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1.
Rev Assoc Med Bras (1992) ; 67(3): 406-410, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34468606

RESUMO

OBJECTIVE: More than 20% of tuberculosis (TB) cases worldwide are attributable to smoking, and it is associated with an increased risk of latent and active TB, recurrence, and mortality. The aim of this study is to assess the smoking prevalence and the effects on treatment outcomes in TB patients. METHODS: A prospective cohort study was conducted in patients with a recent TB diagnosis. The smoking status was defined, in addition to the patients' knowledge and attitudes toward smoking. The patients were followed up until the end of the treatment, and the treatment result was recorded. RESULTS: Ninety-two patients were included in this study. The prevalence of active smoking was 31.5%. Active smokers had less chance for cure (62.1% versus 82.5%; p=0.032) and more treatment dropout (31.0% versus 12.7%; p=0.035) than non-active smokers. Patients demonstrated positive attitudes and good knowledge about smoking. CONCLUSIONS: Active smokers had less chance for cure and more abandonment than non-active smokers. These results can be useful for the proper planning of actions that impact TB control, especially in the treatment results, such as cognitive-behavioral approaches to smoking cessation.


Assuntos
Fumar , Tuberculose , Humanos , Prevalência , Estudos Prospectivos , Fumar/efeitos adversos , Resultado do Tratamento , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia
2.
Braz Oral Res ; 35: e075, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495136

RESUMO

Smoking has been shown to alter innate and adaptive immune responses and is directly associated with the onset of oral squamous cell carcinoma (OSCC). The purpose of this study was to evaluate the effect of cigarette smoke exposure on dendritic cells (DCs) from OSCC patients. CD1a and CD83 antibodies were used to identify immature and mature DCs, respectively, by immunohistochemistry in OSCC samples of 24 smokers and 24 non-smokers. Density of DCs was calculated in intra and peritumoral areas. Clinical and microscopic findings were reviewed and analyzed for all patients. Smokers with OSCC had a lower density of intra and peritumoral DCs when compared to non-smokers. Tumors classified as moderately/poorly differentiated had lower peritumoral CD1a+ DCs than well-differentiated tumors (p < 0.001). Smoking contributed to a depletion of immature and mature DCs in the OSCC.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Células Dendríticas , Humanos , Fumar/efeitos adversos , Carcinoma de Células Escamosas de Cabeça e Pescoço
3.
Eur Rev Med Pharmacol Sci ; 25(16): 5255-5260, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34486701

RESUMO

OBJECTIVE: Our study aims to analyze the correlation between the decrease of ovarian reserve and lower oocyte quality produced by the follicle associated with use of tobacco. In particular, the study analyzed the potential effects of cigarette smoking on hormonal dosages in infertile patients and patients with recurrent miscarriages. PATIENTS AND METHODS: This retrospective study included 61 women with a history of infertility and recurrent miscarriage between March 2016 and March 2019 selected at the clinic of poly-abortivity and infertility at the ASL Roma 2 - Department of Obstetrics and Gynecology, "S. Eugenio" Hospital. Patients' medical history (familiar, physiological and pathological with particular attention to smoking habits and nutrition), the obstetric history, gynecological examination and ultrasound were recorded. The serum concentration of FSH, AMH, Inhibin B were examined between the second and third day of the period. RESULTS: A total of 61 patients between 25 and 43 years of age admitted into our clinic were identified; 42 patients with a history of recurrent abortion (more than two abortions) and 19 patients with a history of infertility were selected. A total of 31 non-smokers women (50.82%) (G1) and 30 (49.18%) (G2) smokers were included. No differences were detected between the two groups under examination; the parameter that did appear discordant is the AMH value; this value scored higher in non-smokers than in smokers. Specifically, in smoker patients with recurrent abortions. CONCLUSIONS: The connection between nicotine, combustion material, and oocyte quality is an important and controversial research topic. Further studies are needed to clarify the influence of nicotine and combustion on the ovarian reserve in order to identify the main risk factors.


Assuntos
Hormônio Antimülleriano/sangue , Oócitos , Reserva Ovariana , Fumar/efeitos adversos , Adulto , Feminino , Humanos , Projetos Piloto , Ultrassonografia
4.
Front Public Health ; 9: 684683, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34497791

RESUMO

A growing body of scientific studies has been published to inform responses to the ongoing coronavirus pandemic, and some have claimed that cigarette smoking has a beneficial or mixed effect on the prevention and treatment of COVID-19. The presentation of such findings, unfortunately, has created an infodemic. This study integrated the theory of planned behavior and the health belief model and incorporated findings on addiction from the medical literature to predict cessation intention and support for tobacco control measures in the context of the COVID-19 infodemic. The study found that cessation intention partially mediated the effect of perceived severity and fully mediated the effects of perceived benefits, self-efficacy, and addiction on support for control measures. In addition, a positively-valenced message of the effect of smoking on the prevention and treatment of COVID-19 vs. a mixedly-valenced message was significant in predicting cessation intention, and the positively-valenced message of smoking indirectly predicted support for tobacco control measures. Perceived susceptibility, barriers, and subjective norms, however, exerted neither direct nor indirect effects on the two outcome variables.


Assuntos
COVID-19 , Abandono do Hábito de Fumar , Estudos Transversais , Humanos , Intenção , SARS-CoV-2 , Fumar/efeitos adversos , Inquéritos e Questionários
5.
Nat Commun ; 12(1): 5095, 2021 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429407

RESUMO

Maternal smoking during pregnancy (MSDP) contributes to poor birth outcomes, in part through disrupted placental functions, which may be reflected in the placental epigenome. Here we present a meta-analysis of the associations between MSDP and placental DNA methylation (DNAm) and between DNAm and birth outcomes within the Pregnancy And Childhood Epigenetics (PACE) consortium (N = 1700, 344 with MSDP). We identify 443 CpGs that are associated with MSDP, of which 142 associated with birth outcomes, 40 associated with gene expression, and 13 CpGs are associated with all three. Only two CpGs have consistent associations from a prior meta-analysis of cord blood DNAm, demonstrating substantial tissue-specific responses to MSDP. The placental MSDP-associated CpGs are enriched for environmental response genes, growth-factor signaling, and inflammation, which play important roles in placental function. We demonstrate links between placental DNAm, MSDP and poor birth outcomes, which may better inform the mechanisms through which MSDP impacts placental function and fetal growth.


Assuntos
Metilação de DNA , Desenvolvimento Fetal/efeitos dos fármacos , Desenvolvimento Fetal/genética , Placenta/metabolismo , Fumar/efeitos adversos , Epigênese Genética , Feminino , Heterogeneidade Genética , Humanos , Motivos de Nucleotídeos , Gravidez , Tabaco
6.
Sports Med Arthrosc Rev ; 29(3): e24-e33, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398119

RESUMO

Meniscus surgery is one of the most commonly performed orthopedic procedures worldwide. Modifiable risk factors for meniscus injury include body mass index, participation in athletics and occupation. Nonmodifiable risk factors include age, sex, lower extremity alignment, discoid meniscus, ligamentous laxity, and biconcave tibial plateau. Conditions commonly associated with meniscal injury are osteoarthritis, anterior cruciate ligament injury, and tibial plateau fractures. Tear type and location vary by patient age and functional status. Surgical management of meniscus injury is typically cost-effective in terms of quality-adjusted life years. The purpose of this review is to provide an overview of meniscal injury epidemiology by summarizing tear types and locations, associated conditions, and factors that increase the risk for meniscal injury. The economic burden of meniscus injury and strategies to prevent injury to the meniscus are also reviewed.


Assuntos
Lesões do Menisco Tibial/epidemiologia , Grupo com Ancestrais do Continente Africano , Fatores Etários , Lesões do Ligamento Cruzado Anterior/complicações , Traumatismos em Atletas/etiologia , Índice de Massa Corporal , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Traumatismos Ocupacionais/etiologia , Osteoartrite do Joelho/complicações , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Ruptura/epidemiologia , Ruptura/etiologia , Fatores Sexuais , Fumar/efeitos adversos , Fraturas da Tíbia/complicações , Lesões do Menisco Tibial/economia , Lesões do Menisco Tibial/etiologia , Lesões do Menisco Tibial/terapia
7.
BMC Public Health ; 21(1): 1554, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34399729

RESUMO

BACKGROUND: Smoking impairs lung immune function and damages upper airways, increasing risks of contracting and severity of infectious diseases. This paper quantifies the association between smoking and COVID-19 disease progression. METHODS: We searched PubMed and Embase for studies published from January 1-May 25, 2020. We included studies reporting smoking behavior of COVID-19 patients and progression of disease, including death. We used random effects meta-analysis, meta-regression and locally weighted regression and smoothing to examine relationships in the data. RESULTS: We identified 46 peer-reviewed papers with a total of 22,939 COVID-19 patients, 5421 (23.6%) experienced disease progression and 2914 (12.7%) with a history of smoking (current and former smokers). Among those with a history of smoking, 33.5% experienced disease progression, compared with 21.9% of non-smokers. The meta-analysis confirmed an association between ever smoking and COVID-19 progression (OR 1.59, 95% CI 1.33-1.89, p = 0.001). Ever smoking was associated with increased risk of death from COVID-19 (OR 1.19, 95% CI 1.02-1.39, p = 0.003). We found no significant difference (p = 0.864) between the effects of ever smoking on COVID-19 disease progression between adjusted and unadjusted analyses, suggesting that smoking is an independent risk factor for COVID-19 disease progression. We also found the risk of having COVID-19 progression higher among younger adults (p = 0.001), with the effect most pronounced among younger adults under about 45 years old. CONCLUSIONS: Smoking is an independent risk for having progression of COVID-19, including mortality. The effects seem to be higher among young people. Smoking prevention and cessation should remain a priority for the public, physicians, and public health professionals during the COVID-19 pandemic.


Assuntos
COVID-19 , Pandemias , Adolescente , Adulto , Humanos , Pessoa de Meia-Idade , SARS-CoV-2 , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar Tabaco
8.
Rev Assoc Med Bras (1992) ; 67Suppl 1(Suppl 1): 22-25, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34406293

RESUMO

Despite substantial evidence on the negative effect of active smoking to Covid-19, the impact of passive smoking in the course of disease remains largely unclear. Our aim was to reflect passive smoking as a risk factor in the current pandemic. Studies are needed to increase our knowledge on passive smoking and Covid-19 implications. The reflections current findings strongly support interventions and policies to curb the tobacco epidemic.


Assuntos
COVID-19 , Produtos do Tabaco , Poluição por Fumaça de Tabaco , Humanos , SARS-CoV-2 , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos
9.
PLoS One ; 16(8): e0255692, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34351990

RESUMO

INTRODUCTION: In the absence of a universally accepted association between smoking and COVID-19 health outcomes, we investigated this relationship in a representative cohort from one of the world's highest tobacco consuming regions. This is the first report from the Middle East and North Africa that tackles specifically the association of smoking and COVID-19 mortality while demonstrating a novel sex-discrepancy in the survival rates among patients. METHODS: Clinical data for 743 hospitalized COVID-19 patients was retrospectively collected from the leading centre for COVID-19 testing and treatment in Lebanon. Logistic regression, Kaplan-Meier survival curves and Cox proportional hazards model adjusted for age and stratified by sex were used to assess the association between the current cigarette smoking status of patients and COVID-19 outcomes. RESULTS: In addition to the high smoking prevalence among our hospitalized COVID-19 patients (42.3%), enrolled smokers tended to have higher reported ICU admissions (28.3% vs 16.6%, p<0.001), longer length of stay in the hospital (12.0 ± 7.8 vs 10.8 days, p<0.001) and higher death incidences as compared to non-smokers (60.5% vs 39.5%, p<0.001). Smokers had an elevated odds ratio for death (OR = 2.3, p<0.001) and for ICU admission (OR = 2.0, p<0.001) which remained significant in a multivariate regression model. Once adjusted for age and stratified by sex, our data revealed that current smoking status reduces survival rate in male patients ([HR] = 1.9 [95% (CI), 1.029-3.616]; p = 0.041) but it does not affect survival outcomes among hospitalized female patients([HR] = 0.79 [95% CI = 0.374-1.689]; p = 0.551). CONCLUSION: A high smoking prevalence was detected in our hospitalized COVID-19 cohort combined with worse prognosis and higher mortality rate in smoking patients. Our study was the first to highlight potential sex-specific consequences for smoking on COVID-19 outcomes that might further explain the higher vulnerability to death from this disease among men.


Assuntos
COVID-19/mortalidade , Fumar/efeitos adversos , Adulto , Idoso , COVID-19/epidemiologia , Teste para COVID-19 , Estudos de Coortes , Comorbidade/tendências , Feminino , Mortalidade Hospitalar , Hospitalização/tendências , Humanos , Estimativa de Kaplan-Meier , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/patogenicidade , Fatores Sexuais , Fumar/fisiopatologia , Taxa de Sobrevida
10.
Microsurgery ; 41(6): 513-521, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34390277

RESUMO

INTRODUCTION: Active smoking is known to impair wound healing following free tissue transfer for reconstruction due to its vasoconstrictive effect on the microcirculation. The aim of this study was to evaluate the impact of flap selection on flap loss, in nonelective, traumatic extremity-free soft tissue transfer in active smokers. METHODS: All patients undergoing a free tissue transfer for acute trauma of the extremity at a level I trauma center from 2011 to 2017 were identified. Breast reconstruction and osseous/osseocutaneous flaps were excluded. The study population was divided in two groups based on the type of flap used (muscle versus perforator flap). Factors known to be associated with impaired wound healing were extracted from the database. Primary outcome was major smoking related complications (complete/partial flap loss). Secondary outcomes included minor flap-related complications (infection, dehiscence) and donor site complications. The impact of smoking was assessed for the different type of flaps using multivariate analyses. RESULTS: A total of 118 flaps were identified during the study period. Out of those, 52 were perforator-based fasciocutaneous flaps, while 66 were muscle flaps. Active smoking status resulted in a statistically significant increase in the incidence of major and minor complications in the perforator flap group (36% vs. 4%, adjusted odds ratio, AOR [95%CI]: 2.31[1.48,19.30], adj-p = 0.021 and 32% vs. 17%, AOR [95% CI]: 1.23[1.11,14.31], adj-p = 0.034) but had no impact in the muscle group. CONCLUSIONS: The present study suggests a higher incidence of flap related complications in smokers when a perforator flap was selected but no impact when a muscle flap was utilized.


Assuntos
Retalhos de Tecido Biológico , Mamoplastia , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Estudos de Casos e Controles , Extremidades , Humanos , Músculos , Estudos Retrospectivos , Fumar/efeitos adversos , Resultado do Tratamento
11.
Medicine (Baltimore) ; 100(31): e26757, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397819

RESUMO

ABSTRACT: The role of cognitive, social and biological factors in the etiology of chronic periodontitis has been reported.The aim of this study was to evaluate the salivary cortisol level and interleukin-1 B level in patients of Chronic periodontitis in smokers and stress and nonsmokers without stress.The design of study randomized, prospective, double-blinded, and prospective study.The total sample size was comprised of 600 subjects between the ages of 20 and 50 years. The sample size was divided into 300 males and 300 females. Out of 600 subjects, 200 subjects comprised of subjects with chronic periodontitis with positive depression level with a history of smoking (Group I), 200 subjects comprised of subjects with chronic periodontitis without depression and without smoking (Group II), and 200 subjects who were taken as the control group comprised of healthy subjects without chronic periodontitis, without depression level, and no smoking history (Group III). Salivary cortisol levels were determined by enzyme-linked immunosorbent assay (ELISA).The result showed that there was a positive correlation between morning and evening salivary cortisol level in all the groups with correlation coefficient. There was significant higher value of salivary cortisol in Group I patients when compared with Group II and Group III. However, when the comparison of salivary cortisol levels was done between the Group II and Control group, the result showed nonsignificant P value.It is suggested that stress is positively correlated with the salivary cortisol levels in smokers and nonsmokers.


Assuntos
Periodontite Crônica/sangue , Hidrocortisona/análise , Interleucina-1beta/análise , Adulto , Biomarcadores/análise , Biomarcadores/sangue , Periodontite Crônica/diagnóstico , Periodontite Crônica/epidemiologia , Feminino , Voluntários Saudáveis , Humanos , Hidrocortisona/sangue , Interleucina-1beta/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Saliva/enzimologia , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-34444074

RESUMO

Smoking and lead (Pb) exposure increased oxidative stress in human body, and people with some gene variants may be susceptible to Pb and smoking via oxidative stress. The aim of this study is to evaluate oxidative stress by measuring thiobarbituric acid reactive substances (TBARS) and the relationship of lipid peroxidation markers in Pb workers with different gene polymorphisms (rs4673 and rs1050450) in both smokers and nonsmokers. Blood samples were collected from 267 Pb workers who received their annual health examination in the Kaohsiung Medical University Hospital. Glutathione peroxidase 1 (GPx-1) rs1050450 and cytochrome B-245 Alpha Chain (CYBA) rs4673 single-nucleotide polymorphisms (SNP) were analyzed by specific primer-probes using Real-Time PCR methods. The interaction between blood Pb and smoking increased serum levels of TBARS and the ratio of oxidative low-density lipoprotein and low-density lipoprotein (oxLDL/LDL). Analysis of workers with rs1050450 SNPs showed higher blood Pb levels in the workers with CC genotype than those with CT genotype. Smokers had significantly higher blood Pb, alanine transaminase (ALT), TBARS, and OxLDL levels than nonsmokers. TBARS increased 0.009 nmol/mL when blood Pb increased one µg/dL in smokers compared to nonsmokers. The ratio of OxLDL/LDL increased 0.223 when blood Pb increased one µg/dL in smokers compared to nonsmokers. TBARS levels and the ratio of OxLDL/LDL were positively correlated and interacted between blood Pb and smoking after the adjustment of confounders, suggesting that smoking cessation is an important issue in the Pb-exposed working environment.


Assuntos
Chumbo , Estresse Oxidativo , Fumar/efeitos adversos , Humanos , Chumbo/efeitos adversos , Peroxidação de Lipídeos , Estresse Oxidativo/genética , Substâncias Reativas com Ácido Tiobarbitúrico
14.
Artigo em Inglês | MEDLINE | ID: mdl-34360367

RESUMO

BACKGROUND: The determination of the impact of risk factors such as smoking in periodontal disease development is of importance to better characterize the disease. However, its impact on host response remains unclear. This study aimed to evaluate the effects of tobacco smoking on GCF levels of neutrophil enzymes (myeloperoxidase (MPO), beta-glucuronidase (BGD), neutrophil elastase (NE) and periodontal parameters in healthy young adults with dental plaque biofilm-induced gingivitis. METHODS: The study population consisted of 60 systemically healthy young adults (39 smokers (Sm) and 21 non-smokers (n-Sm)) diagnosed with plaque-induced gingivitis. The periodontal examination consisted of a plaque index (PI); gingival index (GI); probing depth (PD); bleeding on probing (BoP), and clinical attachment level (CAL). GCF MPO, BGD, and NE levels were determined by means of an enzyme-linked immunosorbent assay (ELISA). RESULTS: PI, GI, and BoP were significantly increased in the Sm group (p < 0.05). PD and CAL showed no significant difference between Sm and n-Sm groups (p > 0.05). In GCF, MPO, BGD, and NE levels were significantly increased in Sm group (p < 0.05). NE levels showed a significant correlation with GI and BoP (p < 0.05 for both). Moreover, a positive correlation between BGD and NE levels (p < 0.05) was measured. CONCLUSIONS: It may be concluded that, even in young patients, tobacco consumption affects the host's immune response related to gingival inflammation. It is, therefore, mandatory to inform young patients about the risk related to tobacco consumption for their gingival health.


Assuntos
Gengivite , Neutrófilos , Estudos de Casos e Controles , Líquido do Sulco Gengival , Humanos , Perda da Inserção Periodontal , Fumar/efeitos adversos , Fumar Tabaco , Adulto Jovem
15.
Epidemiol Infect ; 149: e176, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34338184

RESUMO

Evidence that more people in some countries and fewer in others are dying because of the pandemic, than is reflected by reported coronavirus disease 2019 (Covid-19) mortality rates, is derived from mortality data. Using publicly available databases, deaths attributed to Covid-19 in 2020 and all deaths for the years 2015-2020 were tabulated for 35 countries together with economic, health, demographic and government response stringency index variables. Residual mortality rates (RMR) in 2020 were calculated as excess mortality minus reported mortality rates due to Covid-19 where excess deaths were observed deaths in 2020 minus the average for 2015-2019. Differences in RMR are differences not attributed to reported Covid-19. For about half the countries, RMR's were negative and for half, positive. The absolute rates in some countries were double those in others. In a regression analysis, population density and proportion of female smokers were positively associated with both Covid-19 and excess mortality while the human development index and proportion of male smokers were negatively associated with both. RMR was not associated with any of the investigated variables. The results show that published data on mortality from Covid-19 cannot be directly comparable across countries. This may be due to differences in Covid-19 death reporting and in addition, the unprecedented public health measures implemented to control the pandemic may have produced either increased or reduced excess deaths due to other diseases. Further data on cause-specific mortality is required to determine the extent to which residual mortality represents non-Covid-19 deaths and to explain differences between countries.


Assuntos
COVID-19/mortalidade , Mortalidade , Pandemias , Densidade Demográfica , Fumar/efeitos adversos , Feminino , Humanos , Masculino , SARS-CoV-2/fisiologia
16.
Trials ; 22(1): 512, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34340694

RESUMO

BACKGROUND: Financial incentives are an effective way of helping women to stop smoking during pregnancy. Unfortunately, most women who stop smoking at this time return to smoking within 12 months of the infant's birth. There is no evidence for interventions that are effective at preventing postpartum smoking relapse. Financial incentives provided after the birth may help women to sustain cessation. This randomised controlled trial will assess the effectiveness and cost-effectiveness of financial incentives to help women who are abstinent from smoking at end-of-pregnancy to avoid return to smoking up to 12 months postpartum. METHODS: This is a UK-based, multi-centre, three-arm, superiority, parallel group, individually randomised controlled trial, with 1:1:1 allocation. It will compare the effectiveness of two financial incentive interventions with each other (one intervention for up to 3 months postpartum offering up to £120 of incentives (£60 for the participant and £60 for a significant other support); the other for up to 12 months postpartum with up to £300 of incentives (£240 for the participant and £60 for a significant other support) and with a no incentives/usual care control group. Eligible women will be between 34 weeks gestation and 2 weeks postpartum, abstinent from smoking for at least 4 weeks, have an expired carbon monoxide (CO) reading < 4 parts per million (ppm), aged at least 16 years, intend remaining abstinent from smoking after the birth and able to speak and read English. The primary outcome is self-reported, lapse-free, smoking abstinence from the last quit attempt in pregnancy until 12 months postpartum, biochemically validated by expired CO and/or salivary cotinine or anabasine. Outcomes will be analysed by intention-to-treat and regression models used to compare the proportion of abstinent women between the two intervention groups and between each intervention group and the control group. An economic evaluation will assess the cost-effectiveness of offering incentives and a qualitative process evaluation will examine barriers and facilitators to trial retention, effectiveness and implementation. DISCUSSION: This pragmatic randomised controlled trial will test whether offering financial incentives is effective and cost-effective for helping women to avoid smoking relapse during the 12 months after the birth of their baby. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number 55218215 . Registered retrospectively on 5th June 2019.


Assuntos
Motivação , Abandono do Hábito de Fumar , Feminino , Humanos , Lactente , Estudos Multicêntricos como Assunto , Período Pós-Parto , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Fumar/efeitos adversos
17.
J Stroke Cerebrovasc Dis ; 30(9): 105946, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34214964

RESUMO

OBJECTIVES: Cerebral small vessel disease (SVD) is often associated with hypertension and may evolve towards intracerebral hemorrhage (ICH) or lacunar ischemic stroke. However, the factors favoring the evolution towards ICH or lacunar stroke are not well understood. MATERIALS AND METHODS: This retrospective study included 326 consecutive patients (71.1±13.2 years, 38% women): 143 with deep ICH and 183 with lacunar lesions (LL) <2 cm, which were visible in a deep location on brain CT scan. Among LL patients, 143 had a small-artery occlusion (SAO) stroke according to the TOAST classification. Clinical characteristics plus laboratory and neuroradiological variables of these patients had been prospectively collected and a subgroup underwent echocardiography. RESULTS: In multivariate analysis, ICH patients (97% hypertensive), compared to SAO patients (89% hypertensive), had greater left ventricular wall thickness (LVWT; OR 4.15, 95%CI 1.64-10.53, for those with LVWT ≥ 1.4 cm, 70% of whom were hemorrhagic) and lower prevalence of white matter lesions (OR 0.30, 95%CI 0.13-0.70), ever smokers (OR 0.39, 95%CI 0.18-0.82) and diabetics (OR 0.29, 95% CI 0.10-0.84). Moreover, ICH patients had a greater prevalence of atrial fibrillation than LL patients (OR 3.14, 95%CI 1.11-8.93), and so they were more often anticoagulated. CONCLUSIONS: Most SVD patients were hypertensive, but those evolving towards ICH were characterized by organ damage at the cardiac level (increase in LVWT and atrial fibrillation), while those evolving towards lacunar stroke were characterized by a higher prevalence of smokers and diabetics, and by organ damage at the cerebral level (white matter lesions).


Assuntos
Fibrilação Atrial/epidemiologia , Hemorragia Cerebral/epidemiologia , Hipertensão/epidemiologia , Hipertrofia Ventricular Esquerda/epidemiologia , Acidente Vascular Cerebral Lacunar/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Diabetes Mellitus/epidemiologia , Progressão da Doença , Feminino , Frequência Cardíaca , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/fisiopatologia , Itália/epidemiologia , Leucoencefalopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Acidente Vascular Cerebral Lacunar/diagnóstico por imagem , Acidente Vascular Cerebral Lacunar/fisiopatologia , Função Ventricular Esquerda , Remodelação Ventricular
19.
Am J Gastroenterol ; 116(9): 1844-1852, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34240714

RESUMO

INTRODUCTION: To help target preventive strategies, we estimated US population attributable risks (PARs) of demographic and potentially modifiable risk factors for esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA), and gastric noncardia adenocarcinoma (GNCA). METHODS: We prospectively examined the associations for risk factors and these cancers in 490,605 people in the National Institutes of Health-the American Association of Retired Persons Diet and Health cohort Diet and Health Study cohort from 1995 to 2011. Exposures were obtained from the baseline questionnaire. Diagnoses of gastroesophageal reflux disease were extracted for a subset of eligible National Institutes of Health-the American Association of Retired Persons Diet and Health cohort subjects through linkage to Medicare and then multiply imputed for non-Medicare-eligible subjects. Hazard ratios were calculated using multivariable-adjusted Cox proportional hazards regression. Adjusted population attributable risks were calculated for the US population aged 50-71 years by combining the hazard ratios with the estimated joint distribution of risk factor prevalence from the 2015 National Health Interview Survey. RESULTS: Smoking remained the most important risk factor for ESCC and was estimated to cause more than 1/3 of EAC and GCA and 1/10 of GNCA. Obesity and gastroesophageal reflux disease were associated with more than 1/2 of EAC and 1/3 of GCA. Compared with each lowest-risk level category, common risk factors were estimated to be associated with 73.7% of ESCC (95% confidence interval [CI]: 62.1%-85.4%), 70.3% of EAC (95% CI: 64.4%-76.2%), 69.3% of GCA (95% CI: 61.0%-77.7%), and 33.6% of GNCA (95% CI: 21.7%-45.5%). DISCUSSION: These factors accounted for a large proportion of esophageal and gastric cancers in the United States, highlighting opportunities for education and intervention to reduce the burden of these highly fatal cancers.


Assuntos
Adenocarcinoma/epidemiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Neoplasias Esofágicas/epidemiologia , Carcinoma de Células Escamosas do Esôfago/epidemiologia , Fumar/efeitos adversos , Neoplasias Gástricas/epidemiologia , Adenocarcinoma/etiologia , Idoso , Dieta/efeitos adversos , Neoplasias Esofágicas/etiologia , Carcinoma de Células Escamosas do Esôfago/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Neoplasias Gástricas/etiologia , Estados Unidos/epidemiologia
20.
J Stroke Cerebrovasc Dis ; 30(9): 105965, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34247053

RESUMO

OBJECTIVES: Ischemic stroke and hemorrhagic stroke are the most common sequelae of the Moyamoya variants [Moyamoya disease (MMD) and syndrome (MMS)]. We sought to determine the rates of stroke subtypes and the predictive factors of arterial ischemic stroke (AIS) utilizing a large data sample of MMD and MMS patients in the US. MATERIALS AND METHODS: We queried the 2016 and 2017 National Inpatient Sample database for Moyamoya diagnosis plus any of the following associated conditions; sickle cell disease, neurofibromatosis type 1, cranial radiation therapy or Down Syndrome. Multivariate regression determined the risk factors for AIS onset in MMD and MMS. RESULTS: 2323 patients with a diagnosis of Moyamoya were included; 668 (28.8%) patients were classified as MMS and 1655 (71.2%) as MMD. AIS was the most common presentation in both cohorts; however, MMD patients had higher rates of AIS (20.4 vs 6%, p < 0.001), hemorrhagic stroke (7.4vs 2.5%, p < 0.001), and TIA (3.3vs 0.9%, p = 0.001) compared to MMS patients. Multivariate analysis showed that increasing age [OR = 1.017 95%CI: 1.008-1.03, p < 0.001], lipidemia [OR = 1.32 95%CI: 1.02-1.74, p = 0.049], and current smoking status [OR = 1.43 95%CI: 1.04-1.97, p = 0.026] were independent risk factors for AIS in MMD patients, whereas hypertension [OR = 2.61 95%CI: 1.29-5.25, p = 0.007] and African-American race [OR = 0.274, 95%CI: .117-.64, p = 0.003] were independent predictors in the MMS cohort. CONCLUSION: AIS is the most common presentation in both, MMD and MMS. However, MMD patients had higher rates of stroke events compared to MMS. Risk factors for AIS in MMD included increasing age, lipidemia and smoking status, whereas in MMS hypertension was the only independent risk factor.


Assuntos
AVC Hemorrágico/epidemiologia , Ataque Isquêmico Transitório/epidemiologia , AVC Isquêmico/epidemiologia , Doença de Moyamoya/epidemiologia , Adolescente , Adulto , Fatores Etários , Comorbidade , Bases de Dados Factuais , Dislipidemias/epidemiologia , Feminino , AVC Hemorrágico/diagnóstico , Humanos , Hipertensão/epidemiologia , Pacientes Internados , Ataque Isquêmico Transitório/diagnóstico , AVC Isquêmico/diagnóstico , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/diagnóstico , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
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