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1.
Medicine (Baltimore) ; 100(22): e25842, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087827

RESUMO

ABSTRACT: To investigate the relationship between urinary cotinine and colorectal neoplasm (CRN).The participants in the health screening cohort of the National Cancer Center who underwent screening colonoscopy between June 2007 and December 2009 were included. A total of 8121 subjects who underwent urinary cotinine measurement within 14 days from the index colonoscopy were included. Cotinine positivity was defined as having a urinary cotinine level ≥50 ng/mL. Follow-up colonoscopy data were collected by reviewing the patients' medical records.Patients were classified according to their urinary cotinine level and self-reported smoking status, and the number of patients with cotinine positivity was 1960 (24.1%). There was no significant difference in the cumulative CRN and advanced CRN (ACRN) risks according to the self-reported smoking status. However, cotinine positivity at the time of index colonoscopy was an independent risk factor for CRN (hazard ratio [HR]= 1.23, P = .006) in follow-up colonoscopy. Moreover, in never- and ex-smokers, cotinine positivity was an independent risk factor for CRN (HR = 1.95, P = .019; HR = 2.12, P = .003, respectively) and ACRN (HR = 8.89, P < .001; HR = 5.03, P = .003) during follow-up colonoscopy. The cumulative incidence of CRN and ACRN was higher in the cotinine-positive never- and ex-smokers than in the cotinine-negative never- and ex-smokers (P < .001 and P = .008, respectively).CRN or ACRN is more likely to occur at follow-up colonoscopy in the urinary cotinine-positive never- and ex-smokers than in the urinary cotinine-negative group. Therefore, urinary cotinine measurements may provide useful information on never- or ex-smokers undergoing screening colonoscopy.


Assuntos
Neoplasias Colorretais/epidemiologia , Cotinina/urina , Fumantes/estatística & dados numéricos , Fumar Tabaco/epidemiologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/epidemiologia , Pesos e Medidas Corporais , Colonoscopia/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais
2.
PLoS One ; 16(6): e0252427, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1259241

RESUMO

INTRODUCTION: COVID-19 is primarily a respiratory illness, and smoking adversely impacts the respiratory and immune systems; this confluence may therefore incentivize smokers to quit. The present study, conducted in four high-income countries during the first global wave of COVID-19, examined the association between COVID-19 and: (1) thoughts about quitting smoking; (2) changes in smoking (quit attempt, reduced or increased smoking, or no change); and (3) factors related to a positive change (making a quit attempt or reducing smoking) based on an adapted framework of the Health Belief Model. METHODS: This cross-sectional study included 6870 adult smokers participating in the Wave 3 (2020) ITC Four Country Smoking and Vaping Survey conducted in Australia, Canada, England, and United States (US). These four countries had varying responses to the pandemic by governments and public health, ranging from advising voluntary social distancing to implementing national and subnational staged lockdowns. Considering these varying responses, and the differences in the number of confirmed cases and deaths (greatest in England and the US and lowest in Australia), smoking behaviours related to COVID-19 may have differed between countries. Other factors that may be related to changes in smoking because of COVID-19 were also explored (e.g., sociodemographics, nicotine dependence, perceptions about personal and general risks of smoking on COVID-19). Regression analyses were conducted on weighted data. RESULTS: Overall, 46.7% of smokers reported thinking about quitting because of COVID-19, which differed by country (p<0.001): England highest (50.9%) and Australia lowest (37.6%). Thinking about quitting smoking because of COVID-19 was more frequent among: females, ethnic minorities, those with financial stress, current vapers, less dependent smokers (non-daily and fewer cigarettes smoked/day), those with greater concern about personal susceptibility of infection, and those who believe COVID-19 is more severe for smokers. Smoking behaviour changes due to COVID-19 were: 1.1% attempted to quit, 14.2% reduced smoking, and 14.6% increased smoking (70.2% reported no change). Positive behaviour change (tried to quit/reduced smoking) was reported by 15.5% of smokers, which differed by country (p = 0.02), where Australia had significantly lower rates than the other three countries. A positive behavioural smoking change was more likely among smokers with: lower dependence, greater concern about personal susceptibility to infection, and believing that COVID-19 is more severe for smokers. CONCLUSIONS: Though nearly half of smokers reported thinking about quitting because of COVID-19, the vast majority did not change their smoking behaviour. Smokers were more likely to try and quit or reduce their smoking if they had greater concern about susceptibility and severity of COVID-19 related to smoking. Smokers in Australia were least likely to reduce or try to quit smoking, which could be related to the significantly lower impact of COVID-19 during the early phase of the pandemic relative to the other countries.


Assuntos
COVID-19/epidemiologia , Cognição , Comportamentos Relacionados com a Saúde , SARS-CoV-2 , Fumantes , Abandono do Hábito de Fumar , Inquéritos e Questionários , Fumar Tabaco/epidemiologia , Vaping/epidemiologia , Adolescente , Adulto , COVID-19/psicologia , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fumar Tabaco/psicologia , Vaping/psicologia
3.
PLoS One ; 16(6): e0252427, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34086706

RESUMO

INTRODUCTION: COVID-19 is primarily a respiratory illness, and smoking adversely impacts the respiratory and immune systems; this confluence may therefore incentivize smokers to quit. The present study, conducted in four high-income countries during the first global wave of COVID-19, examined the association between COVID-19 and: (1) thoughts about quitting smoking; (2) changes in smoking (quit attempt, reduced or increased smoking, or no change); and (3) factors related to a positive change (making a quit attempt or reducing smoking) based on an adapted framework of the Health Belief Model. METHODS: This cross-sectional study included 6870 adult smokers participating in the Wave 3 (2020) ITC Four Country Smoking and Vaping Survey conducted in Australia, Canada, England, and United States (US). These four countries had varying responses to the pandemic by governments and public health, ranging from advising voluntary social distancing to implementing national and subnational staged lockdowns. Considering these varying responses, and the differences in the number of confirmed cases and deaths (greatest in England and the US and lowest in Australia), smoking behaviours related to COVID-19 may have differed between countries. Other factors that may be related to changes in smoking because of COVID-19 were also explored (e.g., sociodemographics, nicotine dependence, perceptions about personal and general risks of smoking on COVID-19). Regression analyses were conducted on weighted data. RESULTS: Overall, 46.7% of smokers reported thinking about quitting because of COVID-19, which differed by country (p<0.001): England highest (50.9%) and Australia lowest (37.6%). Thinking about quitting smoking because of COVID-19 was more frequent among: females, ethnic minorities, those with financial stress, current vapers, less dependent smokers (non-daily and fewer cigarettes smoked/day), those with greater concern about personal susceptibility of infection, and those who believe COVID-19 is more severe for smokers. Smoking behaviour changes due to COVID-19 were: 1.1% attempted to quit, 14.2% reduced smoking, and 14.6% increased smoking (70.2% reported no change). Positive behaviour change (tried to quit/reduced smoking) was reported by 15.5% of smokers, which differed by country (p = 0.02), where Australia had significantly lower rates than the other three countries. A positive behavioural smoking change was more likely among smokers with: lower dependence, greater concern about personal susceptibility to infection, and believing that COVID-19 is more severe for smokers. CONCLUSIONS: Though nearly half of smokers reported thinking about quitting because of COVID-19, the vast majority did not change their smoking behaviour. Smokers were more likely to try and quit or reduce their smoking if they had greater concern about susceptibility and severity of COVID-19 related to smoking. Smokers in Australia were least likely to reduce or try to quit smoking, which could be related to the significantly lower impact of COVID-19 during the early phase of the pandemic relative to the other countries.


Assuntos
COVID-19/epidemiologia , Cognição , Comportamentos Relacionados com a Saúde , SARS-CoV-2 , Fumantes , Abandono do Hábito de Fumar , Inquéritos e Questionários , Fumar Tabaco/epidemiologia , Vaping/epidemiologia , Adolescente , Adulto , COVID-19/psicologia , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fumar Tabaco/psicologia , Vaping/psicologia
4.
Medicine (Baltimore) ; 100(20): e25659, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011027

RESUMO

ABSTRACT: Upper extremity digital ischaemia (UEDI) is a rare heterogeneous condition whose frequency is 40 times less than that of toe ischaemia. Using a large cohort, the aim of this study was to evaluate aetiologies, prognosis and midterm clinical outcomes of UEDI.All patients with UEDI with or without cutaneous necrosis in a university hospital setting between January 2000 to December 2016 were included. Aetiologies, recurrence of UEDI, digital amputation and survival were analyzed retrospectively.Three hundred twenty three patients were included. UEDI due to cardio-embolic disease (DICE) was the highest occurring aetiology with 59 patients (18.3%), followed by DI due to Systemic Sclerosis (SSc) (16.1%), idiopathic causes (11.7%), Thromboangiitis obliterans (TAO) (9.3%), iatrogenic causes (9.3%), and cancer (6.2%). DICE patients tended to be older and featured more cases with arterial hypertension whereas TAO patients smoked more tobacco and cannabis. During follow-up, recurrences were significantly more frequent in SSc than in all other tested groups (P < .0001 vs idiopathic and DICE, P = .003 vs TAO) and among TAO patients when compared to DICE patients (P = .005). The cumulated rate of digital amputation was higher in the SSc group (n = 18) (P = .02) and the TAO group (n = 7) (P = .03) than in DICE (n = 2).This retrospective study suggests that main aetiologies of UEDI are DICE, SSc and idiopathic. This study highlights higher frequency of iatrogenic UEDI than previous studies. UEDI associated with SSc has a poor local prognosis (amputations and recurrences) and DICE a poor survival. UEDI with SSc and TAO are frequently recurrent.


Assuntos
Amputação/estatística & dados numéricos , Dedos/irrigação sanguínea , Isquemia/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolia/complicações , Embolia/epidemiologia , Feminino , Dedos/patologia , Dedos/cirurgia , Seguimentos , Humanos , Doença Iatrogênica/epidemiologia , Isquemia/epidemiologia , Isquemia/cirurgia , Estimativa de Kaplan-Meier , Masculino , Fumar Maconha/efeitos adversos , Fumar Maconha/epidemiologia , Pessoa de Meia-Idade , Necrose/epidemiologia , Necrose/etiologia , Necrose/cirurgia , Neoplasias/complicações , Neoplasias/epidemiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/epidemiologia , Taxa de Sobrevida , Tromboangiite Obliterante/complicações , Tromboangiite Obliterante/epidemiologia , Trombose/complicações , Trombose/epidemiologia , Fumar Tabaco/efeitos adversos , Fumar Tabaco/epidemiologia
5.
Aust N Z J Public Health ; 45(3): 290-298, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34028952

RESUMO

OBJECTIVE: To map patterns and prevalence of daily smoking among employed Australians over time. METHODS: Data from four waves of the triennial National Drug Strategy Household Survey (2007, 2010, 2013 and 2016) were used to assess daily smoking. Frequency analyses and significance testing examined smoking prevalence by sex, age, state, remoteness, Indigeneity, socioeconomic status (SES) and psychological distress. Logistic regression models estimated adjusted effects of demographics on smoking prevalence. RESULTS: Workers' daily smoking prevalence reduced by 32% between 2007 and 2016. The adjusted model showed the lowest smoking reductions among men and non-metropolitan workers. Other interaction effects showed the highest daily smoking rates for: male workers aged 14-39 years; low SES non-metropolitan workers; and low SES workers aged 40-59 years. CONCLUSIONS: Specific workplace policies, prevention and intervention strategies are warranted for male workers, especially those aged 14-39; non-metropolitan workers, especially low SES rural workers; and low SES workers especially 40-59-year-olds. Implications for public health: In spite of significant smoking reductions among workers over time, reductions were unevenly distributed. Tailored, innovative workplace prevention and intervention strategies that apply principles of proportionate universalism and address individual, workplace settings and cultural factors are warranted to reduce smoking disparities among male, rural and low SES workers.


Assuntos
Fumar/epidemiologia , Fumar Tabaco/tendências , Local de Trabalho , Adolescente , Adulto , Austrália/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Abandono do Hábito de Fumar/estatística & dados numéricos , Prevenção do Hábito de Fumar , Fatores Socioeconômicos , Fumar Tabaco/epidemiologia , Adulto Jovem
6.
BMC Res Notes ; 14(1): 141, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33863380

RESUMO

OBJECTIVE: Although children from language backgrounds other than English (LBOTE) may be disadvantaged in English-reliant exams, they outperform children from an English language background (ELB) on many Australian National Assessment Program-Literacy and Numeracy (NAPLAN) assessments. Maternal alcohol and tobacco use during pregnancy and/or breastfeeding have been associated with poorer cognitive and academic performance. Using data from the Growing Up in Australia Study, this paper aimed to identify demographic, lifestyle, and prenatal and perinatal risk differences related to maternal tobacco and alcohol use between LBOTE and ELB groups, as a first step in trying to understand the academic performance differences. RESULTS: Only data from breastfed babies was included in the current analyses. Although LBOTE children were disadvantaged in several demographic areas, their NAPLAN performance was the same or superior to ELB children across all Grade 3 and 5 NAPLAN assessments. The LBOTE group were, however, breastfed for longer, and their mothers smoked fewer cigarettes and drank less alcohol on fewer occasions throughout their pregnancy. The LBOTE mothers also had lower or less risky patterns of alcohol consumption while breastfeeding. The longer breastfeeding duration of LBOTE children combined with lower maternal use of alcohol and cigarettes during pregnancy and/or breastfeeding may partially contribute to their exceptional NAPLAN performance.


Assuntos
Desempenho Acadêmico , Consumo de Bebidas Alcoólicas/epidemiologia , Aleitamento Materno , Fumar Tabaco/epidemiologia , Adulto , Austrália/epidemiologia , Criança , Desenvolvimento Infantil , Feminino , Humanos , Lactente , Idade Materna , Gravidez , Fumar
7.
Contemp Clin Trials ; 105: 106352, 2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1120198

RESUMO

Cigarette smoking among postpartum women remains a significant public health problem despite known health risks to women and their newborns. It is estimated that over 50% of women quit smoking during pregnancy but 90% relapse by one year. Safe and effective postpartum relapse prevention strategies are urgently needed. In an attempt to address this deficit, we will investigate the efficacy of bupropion vs. placebo as a smoking relapse prevention aid in postpartum women. The objective of this paper is to detail an approach to investigate bupropion's efficacy for preventing postpartum smoking relapse among women who quit smoking during pregnancy. Specifically, we designed a two-arm, double-blind, placebo-controlled randomized trial testing the efficacy of bupropion vs. placebo as a relapse prevention tool. Mothers of healthy infants who quit smoking while pregnant will be stratified based on current or past history of major depressive disorder or persistent depressive disorder and randomized to receive either active (bupropion XL 300 mg/day) or placebo medication for 12 weeks. To respond to safety concerns associated with participant and staff exposure to COVID-19, we revised our original protocol and present procedures which allow our trial to be conducted entirely remotely. Primary and secondary outcomes will be assessed at weeks 12, 24, 36 and 52 post-randomization. The primary outcome is 7-day point prevalence abstinence at 24 weeks. Results of this work have the potential to positively impact women and their children by promoting lifelong cessation, eliminating secondhand smoke exposure, and modelling of abstinence to children.


Assuntos
Antidepressivos/administração & dosagem , Bupropiona/administração & dosagem , Transtorno Depressivo/epidemiologia , Período Pós-Parto , Prevenção Secundária/métodos , Fumar Tabaco/prevenção & controle , COVID-19/epidemiologia , Preparações de Ação Retardada , Transtorno Depressivo Maior/epidemiologia , Método Duplo-Cego , Feminino , Humanos , SARS-CoV-2 , Fumar Tabaco/epidemiologia
8.
Contemp Clin Trials ; 105: 106352, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33706003

RESUMO

Cigarette smoking among postpartum women remains a significant public health problem despite known health risks to women and their newborns. It is estimated that over 50% of women quit smoking during pregnancy but 90% relapse by one year. Safe and effective postpartum relapse prevention strategies are urgently needed. In an attempt to address this deficit, we will investigate the efficacy of bupropion vs. placebo as a smoking relapse prevention aid in postpartum women. The objective of this paper is to detail an approach to investigate bupropion's efficacy for preventing postpartum smoking relapse among women who quit smoking during pregnancy. Specifically, we designed a two-arm, double-blind, placebo-controlled randomized trial testing the efficacy of bupropion vs. placebo as a relapse prevention tool. Mothers of healthy infants who quit smoking while pregnant will be stratified based on current or past history of major depressive disorder or persistent depressive disorder and randomized to receive either active (bupropion XL 300 mg/day) or placebo medication for 12 weeks. To respond to safety concerns associated with participant and staff exposure to COVID-19, we revised our original protocol and present procedures which allow our trial to be conducted entirely remotely. Primary and secondary outcomes will be assessed at weeks 12, 24, 36 and 52 post-randomization. The primary outcome is 7-day point prevalence abstinence at 24 weeks. Results of this work have the potential to positively impact women and their children by promoting lifelong cessation, eliminating secondhand smoke exposure, and modelling of abstinence to children.


Assuntos
Antidepressivos/administração & dosagem , Bupropiona/administração & dosagem , Transtorno Depressivo/epidemiologia , Período Pós-Parto , Prevenção Secundária/métodos , Fumar Tabaco/prevenção & controle , COVID-19/epidemiologia , Preparações de Ação Retardada , Transtorno Depressivo Maior/epidemiologia , Método Duplo-Cego , Feminino , Humanos , SARS-CoV-2 , Fumar Tabaco/epidemiologia
9.
Medicine (Baltimore) ; 100(8): e24513, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663058

RESUMO

ABSTRACT: To compare visual function of 2-wall (medial and lateral) versus 3-wall (medial, lateral, and inferior) orbital decompression in patients with dysthyroid optic neuropathy (DON).A total of 52 eyes of 37 patients underwent orbital decompression for DON between 2013 and 2019 were retrospectively reviewed. Two- or 3-wall decompression was performed in 31 eyes of 23 patients and 21 eyes of 14 patients, respectively. We examined best-corrected visual acuity (BCVA), visual field mean deviation (MD) and pattern standard deviation (PSD), pattern-reversed visual evoked potential (PVEP) for P100 latency and amplitude at 60 and 15 arcmin stimulation checkerboard size, as well as proptosis using Hertel exophthalmometry.Whether 2-wall or 3-wall decompression, all parameters of visual function were improved after surgery (all P < .05). The improvement in BCVA, MD, and PSD was not statistically significant between groups (all P > .05). Proptosis reduction was higher after 3-wall decompression (P = .011). Mean increase in P100 amplitude after 3-wall decompression was statistically higher than that of after 2-wall decompression at 60 and 15 arcmin (P = .045 and .020, respectively), while the mean decrease in P100 latency was similar between the groups (P = .821 and .655, respectively). Six patients (66.67%) had persistent postoperative diplopia and 1 patient (20%) had new-onset diplopia in 3-wall decompression group, which were higher than in 2-wall decompression group (46.15% persistent postoperative diplopia and no new-onset diplopia).Both 2-wall and 3-wall decompression can effectively improve visual function of patients with DON. Three-wall decompression provides better improvement in P100 amplitude and proptosis, however new-onset diplopia is more common with this surgical technique.


Assuntos
Descompressão Cirúrgica/métodos , Oftalmopatia de Graves/cirurgia , Órbita/cirurgia , Percepção Visual , Adulto , Fatores Etários , Idoso , Potenciais Evocados Visuais , Feminino , Oftalmopatia de Graves/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Testes de Função Tireóidea , Fumar Tabaco/epidemiologia , Acuidade Visual , Campos Visuais
11.
Environ Health Prev Med ; 26(1): 24, 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33596818

RESUMO

BACKGROUND: Smoking among Japanese adolescents has decreased noticeably. However, little is known whether the decreasing trend in adolescent smoking can be seen across all socioeconomic status (SES) groups. This study aimed to examine trends in socioeconomic inequalities in smoking among Japanese adolescents between 2008 and 2016. METHODS: We conducted a repeated cross-sectional study using data from three surveys of high school students in Okinawa, Japan, in 2008, 2012, and 2016. The study participants consisted of 7902 students in grades 10 through 12 (15-18 years). Smoking was assessed as current cigarette use. SES indicators included familial SES (parental education and family structure) and student's own SES (school type). To evaluate absolute and relative inequalities, prevalence differences (PDs) and ratios (PRs) between low and high SES groups were estimated. The slope index of inequality (SII) and relative index of inequality (RII) were also calculated. RESULTS: Smoking prevalence among boys and girls significantly declined from 11.5% and 6.2% in 2008 to 4.7% and 1.9% in 2016, respectively. Similar decreasing trends in smoking were found among most of the SES groups. The PDs and SII for parental education in boys and family structure in girls decreased over time while those for school type persisted among boys and girls. The PRs and RII for school type in boys increased while those for other SES indicators among both sexes remained stable over time. CONCLUSIONS: Smoking among Japanese adolescents has been declining and time trends of socioeconomic inequalities in smoking varied by absolute and relative measures. Further policies and/or interventions to reduce smoking inequalities should focus on the context of schools, especially in vocational high schools.


Assuntos
Fatores Socioeconômicos , Fumar Tabaco/epidemiologia , Adolescente , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Prevalência
12.
Infect Dis Poverty ; 10(1): 12, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579391

RESUMO

BACKGROUND: Although the high burden of both active smoking and human immunodeficiency virus (HIV) is clearly known, the relationship between them is still not well characterized. Therefore, we estimated the global prevalence of active smoking in people living with HIV (PLHIV) on antiretroviral therapy (ART) and investigated the association between exposure to active smoking and risk for suboptimal adherence to ART. Main text: We searched PubMed, Embase, and Web of Science to identify articles published until September 19, 2019. Eligible studies reported the prevalence of active smoking in PLHIV on ART or investigated the association between active smoking and ART adherence; or enough data to compute these estimates. We used a random-effects model to pool data and quantified heterogeneity (I2). The global prevalence of active smoking was 36.1% (95% CI: 33.7-37.2; 329 prevalence data; 462 104 participants) with substantial heterogeneity. The prevalence increased with level of country income; from 10.1% (95% CI: 6.8-14.1) in low-income to 45.2% (95% CI: 42.7-47.7) in high-income countries; P < 0.0001. With regards to the Joint United Nations Programme on HIV/AIDS (UNAIDS) regions, the prevalence was higher in West and Central Europe and North America 45.4% (42.7-48.1) and lowest in the two UNAIDS regions of sub-Saharan Africa: Eastern and Southern Africa 10.7% (95% CI: 7.8-14.0) and West and Central Africa 4.4% (2.9-6.3); P < 0.0001. Globally, we estimated that there were 4 110 669 PLHIV on ART who were active smokers, among which the highest number was from Eastern and Southern Africa (35.9%) followed by Asia and the Pacific (25.9%). Active smoking was significantly associated with suboptimal ART adherence: pooled odds ratio 1.57 (95% CI: 1.37-1.80; I2 = 56.8%; 19 studies; 48 450 participants); even after considering adjusted estimates: 1.67 (95% CI: 1.39-2.01; I2 = 53.0%; 14 studies). CONCLUSIONS: This study suggests a high prevalence of active smoking in PLHIV on ART and an association between active smoking and ART suboptimal adherence. As such, healthcare providers and policy makers should focus on adopting and implementing tobacco harm reduction strategies in HIV care, especially in sub-Saharan Africa known as epicenter of HIV pandemic with highest number of active tobacco smoking among PLHIV on ART.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Fumar Tabaco/epidemiologia , Saúde Global , Infecções por HIV/epidemiologia , Humanos , Adesão à Medicação/estatística & dados numéricos , Prevalência , Fatores Socioeconômicos
14.
JAMA Netw Open ; 4(2): e2037936, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33620445

RESUMO

Importance: Hypertension is a leading cause of cardiovascular disease in adults; preclinical associations between hypertension and cardiovascular disease are seen in childhood. Nicotine is a known toxin, but its association with pediatric hypertension is unclear. Objective: To test the hypothesis that tobacco exposure is associated with the presence of elevated blood pressure in US children and adolescents and that this association is dose dependent. Design, Setting, and Participants: This cross-sectional study used data from the 2007 to 2016 National Health and Nutrition Examination Survey (NHANES), a population-based nationally representative sample of US children and adolescents. Children were eligible if they were aged 8 to 19 years at the time of participation in the main NHANES study. Exclusion criteria included those of the main NHANES study, inability to complete testing, or missing questionnaires. Of the 10 143 participants in NHANES aged 8 to 19 during the study years, 8520 were included in the analysis. Analysis was conducted from October 12, 2019, to July 9, 2020. Exposures: Tobacco exposure, defined as serum cotinine levels greater than 0.05 µg/L, or reporting living with a smoker or smoking themselves. Main Outcomes and Measures: Elevated blood pressure, classified as greater than 90% for a child's age, sex, and height according to the 2017 American Academy of Pediatrics Clinical Practice Guidelines. The a priori hypothesis that there is a positive association between tobacco exposure and elevated blood pressure in the study population was tested. Analysis included logistic regression with adjustment for possible confounders. Subgroup and sensitivity analyses were conducted. Results: A total of 8520 children were included in the analysis, representing 41 million US children. The mean (SD) age of the participants was 13.1 (0.05) years, 51% (95% CI, 49%-52%) were male, and 58% (95% CI, 54%-62%) were non-Hispanic White individuals. Participants with any tobacco smoke exposure were more likely than those without exposure to be older (mean [SD] age, 13.3 [0.07] years vs 12.8 [0.06] years), male (53% [95% CI, 51%-55%] vs 49% [95% CI, 47%-50%]), and non-Hispanic Black individuals (19% [95% CI, 16%-22%] vs 10% [95% CI, 8%-12%]). The odds of having elevated blood pressure was 1.31 (95% CI, 1.06-1.61) for any tobacco exposure after adjustment; odds were similar across subgroups and remained significant in multiple sensitivity analyses. Conclusions and Relevance: This study suggests that tobacco exposure is associated with elevated blood pressure in US children and adolescents. This modifiable risk factor represents a target for further research into reducing hypertension in children and adolescents.


Assuntos
Hipertensão/epidemiologia , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Fumar Tabaco/epidemiologia , Adolescente , Afro-Americanos , Distribuição por Idade , Pressão Sanguínea , Criança , Cotinina/sangue , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Masculino , Distribuição por Sexo , Fumar Tabaco/sangue , Estados Unidos/epidemiologia , Adulto Jovem
15.
Lancet Child Adolesc Health ; 5(4): 245-255, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33545071

RESUMO

BACKGROUND: Tobacco use is a leading preventable cause of morbidity and mortality worldwide. Little is known about recent prevalence and trends in tobacco use among adolescents globally. We aimed to assess the recent global prevalence of tobacco use in young adolescents and the secular trends in prevalence between 1999 and 2018. METHODS: We used the most recent Global Youth Tobacco Surveys data on adolescents aged 13-15 years from 143 countries or territories that had done at least one survey between Jan 1, 2010, and Dec 31, 2018, to assess the recent prevalence of tobacco use; and data from 140 countries that had done two or more surveys between Jan 1, 1999, and Dec 31, 2018, to assess the trends in the prevalence of tobacco use. FINDINGS: 530 234 adolescents were included from the 143 countries that had done at least one survey between 2010 and 2018. 1 192 312 adolescents were included from the 140 countries that had done two or more surveys between 1999 and 2018. The most recent global prevalence of cigarette smoking was 11·3% (95% CI 10·3-12·3) in boys and 6·1% (5·6-6·6) in girls, based on cigarette smoking on at least 1 day during the past 30 days, 6·0% (5·5-6·6) and 2·6% (2·4-2·9) based on smoking on at least 3 days, and 4·2% (3·8-4·6) and 1·6% (1·4-1·8) based on smoking on at least 6 days. The most recent prevalence of the use of tobacco products other than cigarettes (eg, chewing tobacco, snuff, dip, cigars, cigarillos, pipe, electronic cigarettes) on at least 1 day during the past 30 days was 11·2% (9·9-12·6) in boys and 7·0% (6·4-7·7) in girls. The most recent prevalence of any tobacco use on at least 1 day during the past 30 days was 17·9% (16·1-19·6) in boys and 11·5% (10·5-12·4) in girls. The prevalence of cigarette smoking on at least 1 day during the past 30 days decreased between the first and last surveys in 80 (57·1%) of 140 countries, was unchanged in 39 countries (27·9%), and increased in 21 countries (15·0%). However, the prevalence of the use of tobacco products other than cigarettes was unchanged or increased in 81 (59·1%) of 137 countries. INTERPRETATION: The global prevalence of tobacco use among adolescents aged 13-15 years was substantial. Although the prevalence of cigarette smoking decreased over time in the majority of countries, the prevalence of the use of other tobacco products increased or did not change in the majority of countries during the past two decades. These findings re-emphasise the need to strengthen tobacco control efforts among young adolescents globally. FUNDING: Shandong University.


Assuntos
Fumar Cigarros/epidemiologia , Uso de Tabaco/epidemiologia , Tabaco sem Fumaça , Adolescente , África/epidemiologia , Ásia/epidemiologia , América Central/epidemiologia , Fumar Cigarros/tendências , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , América do Norte/epidemiologia , Prevalência , Distribuição por Sexo , América do Sul/epidemiologia , Fumar Tabaco/epidemiologia , Fumar Tabaco/tendências , Uso de Tabaco/tendências
16.
Drug Alcohol Depend ; 219: 108481, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33429295

RESUMO

INTRODUCTION: Smoking tobacco and unhealthy alcohol use may negatively influence HIV care continuum outcomes but have not been examined in combination. METHODS: Participants were people with HIV (PWH) in Kaiser Permanente Northern California. Predictors included smoking status and unhealthy alcohol use (exceeding daily and/or weekly limits) reported by patients during primary care screening (index date). Outcomes were based on not achieving the following steps in the care continuum: linkage to HIV care (≥1 visit within 90 days of newly identified HIV diagnosis), retention (2+ in-person visits, 60+ days apart) and HIV RNA control (<75 copies/mL). Adjusted odds ratios (ORs) were obtained from separate logistic regression models for each outcome associated with smoking and unhealthy alcohol use independently and combined. RESULTS: The overall sample (N = 8958) had a mean age of 48.0 years; was 91.3 % male; 54.0 % white, 17.6 % Latino, 15.1 % black, and 9.6 % other race/ethnicity. Smoking was associated with higher odds of not being linked to HIV care (OR = 1.60 [95 % CI 1.03-2.48]), not retained (OR = 1.30 [95 % CI 1.13-1.50]), and HIV RNA not in control (OR = 1.91 [95 % CI 1.60-2.27]). Alcohol measures were not independently associated with outcomes. The combination of unhealthy alcohol use and smoking (versus neither) was associated with higher odds of not being linked to care (OR = 2.83 [95 % CI 1.40-5.71]), although the interaction did not reach significance (p = 0.18). CONCLUSIONS: In this large sample of PWH in an integrated health care system, smoking, both independently and in combination with unhealthy alcohol use, was associated with worse HIV care continuum outcomes.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Infecções por HIV/psicologia , Fumar Tabaco/epidemiologia , Adulto , Continuidade da Assistência ao Paciente , Prestação Integrada de Cuidados de Saúde , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Fumar
17.
Medicine (Baltimore) ; 100(2): e23997, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466141

RESUMO

ABSTRACT: There are reports that the use of regional anesthesia (RA) may be associated with better perioperative surgical stress response in cancer patients compared with general anesthetics (GA). However, the role of anesthesia on the magnitude of the postoperative systemic inflammatory response (SIR) in colorectal cancer patients, within an enhanced recovery pathway (ERP), is not clear.The aim of the present study was to examine the effect of anesthesia, within an enhanced recovery pathway, on the magnitude of the postoperative SIR in patients undergoing elective surgery for colorectal cancer.Database of 507 patients who underwent elective open or laparoscopic colorectal cancer surgery between 2015 and 2019 at a single center was studied. The anesthetic technique used was categorized into either GA or GA + RA using a prospective proforma. The relationship between each anesthetic technique and perioperative clinicopathological characteristics was examined using binary logistic regression analysis.The majority of patients were male (54%), younger than 65 years (41%), either normal or overweight (64%), and were nonsmokers (47%). Also, the majority of patients underwent open surgery (60%) and received mainly general + regional anesthetic technique (80%). On univariate analysis, GA + RA was associated with a lower day 4 CRP (≤150/>150 mg/L) concentration. On day 4, postoperative CRP was associated with anesthetic technique [odds ratio (OR) 0.58; confidence interval (CI) 0.31-1.07; P = .086], age (OR 0.70; CI 0.50-0.98; P = .043), sex (OR 1.15; CI 0.95-2.52; P = .074), smoking (OR 1.57; CI 1.13-2.19; P = .006), preoperative mGPS (OR 1.55; CI 1.15-2.10; P = .004), and preoperative dexamethasone (OR 0.70; CI 0.47-1.03; P = .072). On multivariate analysis, day 4 postoperative CRP was independently associated with anesthetic technique (OR 0.56; CI 0.32-0.97; P = .039), age (OR 0.74; CI 0.55-0.99; P = .045), smoking (OR 1.58; CI 1.18-2.12; P = .002), preoperative mGPS (OR 1.41; CI 1.08-1.84; P = .012), and preoperative dexamethasone (OR 0.68; CI 0.50-0.92; P = .014).There was a modest but an independent association between RA and a lower magnitude of the postoperative SIR. Future work is warranted with multicenter RCT to precisely clarify the relationship between anesthesia and the magnitude of the postoperative SIR.


Assuntos
Anestesia/efeitos adversos , Anestesia/métodos , Neoplasias Colorretais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Fatores Etários , Idoso , Proteína C-Reativa/biossíntese , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Fumar Tabaco/epidemiologia
18.
Nicotine Tob Res ; 23(3): 605-608, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-32812028

RESUMO

INTRODUCTION: Based on arguments for harm reduction and health benefits, tobacco companies in the United States can apply for regulatory authorization to make "modified risk tobacco product" (MRTP) marketing claims. The impact of future MRTP claims may depend on whether they are noticed, believed, and lead to smokers switching products. This study provides baseline data about smokers' exposure to perceived MRTP claims ahead of any MRTP authorizations. AIMS AND METHODS: We analyzed measures from Wave 3 of the US-based Population Assessment of Tobacco and Health (PATH) study which asked smokers to indicate if they had seen any e-cigarettes, snus, or other smokeless tobacco (SLT) products that claim to be "less harmful" in the past 12 months, and their likelihood of using products with these claims in the next 30 days. RESULTS: Significantly fewer smokers noted having seen snus (5.1%) or other SLT (5.6%) with "less harmful" claims compared with e-cigarettes (29.1%). For each product, the prevalence of MRTP claim exposure was higher among smokers who perceived the product to be less harmful than smoking, who currently used the product, and who had higher rates of tobacco advertising exposure at the point of sale. Among smokers who noticed products with "less harmful" claims, about one-quarter said they would use them in the future (24%-27%). CONCLUSIONS: Ahead of any Food & Drug Administration (FDA) authorization for MRTP claims, some smokers already perceive exposure to "less harmful" claims for e-cigarettes, but few do for SLT. MRTP claims may motivate some smokers to use these products. IMPLICATIONS: This study provides new baseline data about smokers' perceived exposure to MRTP claims in the United States ahead of any regulatory claim authorization. Using data from Wave 3 of the US PATH study, we found that some smokers already perceive exposure to "less harmful" claims for e-cigarettes (29%), but few do for SLT (5%-6%). Among smokers who noticed products with "less harmful" claims, about one-quarter said they would use them in the future (24%-27%), suggesting MRTP claims may motivate some smokers to use products described as "less harmful."


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Redução do Dano , Marketing/normas , Fumantes/psicologia , Fumar Tabaco/epidemiologia , Tabaco sem Fumaça/análise , Adolescente , Adulto , Publicidade , Feminino , Humanos , Masculino , Motivação , Fumar Tabaco/psicologia , Estados Unidos/epidemiologia , United States Food and Drug Administration , Adulto Jovem
19.
Arch Bronconeumol ; 57 Suppl 1: 21-34, 2021 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32912707

RESUMO

OBJECTIVE: The aim of this study was to determine if tobacco use in patients with Covid-19 is associated with a negative disease course and adverse outcome, and if smoking, current and past, is associated with a greater possibility of developing COVID-19. MATERIAL AND METHODS: A systematic review (SR) and meta-analysis (MA) of previously published works were performed. The search strategy included all known descriptors for Covid-19 and tobacco and was conducted in different databases. Appropriate statistical models were used to address the effect size in meta-analysis, namely random effects and fixed effects model. RESULTS: Thirty-four articles were identified in the SR of which 19 were included in the MA. Being a smoker or former smoker was shown to be a risk factor for worse progression of Covid-19 infection (OR 1.96, 95% CI, 1.36 - 2.83) and a greater probability of presenting a more critical condition (OR 1.79 95% CI, 1.19 - 2.70). As limitations of the MA, we found that most of the studies analyzed were observational with limited publication bias. Two studies that disagreed with the rest were included, although after withdrawing them from the MA, smoking was maintained as a risk factor for worse progress. CONCLUSION: Current and past smoking produces a more serious clinical form of Covid-19 and more frequently leads to intensive care admission, intubation, and death.


Assuntos
COVID-19/epidemiologia , SARS-CoV-2 , Fumar/epidemiologia , COVID-19/tratamento farmacológico , COVID-19/terapia , Comorbidade , Cuidados Críticos , Progressão da Doença , Suscetibilidade a Doenças , Humanos , Prognóstico , Viés de Publicação , Respiração Artificial , Fatores de Risco , Fumar/efeitos adversos , Fumar Tabaco/efeitos adversos , Fumar Tabaco/epidemiologia , Resultado do Tratamento
20.
J Intern Med ; 289(4): 574-583, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33270312

RESUMO

BACKGROUND: COVID-19 is a new pneumonia. It has been hypothesized that tobacco smoking history may increase severity of this disease in the patients once infected by the underlying coronavirus SARS-CoV-2 because smoking and COVID-19 both cause lung damage. However, this hypothesis has not been tested. OBJECTIVE: Current study was designed to focus on smoking history in patients with COVID-19 and test this hypothesis that tobacco smoking history increases risk for severe COVID-19 by damaging the lungs. METHODS AND RESULTS: This was a single-site, retrospective case series study of clinical associations, between epidemiological findings and clinical manifestations, radiographical or laboratory results. In our well-characterized cohort of 954 patients including 56 with tobacco smoking history, smoking history increased the risk for severe COVID-19 with an odds ratio (OR) of 5.5 (95% CI: 3.1-9.9; P = 7.3 × 10-8 ). Meta-analysis of ten cohorts for 2891 patients together obtained an OR of 2.5 (95% CI: 1.9-3.3; P < 0.00001). Semi-quantitative analysis of lung images for each of five lobes revealed a significant difference in neither lung damage at first examination nor dynamics of the lung damage at different time-points of examinations between the smoking and nonsmoking groups. No significant differences were found either in laboratory results including D-dimer and C-reactive protein levels except different covariances for density of the immune cells lymphocyte (P = 3.8 × 10-64 ) and neutrophil (P = 3.9 × 10-46 ). CONCLUSION: Tobacco smoking history increases the risk for great severity of COVID-19 but this risk is achieved unlikely by affecting the lungs.


Assuntos
COVID-19 , Pulmão , Pneumonia Viral , Fumar Tabaco , Proteína C-Reativa/análise , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/fisiopatologia , COVID-19/psicologia , China/epidemiologia , Correlação de Dados , Ex-Fumantes/estatística & dados numéricos , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Contagem de Leucócitos/métodos , Contagem de Leucócitos/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , não Fumantes/estatística & dados numéricos , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/etiologia , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , SARS-CoV-2 , Índice de Gravidade de Doença , Fumar Tabaco/sangue , Fumar Tabaco/epidemiologia , Fumar Tabaco/patologia
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