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1.
Bull Cancer ; 106(9): 725-733, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31202557

RESUMO

BACKGROUND: Despite recent progress, non-small cell lung cancer (NSCLC) first-line treatment remains a platinum-based doublet in most cases. No guidelines exist beyond third line. Chemotherapy rechallenge is an option, but little data is available in NSCLC. Our study aims to describe patients who underwent chemotherapy rechallenge while assessing its efficacy and safety. METHODS: Consecutive patients with advanced-stage NSCLC receiving first-line treatment in Tenon hospital in 2011 were included, with a 5-year follow-up. Patients were analyzed according to chemotherapy rechallenge or not. Chemotherapy rechallenge was defined as re-initiation of a previously administered chemotherapy agent at any point in the treatment sequence, with at least one treatment regimen between first use and rechallenge. RESULTS: Of 149 patients, 18 underwent chemotherapy rechallenge (12%). They were younger (56 vs. 61 years, P=0.04), mostly women (61% vs. 30%, P=0.02), with lepidic adenocarcinoma (23% vs. 3.5%, P=0.03), a better general state of health (100% performance status 0-1 vs. 74%, P=0.04), and fewer cardiovascular comorbidities (16% vs. 42%, P=0.04). They were more likely to have received a receptor tyrosine kinase inhibitor treatment (89% vs. 43%, P=0.0003). Progression-free survival was longer at first use than at rechallenge (median 9.2 vs. 2.7 months, P=0.002). No increased toxicity was observed at rechallenge compared to first use. Finally, a subsequent line of treatment was given after rechallenge in 61% of the patients. CONCLUSION: Patients eligible for chemotherapy rechallenge were those with good prognostic factors. Chemotherapy rechallenge may provide a well-tolerated additional line of treatment, with decreased efficacy compared to its first application.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Grandes/tratamento farmacológico , Carcinoma de Células Grandes/mortalidade , Carcinoma de Células Grandes/patologia , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Ex-Fumantes , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Intervalo Livre de Progressão , Receptores Proteína Tirosina Quinases/antagonistas & inibidores , Retratamento/métodos , Retratamento/estatística & dados numéricos , Fumantes
2.
Osteoporos Int ; 30(8): 1561-1571, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31161317

RESUMO

CT scans performed to evaluate chronic obstructive pulmonary disease (COPD) also enable evaluation of bone attenuation (BA; a measure of bone density) and vertebral fractures (VFs). In 1239 current/former smokers with (n = 999) and without (n = 240) COPD, the combination of BA and prevalent VFs was associated with the incident VF risk. INTRODUCTION: Chest CT scans are increasingly used to evaluate pulmonary diseases, including COPD. COPD patients have increased risk of osteoporosis and VFs. BA on CT scans is correlated with bone mineral density and prevalent VFs. The aim of this study was to evaluate the association between BA and prevalent VFs on chest CT scans, and the risk of incident VFs in current and former smokers with and without COPD. METHODS: In participants of the ECLIPSE study with baseline and 1-year and 3-year follow-up CT scans, we evaluated BA in vertebrae T4-T12 and prevalent and incident VFs. RESULTS: A total of 1239 subjects were included (mean age 61.3 ± 8.0, 61.1% men, 999 (80.6%) COPD patients). The mean BA was 155.6 ± 47.5 Hounsfield Units (HU); 253 (20.5%) had a prevalent VF and 296 (23.9%) sustained an incident VF within 3 years. BA and prevalent VFs were associated with incident VFs within 1 (per - 1SD HR = 1.38 [1.08-1.76] and HR = 3.97 [2.65-5.93] resp.) and 3 years (per - 1SD HR = 1.25 [1.08-1.45] and HR = 3.10 [2.41-3.99] resp.), while age, sex, body mass index (BMI), smoking status and history, or presence of COPD was not. In subjects without prevalent VFs and BA, and for 1-year incidence, BMI values were associated with incident fractures (1 year, BA per - 1SD HR = 1.52 [1.05-2.19], BMI per SD HR = 1.54 [1.13-2.11]; 3 years, per - 1SD HR = 1.37 [1.12-1.68]). CONCLUSIONS: On CT scans performed for pulmonary evaluation in (former) smokers with and without COPD, the combination of BA and prevalent VFs was strongly associated with the short-term risk of incident VFs.


Assuntos
Densidade Óssea/fisiologia , Fraturas por Osteoporose/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Fraturas da Coluna Vertebral/etiologia , Adulto , Idoso , Ex-Fumantes , Feminino , Seguimentos , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Medição de Risco/métodos , Fumar/efeitos adversos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital/fisiologia
3.
BMC Cancer ; 19(1): 631, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242899

RESUMO

BACKGROUND: Mammographic density is one of the strongest risk factors for breast cancer. In the general population, mammographic density can be modified by various exposures; whether this is true for women a strong family history is not known. Thus, we evaluated the association between reproductive, hormonal, and lifestyle risk factors and mammographic density among women with a strong family history of breast cancer but no BRCA1 or BRCA2 mutation. METHODS: We included 97 premenopausal and 59 postmenopausal women (age range: 27-68 years). Risk factor data was extracted from the research questionnaire closest in time to the mammogram performed nearest to enrollment. The Cumulus software was used to measure percent density, dense area, and non-dense area for each mammogram. Multivariate generalized linear models were used to evaluate the relationships between breast cancer risk factors and measures of mammographic density, adjusting for relevant covariates. RESULTS: Among premenopausal women, those who had two live births had a mean percent density of 28.8% vs. 41.6% among women who had one live birth (P=0.04). Women with a high body weight had a lower mean percent density compared to women with a low body weight among premenopausal (17.6% vs. 33.2%; P=0.0006) and postmenopausal women (8.7% vs. 14.7%; P=0.04). Among premenopausal women, those who smoked for 14 years or longer had a lower mean dense area compared to women who smoked for a shorter duration (25.3cm2 vs. 53.1cm2; P=0.002). Among postmenopausal women, former smokers had a higher mean percent density (19.5% vs. 10.8%; P=0.003) and dense area (26.9% vs. 16.4%; P=0.01) compared to never smokers. After applying the Bonferroni correction, the association between body weight and percent density among premenopausal women remained statistically significant. CONCLUSIONS: In this cohort of women with a strong family history of breast cancer, body weight was associated with mammographic density. These findings suggest that mammographic density may explain the underlying relationship between some of these risk factors and breast cancer risk, and lend support for the inclusion of mammographic density into risk prediction models.


Assuntos
Peso Corporal , Densidade da Mama/genética , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/genética , Saúde da Família , Mamografia , Adulto , Idoso , Estudos Transversais , Ex-Fumantes/estatística & dados numéricos , Feminino , Genes BRCA1 , Genes BRCA2 , Humanos , Estilo de Vida , Modelos Lineares , Pessoa de Meia-Idade , Paridade , Pós-Menopausa , Pré-Menopausa , Saúde Reprodutiva , Fatores de Risco , Fumantes/estatística & dados numéricos
4.
Public Health ; 171: 123-130, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31128557

RESUMO

OBJECTIVE: Smokers who access free National Health Service (NHS) Stop Smoking Services (SSS) in the UK are four times more likely to stop smoking, yet uptake of the services has been in decline in recent years. Evidence was collated to explore the beliefs of smokers, ex-smokers and Stop Smoking Advisors (SSAs) about SSS and the barriers and facilitators to access. STUDY DESIGN: Mixed-methods design including i) a search of the literature; ii) a cross-sectional online questionnaire completed by 38 smokers and ex-smokers; and iii) semistructured interviews with 5 SSAs. METHODS: PubMed, Web of Science, Scopus, Prospero and the NIHR Portfolio were searched in October 2017 to identify relevant studies. Smokers and ex-smokers were recruited to the online questionnaire via Public Health websites and social media in Warwickshire. SSAs identified via Public Health Warwickshire were invited to take part in an interview conducted over the telephone. Findings were collated and analysed using the COM-B ('Capability', 'Opportunity', 'Motivation' and 'Behaviour') model framework. RESULTS: A range of practical and psychological or belief-based barriers and facilitators to accessing SSS were identified within all the components of the COM-B model, aside from physical capability, for example; 'Psychological capability', such as lack of understanding about what the service offers; 'Reflective motivation', such as lack of confidence in service efficacy; and 'Social opportunity', such as recommendations from healthcare professionals to attend. Suggestions and consideration on how future tobacco control intervention and public health messages can address these components are reported. CONCLUSIONS: Public health interventions and campaigns may benefit from focussing on addressing the well-known perceived barriers and facilitators smokers experience, in particular focussing on the components of the COM-B that have been identified as being important to increase the uptake of SSS.


Assuntos
Atitude Frente a Saúde , Conselheiros/psicologia , Ex-Fumantes/psicologia , Acesso aos Serviços de Saúde , Fumantes/psicologia , Prevenção do Hábito de Fumar , Medicina Estatal , Adolescente , Adulto , Idoso , Conselheiros/estatística & dados numéricos , Estudos Transversais , Ex-Fumantes/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumantes/estatística & dados numéricos , Reino Unido , Adulto Jovem
6.
Pregnancy Hypertens ; 15: 123-129, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30825909

RESUMO

OBJECTIVES: The objective of this study was to examine whether the association between maternal smoking and gestational hypertension varies by the timing of exposure. STUDY DESIGN: Retrospective cohort study of women identified in 2015 US natality records for singleton births. MAIN OUTCOME MEASURES: Our outcome was whether a woman was diagnosed with gestational hypertension (GH) on the birth record, a category which includes preeclampsia. RESULTS: Women who smoked before and during pregnancy had a reduced risk for GH relative to non-smokers (adjusted RR 0.92, 95% CI 0.90-0.94). In contrast, women who apparently quit just before the start of pregnancy had higher risk than non-smokers (adjusted RR 1.02, 95% CI 1.00-1.05). When the trimester-specific effects were examined, only women who smoked before pregnancy and in all three trimesters had reduced risk for GH. Smoking mothers who quit just before the start of the 3rd trimester had an increased risk for GH compared to non-smokers (adjusted RR 1.08, 95% CI 1.02-1.16). CONCLUSION: In our analysis, women who smoked before pregnancy and in all three trimesters have reduced risk of GH compared to non-smokers, while smokers who reported quitting before pregnancy were at an increased risk. Our results offer new insights into the importance of timing of smoking in pregnancy on risk of GH, and challenge the notion that any smoking during pregnancy has a protective effect.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adulto , Intervalo entre Nascimentos/estatística & dados numéricos , Ex-Fumantes/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , não Fumantes/estatística & dados numéricos , Vigilância da População , Gravidez , Estudos Retrospectivos , Fatores de Risco , Fumantes/estatística & dados numéricos , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
7.
Health Qual Life Outcomes ; 17(1): 48, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30876466

RESUMO

INTRODUCTION: The aim of this paper is to find out generic preference-based Short-Form 6 Dimensions (SF-6D) utility scores of smokers and ex-smokers with varying cigarette exposure, with and without respiratory symptoms. METHODS: Seven hundred thirty one people aged ≥30 with a history of smoking who attended 5 public primary care clinics completed a cross-sectional survey using SF-6D utility score, Breathlessness, Cough, and Sputum Scale (BCSS©) and office spirometry. RESULTS: Most of the subjects were men (92.5%) in an older age group (mean age 62.2 ± 11.7 years). About half of them (48.3%) were current smokers while the other half (51.7%) were ex-smokers. More than half of them (54.2%) reported mild respiratory symptoms (mean BCSS score 0.95 ± 1.12). The most common symptoms were sputum (45.1%), followed by cough (34.2%) and breathlessness (6.0%). The SF-6D overall utility score was 0.850 ± 0.106. The subjects reported significantly lower SF-6D scores when they had breathlessness (0.752 ± 0.138; p = < 0.001), cough (0.836 ± 0.107; p = 0.007), sputum (0.838 ± 0.115; p = 0.004) or any of the above symptom (0.837 ± 0.113; p < 0.001). In both groups of current smokers and ex-smokers, there was no statistically significant difference in the scores among light, moderate or heavy smokers. In the Tobit regression model of factors affecting SF-6D utility score, subjects who reported more respiratory symptoms (i.e. higher BCSS©) had lower SF-6D scores (B = - 0.018 ± 0.007, p < 0.001), while men had higher SF-6D scores than women (B = 0.037 ± 0.031, p = 0.019). Subjects who attended middle or high school had higher SF-6D score than those attended the University or above. The presence of airflow obstruction was not associated with the score. CONCLUSIONS: The study yielded SF-6D utility scores of smokers and ex-smokers with different reported cigarette exposure, which could be useful in future clinical studies and cost-effectiveness analysis.


Assuntos
Ex-Fumantes/estatística & dados numéricos , Qualidade de Vida , Fumantes/estatística & dados numéricos , Idoso , Análise Custo-Benefício , Tosse/complicações , Tosse/psicologia , Estudos Transversais , Dispneia/complicações , Dispneia/psicologia , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Inquéritos e Questionários
8.
Prev. tab ; 21(1): 11-17, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184690

RESUMO

Objetivo: Conocer la evolución del peso durante un año en fumadores en proceso de deshabituación tabáquica. Los objetivos secundarios son valorar la evolución del peso en función de características propias de los fumadores y del tipo de tratamiento realizado. Pacientes y métodos: Se recogieron los datos de los pacientes que acudieron a la consulta de deshabituación tabáquica entre 2009 y 2015 de forma prospectiva y se realizó un análisis retrospectivo. Las variables analizadas fueron edad, sexo, IMC, cigarrillos/día, índice de paquetes-año (IPA), test de Fagerström, tratamiento recibido, éxito del tratamiento y peso tras 1, 2, 3, 6, y 12 meses. Resultados: Los pacientes experimentaron una ganancia de peso significativa sostenida a lo largo de los 12 meses de seguimiento, con una media de 3,02 kg. Los pacientes que solo recibieron tratamiento conductual ganaron significativamente menos peso que aquellos que recibieron además tratamiento farmacológico. Los pacientes con un menor IMC inicial, un valor alto de IPA y dependencia alta en el test de Fagerström ganaron significativamente más peso. No se encontraron diferencias significativas en cuanto a género, edad o éxito en el tratamiento a los 12 meses. Conclusiones. Los pacientes fumadores que se plantean dejar de fumar presentan un incremento de peso progresivo, que guarda relación con el IMC inicial, con un consumo elevado y prolongado de tabaco y con un índice de dependencia nicotínica elevado. No guarda relación con otras variables que, a priori, parecerían resultar determinantes como la edad, el género o el tratamiento utilizado


Objective: To know the weight gain in smokers after one year of tobacco cessation, as well as the possible influence of different variables in post-cessation weight gain. Methods: Data from the Tobacco Unit of the University Hospital of Salamanca were collected between 2009 and 2015. The variables analyzed were age, gender, BMI, cigarettes per day, packet-year, Fagerström test score, treatment, success of failure of the treatment and weight after 1, 2, 3, 6 and 12 months. Results: Patients experienced significant weight gain sustained over the 12-month follow-up, with an average of 3.02 kg. Patients who received behavioral therapy alone gained significantly less weight than those who also received drug treatment. Patients with lower initial BMI, a high packet-year, cigarette-day and test Fagerström gained significantly more weight. No significant differences in gender, age or treatment success at 12 months was found. Conclusions: Smokers posed quit smoking show a progressive weight gain, which is related to the initial BMI, a high and prolonged consumption of tobacco, and a high rate of dependency. Not related to other variables, which could seem to be determinants such as age, gender or treatment used


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Abandono do Hábito de Fumar/estatística & dados numéricos , Ex-Fumantes/estatística & dados numéricos , Ganho de Peso/fisiologia , Abandono do Uso de Tabaco/estatística & dados numéricos , Agentes de Cessação do Hábito de Fumar/farmacocinética , Tabagismo/terapia
9.
Chaos ; 29(1): 013128, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30709146

RESUMO

In this paper, taking fractional derivative due to Caputo and Fabrizo, we have investigated a biological model of smoking type. By using Sumudu transform and Picard successive iterative technique, we develop the iterative solutions for the considered model. Furthermore, some results related to uniqueness of the equilibrium solution and its stability are discussed utilizing the techniques of nonlinear functional analysis. The dynamics of iterative solutions for various compartments of the model are plotted with the help of Matlab.


Assuntos
Fumar , Algoritmos , Ex-Fumantes , Humanos , Modelos Biológicos , não Fumantes , Fumantes
10.
Med J Aust ; 210(5): 213-220, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30656698

RESUMO

OBJECTIVE: To estimate the burden of pancreatic cancer in Australia attributable to modifiable exposures, particularly smoking. DESIGN: Prospective pooled cohort study. SETTING, PARTICIPANTS: Seven prospective Australian study cohorts (total sample size, 365 084 adults); participant data linked to national registries to identify cases of pancreatic cancer and deaths. MAIN OUTCOME MEASURES: Associations between exposures and incidence of pancreatic cancer, estimated in a proportional hazards model, adjusted for age, sex, study, and other exposures; future burden of pancreatic cancer avoidable by changes in exposure estimated as population attributable fractions (PAFs) for whole population and for specific population subgroups with a method accounting for competing risk of death. RESULTS: There were 604 incident cases of pancreatic cancer during the first 10 years of follow-up. Current and recent smoking explained 21.7% (95% CI, 13.8-28.9%) and current smoking alone explained 15.3% (95% CI, 8.6-22.6%) of future pancreatic cancer burden. This proportion of the burden would be avoidable over 25 years were current smokers to quit and there were no new smokers. The burden attributable to current smoking is greater for men (23.9%; 95% CI, 13.3-33.3%) than for women (7.2%; 95% CI, -0.4% to 14.2%; P = 0.007) and for those under 65 (19.0%; 95% CI, 8.1-28.6%) than for older people (6.6%; 95% CI, 1.9-11.1%; P = 0.030). There were no independent relationships between body mass index or alcohol consumption and pancreatic cancer. CONCLUSIONS: Strategies that reduce the uptake of smoking and encourage current smokers to quit could substantially reduce the future incidence of pancreatic cancer in Australia, particularly among men.


Assuntos
Ex-Fumantes/estatística & dados numéricos , não Fumantes/estatística & dados numéricos , Neoplasias Pancreáticas/mortalidade , Fumantes/estatística & dados numéricos , Fumar/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Neoplasias Pancreáticas/etiologia , Neoplasias Pancreáticas/prevenção & controle , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Abandono do Hábito de Fumar
11.
Med Sci Monit ; 25: 866-871, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30698164

RESUMO

BACKGROUND The aim of this study was to assess the long-term effects of smoking and to investigate the permanence of this damage to the oral microcirculation. MATERIAL AND METHODS We recruited 75 patients and divided them into 3 groups: group 1 was composed of 25 healthy non-smokers, group 2 was composed of 25 healthy current smokers, and group 3 was composed of 25 healthy ex-smokers. Video-capillaroscopic examination was performed on all patients. The video-capillaroscopic investigation was performed on patients in sitting position, always with the same light source, at the same room temperature (23°C), in the morning, with the same operator (GAS), and was repeated many times for every area under investigation. An enlargement of 200× allowed us to explore point-by-point all the morpho-structural characteristics of the capillaroscopic field. For non-parametric data, we evaluated the visibility of the loops and their position in relation to the surface of the mucosa. The evaluated parametric data were length of capillary loop, diameter of the loop, capillary tortuosity, and capillary density. RESULTS Our study clearly shows there was no remission of vascular damage, even 13 years after smoking cessation. CONCLUSIONS Our research shows that that the effects of smoking are still visible in ex-smokers, even at 13 years after cessation and also that ex-smokers are still subject to the risk of oral pathologies in the interval of time that we considered.


Assuntos
Fumar Cigarros/efeitos adversos , Microcirculação/efeitos dos fármacos , Capilares/patologia , Ex-Fumantes , Feminino , Gengiva/patologia , Humanos , Masculino , Angioscopia Microscópica/métodos , Pessoa de Meia-Idade , Mucosa Bucal , Fumantes , Fumar/efeitos adversos
12.
Ann Cardiol Angeiol (Paris) ; 68(3): 155-161, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-30691680

RESUMO

AIM OF THE STUDY: Are the recommendations issued by the Haute Autorité de santé in 2012 on screening for abdominal aortic aneurysm (AAA) being applied? METHOD: We interviewed the target patients, ex. male patients aged 65 to 75, smokers or former smokers, or as young as 50 in the event of a family history of AAA in the parents or siblings, entering the emergency room of Dunkerque between May 7 and December 31, 2015. We asked them if they had had an abdominal aortic ultrasound, or an abdominal ultrasound, or an arterial Doppler ultrasound of the lower limbs, and when, to see if they had had an AAA test since November 2012. RESULTS: We included 55 patients and excluded 5 of 180 eligible patients (31 %). It was not possible to conclude for 4 patients due to missing data. Thirteen of 46 patients (28.3 %, 95 % CI [16.0-43.5]) have had AAA ultrasound screening since November 2012; 33 have not (71.7 %, 95 % CI [56.5-84.0]) and no screening was offered. Of the 13 patients screened, 7 were screened by the attending physician (53.9 %, 95 % CI [25.1-80.8]) and 6 by another specialist (46.2 %, 95 % CI [19.2-74.9]). CONCLUSION: AAA screening in our population is low. Physicians should be urged to publicize and implement the November 2012 French recommendations to reduce AAA-related mortality.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Fidelidade a Diretrizes , Abdome/diagnóstico por imagem , Idoso , Aorta Abdominal/diagnóstico por imagem , Serviço Hospitalar de Emergência , Ex-Fumantes/estatística & dados numéricos , Saúde da Família , França , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fumantes/estatística & dados numéricos , Ultrassonografia/estatística & dados numéricos
13.
BMJ ; 364: k4981, 2019 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-30606716

RESUMO

OBJECTIVES: To conduct a comprehensive analysis of prospectively measured circulating high sensitivity C reactive protein (hsCRP) concentration and risk of lung cancer overall, by smoking status (never, former, and current smokers), and histological sub-type. DESIGN: Nested case-control study. SETTING: 20 population based cohort studies in Asia, Europe, Australia, and the United States. PARTICIPANTS: 5299 patients with incident lung cancer, with individually incidence density matched controls. EXPOSURE: Circulating hsCRP concentrations in prediagnostic serum or plasma samples. MAIN OUTCOME MEASURE: Incident lung cancer diagnosis. RESULTS: A positive association between circulating hsCRP concentration and the risk of lung cancer for current (odds ratio associated with a doubling in hsCRP concentration 1.09, 95% confidence interval 1.05 to 1.13) and former smokers (1.09, 1.04 to 1.14) was observed, but not for never smokers (P<0.01 for interaction). This association was strong and consistent across all histological subtypes, except for adenocarcinoma, which was not strongly associated with hsCRP concentration regardless of smoking status (odds ratio for adenocarcinoma overall 0.97, 95% confidence interval 0.94 to 1.01). The association between circulating hsCRP concentration and the risk of lung cancer was strongest in the first two years of follow-up for former and current smokers. Including hsCRP concentration in a risk model, in addition to smoking based variables, did not improve risk discrimination overall, but slightly improved discrimination for cancers diagnosed in the first two years of follow-up. CONCLUSIONS: Former and current smokers with higher circulating hsCRP concentrations had a higher risk of lung cancer overall. Circulating hsCRP concentration was not associated with the risk of lung adenocarcinoma. Circulating hsCRP concentration could be a prediagnostic marker of lung cancer rather than a causal risk factor.


Assuntos
Proteína C-Reativa/metabolismo , Carcinoma de Células Grandes/sangue , Carcinoma de Células Pequenas/sangue , Carcinoma de Células Escamosas/sangue , Neoplasias Pulmonares/sangue , Fumar/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Biomarcadores Tumorais/sangue , Carcinoma de Células Grandes/epidemiologia , Carcinoma de Células Pequenas/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Estudos de Casos e Controles , Ex-Fumantes/estatística & dados numéricos , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , não Fumantes/estatística & dados numéricos , Razão de Chances , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Fumantes/estatística & dados numéricos , Fumar/epidemiologia , Adulto Jovem
14.
Int J Radiat Oncol Biol Phys ; 103(5): 1125-1131, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30513378

RESUMO

PURPOSE: Tobacco exposure is known to affect the biological behavior of human papilloma virus (HPV)-positive oropharyngeal carcinoma (OPC) with intermediate outcomes relative to tumors that are HPV associated with no smoking exposure and smoking-related HPV-negative tumors. We aim to evaluate the impact of smoking on the outcomes of patients with HPV-associated locally advanced OPC when stratified by treatment modality. METHODS AND MATERIALS: A retrospective chart review was undertaken for 352 patients with known p16-overexpressing locally advanced OPC who were managed with curative-intent therapy from 2006 to 2015. The impact of smoking status on overall survival (OS) and recurrence-free survival were compared using the Kaplan-Meier method. RESULTS: Of the 352 patients, 67.6% (n = 238) were managed with primary chemoradiation therapy (CRT) and 32.4% (n = 114) with primary surgery ± adjuvant therapy. The median smoking pack-year was 15. Twenty-seven percent of patients were active smokers at the time of presentation, with 40.3% identifying as former smokers and 32.7% having never smoked. Median follow-up for surviving patients was 4.2 years. Current smokers had a significantly worse relapse-free survival and OS compared with never and former smokers (P = .03 and P = .0001, respectively), with outcomes significantly worsening with increasing smoking exposure. The 5-year OS for more than 10, 20, and 30 pack-year smoking history was 73.2%, 64.7%, and 59.1%, respectively. Current smokers managed with CRT had a 5-year OS of 64.2% compared with former and never smokers (93.1% and 78.2%, respectively). For current smokers managed primarily by surgery the 5-year OS was 57.6% compared with former and never smokers (69.6% and 73.5%, respectively). CONCLUSIONS: Current smokers and those with higher smoking exposure had poorer outcomes irrespective of their primary modality of treatment. Although not the specific focus of the study, definitive CRT appeared to at least be equivalent to surgery with respect to disease outcomes for patients with HPV-associated oropharyngeal cancer, regardless of smoking status.


Assuntos
Quimiorradioterapia/estatística & dados numéricos , Neoplasias Orofaríngeas/mortalidade , Neoplasias Orofaríngeas/terapia , Neoplasias Orofaríngeas/virologia , Infecções por Papillomavirus/complicações , Fumar/efeitos adversos , Fumar/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Ex-Fumantes/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , não Fumantes/estatística & dados numéricos , Neoplasias Orofaríngeas/cirurgia , Dosagem Radioterapêutica , Estudos Retrospectivos , Fumantes , Fumar/epidemiologia , Fatores de Tempo , Resultado do Tratamento
15.
Eur J Cancer Prev ; 28(2): 115-123, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29360649

RESUMO

Tobacco smoking remains a number one preventable risk factor of premature death worldwide. Findings of recent research show concurrent trends of lung cancer deaths in males and females in Europe. Although lung cancer death rates are consistently decreasing in male population, in women an upward trend is observed. The burden of tobacco-related harm can be prevented by smoking cessation. The main goal of this analysis is to identify the crucial correlates of successful smoking cessation in the middle-aged Polish population. The data came from 13 172 survey participants south-eastern part of Poland as part of the PONS cohort study established in 2010. A total of 6998 records of those who were either ex-smokers or current smokers at baseline were analyzed. We applied logistic regression and adjusted for sociodemographic covariates and health determinants. Characteristics related to being an ex-smoker as opposed to a current smoker included: older age [men: odds ratio (OR)=1.03, 95% confidence interval (CI)=1.01-1.05; women: OR=1.05, 95% CI=1.03-1.07], being married or living together, having secondary (OR=1.51, 95% CI=1.14-1.99) or higher (OR=2.30, 95% CI=1.75-3.18) education (women), full-time employment (men), alcohol consumer (women), being overweight (men: OR=2.85, 95% CI=2.26-3.59; women: OR=1.60, 95% CI=1.36-1.87) or obese (men: OR=3.47, 95% CI=2.67-4.51; women: OR=2.99, 95% CI=2.45-3.65), having normal fasting glucose and cholesterol blood level without any treatment (women), assessing their own health highly (9-10, on the scale from 1 to 10) and having at least one accompanying chronic disease (women, OR=1.25, 95% CI=1.07-1.45). These findings provide valuable information on characteristics of ex-smokers as well as behavioral and sociodemographic predictors of successful cessation. Such data expand our knowledge and can be used to design a more comprehensive and targeted group-specific tobacco control policy focused on increasing the number of ex-smokers.


Assuntos
Ex-Fumantes/psicologia , Comportamentos Relacionados com a Saúde , Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/psicologia , Fumar/terapia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia/etnologia , Fatores de Risco , Fatores Socioeconômicos
16.
Respir Res ; 19(1): 256, 2018 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563522

RESUMO

We performed a post-hoc analysis of the OLiVIA-study investigating whether current and ex-smoking asthmatics with small airways dysfunction (SAD) show a better response in airway hyperresponsiveness (AHR) to small particle adenosine after treatment with extrafine compared to non-extrafine particle inhaled corticosteroids (ICS), and to investigate which clinical parameters predict a favorable response to both treatments. We show that smoking and ex-smoking asthmatics with and without SAD have a similar treatment response with either extrafine or non-extrafine particle ICS. We also found that lower blood neutrophils are associated with a smaller ICS-response in smokers and ex-smokers with asthma, independent from the level of blood eosinophils.


Assuntos
Corticosteroides/administração & dosagem , Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Ex-Fumantes , Tamanho da Partícula , Fumantes , Fumar/tratamento farmacológico , Administração por Inalação , Adulto , Remodelação das Vias Aéreas/efeitos dos fármacos , Remodelação das Vias Aéreas/fisiologia , Asma/sangue , Asma/diagnóstico , Eosinófilos/efeitos dos fármacos , Eosinófilos/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fumar/sangue , Resultado do Tratamento
17.
Folia Med (Plovdiv) ; 60(3): 397-401, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30355843

RESUMO

BACKGROUND: Patients with non-small-cell lung cancer (NSCLC) with anaplastic lymphoma kinase (ALK) rearrangement mutation are found to be 3-13%. AIM: To evaluate the prevalence of ALK mutations in EGFR-negative NSCLC patients in Bulgaria. MATERIALS AND METHODS: One hundred and thirty-two patients with EGFR-negative NSCLC were examined for ALK mutation analysis between January and June 2016. Data were obtained from patients' register of four major oncological hospitals in Bulgaria. RESULTS: Data were available for 124 (93.9%) patients, tumor mass was insufficient for analysis in 8 (6.1%) patients. Most of the patients were with adenocarcinoma (82 patients, 62.1%); 11 patients (8.3%) were with squamous histology and 2 patients (1.5%) were with other type of NSCLC. Histology data were missing in 37 patients (28.0%). ALK mutation was confirmed in 5 patients (3.8%), 119 (90.2%) patients had ALK wild type. ALK positive patients were with adenocarcinoma (n=3), squamous cell carcinoma (n=1) and other type (n=1) NSCLC. All ALK mutations were observed in never smokers (n=3) and former smokers (n=2). CONCLUSION: The present study is the first of this kind in Bulgaria - it investigates the prevalence of ALK mutation rate in EGFR-negative NSCLC patients, which was found to be 3.8%. The presence of EGFR, ALK or other driver mutations is a prerequisite for targeted therapy and thus needs to be accurately assessed in NSCLC.


Assuntos
Adenocarcinoma de Pulmão/genética , Quinase do Linfoma Anaplásico/genética , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma de Células Escamosas/genética , Neoplasias Pulmonares/genética , Idoso , Bulgária , Receptores ErbB/genética , Ex-Fumantes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , não Fumantes
19.
J Clin Psychiatry ; 79(6)2018 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-30289630

RESUMO

OBJECTIVE: Recent findings suggest an association between tobacco and psychosis, but whether this association is mediated by confounding factors is unknown. Psychosis-like experiences (PLEs) are a subclinical expression of psychosis. To disentangle the association of tobacco with PLEs, we examined data from a large US population-based, nationally representative sample. METHODS: Analysis was conducted on Wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (N = 34,653 adults, conducted from 2004 to 2005). Participants were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV. Twenty-two PLEs previously described as observed indicators of psychosis were used. Participants were stratified according to their smoking status (never/former/current) for 5 different types of tobacco. RESULTS: There was a significant association (ie, with 95% CIs for which the lower value was ≥ 1) between smoking status and 14 of the 22 assessed PLEs. These associations remained significant after adjustment for sociodemographic variables (including urbanicity or ethnicity), lifetime drug use disorder, and past-year cannabis use. While 26.33% of nonsmokers reported at least 1 PLE, this prevalence was slightly higher in former smokers (27.48%) and rose as high as 39.09% in current smokers (for current smokers vs lifetime abstainers, adjusted OR = 1.33; 95% CI, 1.23-1.45). All 22 PLEs had higher prevalence in smokers than in former smokers or lifetime abstainers. A total of 8.56% of smokers reported at least 5 PLEs, compared to 3.42% in lifetime abstainers (aOR = 1.56; 95% CI, 1.32-1.84). CONCLUSIONS: In a large population-based, nationally representative sample, smoking status was associated with various PLEs. This association was not explained only by other known risk factors of PLEs or schizophrenia. There is a need to identify the potential neurobiological mechanisms by which smoking and PLEs are associated, for patients and from a public health perspective.


Assuntos
Transtornos Psicóticos/epidemiologia , Fumar Tabaco/psicologia , Estudos Transversais , Ex-Fumantes/psicologia , Ex-Fumantes/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , não Fumantes/psicologia , não Fumantes/estatística & dados numéricos , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/psicologia , Fumantes/psicologia , Fumantes/estatística & dados numéricos , Fumar Tabaco/epidemiologia , Estados Unidos/epidemiologia
20.
BMJ Open ; 8(9): e021059, 2018 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-30206077

RESUMO

OBJECTIVES: To examine the association between neighbourhood deprivation and lung cancer risk. DESIGN: Nested case-control study. SETTING: Southern Community Cohort Study of persons residing in 12 states in the southeastern USA. PARTICIPANTS: 1334 cases of lung cancer and 5315 controls. PRIMARY OUTCOME MEASURE: Risk of lung cancer. RESULTS: After adjustment for smoking status and other confounders, and additional adjustment for individual-level measures of socioeconomic status (SES), there was no monotonic increase in risk with worsening deprivation score overall or within sex and race groups. There was an increase among current and shorter term former smokers (p=0.04) but not among never and longer term former smokers. There was evidence of statistically significant interaction by sex among whites, but not blacks, in which the effect of worsening deprivation on lung cancer existed in males but not in females. CONCLUSIONS: Area-level measures of SES were associated with lung cancer risk in current and shorter term former smokers only in this population.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Ex-Fumantes/estatística & dados numéricos , Neoplasias Pulmonares/epidemiologia , Áreas de Pobreza , Fumantes/estatística & dados numéricos , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Neoplasias Pulmonares/etnologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Sudeste dos Estados Unidos/epidemiologia , Fatores de Tempo
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