The influence of health literacy and knowledge about smoking hazards on the intention to quit smoking and its intensity: an empirical study based on the data of China's health literacy investigation.

OBJECTIVE: This study explored the relationship between smokers' health literacy, knowledge of smoking hazards, and their intention to quit. METHODS: Based on data from the 2019 Health Literacy and Tobacco Use Surveillance among residents of a city in Zhejiang Province, 1120 male smokers were screened. Differential tests were used to analyze whether smokers with varying levels of health literacy and knowledge about smoking hazards differed in their intention to quit smoking and the intensity of their intention. A multi-factor logistic regression model was constructed to explore the extent of these differences. RESULTS: Only 24.8% of smokers had higher health literacy. Among smokers, those with an intention to quit had a higher health literacy level compared to those without such intention (32.7% vs. 17.0%, p < 0.001). Health literacy levels did not differ significantly between groups with different intensity of intention to quit (34.2% vs. 31.9% vs. 30.1%, p = 0.435). About 48.7% of the smokers a higher level of knowledge about smoking hazards. It was more prevalent in the intent to quit group compared to the no intent to quit group (54.0% vs. 43.4%, p < 0.001), and the low intent to quit group had lower knowledge compared to the moderate and high intent to quit groups (49.1% vs. 56.6% vs. 63.4%, p = 0.011). After adjusting for other influences, smokers with lower health literacy were less likely to have intention to quit (OR = 0.659, p = 0.016). And the association between knowledge about smoking hazards and whether smokers have the intention to quit is no longer significant, but it significantly affects the intensity of the intention to quit among smokers who already have the intention (OR = 0.623, p = 0.005). CONCLUSION: General health literacy may play a role in facilitating smokers' progression from the stage of no intent to quit to one of intent to quit, but a more specific understanding of the harms of smoking may be needed to increase the strength of intent to quit.

Smoking, alcohol consumption, and frailty: A Mendelian randomization study.

Background: Tobacco smoking and alcohol consumption have been associated with frailty in observational studies. We sought to examine whether these associations reflect causality using the two-sample Mendelian randomization (MR) design. Methods: We used summary genome-wide association statistics for smoking initiation (N = 2,669,029), alcohol consumption (N = 2,428,851), and the frailty index (FI, N = 175,226) in participants of European ancestry. Both univariable and multivariable MR were performed to comprehensively evaluate the independent effects of smoking and alcohol consumption on the FI, accompanied by multiple sensitivity analyses. Results were verified using lifetime smoking and alcohol use disorder. Reverse direction MR was undertaken to assess the potential for reverse causation. Results: Genetic predisposition to smoking initiation was significantly associated with increased FI (univariable MR: ß = 0.345; 95% confidence interval [CI] = 0.316 to 0.374; p = 1.36E-113; multivariable MR: ß = 0.219; 95% CI = 0.197 to 0.241; p = 2.44E-83). Genetically predicted alcohol consumption showed a suggestive association with the FI (univariable MR: ß = -0.090; 95% CI = -0.151 to -0.029; p = 0.003; multivariable MR ß = -0.153; 95% CI = -0.212 to -0.094; p = 2.03E-07), with inconsistent results in sensitivity analyses. In complementary analysis, genetic predicted lifetime smoking, but not alcohol use disorder was associated with the FI. There is no convincing evidence for reverse causation. Conclusion: The present MR study supported smoking as a causal risk factor of frailty. Further research is warranted to investigate whether alcohol consumption has a causal role in frailty.

Laparoscopic radical antegrade modular pancreatosplenectomy: preliminary experience with 10 cases.

BACKGROUND: The radical antegrade modular pancreatosplenectomy (RAMPS) which is a reasonable surgical approach for left-sided pancreatic cancer is emphasis on the complete resection of regional lymph nodes and tumor-free margin resection. Laparoscopic radical antegrade modular pancreatosplenectomy (LRAMPS) has been rarely performed, with only 49 cases indexed on PubMed. In this study, we present our experience of LRAMPS. METHODS: From December 2018 to February 2020, 10 patients underwent LRAMPS for pancreatic cancer at our department. The data of the patient demographics, intraoperative variables, postoperative hospital stay, morbidity, mortality, pathologic findings and follow-up were collected. RESULTS: LRAMPS was performed successfully in all the patients. The median operative time was 235 min (range 212-270 min), with an EBL of 120 ml (range 100-200 ml). Postoperative complications occurred in 5 (50.0%) patients. Three patients developed a grade B pancreatic fistula. There was no postoperative 30-day mortality and reoperation. The median postoperative hospital stay was 14 days (range 9-24 days).The median count of retrieved lymph nodes was 15 (range 13-21), and four patients (40%) had malignant-positive lymph nodes. All cases achieved a negative tangential margin and R0 resection. Median follow-up time was 11 months (range 3-14 m). Two patients developed disease recurrence (pancreatic bed recurrence and liver metastasis) 9 months, 10 months after surgery, respectively. Others survived without tumor recurrence or metastasis. CONCLUSIONS: LRAMPS is technically safe and feasible procedure in well-selected patients with pancreatic cancer in the distal pancreas. The oncologically outcomes need to be further validated based on additional large-volume studies.

Evaluation of the association between urinary cadmium levels below threshold limits and the risk of diabetes mellitus: a dose-response meta-analysis.

As cadmium levels are increasing in the environment, the adverse effects of cadmium exposure specifically associated with chronic diseases are receiving increasing attention. Several population-based studies have been conducted on the association between cadmium and diabetes mellitus (DM) but have reported controversial results. Here, we aimed to evaluate the association between cadmium exposure and DM. In this meta-analysis, a random effects model was used because there was evidence of heterogeneity among studies. A dose-response relationship was assessed through a restricted cubic spline model with three knots. The results showed a positive association between cadmium levels in the body and DM (OR = 1.27; 95% CI, 1.07-1.52). The cadmium levels in the body were defined on the basis of combined urinary and blood cadmium. Subgroup analysis further indicated a positive association between urinary cadmium levels and DM (OR = 1.31; 95% CI, 1.02-1.69). The dose-response analysis results showed a positive association between levels of urinary cadmium above 2.43 µg/g creatinine and DM, and the risk of DM increased by 16% for each l µg/g creatinine increase in urinary cadmium levels. The results from our meta-analysis indicate that cadmium levels in the body are positively associated with DM, and urinary cadmium levels above 2.43 µg/g creatinine are associated with an increased risk of DM.

Recognizing and managing on toxicities in cancer immunotherapy.

Over the past 4 years, cancer immunotherapy has significantly prolonged survival time of patients with prostate cancer, melanoma, lung cancer, and liver cancer, but its side effects are also impressive. Different types of the immune therapeutic agents have different on-target or off-target toxicity due to high affinity or weak specificity, respectively. Treatment toxicity spectrums vary greatly even in patients with the same type of cancer. Common toxicities are fevers, chills, diarrhea colitis, maculopapular rash, hepatitis, and hormone gland disorder; therefore, routine monitoring of thyroid function, liver function, renal function, and complete blood count are absolutely necessary once treatment begins. Some side effects are reversible, and can be processed through the standard medicines. However, serious toxicities are lethal, which should be frequently followed-up, identified at an early stage and immediately symptomatic treated by high-dose immunosuppressors. In this case, thereafter, the same agent should not be challenged again.

Continuous surveillance of organochlorine pesticides in human milk from 1983 to 1998 in Beijing, China.

A study was carried out to study the accumulative levels and dynamic changes of organochlorine pesticides in human milk in Beijing from 1982 to 1998, and the effect of prohibition and restriction on the use of DDT and BHC (666) in China in 1983. The milk samples were collected from women during the lactation period in four districts of Beijing from 1982 to 1998, in 1991, 1993 and 1998, respectively. The contents of DDT and BHC in human milk were determined according to the standard method of biology-monitoring of PR China. The average fat content of human milk was about 3% from 1982-1998 in Beijing. The average concentration of pp-DDT and op-DDT in 1985 was less than 0.10 mg/kg and remained so until 1998. The average concentration of pp'-DDT decreased from 1.80 mg/kg in 1982 to 0.24 mg/kg in 1998 and that of pp-DDE descended from 5.87 mg/kg to 1.72 mg/kg and the total concentration of DDT dropped from 7.71 mg/kg to 2.04 mg/kg. Since prohibition of organochlorine pesticides 1983, the average concentration of beta-BHC and total BHC fell respectively from 9.66 mg/kg and 10.1 mg/kg in 1983 to 1.18 mg/kg in 1998. However, the accumulative concentration of DDT and BHC was much higher than that of some foreign countries. Therefore, it was important and necessary to monitor organochlorine compounds in human milk continuously.

[The investigation on basic contents of organochlorine pesticides in human milk during consecutive periods in Beijing urban areas].

OBJECTIVE: To investigate the basic contents of organochlorine pesticides (DDT, BHC and HCB) in human milk of normal residents in Beijing urban areas. METHODS: Through continuous survey on the trend of organochlorine contents in human milk since DDT and BHC pesticides were forbidden in use in 1983, and to evaluate the effects of this program, the required lying-in women residents in urban districts for at least 5 years were enrolled in this study. All these lying-in women and also their family members were not exposed to or engaged in producing or selling organochlorine pesticides. In this study, the women chosen were giving birth to a child just after one week to 4 months. The detection method used is the national standard biological detection method. RESULTS: In 1982, the total amount of DDT and BHC contents in human milk were 6.45 mg/kg and 6.97 mg/kg, respectively, which were found the highest level in the word. The contents of organochlorine were descending apparently since the DDT and BHC pesticides were forbidden by Chinese government in 1983. According to the standards of FAO/WHO, the average intake of total DDT and beta-BHC in the infants born in 1998 was 11 and 6 microg/kg, respectively. Both of them were less than the allowable daily intake amount regulated by WHO and the Ministry of Health of Japan. CONCLUSION: The study might make clear that the basic levels of organochlorine pesticides (DDT, BHC and HCB) in human milk of normal residents and the attenuation trend of 2 pesticides cumulative levels in human body, through estimating the intake quantity of organochlorine by infants, showing that the DDT and BHC daily intake from human milk absorbed by infants, who were born after 1998, were at a safe level. It was indicated that the measure for forbidding use of DDT and BHC pesticides is contributory.