomes and patterns of relapse in patients with early stage (T1-2 N0) squamous cell carcinoma of oral tongue treated primarily by surgery. The medical records of all patients with early stage (T1-2 N0) oral tongue cancer, radically treated at King Faisal Specialist Hospital and Research Center between January 1980 and December 1997, were reviewed. Eighty-®ve patients were identi®ed for analysis, 38 male and 47 female. With a median follow-up for surviving patients of 64 months, 5-year actuarial overall, disease-speci®c (DSS), and relapse-free survival (RFS) were 71, 75, and 63%, respectively. Univariate analysis for DSS showed survival advantage for patients with tumor thickness (TT) of 410 mm (P=0.0002) and distance from resection margin (DFRM) of >5 mm (P=0.005). The eect of TT of 410 mm was maintained (P=0.001) on multivariate analysis. Higher RFS was observed with TT of 410 mm (P=0.0002), DFRM of >5 mm (P=0.0002) and DFRM of >10 mm (P=0.007). On multivariate analysis higher RFS was also found for TT 410 mm (P=0.01) and DFRM >5 mm (P=0.01). Salvage of local tongue recurrence was higher than neck node failure, with 5-year DSS of 71 and 19%, respectively (P=0.007). Time interval for recurrence showed no signi®cant impact on outcome. In T1-2 N0 oral tongue cancer, TT, and DFRM are signi®cant prognostic factors for both local control and survival. Neck node recurrence is associated with poor prognosis and low salvage rate.

We investigated colour vision impairment in 45 male workers occupationally exposed to toluene (mean value of toluene concentration in ambient air = 119.96 ppm) and in 53 controls. Colour vision was evaluated by Lanthony-D-15 desaturated test and expressed as Age and Alcohol Intake Adjusted Colour Confusion Score (AACDS) or types of dyschromatopsia. Exposure was evaluated by measurement of toluene concentration in ambient air and blood, and hippuric acid and orthocresol determined in urine after the workshift. A statistically significant higher AACDS value was established in the exposed subjects compared to the controls (p < 0.0001). There was no significant difference between AACDS values on Wednesday morning compared to Monday morning. In the exposed group AACDS significantly correlated with the concentration of toluene in ambient air, concentration of toluene in blood and the concentration of hippuric acid in urine after the workshift (all p < 0.0001). Dyschromatopsias were detected in both groups, although no significant difference between groups was established. In the-exposed group, concentration of toluene in ambient air, alcohol intake and age explained 35.1%, concentration of toluene in blood, age and alcohol intake explained 19.9%, and concentration of hippuric acid in urine and age explained 19.2% of the variation in type III dyschromatopsia. Concentration of toluene in ambient air and age explained 28.3% of the variation in total dyschromatopsia, and concentration of hippuric acid and age explained 13.8%. In the control group, age and alcohol intake explained 19.6% of the variation in type III dyschromatopsia. In exposed workers a significant difference was found in the AACDS value compared to controls. However, no significant difference was found in the prevalence of colour vision loss in the yellow-blue and/or red-green axis. Based on the results of this study the authors conclude that the effect of toluene on colour vision can be chronic and that the possible reparation period in colour vision impairment is longer than 64 hours.

This study examined if the effects of peer smoking, family smoking, and parenting on smoking development during adolescence are moderated by personality characteristics of adolescents. Longitudinal data were obtained from 428 adolescents (aged M ϭ 13.4, SD ϭ .50) and their parents. Latent Growth Curve models assessed the development of smoking as a function of predictors and if effects of smoking-specific parenting and exposure to smoking were moderated by adolescents' Big Five personality dimensions. Findings revealed that having peers who smoked was associated with an increased likelihood of being a smoker at baseline. Further, significant interactions revealed that adolescents lower in agreeableness were more likely to be a smoker at baseline if they had an older sibling who smoked or if their parents engaged in frequent smoking-related discussions with them and that effective smoking-specific conversation was more strongly related to smoking at baseline among adolescents who were highly emotionally stable. No interactions predicted growth in smoking over time yet significant main effects showed that growth in smoking was associated with higher levels of extraversion, lower levels of emotional stability, and less effective parental smoking-specific communication. This study highlights the relevance of personality-target interventions and policy programs directed at parents and peers.

Introduction: There is evidence to suggest that an association exists between oral infections and coronary heart disease (CHD). Subjects presenting lesions of endodontic origin (LEOs) or pulpal inflammation had an increased risk of developing CHD. However, findings concerning systemic manifestations of apical periodontitis (AP) remain controversial. An association between CD14 gene polymorphisms and atherosclerosisassociated diseases has been shown, but there are no data regarding an association between CD14 polymorphism and AP. This study evaluated associations between clinical oral health status, CD14 polymorphisms, and CHD. Methods: A case-controlled clinical trial was designed to compare middle-aged adults with acute myocardial infarction or unstable angina (n = 51) within 12 months of the acute event defined as first manifestation with healthy controls (n = 49). Participants were matched for age, sex, and socioeconomic status. Indicators of oral disease and compliance were evaluated. CD14 polymorphisms were analyzed by restriction fragment length polymorphism-polymerase chain reaction. Results: CHD subjects had a higher prevalence of oral diseases and lower compliance to oral preventive strategies than healthy controls. Multivariate analysis showed a positive association between missing teeth (odds ratio [OR] = 1.37; 95% confidence interval [CI], 1.02-1.85), the number of LEOs (OR = 4.37; 95% CI, 1.69-11.28), chronic periodontitis (OR = 5.87; 95% CI, 1.17-29.4), and CHD. No statistically significant association emerged between the CD14 C(À260)T and the CD14 C(À159)T polymorphism, endodontic or periodontal disease, and CHD. Conclusions: Chronic oral diseases may increase the risk of CHD and may be an unconventional risk factor for CHD. (J Endod 2012;38:1570-1577

The potential cytogenetic damage in offset printing workers was evaluated using sister chromatid exchanges (SCEs), chromosome aberrations (CAs) and micronuclei (MN) as biomarkers in peripheral lymphocytes of 26 volunteers (14 workers, 12 controls). The CA, SCE and MN frequency of offset printing workers was significantly higher than in their controls. The replication index (RI) was not affected while the mitotic index (MI) was affected most in the workers. It can be concluded from this study that chronic occupational exposure to printing dyes and thinner may lead to a slightly increased risk of genetic damage among offset printing workers. Copyright © 2005 John Wiley & Sons, Ltd.

PURPOSE: Misclassification can produce bias in measures of association. Sensitivity analyses have been suggested to explore the impact of such bias, but do not supply formally justified interval estimates. METHODS: To account for exposure misclassification, recently developed Bayesian approaches were extended to incorporate prior uncertainty and correlation of sensitivity and specificity. Under nondifferential misclassification, a contour plot is used to depict relations among the corrected odds ratio, sensitivity, and specificity. RESULTS: Methods are illustrated by application to a case-control study of cigarette smoking and invasive pneumococcal disease while varying the distributional assumptions about sensitivity and specificity. Results are compared with those of conventional methods, which do not account for misclassification, and a sensitivity analysis, which assumes fixed sensitivity and specificity. CONCLUSION: By using Bayesian methods, investigators can incorporate uncertainty about misclassification into probabilistic inferences.

l e t t e r s Saccular intracranial aneurysms are balloon-like dilations of the intracranial arterial wall; their hemorrhage commonly results in severe neurologic impairment and death. We report a second genome-wide association study with discovery and replication cohorts from Europe and Japan comprising 5,89 cases and 4,8 controls with 832,000 genotyped and imputed SNPs across discovery cohorts. We identified three new loci showing strong evidence for association with intracranial aneurysms in the combined dataset, including intervals near RBBP8 on 8q.2 (odds ratio (OR) = .22, P = . × 0 −2 ), STARD13-KL on 3q3. (OR = .20, P = 2.5 × 0 −9 ) and a gene-rich region on 0q24.32 (OR = .29, P = .2 × 0 −9 ). We also confirmed prior associations near SOX17 (8q.23-q2.; OR = .28, P = .3 × 0 −2 ) and CDKN2A-CDKN2B (9p2.3; OR = .3, P = .5 × 0 −22 ). It is noteworthy that several putative risk genes play a role in cell-cycle progression, potentially affecting the proliferation and senescence of progenitor-cell populations that are responsible for vascular formation and repair.

Stomach cancer is not common in Thailand but the life styles of the Thai population are changing to become more Western so that information for planning control programme of stomach cancer is necessary. The highest incidence rates of this neoplasm are found in Eastern Asia, ranging from age-standardized rates of 95.5/105 (men) and 40.1/105 (women) in Yamagata, Japan to 4.1/105 (men) and 2.1/105 (women) in Khon Kaen, Northeast of Thailand. In Thailand, the estimated age-standardized incidence rates in 1993, 1996 were 4.9/105, 4.1/105 in men and 3.0/105 , 2.6/105 in women. Risk factors for stomach cancer in Thai population are unclear, but possibly include low intake of vegetables and fruits, alcohol drinking, tobacco smoking and high intake of salt. To investigate various aspects of dietary factors, smoking, and alcohol drinking in determining risk of stomach cancer in Thai population. A case-control study was conducted in Khon Kaen, Thailand during 2002-2006, to study the role of th...

Although socioeconomic status is a major contributing factor to health disparities, the mechanisms through which socioeconomic status influences health remain unclear. The purpose of the present study was to evaluate an a priori conceptual model of the pathways between socioeconomic status and modifiable health risk factors in a sample of 399 African Americans seeking smoking cessation treatment. A latent variable modeling approach was utilized to characterize the interrelationships among socioeconomic status, neighborhood disadvantage, social support, negative affect/perceived stress, and three specific modifiable risk factors (i.e., overweight/obesity, insufficient physical activity, at-risk drinking). Findings indicated that neighborhood disadvantage, social support, and negative affect/perceived stress function as pathways linking socioeconomic status and modifiable risk factors among African American smokers, and negative affect/perceived stress appears to play a key mediating role. Policy, community, and individual-level interventions may attenuate the impact of socioeconomic status on health by targeting intermediate psychosocial, environmental, and behavioral pathways.