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1.
Artículo en Inglés | MEDLINE | ID: mdl-33806511

RESUMEN

BACKGROUND: Smoking was among the top contributors to deaths and disability as the prevalence among male adults remains high, and that among male youth increases in Indonesia. While local studies have shown high visibility of outdoor tobacco advertising around schools, the country still has no outdoor tobacco advertising ban. OBJECTIVE: To examine the association between youth smoking behavior and measures of outdoor tobacco advertising density and proximity in Indonesia. METHODS: We combined two primary data sources, including outdoor tobacco advertising and smoking behavior among male youth in Semarang city. We randomly selected and interviewed 400 male students at 20 high schools in the city. In addition, we interviewed 492 male adults who lived near the schools for comparison. RESULTS: We found significant associations between smoking use among youth (but not among adults) and measures of outdoor tobacco advertising density and proximity in Semarang city. Youth at schools with medium and high density of outdoor tobacco advertising were up to 2.16 times more likely to smoke, compared to those with low density. Similarly, youth at senior high schools with proximity to outdoor tobacco advertising were 2.8 times more likely to smoke. Also, young people at poorer-neighborhood schools with a higher density of and proximity to outdoor tobacco advertising were up to 5.16 times more likely to smoke. CONCLUSIONS: There were significant associations between smoking use among male youth (but not among male adults) and measures of outdoor tobacco advertising density and proximity in Indonesia. This highlights the need to introduce an outdoor tobacco advertising ban effectively, at least near schools.


Asunto(s)
Publicidad , Tabaco , Adolescente , Humanos , Indonesia/epidemiología , Masculino , Instituciones Académicas , Fumar/epidemiología , Prevención del Hábito de Fumar
2.
Artículo en Inglés | MEDLINE | ID: mdl-33806645

RESUMEN

Smoking is still a serious economic, health, and social problem despite various efforts to curb its prevalence. We examined the influence of financial literacy and financial education on the smoking behavior in the United States in terms of the use of rational decision-making abilities to reduce irrational behavior. We hypothesized that financial literacy and financial education, as proxies for rational decision making, would reduce the likelihood of smoking. We used data from the Preference Parameters Study (PPS) of Osaka University conducted in the United States in 2010 and applied probit regression models to test our hypothesis on a sample of 3831 individuals. We found that financially literate people are less likely to be smokers, though we found no clear role of financial education in reducing the likelihood of smoking. Further, respondents' gender, age, unemployment status, and risky health behaviors such as drinking and gambling, have a significantly positive association with smoking, while marital status, university degree, family size, household income, household assets, physical exercise, and level of happiness have a significantly negative association. Our findings suggest that financial literacy, as an instrument encouraging rational decision making, could be a tool to help reduce smoking in the United States.


Asunto(s)
Alfabetización en Salud , Fumar , Escolaridad , Ejercicio Físico , Composición Familiar , Humanos , Fumar/epidemiología , Estados Unidos/epidemiología
3.
Artículo en Inglés | MEDLINE | ID: mdl-33809014

RESUMEN

Few studies have simultaneously considered the effects of significant others and medical professionals' advice to quit smoking on smoking cessation intention. The present study involved 3841 current adult Korean smokers, divided into four groups with an intention to quit within 1 month, within 6 months, someday, and without intention to quit. Multinomial multiple logistic regression analysis was conducted according to smoking cessation intention level, adjusted for potential confounders, including past smoking cessation attempts. Smokers who had been advised to quit smoking by both significant others and medical professionals, significant others only, and medical professionals only were 2.63 (95% confidence interval (CI): 1.62-4.29), 1.84 (95% CI: 1.17-2.89), and 1.44 (95% CI: 0.70-2.94) times more likely to intend to quit within 1 month, respectively, than those who were not advised to quit. The odds ratios of an intention to quit within 6 months were 2.91 (95% CI: 1.87-4.54), 2.49 (95% CI: 1.69-3.68), and 0.94 (95% CI: 0.44-2.05), respectively. To promote smokers' intention to quit, the role of significant others should be considered. Medical professionals' advice to quit smoking remains important, increasing the effects of significant others' advice.


Asunto(s)
Cese del Hábito de Fumar , Adulto , Humanos , Intención , Fumadores , Fumar/epidemiología , Fumar Tabaco
4.
Neuroepidemiology ; 55(2): 154-161, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33794531

RESUMEN

INTRODUCTION: Smell and taste loss are characteristic symptoms of SARS-CoV-2 infection. The aim of this study is to investigate the prevalence and risk factors associated with olfactory and gustatory dysfunctions in coronavirus disease (COVID-19) patients. METHODS: We conducted an observational, retrospective study on 376 patients with documented SARS-CoV-2 infection admitted to the San Gerardo Hospital in Monza, Italy, from March to July 2020. All patients answered a phone questionnaire providing information on age, sex, smoking status, and clinical characteristics. Adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated through logistic regression models including relevant covariates. RESULTS: The prevalence of olfactory and gustatory dysfunctions in COVID-19 patients was 33.5 and 35.6%, respectively. Olfactory dysfunctions were significantly directly associated with current smoking and history of allergy, the multivariable ORs being 6.53 (95% CI 1.16-36.86) for current smokers versus never smokers, and 1.89 (95% CI 1.05-3.39) for those with an allergy compared to those without any allergy. Respiratory allergy in particular was significantly associated with olfactory dysfunctions (multivariable OR 2.30, 95% CI 1.02-5.17). Significant inverse associations were observed for patients aged 60 years or more (multivariable OR 0.33, 95% CI 0.19-0.57) and hospitalization (multivariable OR 0.22, 95% CI 0.06-0.89). Considering gustatory dysfunctions, after allowance of other variables a significant direct association was found for respiratory allergies (OR 2.24, 95% CI 1.03-4.86), and an inverse association was found only for hospitalization (OR 0.21, 95% CI 0.06-0.76). CONCLUSION: Our study indicates that current smoking and history of allergy (particularly respiratory) significantly increase the risk for smell loss in COVID-19 patients; the latter is also significantly associated to taste loss. Hospitalization has an inverse association with the risk of olfactory and gustatory dysfunctions, suggesting that these may be symptoms characteristics of less severe SARS-CoV-2 infection.


Asunto(s)
/epidemiología , Disgeusia/epidemiología , Hipersensibilidad Respiratoria/epidemiología , Fumar/epidemiología , Factores de Edad , Anciano , Disgeusia/fisiopatología , Servicio de Urgencia en Hospital , Femenino , Hospitalización , Humanos , Hipersensibilidad/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Trastornos del Olfato/epidemiología , Trastornos del Olfato/fisiopatología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Trastornos del Gusto/epidemiología , Trastornos del Gusto/fisiopatología
5.
Artículo en Inglés | MEDLINE | ID: mdl-33803504

RESUMEN

BACKGROUND: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2-4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. CONCLUSION: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.


Asunto(s)
Infecciones por VIH , Sindémico , África , Estudios de Cohortes , Infecciones por VIH/epidemiología , Humanos , Fumar/epidemiología , Fumar Tabaco
6.
JMIR Mhealth Uhealth ; 9(4): e23989, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33792551

RESUMEN

BACKGROUND: Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. OBJECTIVE: This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. METHODS: Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. RESULTS: Participants had widespread (smart)phone ownership-16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention. CONCLUSIONS: The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13722-020-00187-6.


Asunto(s)
Personas sin Hogar/psicología , Fumadores/psicología , Cese del Hábito de Fumar/métodos , Fumar/efectos adversos , Envío de Mensajes de Texto , Adolescente , Adulto , Femenino , Personas sin Hogar/estadística & datos numéricos , Humanos , Los Angeles/epidemiología , Masculino , Evaluación de Resultado en la Atención de Salud , Evaluación de Programas y Proyectos de Salud , Fumar/epidemiología , Apoyo Social , Adulto Joven
7.
Rev Saude Publica ; 55: 3, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33825798

RESUMEN

OBJECTIVE: To estimate the impact of the 2015-2018 economic crisis on tobacco consumption in Brazil. METHODS: This is an interrupted time series analysis conducted with data from 27 cities collected by VIGITEL, using linear regression models to account for first-order autocorrelation. Analyses were conducted based on gender, age group, and education level. RESULTS: Smoking rates decreased between 2006 and 2018, decelerating after the crisis onset. Differently than women, men showed an immediate but transient increase in smoking, followed by a decelerated decrease. Those over 65 also showed increased smoking rates immediately after the economic crisis onset, but decline accelerated later on. In turn, we found a trend reversal among those aged 31-44. Rates also decreased among those with lower education levels, but decelerated among those with more years of schooling. CONCLUSION: An economic crisis have varied impacts on the smoking habits of different population groups. Tobacco control policies should entail a detailed understanding of smoking epidemiology, especially during an economic crisis.


Asunto(s)
Recesión Económica , Fumar , Adulto , Brasil/epidemiología , Ciudades/epidemiología , Femenino , Humanos , Masculino , Prevalencia , Fumar/epidemiología
8.
Cad Saude Publica ; 37(4): e00050120, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-33852693

RESUMEN

This was a time trend study aimed at assessing inequalities in smoking and abusive alcohol consumption, considering schooling as a proxy for socioeconomic status, according to sex and region of Brazil. The study used data from the Risk and Protective Factors Surveillance System for Chronic Non-Comunicable Diseases Through Telephone Interview (Vigitel) survey collected from 2006 to 2017. The outcomes were abusive alcohol consumption and smoking. The inequalities were assessed based on schooling, with double stratification by sex and major geographic region. Weighted linear least squares regression was used to assess the trend in prevalence of outcomes and their inequalities. Prevalence of abusive alcohol consumption increased in women, from 7.8% in 2006 to 12.2% in 2017 and was consistently higher among individuals with more schooling. Prevalence of smoking decreased in both men and women and was consistently higher among those with less schooling. Inequality in alcohol consumption between schooling groups appears to have increased over time, higher in women, but inequality in smoking appears to have decreased. In some regions of Brazil, the measures of inequality suggest stability and in others an increase in inequality in alcohol consumption (Southeast, South, and Central regions in women) and a decrease in smoking (all regions except the Southeast in men; Northeast and Central in women). Despite the strides in smoking reduction, inequalities persist in schooling and are also present in alcohol consumption. The outcomes show opposite trends, so strategies should focus on each of the problems in order to reduce existing inequalities.


Asunto(s)
Fumar , Teléfono , Consumo de Bebidas Alcohólicas/epidemiología , Brasil/epidemiología , Escolaridad , Femenino , Humanos , Masculino , Prevalencia , Fumar/epidemiología , Factores Socioeconómicos
9.
Cent Eur J Public Health ; 29(1): 45-55, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33831286

RESUMEN

OBJECTIVES: The current study employed socio-demographic, health and lifestyle, and academic variables to assess the prevalence and independent predictors of daily smoking, attempts to quit smoking, and agreement with total smoking ban at university. METHODS: Students at the University of Turku (1,177) completed an online questionnaire that assessed socio-demographic, health and lifestyle, and academic characteristics, and three smoking variables (smoking, attempts to quit, agreement with total smoking ban at university). Bivariate relationships and multiple logistic regression assessed relationships between student characteristics and the three smoking variables before and after controlling for all other variables. RESULTS: Slightly < 80% of students never smoked, 16% were occasional, and about 6% were daily smokers, and about 40% had attempted to quit. Nearly half the sample agreed to total smoking ban at university. Physical activity, consuming alcohol, illicit drug/s use and daily smoking were significant independent predictors across > 1 of the three smoking variables. Age, health awareness, importance of achieving good grades, academic performance compared to peers, study burden, and mother's educational level were significant independent predictors of one of the three variables examined. CONCLUSION: Universities need to assess smoking, with specific focus on the modifiable independent predictors that were associated with > 1 the variables examined, to encourage physical activity and pay attention to reduce alcohol consumption and illicit drug/s and daily smoking, whilst targeting at-risk students. University strategies should be part of the wider country-wide effective tobacco control policies.


Asunto(s)
Política para Fumadores , Finlandia/epidemiología , Humanos , Prevalencia , Fumar/epidemiología , Encuestas y Cuestionarios , Universidades
10.
Wiad Lek ; 74(3 cz 1): 517-522, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813461

RESUMEN

OBJECTIVE: The aim: Of our study was to identify the relationship between the main risk factors for heart disease and social factors among northern population. PATIENTS AND METHODS: Materials and methods: We polled 3092 native and non-native habitants of the Sakha Republic (Yakutia). The poll consists of several sections. It includes questions related to social, demographic and life record data, heredity, physical activity and unhealthy habits. RESULTS: Results: Among the people diagnosed with hypertension (HT), there are more smokers than among the people without this medical condition. On the contrary, in the group of people diagnosed with HT at the examination for taking blood pressure, there were fewer smokers than in the group, in which HT was not registered. Patients with CHD, Myocardial infarction (MI) in past medical history, cerebrovascular accident (CVA) and type 2 diabetes (T2D), are smokers to the same degree as the other group. This indicates that this category of the examined are exposed to the risk of cardiovascular aggravations. We determined a high spread of psychosocial risk factors for the examined respondents - the relationship between smoking, overweight, obesity, abdominal obesity and HT, and the level of education, marital status and labor specificity. The increase in the level of education is associated with fewer amounts of smokers among both non-native and native habitants. Overweight is more frequently observed for the people who are not single, have low level of education and are engaged in manual labor. In particular, it is applicable to native habitants. CONCLUSION: Conclusions: Abdominal obesity did not have any relationship with psychosocial factors for native habitants. However, in relation to non-native habitants, overweight, obesity, abdominal obesity and HT are associated with marital status (married) and with manual labor.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipertensión , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Obesidad/epidemiología , Factores de Riesgo , Fumar/epidemiología
11.
BMC Pulm Med ; 21(1): 96, 2021 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-33743654

RESUMEN

BACKGROUND: Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients. METHODS: Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization. RESULTS: 431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO2/FiO2 was similar between men and women (228 [IQR, 134-273] vs 238 mmHg [150-281], p = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men (p = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis (p = 0.898). Accordingly, the Kaplan-Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference (p = 0.687). CONCLUSION: Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.


Asunto(s)
/epidemiología , Anciano , Anciano de 80 o más Años , /fisiopatología , Comorbilidad , Presión de las Vías Aéreas Positiva Contínua/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Hipoxia/epidemiología , Hipoxia/fisiopatología , Hipoxia/terapia , Italia/epidemiología , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Ventilación no Invasiva/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Factores Sexuales , Fumar/epidemiología
13.
Rev Esp Salud Publica ; 952021 Mar 16.
Artículo en Español | MEDLINE | ID: mdl-33724261

RESUMEN

OBJECTIVE: During the state of alarm and once the confinement decreed by the COVID-19 pandemic ended, a cross-sectorial study was carried out in Spain between May 4th and 22nd, 2020 by volunteers who completed a self-administered online survey. The objective of this study was to know how the confinement period affected the consumption of tobacco and other related products in the adult Spanish population. METHODS: The survey consisted of 18 questions concerning sociodemographic characteristics, the consumption of tobacco and other related products, exposure to secondhand smoke and perception of COVID-19 risk associated with consumption. Questions about tobacco and other related products were posed in order to compare consumption prior to and during confinement. The survey was completed by 17,017 people. The analysis of association of variables was carried out with T-student. Variable frequency analysis was performed with χ2. RESULTS: There was a reduction in the prevalence of daily tobacco smoking and no changes were observed in the products consumed in either period (6.73%). The prevalence of exposure to secondhand smoke at home during confinement among non-smokers decreased (61.83%). Most of survey respondents reported that tobacco and e-cigarette consumption increased the risk of contracting COVID-19 and suffering severe complications (39.09% and 31.80% respectively). CONCLUSIONS: During the COVID-19 lockdown in Spain, the tobacco consumption decreased. Also, secondhand smoke exposition reduces in Spain during this period.


Asunto(s)
/complicaciones , Fumar/epidemiología , Medios de Comunicación Sociales , Uso de Tabaco/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Control de Enfermedades Transmisibles , Estudios Transversales , Sistemas Electrónicos de Liberación de Nicotina , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Pandemias , Prevalencia , España/epidemiología , Encuestas y Cuestionarios , Productos de Tabaco , Contaminación por Humo de Tabaco/estadística & datos numéricos , Adulto Joven
14.
Artículo en Inglés | MEDLINE | ID: mdl-33671203

RESUMEN

The COVID-19 pandemic has caused devastating impacts globally. To mitigate virus spread, Israel imposed severe restrictions during March-April 2020. An online cross-sectional survey was conducted in April 2020 among current and ex-smokers to explore changes in smoking behaviour and home-smoking rules during this period. Bivariate analysis and multivariate logistic regression examined associations between sociodemographic characteristics and perceived risk of infection and quitting smoking during the initial COVID-19 period. Current smoking was reported by 437 (66.2%) of the 660 participants, 46 (7%) quit during the initial restriction period, and 177 (26.8%) were ex-smokers. Nearly half (44.4%) of current smokers intensified their smoking, and 16% attempted to quit. Quitting during the COVID-19 period was significantly associated with higher education (adjusted odds ratio (aOR): 1.97, 95% CI: 1.0-3.8), not living with a smoker (aOR: 2.18, 95% CI: 1.0-4.4), and having an underlying chronic condition that increases risk for COVID-19 complications (aOR: 2.32, 95% CI: 1.1-4.6). Both an increase in smoking behaviour and in attempts to quit smoking during the initial COVID-19 pandemic were evident in this sample of adult Israeli smokers. Governments need to use this opportunity to encourage smokers to attempt quitting and create smoke-free homes, especially during lockdown conditions, while providing mental and social support to all smokers.


Asunto(s)
Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Adulto , Control de Enfermedades Transmisibles , Estudios Transversales , Humanos , Israel/epidemiología , Pandemias
15.
JAMA Netw Open ; 4(2): e2037371, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33591367

RESUMEN

Importance: Acute low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition. Acute to chronic LBP transition rates vary widely owing to absence of standardized operational definitions, and it is unknown whether a standardized prognostic tool (ie, Subgroups for Targeted Treatment Back tool [SBT]) can estimate this transition or whether early non-guideline concordant treatment is associated with the transition to chronic LBP. Objective: To assess the associations between the transition from acute to chronic LBP with SBT risk strata; demographic, clinical, and practice characteristics; and guideline nonconcordant processes of care. Design, Setting, and Participants: This inception cohort study was conducted alongside a multisite, pragmatic cluster randomized trial. Adult patients with acute LBP stratified by SBT risk were enrolled in 77 primary care practices in 4 regions across the United States between May 2016 and June 2018 and followed up for 6 months, with final follow-up completed by March 2019. Data analysis was conducted from January to March 2020. Exposures: SBT risk strata and early LBP guideline nonconcordant processes of care (eg, receipt of opioids, imaging, and subspecialty referral). Main Outcomes and Measures: Transition from acute to chronic LBP at 6 months using the National Institutes of Health Task Force on Research Standards consensus definition of chronic LBP. Patient demographic characteristics, clinical factors, and LBP process of care were obtained via electronic medical records. Results: Overall, 5233 patients with acute LBP (3029 [58%] women; 4353 [83%] White individuals; mean [SD] age 50.6 [16.9] years; 1788 [34%] low risk; 2152 [41%] medium risk; and 1293 [25%] high risk) were included. Overall transition rate to chronic LBP at six months was 32% (1666 patients). In a multivariable model, SBT risk stratum was positively associated with transition to chronic LBP (eg, high-risk vs low-risk groups: adjusted odds ratio [aOR], 2.45; 95% CI, 2.00-2.98; P < .001). Patient and clinical characteristics associated with transition to chronic LBP included obesity (aOR, 1.52; 95% CI, 1.28-1.80; P < .001); smoking (aOR, 1.56; 95% CI, 1.29-1.89; P < .001); severe and very severe baseline disability (aOR, 1.82; 95% CI, 1.48-2.24; P < .001 and aOR, 2.08; 95% CI, 1.60-2.68; P < .001, respectively) and diagnosed depression/anxiety (aOR, 1.66; 95% CI, 1.28-2.15; P < .001). After controlling for all other variables, patients exposed to 1, 2, or 3 nonconcordant processes of care within the first 21 days were 1.39 (95% CI, 1.21-2.32), 1.88 (95% CI, 1.53-2.32), and 2.16 (95% CI, 1.10-4.25) times more likely to develop chronic LBP compared with those with no exposure (P < .001). Conclusions and Relevance: In this cohort study, the transition rate to chronic LBP was substantial and increased correspondingly with SBT stratum and early exposure to guideline nonconcordant care.


Asunto(s)
Dolor Agudo/fisiopatología , Dolor Crónico/fisiopatología , Dolor de la Región Lumbar/fisiopatología , Atención Primaria de Salud , Dolor Agudo/diagnóstico por imagen , Dolor Agudo/epidemiología , Dolor Agudo/terapia , Adulto , Anciano , Analgésicos Opioides/uso terapéutico , Trastornos de Ansiedad/epidemiología , Dolor Crónico/epidemiología , Trastorno Depresivo/epidemiología , Diagnóstico por Imagen/estadística & datos numéricos , Progresión de la Enfermedad , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Dolor de la Región Lumbar/diagnóstico por imagen , Dolor de la Región Lumbar/epidemiología , Dolor de la Región Lumbar/terapia , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Oportunidad Relativa , Guías de Práctica Clínica como Asunto , Pronóstico , Derivación y Consulta/estadística & datos numéricos , Factores de Riesgo , Fumar/epidemiología , Estados Unidos/epidemiología
16.
Lancet Neurol ; 20(3): 193-202, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33609477

RESUMEN

BACKGROUND: There is uncertainty around which patients with asymptomatic carotid stenosis should be offered surgical intervention. Although stroke rates were unrelated to the degree of stenosis in the medical-treatment-only groups in previous randomised trials, this could simply reflect recruitment bias and there has been no systematic analysis of a stenosis-risk association in cohort studies. We aimed to establish whether there is any association between the degree of asymptomatic stenosis and ipsilateral stroke risk in patients on contemporary medical treatment. METHODS: We did a prospective population-based study (Oxford Vascular Study; OxVasc), and a systematic review and meta-analysis. All patients in OxVasc with a recent suspected transient ischaemic attack or stroke, between April 1, 2002, and April 1, 2017, who had asymptomatic carotid stenosis were included in these analyses. We commenced contemporary medical treatment and determined ipsilateral stroke risk in this cohort by face-to-face follow-up (to Oct 1, 2020). We also did a systematic review and meta-analysis of all published studies (from Jan 1, 1980, to Oct 1, 2020) reporting ipsilateral stroke risk in patients with asymptomatic carotid stenosis. We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, and included both observational cohort studies and medical treatment groups of randomised controlled trials if the number of patients exceeded 30, ipsilateral stroke rates (or the raw data to calculate these) were provided, and were published in English. FINDINGS: Between April 1, 2002, and April 1, 2017, 2354 patients were consecutively enrolled in OxVasc and 2178 patients underwent carotid imaging, of whom 207 had 50-99% asymptomatic stenosis of at least one carotid bifurcation (mean age at imaging: 77·5 years [SD 10·3]; 88 [43%] women). The 5-year ipsilateral stroke risk increased with the degree of stenosis; patients with 70-99% stenosis had a significantly greater 5-year ipsilateral stroke risk than did those with 50-69% stenosis (six [14·6%; 95% CI 3·5-25·7] of 53 patients vs none of 154; p<0·0001); and patients with 80-99% stenosis had a significantly greater 5-year ipsilateral stroke risk than did those with 50-79% stenosis (five [18·3%; 7·7-29·9] of 34 patients vs one [1·0%; 0·0-2·9] of 173; p<0·0001). Of the 56 studies identified in the systematic review (comprising 13 717 patients), 23 provided data on ipsilateral stroke risk fully stratified by degree of asymptomatic stenosis (in 8419 patients). Stroke risk was linearly associated with degree of ipsilateral stenosis (p<0·0001); there was a higher risk in patients with 70-99% stenosis than in those with 50-69% stenosis (386 of 3778 patients vs 181 of 3806 patients; odds ratio [OR] 2·1 [95% CI 1·7-2·5], p<0·0001; 15 cohort studies, three trials) and a higher risk in patients with 80-99% stenosis than in those with 50-79% stenosis (77 of 727 patients vs 167 of 3272 patients; OR 2·5 [1·8-3·5], p<0·0001; 11 cohort studies). Heterogeneity in stroke risk between studies for patients with severe versus moderate stenosis (phet<0·0001) was accounted for by highly discrepant results (pdiff<0·0001) in the randomised controlled trials of endarterectomy compared with cohort studies (trials: pooled OR 0·8 [95% CI 0·6-1·2], phet=0·89; cohorts: 2·9 [2·3-3·7], phet=0·54). INTERPRETATION: Contrary to the assumptions of current guidelines and the findings of subgroup analyses of previous randomised controlled trials, the stroke risk reported in cohort studies was highly dependent on the degree of asymptomatic carotid stenosis, suggesting that the benefit of endarterectomy might be underestimated in patients with severe stenosis. Conversely, the 5-year stroke risk was low for patients with moderate stenosis on contemporary medical treatment, calling into question any benefit from revascularisation. FUNDING: NIHR Oxford Biomedical Research Centre, Wellcome Trust, Wolfson Foundation, and the British Heart Foundation.


Asunto(s)
Estenosis Carotídea/epidemiología , Accidente Cerebrovascular/epidemiología , Anciano , Anciano de 80 o más Años , Estenosis Carotídea/complicaciones , Estenosis Carotídea/cirugía , Estudios de Cohortes , Endarterectomía Carotidea , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Ataque Isquémico Transitorio/epidemiología , Ataque Isquémico Transitorio/etiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Fumar/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control
17.
Medicine (Baltimore) ; 100(4): e24162, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530207

RESUMEN

ABSTRACT: Nosocomial infections (NI) are common complications after cardiac surgery. To date, there have been few manuscripts investigating NI in the intensive care unit after cardiac surgery. Our study was designed to investigate the characteristics of the distribution of pathogenic bacteria, antibiotic resistance and risk factors for NI.A total of 1360 patients received standard postoperative care, including antibiotic prophylaxis. Microbiological examinations of sputum, blood, catheter tips and excrement were performed as clinically indicated to isolate pathogens. Thirty potential associated variables were collected and compared between the 2 different groups according to the development of NI using univariate and multivariate analyses.Eighty-nine patients (6.54%) acquired a microbiologically documented NI. There was a significant difference in mortality between the 2 groups with or without postoperative NI (23.60% vs 2.28%, P < .00). A total of 98 pathogens (73.13%) were isolated from sputum, 32 pathogens (23.88%) from blood and only 1 (0.75%) from urine. Three (2.24%) surgical site infections were detected, including 2 superficial surgical site infections and 1 mediastinitis. The most common pathogens were Gram-negative bacteria (78.36%), followed by Gram-positive bacteria (14.93%) and fungi (6.71%). The major pathogenic species had different levels of drug resistance, and most of them exhibited multidrug resistance. Six out of thirty variables were identified as independent risk factors for the development of NI, namely, duration of surgery, low cardiac output syndrome, continuous veno-venous hemofiltration, mechanical ventilation time, reintubation and tracheostomy.We analyzed the characteristics of the distribution of pathogens, antibiotic resistance and risk factors for NI in our center and provided some suggestions for clinical practice. In addition to antibiotic treatment, avoidance of risk factors and aggressive infection control measures may be crucial to stop or prevent outbreaks.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/estadística & datos numéricos , Infección Hospitalaria/etiología , Infección Hospitalaria/microbiología , Factores de Edad , Antibacterianos/administración & dosificación , Profilaxis Antibiótica/métodos , Índice de Masa Corporal , Creatinina/sangre , Infección Hospitalaria/epidemiología , Farmacorresistencia Bacteriana , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Fumar/epidemiología , Infección de la Herida Quirúrgica/epidemiología
18.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(2): 284-290, 2021 Feb 10.
Artículo en Chino | MEDLINE | ID: mdl-33626617

RESUMEN

Objective: To assess the relationship between smoking status and sleep duration in male adults in urban-rural areas of 15 provinces (municipalities, autonomous regions) in China in 2015. Methods: Data were derived from the China Nutritional Transition Cohort Study 2015, a total of 4 419 participants aged 18-64 years, including 1 713 urban males (38.8%) and 2 706 rural males (61.2%), with complete information about smoking status and sleep duration were included in the final analysis. Based on the number of cigarettes consumed daily, the current smokers were classified to be heavy (25 cigarettes/d and above), moderate (15-24 cigarettes/d), and light (1-14 cigarettes/d). Sleep duration was classified to be insufficient (<7 h/d), sufficient (7-9 h/d), and excessive (9 h/d and above). Two-level mixed-effects linear and logistic regression models were used for association analysis. Results: The smoking rates in male adults in urban and rural areas were 45.7% and 53.8%, respectively. In male heavy smokers in urban and rural areas, the proportions of sufficient sleep were the lowest (66.7% and 68.1%). However, the proportions of sleep deprivation were highest (15.3% and 20.3%). After controlling for confounding factors, the net effect on male heavy smokers was a significant decrease of 0.21 h/d (ß=-0.21, 95%CI: -0.44 - -0.01) in sleep duration. Moreover, the odds ratio for insufficient sleep were 1.83 (95%CI: 1.03-3.23) in male heavy smokers in rural area compared with nonsmokers. Conclusion: Heavy smoking is associated with decreased sleep duration and increased risk of sleep deprivation in male adults in rural China.


Asunto(s)
Sueño , Fumar , Adolescente , Adulto , China/epidemiología , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Fumar/epidemiología , Factores de Tiempo , Adulto Joven
19.
Artículo en Inglés | MEDLINE | ID: mdl-33562345

RESUMEN

Previous studies suggest that factors related to smoking cessation may vary with age. This study examined the factors affecting smoking cessation by age among Korean adult male smokers using data from the Korea National Health and Nutrition Examination Survey from 2007 to 2018 (excluding 2013). Logistic regression analyses were used to investigate various factors associated with smoking cessation in three different age groups. Out of a total of 15,492 individuals, 31.5% of the 3523 individuals aged 19-39 years (young adult), 54.7% of the 7390 individuals aged 40-64 years (middle-aged), and 78.6% of the 4589 individuals aged ≥65 years (older adults) succeeded in quitting. In the young adult and middle-aged groups, being married was associated with successful quitting, and lifetime smoking was associated with unsuccessful quitting. Willpower and several comorbidities were related to successful cessation in the middle-aged and older adult groups. Skipping any meal, which suggests unhealthy behavior, was negatively related to quitting in the young adult group. We observed that factors associated with smoking cessation success or failure differed by age, which should be considered when developing smoking cessation policies and programs.


Asunto(s)
Cese del Hábito de Fumar , Adulto , Factores de Edad , Anciano , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , República de Corea/epidemiología , Fumadores , Fumar/epidemiología , Adulto Joven
20.
Nutr Metab Cardiovasc Dis ; 31(4): 1286-1292, 2021 04 09.
Artículo en Inglés | MEDLINE | ID: mdl-33558093

RESUMEN

BACKGROUND AND AIMS: Ideal cardiovascular health (CVH) behaviors in adolescents are defined by body mass index (BMI), diet, physical activity and smoking, and are directly associated with better health in later life. To further improve health prevention programs we investigated the prevalence of these behaviors in a cohort of healthy adolescents and focused on the associations with sex, age, and education. METHODS AND RESULTS: The Early Vascular Aging Tyrol study is a cross-sectional study assessing 14- to 19-year-old pupils and apprentices in Western Austria and South Tyrol. Between May 2015 and July 2018 2047 adolescents (43.6% males, mean age 16.4 years) with complete data for all 4 health behaviors were included. The prevalence of ideal body mass index (BMI) was 78.3%, of ideal physical activity 42.5%, of non-smoking 70.4% and of ideal diet 8.1%. Females showed a higher smoking prevalence and a lower physical activity, but better dietary habits than males. Older adolescents of both sexes had lower prevalence of ideal smoking and diet. Apprentices and pupils of vocational schools had a higher BMI and a less favorable diet compared to secondary academic school students. Smoking prevalence was highest in apprentices. Non-ideal BMI was independently associated with smoking. CONCLUSION: In our cohort, only a minority showed ideal CVH behaviors which were best in adolescents younger than 16 years. We observed significant differences between males and females and a clear impact of school education with apprentices being at risk for non-ideal CVH behaviors. CLINICAL TRIAL REGISTRATION NUMBER: NCT03929692, clinicaltrials.gov.


Asunto(s)
Conducta del Adolescente , Enfermedades Cardiovasculares/prevención & control , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Estilo de Vida Saludable , Conducta de Reducción del Riesgo , Adolescente , Factores de Edad , Austria/epidemiología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Dieta Saludable , Escolaridad , Ejercicio Físico , Conducta Alimentaria , Femenino , Estado de Salud , Humanos , Masculino , No Fumadores , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Conducta Sedentaria , Factores Sexuales , Fumar/efectos adversos , Fumar/epidemiología , Adulto Joven
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