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1.
JAMA ; 324(14): 1406-1418, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33048154

RESUMO

Importance: Persistent smoking may cause adverse outcomes among patients with cancer. Many cancer centers have not fully implemented evidence-based tobacco treatment into routine care. Objective: To determine the effectiveness of sustained telephone counseling and medication (intensive treatment) compared with shorter-term telephone counseling and medication advice (standard treatment) to assist patients recently diagnosed with cancer to quit smoking. Design, Setting, and Participants: This unblinded randomized clinical trial was conducted at Massachusetts General Hospital/Dana-Farber/Harvard Cancer Center and Memorial Sloan Kettering Cancer Center. Adults who had smoked 1 cigarette or more within 30 days, spoke English or Spanish, and had recently diagnosed breast, gastrointestinal, genitourinary, gynecological, head and neck, lung, lymphoma, or melanoma cancers were eligible. Enrollment occurred between November 2013 and July 2017; assessments were completed by the end of February 2018. Interventions: Participants randomized to the intensive treatment (n = 153) and the standard treatment (n = 150) received 4 weekly telephone counseling sessions and medication advice. The intensive treatment group also received 4 biweekly and 3 monthly telephone counseling sessions and choice of Food and Drug Administration-approved cessation medication (nicotine replacement therapy, bupropion, or varenicline). Main Outcome and Measures: The primary outcome was biochemically confirmed 7-day point prevalence tobacco abstinence at 6-month follow-up. Secondary outcomes were treatment utilization rates. Results: Among 303 patients who were randomized (mean age, 58.3 years; 170 women [56.1%]), 221 (78.1%) completed the trial. Six-month biochemically confirmed quit rates were 34.5% (n = 51 in the intensive treatment group) vs 21.5% (n = 29 in the standard treatment group) (difference, 13.0% [95% CI, 3.0%-23.3%]; odds ratio, 1.92 [95% CI, 1.13-3.27]; P < .02). The median number of counseling sessions completed was 8 (interquartile range, 4-11) in the intensive treatment group. A total of 97 intensive treatment participants (77.0%) vs 68 standard treatment participants (59.1%) reported cessation medication use (difference, 17.9% [95% CI, 6.3%-29.5%]; odds ratio, 2.31 [95% CI, 1.32-4.04]; P = .003). The most common adverse events in the intensive treatment and standard treatment groups, respectively, were nausea (n = 13 and n = 6), rash (n = 4 and n = 1), hiccups (n = 4 and n = 1), mouth irritation (n = 4 and n = 0), difficulty sleeping (n = 3 and n = 2), and vivid dreams (n = 3 and n = 2). Conclusions and Relevance: Among smokers recently diagnosed with cancer in 2 National Cancer Institute-designated Comprehensive Cancer Centers, sustained counseling and provision of free cessation medication compared with 4-week counseling and medication advice resulted in higher 6-month biochemically confirmed quit rates. However, the generalizability of the study findings is uncertain and requires further research. Trial Registration: ClinicalTrials.gov Identifier: NCT01871506.


Assuntos
Aconselhamento/métodos , Neoplasias/diagnóstico , Abandono do Hábito de Fumar/psicologia , Temperança/psicologia , Dispositivos para o Abandono do Uso de Tabaco , Idoso , Bupropiona/efeitos adversos , Bupropiona/uso terapêutico , Cotinina/análise , Aconselhamento/estatística & dados numéricos , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional , Satisfação do Paciente , Seleção de Pacientes , Saliva/química , Fumar/tratamento farmacológico , Fumar/epidemiologia , Fumar/psicologia , Agentes de Cessação do Hábito de Fumar/efeitos adversos , Agentes de Cessação do Hábito de Fumar/uso terapêutico , Telefone , Dispositivos para o Abandono do Uso de Tabaco/efeitos adversos , Vareniclina/efeitos adversos , Vareniclina/uso terapêutico
2.
BMJ ; 371: m3464, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32998909

RESUMO

OBJECTIVE: To evaluate whether irregular or long menstrual cycles throughout the life course are associated with all cause and cause specific premature mortality (age <70 years). DESIGN: Prospective cohort study. SETTING: Nurses' Health Study II (1993-2017). PARTICIPANTS: 79 505 premenopausal women without a history of cardiovascular disease, cancer, or diabetes and who reported the usual length and regularity of their menstrual cycles at ages 14-17 years, 18-22 years, and 29-46 years. MAIN OUTCOME MEASURES: Hazard ratios and 95% confidence intervals for all cause and cause specific premature mortality (death before age 70 years) were estimated from multivariable Cox proportional hazards models. RESULTS: During 24 years of follow-up, 1975 premature deaths were documented, including 894 from cancer and 172 from cardiovascular disease. Women who reported always having irregular menstrual cycles experienced higher mortality rates during follow-up than women who reported very regular cycles in the same age ranges. The crude mortality rate per 1000 person years of follow-up for women reporting very regular cycles and women reporting always irregular cycles were 1.05 and 1.23 for cycle characteristics at ages 14-17 years, 1.00 and 1.37 for cycle characteristics at ages 18-22 years, and 1.00 and 1.68 for cycle characteristics at ages 29-46 years. The corresponding multivariable adjusted hazard ratios for premature death during follow-up were 1.18 (95% confidence interval 1.02 to 1.37), 1.37 (1.09 to 1.73), and 1.39 (1.14 to 1.70), respectively. Similarly, women who reported that their usual cycle length was 40 days or more at ages 18-22 years and 29-46 years were more likely to die prematurely than women who reported a usual cycle length of 26-31 days in the same age ranges (1.34, 1.06 to 1.69; and 1.40, 1.17 to 1.68, respectively). These relations were strongest for deaths related to cardiovascular disease. The higher mortality associated with long and irregular menstrual cycles was slightly stronger among current smokers. CONCLUSIONS: Irregular and long menstrual cycles in adolescence and adulthood are associated with a greater risk of premature mortality (age <70 years). This relation is slightly stronger among women who smoke.


Assuntos
Ciclo Menstrual , Distúrbios Menstruais/epidemiologia , Mortalidade Prematura , Saúde Reprodutiva/estatística & dados numéricos , Adolescente , Adulto , Doenças Cardiovasculares/epidemiologia , Causas de Morte , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Medição de Risco , Fatores de Risco , Autorrelato , Fumar/epidemiologia , Estados Unidos/epidemiologia
3.
J Affect Disord ; 277: 893-900, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33065831

RESUMO

BACKGROUND: The mental health status caused by major epidemics is serious and lasting. At present, there are few studies about the lasting mental health effects of COVID-19 outbreak. The purpose of this study was to investigate the mental health of the Chinese public during the long-term COVID-19 outbreak. METHODS: A total of 1172 online questionnaires were collected, covering demographical information and 8 common psychological states: depression, anxiety, somatization, stress, psychological resilience, suicidal ideation and behavior, insomnia, and stress disorder. In addition, the geographical and temporal distributions of different mental states were plotted. RESULTS: Overall, 30.1% of smokers increased smoking, while 11.3% of drinkers increased alcohol consumption. The prevalence rates of depression, anxiety, mental health problems, high risk of suicidal and behavior, clinical insomnia, clinical post-traumatic stress disorder symptoms, moderate-to-high levels of perceived stress were 18.8%, 13.3%, 7.6%, 2.8%, 7.2%, 7.0%, and 67.9%, respectively. Further, the geographical distribution showed that the mental status in some provinces/autonomous regions/municipalities was relatively more serious. The temporal distribution showed that the psychological state of the participants was relatively poorer on February 20, 24 to 26 and March 25, especially on March 25. LIMITATIONS: This cross-sectional design cannot make causal inferences. The snowball sampling was not representative enough. CONCLUSION: Our findings suggest that the prevalence rate of mental disorders in the Chinese public is relatively low in the second month of the COVID-19 pandemic. In addition, people's mental state is affected by the geographical and temporal distributions.


Assuntos
Ansiedade/epidemiologia , Infecções por Coronavirus , Depressão/epidemiologia , Pandemias , Pneumonia Viral , Transtornos Somatoformes/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Ideação Suicida , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Ansiedade/psicologia , Betacoronavirus , China/epidemiologia , Estudos Transversais , Depressão/psicologia , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Prevalência , Resiliência Psicológica , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Fumar/epidemiologia , Fumar/psicologia , Transtornos Somatoformes/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto Jovem
4.
BMJ Open Respir Res ; 7(1)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33020114

RESUMO

INTRODUCTION: Smoking causes inflammation of the lung epithelium by releasing cytokines and impairing mucociliary clearance. Some studies have linked smoking with severity of illness of COVID-19 whereas others have found no such association. METHODS: This was a retrospective analysis of all adults hospitalised with COVID-19 from 9 March to 18 May 2020. RESULTS: 1173 patients met the study criteria. 837 patients never smoked whereas 336 patients were either current smokers or past smoker and were grouped together in smokers group. Patients in smokers group were more likely to be male and had higher incidence of underlying chronic obstructive pulmonary disease (19% vs 6%, p<0.001), HIV infection (11% vs 5%,p<0.001), cancer (11% vs 6%, p=0.005), congestive heart failure (15% vs 8%, p<0.001), coronary artery disease (15% vs 9%, p=0.3), chronic kidney disease (11% vs 8%, p=0.037) and end-stage renal disease (10% vs 6%, p=0.009) compared with non-smokers. Outcome analysis showed that smokers were more likely to develop critical illness requiring mechanical ventilation (47% vs 37% p=0.005). Univariate Cox model for survival analysis by smoking status showed that among smokers only current smokers had higher risk of death compared with never smokers (HR 1.61, 95% CI 1.22 to 2.12, p<0.001). In the multivariate approach, Cox model for the survival, female sex, young age, low serum lactate dehydrogenase and systemic steroid use were associated with overall improved survival. CONCLUSION: In our large single-centre retrospective database of patients hospitalised with COVID-19, smoking was associated with development of critical illness and higher likelihood of death.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pacientes Internados/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Pneumonia Viral/epidemiologia , Respiração Artificial/estatística & dados numéricos , Fumar/epidemiologia , Idoso , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida
5.
Medicine (Baltimore) ; 99(39): e22413, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991472

RESUMO

Stroke is the acute onset of neurological deficits and is associated with high morbidity, mortality, and disease burden. In the present study, we aimed to develop a scientific, nomogram for non-invasive predicting risk for early ischemic stroke, in order to improve stroke prevention efforts among high-risk groups. Data were obtained from a total of 2151 patients with early ischemic stroke from October 2017 to September 2018 and from 1527 healthy controls. Risk factors were examined using logistic regression analyses. Nomogram and receiver operating characteristic (ROC) curves were drawn, cutoff values were established. Significant risk factors for early ischemic stroke included age, sex, blood pressure, history of diabetes, history of genetic, history of coronary heart disease, history of smoking. A nomogram predicting ischemic stroke for all patients had an internally validated concordance index of 0.911. The area under the ROC curve for the logistic regression model was 0.782 (95% confidence interval [CI]: 0.766-0.799, P < .001), with a cutoff value of 2.5. The nomogram developed in this study can be used as a primary non-invasive prevention tool for early ischemic stroke and is expected to provide data support for the revision of current guidelines.


Assuntos
Isquemia Encefálica/epidemiologia , Nomogramas , Acidente Vascular Cerebral/epidemiologia , Adulto , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Predisposição Genética para Doença , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologia
6.
PLoS Med ; 17(9): e1003355, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32991589

RESUMO

BACKGROUND: Secondhand smoke can cause adverse pregnancy outcomes, yet there is a lack of effective smoking cessation interventions targeted at expectant fathers. We examined the effectiveness of a video-based smoking cessation intervention focusing on maternal and child health in promoting quitting among expectant fathers. METHODS AND FINDINGS: A single-blind, 3-arm, randomized controlled trial was conducted at the obstetrics registration centers of 3 tertiary public hospitals in 3 major cities (Guangzhou, Shenzhen, and Foshan) in China. Smoking expectant fathers who registered with their pregnant partners were invited to participate in this study. Between 14 August 2017 to 28 February 2018, 1,023 participants were randomized to a video (n = 333), text (n = 322), or control (n = 368) group. The video and text groups received videos or text messages on the risks of smoking for maternal and child health via instant messaging. The control group received a leaflet with information on smoking cessation. Follow-up visits were conducted at 1 week and at 1, 3, and 6 months. The primary outcome, by intention to treat (ITT), was validated abstinence from smoking at the 6-month follow-up. The secondary outcomes included 7-day point prevalence of abstinence (PPA) and level of readiness to quit at each follow-up. The mean age of participants was 32 years, and about half of them were first-time expectant fathers. About two-thirds of participants had completed tertiary education. The response rate was 79.7% (815 of 1,023) at 6 months. The video and text groups had higher rates of validated abstinence than the control group (video group: 22.5% [75 of 333], P < 0.001; text group: 14.9% [48 of 322], P = 0.02; control group: 9.2% [34 of 368]) with adjusted odds ratios (ORs) of 2.80 (95% confidence interval [CI]: 1.79-4.37, P < 0.001) in the video group and 1.70 (95% CI: 1.06-2.74, P = 0.03) in the text group. The video and text groups differed in the rates of validated abstinence (22.5% versus 14.9%, P = 0.008; adjusted OR: 1.64, 95% CI: 1.10-2.46, P = 0.02). The video and text groups had higher rates of 7-day PPA than the control group at 6 months (video group: 24.6% [82 of 333] versus 11.4% [42 of 368], P < 0.001; text group: 17.4% [56 of 333] versus 11.4% [42 of 368], P = 0.02). The video and text groups also differed in the rates of 7-day PPA (24.6% versus 17.4%, P = 0.02). Excluding the quitters, the video and text groups had higher levels of readiness to quit than the control group at 6 months (video group: 43.5% [109 of 251] versus 31.6% [103 of 326], P = 0.002; text group: 40.6% [108 of 266] versus 31.6% [103 of 326], P = 0.01), No such difference was detected between the video and text groups (43.5% versus 40.6%, P = 0.29). The study was limited in that the long-term effectiveness of the intervention is uncertain. CONCLUSIONS: This smoking cessation intervention for expectant fathers that focused on explaining the ramifications of smoking on maternal and child health was effective and feasible in promoting quitting, and video messages were more effective than texts in delivering the information. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03236025.


Assuntos
Saúde da Criança , Pai , Abandono do Hábito de Fumar , Fumar/efeitos adversos , Adulto , Terapia Comportamental/métodos , China , Feminino , Humanos , Masculino , Motivação/fisiologia , Método Simples-Cego , Fumar/epidemiologia , Envio de Mensagens de Texto , Poluição por Fumaça de Tabaco/efeitos adversos
7.
Int J Med Sci ; 17(14): 2187-2193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32922180

RESUMO

Background: The number of asymptomatic infected patients with coronavirus disease 2019 (COVID-2019) is rampaging around the world but limited information aimed on risk factors of asymptomatic infections. The purpose of this study is to investigate the risk factors of symptoms onset and clinical features in asymptomatic COVID-19 infected patients. Methods: A retrospective study was performed in 70 asymptomatic COVID-2019 infected patients confirmed by nucleic acid tests in Hunan province, China between 28 January 2020 and 18 February, 2020. The epidemiological, clinical features and laboratory data were reviewed and analyzed. Presence or absence at the onset of symptoms was taken as the outcome. A Cox regression model was performed to evaluate the potential predictors of the onset of symptoms. Results: The study included 36 males and 34 females with a mean age of 33.24±20.40 years (range, 0.5-84 years). There were 22 asymptomatic carriers developed symptoms during hospitalization isolated observation, and diagnosed as confirmed cases, while 48 cases remained asymptomatic throughout the course of disease. Of 70 asymptomatic patients, 14 (14/70, 20%) had underlying diseases, 3 (3/70, 4.3%) had drinking history, and 11 (11/70, 15.7%) had smoking history. 22 patients developed symptoms onset of fever (4/22, 18.2%), cough (13/22, 59.1%), chest discomfort (2/22, 9.1%), fatigue (1/22, 4.5%), pharyngalgia (1/22, 4.5%) during hospitalization; only one (1/22, 4.5%) patient developed signs of both cough and pharyngalgia. Abnormalities on chest CT were detected among 35 of the 69 patients (50.7%) after admission, except for one pregnant woman had not been examined. 4 (4/70, 5.7%) and 8 (8/70, 11.4%) cases showed leucopenia and lymphopenia. With the effective antiviral treatment, all the 70 asymptomatic infections had been discharged, none cases developed severe pneumonia, admission to intensive care unit, or died. The mean time from nucleic acid positive to negative was 13.2±6.84 days. Cox regression analysis showed that smoking history (P=0.028, hazard ratio=4.49, 95% CI 1.18-17.08) and existence of pulmonary disease (P=0.038, hazard ratio=7.09, 95% CI 1.12-44.90) were risk factors of the onset of symptoms in asymptomatic carries. Conclusion: The initially asymptomatic patients can develop mild symptoms and have a good prognosis. History of smoking and pulmonary disease was prone to illness onset in asymptomatic patients, and it is necessary to be highly vigilant to those patients.


Assuntos
Infecções Assintomáticas/epidemiologia , Infecções por Coronavirus/diagnóstico , Pneumopatias/epidemiologia , Pneumonia Viral/diagnóstico , Fumar/epidemiologia , Exacerbação dos Sintomas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antivirais/uso terapêutico , Criança , Pré-Escolar , China/epidemiologia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Lactente , Pulmão/diagnóstico por imagem , Pneumopatias/complicações , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gravidez , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
8.
Adv Respir Med ; 88(4): 335-342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32869267

RESUMO

In early December 2019, in the city of Wuhan in Hubei Province, China, the first infections by a novel coronavirus were reported. Since then, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been spreading to other cities and countries becoming the global emerging epidemiological issue and quickly reaching the status of a pandemic. Multiple risk factors of disease severity and mortality have been identified so far. These include old age, male sex, smoking, and obesity. This concise narrative review highlights the important role of these factors in the pathobiology and clinical landscape of Coronavirus Disease 2019 (COVID-19). We especially focused on their significant role in disease severity and mortality. However, in spite of intensive research, most of the presented pieces of evidence are weak and need further verification.


Assuntos
Infecções por Coronavirus/epidemiologia , Obesidade/epidemiologia , Pneumonia Viral/epidemiologia , Fumar/epidemiologia , Fatores Etários , Envelhecimento , Feminino , Humanos , Masculino , Pandemias , Fatores de Risco , Fatores Sexuais
9.
Medicine (Baltimore) ; 99(33): e21566, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872008

RESUMO

Metabolic syndrome (MetS) refers to the pathological state of metabolic disorders in the body's proteins, fats, carbohydrates and other substances. MetS is a systemic metabolic disease. Periodontal disease is also a part of systemic inflammatory diseases. Among Chinese patients with middle-aged and elderly MetS, the periodontal morbidity is very high, which is due to the involvement of inflammatory mediators in the pathogenesis of MetS and periodontal disease. The latter may also be a risk factor for the former's morbidity and promotion of disease progression. At present, there are not many investigations and studies on periodontal examination data and periodontal disease prevalence of patients with MetS. Coal mine workers, especially coal mine underground workers, have different work natures and different working environments. See related report.We will collect the clinical diagnosis and treatment information of the enrolled patients. We will focus on checking the incidence of periodontal disease and recording. Establish a database, check every 10 medical records, and make corrections in time to ensure data accuracy. We will popularize oral hygiene knowledge for the included patients and guide them to brush their teeth correctly and how to use dental floss. We will perform periodontal examination on the patients' teeth by site and record the plaque index, gingival sulcus bleeding index, periodontal pocket exploration depth and other indicators. We will repeat the above inspection items and record in the second and fourth weeks of the experiment.This study will explore the correlation between periodontal disease and MetS of coal mine workers. We aim to clarify the role and mechanism of MetS in the occurrence and development of periodontal diseases, guide the prevention of periodontal diseases, and thus reduce the prevalence of periodontal diseases. TRIAL REGISTRATION:: ClinicalTrials.gov, ChiCTR2000034177, Registered on 27 June 2020.


Assuntos
Carvão Mineral , Síndrome Metabólica/epidemiologia , Mineradores/estatística & dados numéricos , Doenças Periodontais/epidemiologia , Adulto , Glicemia , Pressão Sanguínea , Índice de Massa Corporal , China/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Higiene Bucal , Índice Periodontal , Prevalência , Fatores de Risco , Fumar/epidemiologia , Adulto Jovem
12.
BMC Public Health ; 20(1): 1478, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993598

RESUMO

BACKGROUND: Four decades of population-based tobacco control strategies have contributed to substantial reduction in smoking prevalence in Australia. However, smoking prevalence is still double in socially disadvantaged groups compared to those that are not. But not all tobacco control strategies successfully used in the general population is effective in specific high-risk population groups. Hence, an effective way to reduce smoking in high risk population groups may include targeting them specifically to identify and support smokers to quit. In this backdrop, we examined whether tobacco control interventions at the population-level are more effective in increasing life expectancy among Australians compared to interventions targeting a high risk group or a combination of the two when smoking prevalence is reduced to 10 and 0% respectively. METHODS: Using the risk percentiles approach, analyses were performed separately for men and women using data from various sources such as the 2014-15 National Health Survey linked to death registry, simulated data for high risk groups, and the Australian population and deaths data from the census. Indigenous status was simulated by preferentially assigning those who are indigenous to lower SES quintiles. The age-sex distribution of mental disorder status was simulated using its distribution from 2016 National Drug Strategy Household Survey with 25.9% of mentally ill being assigned to current smoking category and the rest to non-smoking category. The age-sex distribution of prisoners was simulated based on 2014 ABS Prisoners Australia survey with 74% of prisoners being assigned to current smoker category and the rest to non-smoker category. Homelessness status was simulated according to age, sex and indigenous status for 2011 census with all homeless being allocated to the lowest SES category. The age-sex distribution of total cholesterol level was simulated based on 2011-13 Australian Health Survey. RESULTS: The results showed that the combined approach for reducing smoking is most effective for improving life expectancy of Australians particularly for the socially disadvantaged and mentally ill groups both of which have high fraction of smokers in the population. For those who were mentally ill the gain in ALE due to reduction of smoking to 10% was 0.53 years for males and 0.36 years for females which were around 51 and 42% respectively of the maximal gains in ALE that could be achieved through complete cessation. CONCLUSIONS: Targeting high-risk population groups having substantial fraction of smokers in the population can strongly complement the existing population-based smoking reduction strategies. As population and high risk approaches are both important, the national prevention policies should make judicious use of both to maximize health gain.


Assuntos
Promoção da Saúde/estatística & dados numéricos , Expectativa de Vida/tendências , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Austrália/epidemiologia , Feminino , Comportamentos Relacionados com a Saúde , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Dinâmica Populacional , Prevalência , Fatores de Risco , Distribuição por Sexo , Prevenção do Hábito de Fumar
13.
Respir Res ; 21(1): 252, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993656

RESUMO

SARS-CoV-2 is causing a pandemic with currently > 29 million confirmed cases and > 900,000 deaths worldwide. The locations and mechanisms of virus entry into the human respiratory tract are incompletely characterized. We analyzed publicly available RNA microarray datasets for SARS-CoV-2 entry receptors and cofactors ACE2, TMPRSS2, BSG (CD147) and FURIN. We found that ACE2 and TMPRSS2 are upregulated in the airways of smokers. In asthmatics, ACE2 tended to be downregulated in nasal epithelium, and TMPRSS2 was upregulated in the bronchi. Furthermore, respiratory epithelia were negative for ACE-2 and TMPRSS2 protein expression while positive for BSG and furin, suggesting a possible alternative entry route for SARS-CoV-2.


Assuntos
Asma/virologia , Infecções por Coronavirus/genética , Regulação da Expressão Gênica , Pneumonia Viral/genética , Serina Endopeptidases/genética , Síndrome Respiratória Aguda Grave/virologia , Fumar/epidemiologia , Asma/fisiopatologia , Bases de Dados Factuais , Humanos , Pandemias , Receptores Virais/genética , Valores de Referência , Sistema Respiratório/metabolismo , Sistema Respiratório/virologia , Estudos Retrospectivos , Síndrome Respiratória Aguda Grave/metabolismo , Fumar/fisiopatologia , Internalização do Vírus
14.
Lancet Glob Health ; 8(10): e1282-e1294, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32971051

RESUMO

BACKGROUND: Worldwide, smoking tobacco causes 7 million deaths annually, and this toll is expected to increase, especially in low-income and middle-income countries. In Latin America, smoking is a leading risk factor for death and disability, contributes to poverty, and imposes an economic burden on health systems. Despite being one of the most effective measures to reduce smoking, tobacco taxation is underused and cigarettes are more affordable in Latin America than in other regions. Our aim was to estimate the tobacco-attributable burden on mortality, disease incidence, quality of life lost, and medical costs in 12 Latin American countries, and the expected health and economic effects of increasing tobacco taxes. METHODS: In this modelling study, we developed a Markov probabilistic microsimulation economic model of the natural history, medical costs, and quality-of-life losses associated with the most common tobacco-related diseases in 12 countries in Latin America. Data inputs were obtained through a literature review, vital statistics, and hospital databases from each country: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru, and Uruguay. The main outcomes of the model are life-years, quality-adjusted life-years, disease events, hospitalisations, disease incidence, disease cost, and healthy years of life lost. We estimated direct medical costs for each tobacco-related disease included in the model using a common costing methodology for each country. The disease burden was estimated as the difference in disease events, deaths, and associated costs between the results predicted by the model for current smoking prevalence and a hypothetical cohort of people in each country who had never smoked. The model estimates the health and financial effects of a price increase of cigarettes through taxes, in terms of disease and health-care costs averted, and increased tax revenues. FINDINGS: In the 12 Latin American countries analysed, we estimated that smoking is responsible for approximately 345 000 (12%) of the total 2 860 921 adult deaths, 2·21 million disease events, 8·77 million healthy years of life lost, and $26·9 billion in direct medical costs annually. Health-care costs attributable to smoking were estimated to represent 6·9% of the health budgets of these countries, equivalent to 0·6% of their gross domestic product. Tax revenues from cigarette sales cover 36·0% of the estimated health expenditures caused by smoking. We estimated that a 50% increase in cigarette price through taxation would avert more than 300 000 deaths, 1·3 million disease events, gain 9 million healthy life-years, and save $26·7 billion in health-care costs in the next 10 years, with a total economic benefit of $43·7 billion. INTERPRETATION: Smoking represents a substantial health and economic burden in these 12 countries of Latin America. Tobacco tax increases could successfully avert deaths and disability, reduce health-care spending, and increase tax revenues, resulting in large net economic benefits. FUNDING: International Development Research Centre (IDRC), Canada.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Fumar/economia , Fumar/epidemiologia , Impostos/economia , Produtos do Tabaco/economia , Humanos , América Latina/epidemiologia , Cadeias de Markov , Modelos Econômicos , Impostos/estatística & dados numéricos , Produtos do Tabaco/estatística & dados numéricos
15.
PLoS One ; 15(9): e0237307, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915825

RESUMO

OBJECTIVE: To estimate the prevalence of multimorbidity and investigate the socioeconomic factors that are associated with multimorbidity among persons 70 years and older in Trinidad and Tobago. DESIGN AND METHODS: The data were obtained from a nationally representative comprehensive cross-sectional survey conducted in 2014 among elderly persons in the targeted age group. The prevalence of multimorbidity among the elderly population was estimated. A logit model was utilized to determine the socioeconomic characteristics that are associated with multimorbidity in the elderly. RESULTS: The results of the study show that multimorbidity in the elderly population is strongly associated with age, ethnicity, lower education, smoking history, no physical activity and being female. An interesting finding is that elderly persons in the richest quintile are in general, more prone to multimorbidity. CONCLUSION: The findings suggest that interventions to reduce multimorbidity among the elderly population must encourage greater levels of physical activity, provide education on the risk factors of multimorbidity, and discourage smoking.


Assuntos
Escolaridade , Renda/estatística & dados numéricos , Expectativa de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Estilo de Vida Saudável , Humanos , Masculino , Morbidade , Fatores Sexuais , Fumar/epidemiologia , Trinidad e Tobago
16.
Int J Mol Sci ; 21(18)2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32916821

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic, an infection caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), has led to more than 771,000 deaths worldwide. Tobacco smoking is a major known risk factor for severe illness and even death from many respiratory infections. The effects of smoking on COVID-19 are currently controversial. Here, we provide an overview of the current knowledge on the effects of smoking on the clinical manifestations, disease progression, inflammatory responses, immunopathogenesis, racial ethnic disparities, and incidence of COVID-19. This review also documents future directions of smoking related research in COVID-19. The current epidemiological finding suggests that active smoking is associated with an increased severity of disease and death in hospitalized COVID-19 patients. Smoking can upregulate the angiotensin-converting enzyme-2 (ACE-2) receptor utilized by SARS-CoV-2 to enter the host cell and activate a 'cytokine storm' which can lead to worsen outcomes in COVID-19 patients. This receptor can also act as a potential therapeutic target for COVID-19 and other infectious diseases. The COVID-19 pandemic sheds light on a legacy of inequalities regarding gender, racial, and ethnic health disparities associated with active smoking, thus, smoking cessation may help in improving outcomes. In addition, to flatten the COVID-19 curve, staying indoors, avoiding unnecessary social contact, and bolstering the immune defense system by maintaining a healthy diet/living are highly desirable.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Fumar/epidemiologia , Humanos , Pandemias
17.
Tohoku J Exp Med ; 252(2): 103-107, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32938838

RESUMO

Coronavirus disease 2019 (COVID-19) is a global public health concern that can be classified as mild, moderate, severe, or critical, based on disease severity. Since the identification of critical patients is crucial for developing effective management strategies, we evaluated clinical characteristics, laboratory data, treatment provided, and oxygenation to identify potential predictors of mortality among critical COVID-19 pneumonia patients. We retrospectively utilized data from seven critical patients who were admitted to our hospital during April 2020 and required mechanical ventilation. The primary endpoint was to clarify potential predictor of mortality. All patients were older than 70 years, five were men, six had hypertension, and three ultimately died. Compared with survivors, non-survivors tended to be never smokers (0 pack-years vs. 30 pack-years, p = 0.08), to have higher body mass index (31.3 kg/m2 vs. 25.3 kg/m2, p = 0.06), to require earlier tracheal intubation after symptom onset (2.7 days vs. 5.5 days, p = 0.07), and had fewer lymphocytes on admission (339 /µL vs. 518 /µL, p = 0.05). During the first week after tracheal intubation, non-survivors displayed lower values for minimum ratio of the partial pressure of oxygen to fractional inspiratory oxygen concentration (P/F ratio) (44 mmHg vs. 122 mmHg, p < 0.01) and poor response to intensive therapy compared with survivors. In summary, we show that obesity and lymphopenia could predict the severity of COVID-19 pneumonia and that the trend of lower P/F ratio during the first week of mechanical ventilation could provide useful prognostic information.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Estado Terminal/terapia , Intubação Intratraqueal , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Fumar , Idoso , Betacoronavirus/fisiologia , Estudos de Coortes , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Estado Terminal/epidemiologia , Estado Terminal/mortalidade , Feminino , Hospitalização , Humanos , Intubação Intratraqueal/mortalidade , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Prognóstico , Radiografia Torácica , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/mortalidade , Fumar/terapia , Tomografia Computadorizada por Raios X
18.
Medicine (Baltimore) ; 99(38): e21786, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957307

RESUMO

The present study is a retrospective cohort study. Metabolic syndrome (MetS) is a clustering of clinical findings that has been shown to increase the risk of the surgical outcomes. Our study aimed to evaluate whether MetS was a risk factor for increased perioperative outcomes in patients undergoing posterior lumbar interbody fusion (PLIF).We retrospectively analyzed patients over 18 years following elective posterior lumbar spine fusion from January 2014 to December 2018. Emergency procedures, infections, tumor, fracture, and revision surgeries were excluded. Patients were divided into 2 groups with and without MetS. The MetS was defined by having 3 of the following 4 criteria: obesity (body mass index ≥30 kg/m), dyslipidemia, hypertension, and diabetes. The follow-up period lasted up to 30 days after surgery. The outcomes of demographics, comorbidities, perioperative complications, and length of stay were compared between the 2 groups. Multivariate logistic regression analysis was used to identify perioperative outcomes that were independently associated with MetS.The overall prevalence of MetS was 12.5% (360/2880). Patients with MetS was a significantly higher risk factor for perioperative complications, and longer length of stay cmpared with patients without MetS (P < .05). The MetS group had a higher rate of cardiac complications (P = .019), pulmonary complication (P = .035), pneumonia (P = .026), cerebrovascular event (P = .023), urinary tract infection (P = .018), postoperative ICU admission (P = .02), and deep vein thrombosis (P = .029) than non-MetS group. The patients with MetS had longer hospital stays than the patients without MetS (22.16 vs 19.99 days, P < .001). Logistic regression analysis revealed that patients with MetS were more likely to experience perioperative complications (odds ratio [OR] 1.31; 95% confidence interval [CI]: 1.06-2.07; P < .001), and extend the length of stay (OR: 1.69; 95% CI: 1.25-2028; P = .001).The MetS is a significant risk factor for increased perioperative complications, and extend length of stay after PLIF. Strategies to minimize the adverse effect of MetS should be considered for these patients.


Assuntos
Vértebras Lombares/cirurgia , Síndrome Metabólica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Comorbidade , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Hipertensão/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologia , Fatores Socioeconômicos , Adulto Jovem
19.
Medicine (Baltimore) ; 99(38): e22027, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957319

RESUMO

To understand the self-rated depression scores of military recruits and to analyze the relationship between depression, the family environment, and coping styles.Multistage stratified cluster random sampling was used to study participants who, in September 2014, had enrolled as military personnel in the Xinjiang military. The participants were requested to complete the Chinese versions of the Self-rated Depression Scale (SDS), the Family Environment Scale (FES-CV), and the Simplified Coping Style Questionnaire (SCSQ). Between-groups comparisons were performed using a t test and Mann-Whitney U test. Correlations were determined utilizing Spearman rank correlation coefficient, and the influencing factors of the SDS scores were analyzed using logistic regression.The average score of the SDS among the 323 participants was 42.53 ±â€Š8.51. Specifically, the score of the "high school and below" group was higher than that of the "college and above" group [i.e., (43.98 ±â€Š8.30)] vs [(40.43.98 ±â€Š8.30) vs (37.94 ±â€Š5.50), P < .05]. The SDS score of the "nonstudent" (i.e., social status before enlistment) group was higher than that of the "student" group [(i.e., 45.00 ±â€Š7.60) vs (40.42 ±â€Š8.02), P < .05] and the SDS score of the "smoking" group was higher than that of the "nonsmoking" group [i.e., (45.33 ±â€Š7.74 vs 40.34 ±â€Š7.58, P < .05)]. In addition, the scores related to the entertainment, organization, and controllability of the SDS≥50 group were lower than those observed for the SDS < 50 group, (i.e., Ps < .05). The SDS score was positively correlated with the SCSQ (r = 0.30) negative copying style score (r = 0.30), positively correlated with the FES-CV contradiction score (r = 0.32), and negatively correlated with the FES-CV knowledge score (r = -0.43), entertainment score (r = -0.42), organization score (r = -0.37), and controllability score (r = -0.28), respectively, (Ps < .05). The results of the logistic regression analysis showed that entertainment was contained in the final regression equation (P < .001) with odds radio (95% confidence interval) of 0.512 (0.319-0.824).A correlation was found between depression among military personnel and their family environment, and entertainment may be a potential protective factor against depression.


Assuntos
Adaptação Psicológica , Depressão/epidemiologia , Relações Familiares/psicologia , Militares/psicologia , Adulto , Fatores Etários , China/epidemiologia , Estudos Transversais , Humanos , Masculino , Fumar/epidemiologia , Adulto Jovem
20.
Epidemiol Serv Saude ; 29(4): e2020407, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32997069

RESUMO

OBJECTIVE: To describe lifestyle changes with regard to consumption of tobacco and alcohol, food intake and physical activity, in the period of social restriction resulting from the COVID-19 pandemic. METHODS: This is a cross-sectional study conducted in Brazil with data from the ConVid online health behavior survey. The data were collected via an online questionnaire answered by the survey participants. Post-stratification procedures were used to calculate prevalence rates and 95% confidence intervals. RESULTS: 45,161 individuals aged 18 years or more participated. During the period of social restriction participants reported a decrease in practicing physical activity and an increase in time spent using computers or tablets or watching TV, intake of ultra-processed foods, number of cigarettes smoked and alcoholic beverage consumption. Differences were observed according to sex and age group. CONCLUSION: The results indicate a worsening of lifestyles and an increase in health risk behaviors.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Estilo de Vida , Pneumonia Viral/epidemiologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Exercício Físico , Fast Foods/estatística & dados numéricos , Feminino , Qualidade dos Alimentos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Comportamento Sedentário , Fatores Sexuais , Fumar/epidemiologia , Lanches , Adulto Jovem
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