The prevalence, odds, predictors, and management of tobacco use disorder or nicotine dependence among people with severe mental illness: Systematic review and meta-analysis.

The prevalence, correlates, and management of tobacco use disorder (TUD) or nicotine dependence (ND) among people with severe mental illness (SMI), namely schizophrenia, bipolar disorder (BD), and major depressive disorder (MDD), remain unclear. Therefore, a systematic review and meta-analysis was conducted. Electronic databases were systematically searched from inception to July 12, 2020, for observational studies documenting the prevalence, odds, and correlates of TUD/ND among people with SMI; randomized controlled trials (RCTs) informing the management of TUD/ND in people with SMI were also included. Random-effects meta-analyses were conducted. Sources of heterogeneity were explored. Nineteen observational studies, including 7527 participants with SMI met inclusion criteria. TUD/ND co-occurred in 33.4-65% of people with SMI. Rates were higher among males. While bupropion and varenicline represent promising treatment opportunities for schizophrenia with TUD/ND, non-pharmacological interventions require further research, mainly for people with primary mood disorders. TUD/ND represent prevalent co-occurring conditions among people with SMI. Further well-designed RCTs are warranted to inform their management.

The circuits of healthcare: Understanding healthcare seeking behaviour-A qualitative study with tuberculosis patients in Lisbon, Portugal.

BACKGROUND: Understanding health delivery service from a patient´s perspective, including factors influencing healthcare seeking behaviour, is crucial when treating diseases, particularly infectious ones, like tuberculosis. This study aims to trace and contextualise the trajectories patients pursued towards diagnosis and treatment, while discussing key factors associated with treatment delays. Tuberculosis patients' pathways may serve as indicator of the difficulties the more vulnerable sections of society experience in obtaining adequate care. METHODS: We conducted 27 semi-structured interviews with tuberculosis patients attending a treatment centre in a suburban area of Lisbon. We invited nationals and migrant patients in active treatment to participate by sharing their illness experiences since the onset of symptoms until the present. The Health Belief Model was used as a reference framework to consolidate the qualitative findings. RESULTS: By inductive analysis of all interviews, we categorised participants' healthcare seeking behaviour into 4 main types, related to the time participants took to actively search for healthcare (patient delay) and time the health system spent to diagnose and initiate treatment (health system delay). Each type of healthcare seeking behaviour identified (inhibited, timely, prolonged, and absent) expressed a mindset influencing the way participants sought healthcare. The emergency room was the main entry point where diagnostic care cascade was initiated. Primary Health Care was underused by participants. CONCLUSIONS: The findings support that healthcare seeking behaviour is not homogeneous and influences diagnostic delays. If diagnostic delays are to be reduced, the identification of behavioural patterns should be considered when designing measures to improve health services' delivery. Healthcare professionals should be sensitised and perform continuous capacity development training to deal with patients´ needs. Inhibited and prolonged healthcare seeking behaviour contributes significantly to diagnostic delays. These behaviours should be detected and reverted. Timely responses, from patients and the healthcare system, should be promoted.

One-year retrospective radiographic assessment of marginal bone loss around basal implants and impact of multiple risk factors using multivariate analysis / Evaluación radiográfica retrospectiva de un año de la pérdida ósea marginal alrededor de los implantes basales y el impacto de múltiples factores de riesgo mediante análisis multivariado

Background: Factors like medical and periodontal conditions, implant location and smoking can affect marginal bone loss (MBL) of basal implants. Objectives: The purpose of this study is to explore the association of MBL with multiple variables including gender, age, smoking status, diabetes, implant placement protocol, location of implant, and type of prosthesis. Material and Methods: A total of 156 single-piece basal implants (Dr. Ihde Dental AG in Gommiswald, Switzerland) were placed in 44 patients. Dental panoramic tomographs were obtained postoperatively and following a one-year of service to determine MBL on mesial and distal sides. The association of MBL with the multiple variables was analysed using the multivariate and the random forest analysis. Results: The mean mesial and distal MBL was 0.64 millimetres. None of the implants presented MBL exceeding 1 millimetre. All implants were retained without complications during the firstyear of service. The MBL was remarkably associated with the smoking status, diabetes, location of implant and implant placement protocol. Diabetes mellitus is the most vital parameter in predicting MBL. Conclusion: The mean MBL of all implants did not exceed the threshold of 1 millimetre during the first year of service. When placing implants in patients who smoke and have diabetes, care should be taken.

Antecedentes: Factores como las condiciones médicas y perio-dontales, la ubicación del implante y el tabaquismo pueden afectar la pérdida marginal de hueso (PMH) de los implantes basales. Objetivo: La finalidad de este estudio es explorar la asociación de PMH con múltiples variables, incluido el sexo, la edad, el tabaquismo, la diabetes, el protocolo de colocación del implante, la ubicación del implante y el tipo de prótesis. Material y Métodos: Se colocaron 156 implantes basales de una sola pieza (Dr.Ihde Dental AG, Gommiswald, Suiza) en 44 pacientes. Se obtuvieron tomografías panorámicas dentales después de la operación y después de un año de servicio para deter-minar la MBL en los lados mesial y distal. La asociación de la PMH con las múltiples variables se analizó mediante el análisis multivariado y de bosque aleatorio. Resultados: La PMH media mesial y distal fue de 0,64 milímetros. Ninguno de los implantes presentó PMH superior a 1 milímetro. Todos los implantes se mantuvieron sin complicaciones durante el primer año de servicio. La PMH se asoció nota-blemente con el tabaquismo, la diabetes, la ubicación del implante y el protocolo de colocación del implante. La diabetes mellitus es el paráme-tro más importante para predecir la MBL. Conclusion: La PMH media de todos los implantes no superó el umbral de 1 milímetro durante el primer año de servicio. Se debe tener especial cuidado al colocar implantes en pacientes que fuman y tienen diabetes.

Indicadores de saúde em usuários de uma unidade básica de saúde da cidade de Santarém, Pará, Brasil / Health indicators in users of a basic health unit in the city of Santarém, Pará, Brazil

Introdução: Usuários do sistema de saúde com doenças crônicas não transmissíveis devem estar em acompanhamento constante para evitar complicações em seu estado de saúde. Objetivo: Analisar os indicadores laboratoriais de saúde em usuários de uma Unidade Básica de Saúde com e sem o diagnóstico para a diabetes e hipertensão. Métodos: A amostra foi de 231 usuários de uma unidade básica de saúde da cidade de Santarém-PA, maiores de idade, que foram agrupados em pacientes com DM/HAS (DM/HAS; n=144), e sem o diagnóstico para DM/HAS (AUS; n=87). As coletas envolveram informações socioeconômicas, clínicas e laboratoriais. Os dados foram tratados com estatística descritiva e inferencial, adotando-se p<0.05. Resultados: Tanto no DM/HAS como no AUS predominou o sexo feminino, estado civil casado, com vínculo empregatício, cor de pele parda, com 4-7 anos de estudo, renda de 1-2 salários, não tabagistas, não etilista e faixa etária de 38-77 anos. A HAS foi a doença mais presente de forma geral, bem como por sexo. Identificou-se no DM/HAS valores menores para a taxa de filtração glomerular (TFG) e maiores valores para a glicemia, triglicerídeos, colesterol total, LDL-c e não HDL-c. Conclusão: De acordo com a proposta desenvolvida, destaca-se que os usuários com DM/HAS apresentam associação positiva para valores alterados de glicemia, colesterol total, não HDL-c, triglicerídeos, TFG e para a presença da síndrome metabólica e risco cardiovascular moderado/alto.

Introduction: Users of the health system with chronic non-communicable diseases must be constantly monitored to avoid complications in their health status. Objective: Analyze laboratory health indicators in users of a Basic Health Unit with and without a diagnosis for diabetes and hypertension. Methods: The sample consisted of 231 users of a basic health unit in the city of Santarém-PA, all of them of age, grouped into patients with DM/SAH (DM/SAH; n=144), and without the diagnosis for DM/SAH (ABS; n=87). The collections involved socioeconomic, clinical, and laboratory information. The data were treated with descriptive and inferential statistics, adopting p <0.05. Results: In both DM/SAH and ABS groups, there was a predominance of female individuals, married status, employed, brown skin color, with 4-7 years of study, income of 1-2 salaries, non-smokers, non-alcoholic drinkers, and aged between 38-77 years. SAH was the most common disease in general, as well as when analyzing by gender. Lower values for the glomerular filtration rate (GFR) were identified in the DM/SAH and higher values for the glycemia, triglycerides, total cholesterol, LDL-c, and non-HDL-c. Conclusion: According to the proposal of this paper, it is noteworthy that users with DM/SAH have a positive association for altered values of blood glucose, total cholesterol, non-HDL-c, triglycerides, GFR, and for the presence of metabolic syndrome and moderate/high cardiovascular risk.

Alta prevalencia en el consumo de tabaco y desigualdades en población Lenca, Intibucá, Honduras, 2015 / High prevalence of tobacco consumption and inequalities in Lenca population, Intibucá, Honduras, 2015

Antecedentes: Aproximadamente un sexto de la población mundial tiene el hábito de fumar para una prevalencia de 24%. La OMS considera que, de no cambiar las tendencias durante el siglo XXI, el tabaco será responsable de la muerte prematura de mil millones de personas. Objetivo: Determinar la prevalencia del consumo de tabaco y la medición de desigualdades socioeconómicas en la población Lenca, Municipio de Intibucá, Intibucá, Honduras, 2015. Métodos: Estudio descriptivo transversal con análisis de asociación. Se aplicó formulario estructurado para recolectar datos generales, sociodemográficos y tabaquismo, previo consentimiento informado. Dependencia al tabaco fue evaluada con test Faguerström. Se prepararon bases de datos en Epi-info-7 y SPSS-18. Se calcularon razones de disparidad (OR). Resultados: De un total de 602 entrevistados,se identificaron 167 fumadores para una prevalencia de consumo de tabaco de 27.7%. El 76.6% (128) de fumadores tuvo dependencia baja a nicotina y 23.4% (39) dependencia moderada. La media de ingreso familiar mensual fue USD$193 en fumadores y USD$168 en no fumadores. El 40.1% (67) de fumadores gastó mensualmente en tabaco un mínimo de USD$95. No se encontró relación entre consumo de tabaco e ingreso familiar mensual (OR=0.87, IC95% 0.7-1.0) ni con analfabetismo (OR=1.20, IC95% 0.7-2.0). Discusión: No se observaron diferencias significativas entre consumo de tabaco y las variables socioeconómicas, se encontró una elevada prevalencia de consumo de tabaco en esta población en relación con otros estudios realizados en el país. Los resultados apoyan la necesidad de políticas enfocadas en prevención del tabaco en indígenas...(AU)

Assessment of sleep quality of patients with panic disorder and generalized anxiety disorder during remission: a case-control study

Abstract Background Sleep disorders are common in psychiatric diseases. Panic disorder (PD) and generalized anxiety disorder (GAD) are two major anxiety disorders that are associated with sleep disorders. Objective We hypothesized that poor sleep quality continues in PD and GAD during remission. Therefore, in this study we aimed to compare the sleep quality of patients with PD and GAD to that of healthy controls. Methods The study included patients with PD (n = 42) and GAD (n = 40) who had been in remission for at least 3 months and healthy control volunteers (n = 45). The patients were administered the Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). Results The total PSQI scores of the GAD group were significantly increased in comparison to those of the PD (p = 0.009) and control (p < 0.001) groups. The rate of poor sleep quality in GAD during remission (77.5%) was greater than that of the PD (47.6%) and control (51.1%) groups (p = 0.011). Discussion GAD is a chronic and recurrent disease. In this study, it was found that the deterioration in sleep quality of patients with GAD may continue during remission. In the follow-up and treatment of patients, it is appropriate to question about sleep symptoms and to plan interventions according to these symptoms.

Incidence and characteristics angiographic of patients with acute myocardial / Incidência e características angiográficas de pacientes com doença miocárdica aguda

Background: Acute myocardial infarction (AMI) is defined as the death of cardiomyocytes due to prolonged ischemia, caused by thrombosis and / or vasospasm on an atherosclerotic plaque. Objective: To determine the incidence of patients with myocardial infarction undergoing primary angioplasty; characterize the anthropometric variables and identify the risk factors in this population. Methods: This was a cross-sectional, observational, retrospective study in which we collected secondary data from medical records of a hospital in a city in the state of São Paulo, where the largest number of interventions is via Public Health System, patients with a diagnosis of Myocardial Infarction, undergoing primary coronary angioplasty, from January 2011 to December 2013. Results: The total sample consisted of 437 subjects, 282 male and 155 female. In this study, there was predominance of myocardial infarction in the anterior descending artery ADA (45.51%), followed by right coronary artery RCA (38.46%), in carrying out the rescue angioplasty and stent implantation in 96.62% of cases. There was a predominance of high blood pressure as risk factors for 73.71%, followed by smoking with 41.66% of the sample. Conclusion: According to the present study data, it appears a higher prevalence of infarction occurred in the ADA, with individuals performing the rescue angioplasty procedure and the placement of the stent, and a growing incidence of drug stent placement. We observed a high incidence of risk factors, prevailing hypertension

Avaliação da relação do índice tornozelo-braquial com a gravidade da doença arterial coronáriana / Assessment of the relationship of ankle-brachial index with coronary artery disease severity

Fundamento: A Doença Arterial Periférica (DAP) está associada a eventos cardiovasculares, podendo ser diagnosticada e estimada através do Índice Tornozelo-Braquial (ITB). Está bem estabelecido que o ITB é fator agravante na estratificação de risco cardiovascular, mas sua contribuição para definir a gravidade do acometimento arterial coronariano não está bem estabelecida. Objetivos: Estudo testou o valor do ITB com a gravidade da doença aterosclerótica coronariana pelo Escore de Syntax (ES) em pacientes com Síndrome Coronariana Aguda (SCA). Métodos: Estudo prospectivo com medida do ITB de todos os pacientes internados com SCA no Hospital São Lucas da PUCRS, consecutivamente, de maio a setembro de 2016, e comparação de seu valor com o ES e tipos de SCA desses pacientes. As análises foram realizadas considerando-se o nível de confiança de 95% ( α = 5%). Resultados: 101 pacientes, com média de idade de 62,6±12,0 anos, 58 (57,4%) masculinos, 74 (82,2%) hipertensos, 33 (45,8%) diabéticos e 46 (45,5%) com infarto agudo do miocárdio com supradesnivelamento do ST (IAMCSST). A gravidade da DAP não teve relação com a gravidade anatômica da doença arterial coronariana (DAC). Encontramos uma associação significativa de ES intermediário com infarto agudo do miocárdio sem supradesnivelamento do ST (IAMSSST) e de ES baixo com angina instável (AI) [OR (IC95%): 1,11 (1,03-1,20); p = 0,004], que se manteve após análise multivariada, ajustada para idade, tabagismo, história familiar de DAC e DAC prévia [OR (IC95%): 1,13 (1,02-1,25); p = 0,019]. Conclusões: Analisando nossos resultados, encontramos que pacientes com ITB < 0,9 não apresentaram associação com maior complexidade determinada pelo ES em pacientes com SCA. Os pacientes com IAMSSST estiveram mais associados com ES intermediário

DOI: 10.5935/2359-4802.20170094 47 International Journal of Cardiovascular Sciences. 2018;31(1)47-55 ARTIGO ORIGINAL Correspondência: Andrea Mabilde Petracco Av. Ipiranga, 7464, sala 524. CEP: 91530-000, Jardim Botânico, Porto Alegre, RS ­ Brasil. E-mail: apetracco@terra.com.br; apetracco@cardiol.br Avaliação da Relação do Índice Tornozelo-Braquial com a Gravidade da Doença Arterial Coronária Assessment of the Relationship of Ankle-Brachial Index With Coronary Artery Disease Severity Andrea Mabilde Petracco, Luiz Carlos Bodanese, Gustavo Farias Porciúncula, Gabriel Santos Teixeira, Denise de Oliveira Pellegrini, Luiz Claudio Danzmann, Ricardo Medeiros Pianta, João Batista Petracco Hospital São Lucas, da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS ­ Brasil Artigo recebido em 28/02/2017; revisado em 12/08/2017; aceito em 21/08/2017 Resumo Fundamento: A Doença Arterial Periférica (DAP) está associada a eventos cardiovasculares, podendo ser diagnosticada e estimada através do Índice Tornozelo-Braquial (ITB). Está bem estabelecido que o ITB é fator agravante na estratificação de risco cardiovascular, mas sua contribuição para definir a gravidade do acometimento arterial coronariano não está bem estabelecida. Objetivos: Estudo testou o valor do ITB com a gravidade da doença aterosclerótica coronariana pelo Escore de Syntax (ES) em pacientes com Síndrome Coronariana Aguda (SCA). Métodos: Estudo prospectivo com medida do ITB de todos os pacientes internados com SCA no Hospital São Lucas da PUCRS, consecutivamente, de maio a setembro de 2016, e comparação de seu valor com o ES e tipos de SCA desses pacientes. As análises foram realizadas considerando-se o nível de confiança de 95% ( α = 5%). Resultados: 101 pacientes, com média de idade de 62,6±12,0 anos, 58 (57,4%) masculinos, 74 (82,2%) hipertensos, 33 (45,8%) diabéticos e 46 (45,5%) com infarto agudo do miocárdio com supradesnivelamento do ST (IAMCSST). A gravidade da DAP não teve relação com a gravidade anatômica da doença arterial coronariana (DAC). Encontramos uma associação significativa de ES intermediário com infarto agudo do miocárdio sem supradesnivelamento do ST (IAMSSST) e de ES baixo com angina instável (AI) [OR (IC95%): 1,11 (1,03-1,20); p = 0,004], que se manteve após análise multivariada, ajustada para idade, tabagismo, história familiar de DAC e DAC prévia [OR (IC95%): 1,13 (1,02-1,25); p = 0,019]. Conclusões: Analisando nossos resultados, encontramos que pacientes com ITB < 0,9 não apresentaram associação com maior complexidade determinada pelo ES em pacientes com SCA. Os pacientes com IAMSSST estiveram mais associados com ES intermediário. (Int J Cardiovasc Sci. 2018;31(1)47-55) Palavras-chave: Índice Tornozelo-Braço, Síndrome Coronariana Aguda, Doença da Artéria Coronariana, Índice de Severidade da Doença, Aterosclerose, Doença Arterial Periférica. Abstract Background: Peripheral Artery Disease (PAD) is associated with cardiovascular events and can be diagnosed and estimated by use of the Ankle-Brachial Index (ABI). ABI is a worsening factor in the stratification of cardiovascular risk, but its contribution to define the severity of coronary artery disease has not been well established. Objectives: To compare the ABI value with the coronary atherosclerotic disease severity by use of the Syntax Score (SS) in patients with Acute Coronary Syndrome (ACS). Methods: This prospective study measured the ABI of all patients with ACS consecutively admitted to the São Lucas Hospital of PUCRS from May to September 2016, and compared the ABI values with the SS and ACS types of those patients. The analyzes were performed considering the 95%confidence interval ( α = 5%). Results: This study assessed 101 patients [mean age, 62.6 ± 12.0 years; 58 men (57.4%)], 74 (82.2%) were hypertensive, 33 (45.8%) had diabetes and 46 (45,5%) had ST-elevation acute myocardial infarction (STEMI). The PAD severity was not related to the anatomical severity of the coronary artery disease (CAD). We found a significant association of intermediate SS with non-ST-elevation acute myocardial infarction (NSTEMI), and of low SS with unstable angina (UA) [OR (95% CI): 1.11 (1.03-1.20) (p = 0.004)], which remained after multivariate analysis adjusted to age, smoking, family history of CAD and previous CAD [(OR 95%): 1.13 (1.02-1.25) (p = 0.019)]. Conclusions: Patients with ABI < 0.9 showed no association with higher disease complexity determined by the SS in patients with ACS. Patients with NSTEMI were more associated with an intermediate risk on the SS

Enfermedad pulmonar obstructiva crónica (EPOC) y tabaquismo / Chronic obstructive pulmonary diisease (COPD) and smoking

Se describe cómo el consumo de tabaco produce la Enfermedad Obstructiva Pulmonar (EPOC), y su repercusión en la salud pública. Se explica la fisiopatología, la clínica, el diagnóstico y el tratamiento de esta enfermedad prevenible.

It describes how the consumption of tobacco causes Chronic Obstructive Pulmonary Disease (COPD) and its impact on public health. Pathophysiology, clinical, diagnosis and treatment of this preventable disease is explained.

Time to first cigarette and serum cholesterol levels.

RATIONALE: Cigarette smoking is a primary cause of cardiovascular disease (CVD); however, prior research has rarely distinguished smoking behavior from nicotine dependence. OBJECTIVE: The current study presents a novel investigation into whether time to first cigarette (TTFC), a reliable proxy for nicotine dependence, is associated with lipid cholesterol, a biomarker for CVD, after controlling for smoking behavior and other risk factors. METHODS: In total, 3903 current adult smokers were drawn from four consecutive cross-sectional waves (2005-06, 2007-08, 2009-10, and 2011-12) of the National Health and Nutrition Survey (NHANES). Weighted regressions were used to examine whether earlier TTFC is associated with differences in a) numeric values; b) guideline-based binary outcomes of total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and the LDL/HDL ratio; and c) 10-year risk scores for CVD. RESULTS: Earlier TTFC (within 5, 30, or 60 min vs. >60 min) was significantly (p < 0.05) associated with lower HDL (2-3 mg/dL) and a lower odds ratio (OR = 0.70) of having optimal HDL levels, and a lower LDL/HDL ratio (0.14-0.32); these results were consistent across three models (unadjusted, adjusted for smoking behavior, and also adjusted for demographics and other CVD risk factors). Earlier TTFC was also associated (p < 0.05) with higher odds of having sub-optimal total cholesterol levels (OR = 1.55) and higher LDL values (8 mg/dL), but only in the models adjusting for smoking behavior. However, the association of TTFC with 10-year CVD risk scores did not reach significance (p > 0.05). CONCLUSION: More "addicted" smokers, as indicated by earlier TTFC, have less favorable lipid profiles, even after accounting for current and lifetime smoking history and other CVD risk factors. Future research should further explore whether TTFC could be a useful tool for refining clinically significant CVD risk among smokers.

Hospital Admissions for Chest Pain Associated with Cocaine Use in the United States.

BACKGROUND: The outcomes related to chest pain associated with cocaine use and its burden on the healthcare system are not well studied. METHODS: Data were collected from the Nationwide Inpatient Sample (2001-2012). Subjects were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was a composite of mortality, myocardial infarction, stroke, and cardiac arrest. RESULTS: We identified 363,143 admissions for cocaine-induced chest pain. Mean age was 44.9 (±21.1) years with male predominance. Left heart catheterizations were performed in 6.7%, whereas the frequency of acute myocardial infarction and percutaneous coronary interventions were 0.69% and 0.22%, respectively. The in-hospital mortality was 0.09%, and the primary outcome occurred in 1.19% of patients. Statistically significant predictors of primary outcome included female sex (odds ratio [OR], 1.16; confidence interval [CI], 1.00-1.35; P = .046), age >50 years (OR, 1.24, CI, 1.07-1.43; P = .004), history of heart failure (OR, 1.63, CI, 1.37-1.93; P <.001), supraventricular tachycardia (OR, 2.94, CI, 1.34-6.42; P = .007), endocarditis (OR, 3.5, CI, 1.50-8.18, P = .004), tobacco use (OR, 1.3, CI, 1.13-1.49; P <.001), dyslipidemia (OR, 1.5, CI, 1.29-1.77; P <.001), coronary artery disease (OR, 2.37, CI, 2.03-2.76; P <.001), and renal failure (OR, 1.27, CI, 1.08-1.50; P = .005). The total annual projected economic burden ranged from $155 to $226 million with a cumulative accruement of more than $2 billion over a decade. CONCLUSION: Hospital admissions due to chest pain and concomitant cocaine use are associated with low rates of adverse outcomes. For the low-risk cohort in whom acute coronary syndrome has been ruled out, hospitalization may not be beneficial and may result in unnecessary cardiac procedures.

Reproducibility of NIRS assessment of muscle oxidative capacity in smokers with and without COPD.

Low muscle oxidative capacity contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). Near-infrared spectroscopy (NIRS) allows non-invasive determination of the muscle oxygen consumption (mV̇O2) recovery rate constant (k), which is proportional to oxidative capacity assuming two conditions are met: 1) exercise intensity is sufficient to fully-activate mitochondrial oxidative enzymes; 2) sufficient O2 availability. We aimed to determine reproducibility (coefficient of variation, CV; intraclass correlation coefficient, ICC) of NIRS k assessment in the gastrocnemius of 64 participants with (FEV1 64±23%predicted) or without COPD (FEV1 98±14%predicted). 10-15s dynamic contractions preceded 6min of intermittent arterial occlusions (5-10s each, ∼250mmHg) for k measurement. k was lower (P<0.05) in COPD (1.43±0.4min-1; CV=9.8±5.9%, ICC=0.88) than controls (1.74±0.69min-1; CV=9.9±8.4%; ICC=0.93). Poor k reproducibility was more common when post-contraction mV̇O2 and deoxygenation were low, suggesting insufficient exercise intensity for mitochondrial activation and/or the NIRS signal contained little light reflected from active muscle. The NIRS assessment was well tolerated and reproducible for muscle dysfunction evaluation in COPD.

Overview of Electronic Nicotine Delivery Systems: A Systematic Review.

CONTEXT: Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION: The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS: There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS: Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.

A study of assessment of sexual dysfunction in male subjects with opioid dependence.

CONTEXT: The relationship between opioid use and sexual problems among males is complex one, as some are using opioids to increase their sexual performance while others are suffering from sexual problems due to its use. And research addressing this relationship is still limited. AIMS: The aim of the current study was to assess and evaluate sexual dysfunction in male subjects seeking treatment for opioid dependence and to compare it with healthy control group. METHODS AND MATERIAL: 60 male subjects with opioid dependence for more than one year (ICD-10 criteria) were compared to 120 healthy age & tobacco abuse matched control group (case: control=1:2) using standard questionnaires evaluating various domains of sexual dysfunction. RESULTS: Opioid dependents were found to have sexual dysfunction ranging from 53.3% to 81.7% which was significantly greater than the healthy control group (15.8% to 41.7%). CONCLUSIONS: Sexual dysfunctions are highly prevalent in opioid dependents and this should be addressed properly while assessing and treating a patient of opioid dependence.

The substitutability of cigarettes and food: A behavioral economic comparison in normal weight and overweight or obese smokers.

Obesity and cigarette smoking contribute to a multitude of preventable deaths in the United States and eating and smoking behavior may influence each other. The field of behavioral economics integrates principles from psychology and economics and permits systematic examination of how commodities interrelate with one another. Using this framework, the current study evaluated the effects of rising food and cigarette prices on consumption to investigate their substitutability and their relationship to BMI and associated variables. Behavioral economics categorizes commodities as substitutable when the consumption of one increases as a function of a price increase in the other. Smokers (N = 86) completed a 2-part hypothetical task in which money was allocated to purchase cigarettes and fast-food-style reinforcers (e.g., hamburgers, ice cream) at various prices. Results indicated that food and cigarettes were not substitutes for one another (cross-price elasticity coefficients < .20). Food purchases were independent of cigarette price, whereas cigarette purchases decreased as food price rose. Cross-price elasticity coefficients were significantly associated with confidence in one's ability to control weight without smoking (rs = -.23 and .29), but not BMI (rs = .04 and .04) or postcessation weight concerns (rs = -.05 and .12). Perceived ability to manage weight without cigarettes may influence who substitutes food for cigarettes when quitting. In addition, given observed decreases in purchases of both commodities as food prices increased, these findings imply that greater taxation of fast-food-style reinforcers could potentially reduce consumption of these foods and also cigarettes among smokers. (PsycINFO Database Record

Electronic Cigarettes for Curbing the Tobacco-Induced Burden of Noncommunicable Diseases: Evidence Revisited with Emphasis on Challenges in Sub-Saharan Africa.

Introduction. This review examines whether electronic cigarettes (e-cigs) implementation or vulgarization in sub-Saharan Africa (SSA) could be helpful in curtailing the toll of tobacco smoking in the region. Discussion. There are about 1.3 billion smokers worldwide, with nearly 80% of them living in developing countries where the burden of tobacco-related illnesses and deaths is the heaviest. Studies report that e-cigs may facilitate smoking cessation, reduction, or abstinence and may pose only a small fraction of the risks of traditional tobacco cigarettes; e-cigs may also considerably reduce second-hand smoking. Thereby, implementation of e-cig use could help to substantially reduce the burden driven by tobacco smoking in SSA, in a particular context of lack of regulations and control policies towards this threat. However, the evidence is not clear on whether e-cigs are risk-free, especially if used in the long term. Conclusions. On the whole, if e-cigs were to be introduced in SSA, they should be strictly recommended to current and/or ex-smokers as a method to quit smoking or prevent relapse and never-smokers should be strongly encouraged to avoid using these devices. Bans on sales of e-cigs to youngsters should be legislated, e-cig advertisements prohibited, and their usage continuously controlled and monitored.

Smoking in the home after childbirth: prevalence and determinants in an English cohort.

OBJECTIVES: Children's exposure to secondhand smoke (SHS) is causally linked to childhood morbidity and mortality. Over 38% of English children (aged 4-15) whose parents are smokers are exposed to SHS in the home. Little is known about the prevalence of SHS exposure in the homes of young infants (≤3 months). This study aimed to estimate maternal self-reported prevalence of SHS exposure among infants of women who smoked just before or during pregnancy, and identify factors associated with exposure. SETTING: Primary Care, Nottingham, England. PARTICIPANTS: Current and recent ex-smoking pregnant women (n=850) were recruited in Nottingham, England. Women completed questionnaires at 8-26 weeks gestation and 3 months after childbirth. Data on smoking in the home 3 months after childbirth was available for 471 households. PRIMARY AND SECONDARY OUTCOME MEASURES: Maternal-reported smoking in the home 3 months after childbirth. RESULTS: The prevalence of smoking in the home 3 months after childbirth was 16.3% (95% CI 13.2% to 19.8%) and after multiple imputation controlling for non-response 18.2% (95% CI 14.0% to 22.5%). 59% of mothers were current smokers; of these, 24% reported that smoking occurred in their home compared to 4.7% of non-smokers. In multivariable logistic regression, mothers smoking ≥11 cigarettes per day were 8.2 times (95% CI 3.4 to 19.6) more likely to report smoking in the home. Younger age, being of non-white ethnicity, increased deprivation and less negative attitudes towards SHS were also associated with smoking in the home. CONCLUSIONS: This survey of smoking in the home 3 months after childbirth found a lower prevalence than has been reported in older children. Interventions to support smoking mothers to quit, or to help them restrict smoking in the home, should target attitudinal change and address inequality relating to social disadvantage, younger age and non-white ethnic groups.